Opioid withdrawal: a term that conjures images of discomfort, but rarely does it evoke the specter of death. However, this unsettling reality cannot be ignored any longer. In the depths of opioid withdrawal, lives are hanging by a thread, and we must act to prevent these avoidable tragedies.
This narrative unveils the lesser-known fatal risks of withdrawal, sharing heart-wrenching stories from both the United States and the United Kingdom's correctional facilities. We delve into the critical implications for clinical management and advocate for change that can save lives. It's time we acknowledge that opioid withdrawal isn't just unpleasant; it can be a matter of life and death, and it's within our power to make a difference.
The opioid withdrawal journey is a familiar path to those who've suffered its wrath. Dysphoria, insomnia, muscle aches, vomiting, and diarrhea are its cruel companions. While it might sound severe, it's often deemed non-lethal, unlike the life-threatening perils of alcohol and benzodiazepine withdrawal. Some have even boldly claimed, "...no one dies of opiate withdrawal." But therein lies a silent killer—vomiting and diarrhea. Left untreated, they lead to dehydration, elevated blood sodium levels (hypernatraemia), and eventual heart failure. Shockingly, documented cases of such deaths during withdrawal trace back to the late '90s, all within the confines of jails and prisons.
Judith McGlinchey's tragic story epitomizes this crisis. In 1998, she faced heroin withdrawal behind bars in the United Kingdom. Persistent vomiting, rapid weight loss, and dehydration claimed her life, the cause being hypoxic brain damage due to cardiac arrest. Her death became a testament to a failure of duty of care, as argued before the European Court of Human Rights. Sadly, Judith's case is not isolated. Between 2013 and 2016, the United States witnessed ten reported deaths during opioid withdrawal in its jails—six women and four men, aged 18 to 49. These are lives extinguished prematurely, all preventable with proper medical attention.
The question that haunts us: why did these deaths occur? Neglect and a lack of medical resources in custodial settings bear the blame. Basic interventions like intravenous rehydration, considered standard in healthcare, are often overlooked. The seriousness of dehydration goes unnoticed, and silence is misconstrued as cooperation. Jails process countless drug withdrawals, yet a shocking study reveals that only a quarter of US jails offer alcohol or drug detoxification services.
Now is the time to awaken to the grave risk of fatal outcomes due to poor clinical governance. People are perishing during opiate withdrawal, and the surge in heroin use in the United States only compounds this crisis. Opiate users constitute a significant portion of prison populations, with jails being the primary point of entry into the correctional system. The urgency for addressing acute withdrawal among opioid-dependent inmates cannot be overstated.
Is there a solution? Yes, withdrawal protocols for jails already exist in the United States. However, heroin-dependent inmates often describe the medical management as suboptimal. These reported deaths in jails attest to that fact. It's high time that we recognize opiate withdrawal as potentially life-threatening, demanding proper management. This holds particular significance for jails, short-stay facilities where a heroin user might find themselves incarcerated within an hour of being arrested.
An alternative to withdrawal presents itself: providing opiate substitution therapy to opioid-dependent inmates entering the correctional system. This approach has proven successful in various jurisdictions, leading to lower mortality rates and improved clinical outcomes post-release compared to enforced withdrawal. One recent study even reported a staggering 93% reduction in the risk of death in custody over ten years due to continued maintenance treatment. Similar action to offer effective drug treatment must be taken across custodial settings, especially in the United States, where the heroin and opioid dependence epidemic looms large.
Let's be clear: heroin withdrawal is far from trivial. The alarming rise in deaths during withdrawal in US jails has largely gone unnoticed. Yet, with appropriate clinical management, these fatalities can be prevented. It's time to rewrite this tragic narrative and save lives from the clutches of opioid withdrawal.