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Jail Called to Scrutinize Detox Procedure in Wake of Increased Deaths

The second death in six months of a pre-trial detainee at Pennsylvania’s Buck County prison has raised questions about its detox procedures. The scrutiny of such procedures should be a focal point for jail administrators throughout the nation because such deaths are occurring with increasing frequency.

In October 2013, Valene Karaharisis, 29, was found dead in her Buck County cell. She was going through a heroin detox for the month of her incarceration for credit card fraud charges. The day of her death, she had common withdrawal symptoms of a running fever. Her cause of death was “undetermined”.

Then, on March 22, 2014, Marlene Yarnall, 49, was found dead in her Bucks County cell. Just three hours before her death, she had been given the scheduled doses of medication to ease her withdrawal symptoms. Yet, no one checked her vital signs. An autopsy concluded she had a cardiac arrest during detox.

Bucks County illustrates a growing issue for jail officials from July 2013 to April 2014; about 6,700 people were booked into the Bucks County prison. Of them, nearly one-quarter, or 1,703, required detox, said Todd Haskins, vice president for operations of Prime Care, the prison’s private medical vendor.

The Federal Bureau of Prisons estimates that only 32 percent of local jails provide detox programs. A 2005 survey on access and management of opiate dependency among prisoners had 245 jails respond. While more than half said they routinely assess individuals for opiate dependency, many failed to use recommended opiate detox procedures.

The failure to treat for withdrawal from drugs and alcohol has lethal effects. PLN regularly reports on such deaths, and the frequency of such articles has increased dramatically in recent years.

Opiate withdrawal causes severe physical and mental effects. It can increase strain on a compromised organ functions and weakened blood vessels, says Dr. William Lorman, vice president of clinical services at the Livengrin Foundation, a nonprofit substance abuse rehabilitation center. Other symptoms include, he said, vomiting and diarrhea that can create dangerous complications such as aspiration dehydration, and chemical imbalances.

 “The while such of detox is to tell the patient if you are feeling anxious or sick, come and see us right away,” Lorman added.

Prisoners such as Yarnall who have cardiac disease are more sensitive to sympathetic hyperactivity. That syndrome causes episodes of increased activity of the sympathetic nervous system, which mobilizes the body’s fight-or-flight response. This requires close monitoring of hourly vital sign checks and slower tapering off of opiate-substitute medications.

Bucks County is a rare example of a jail that provides narcotics to treat detoxing prisoners. The policy went into effect when PrimeCare took over the jail’s medical care’ before then, prisoners had to go cold turkey. That’s a tough way to detox.

“I couldn’t forget it. It was terrible,” said F.B. , who detoxed while other prisoners check his well-being at Bucks County. “Pretty much, they just looked into, literally, see if I was alive.”

His brother, who also was a heroin addict, recently detoxed at Bucks County prison. He was given Tylenol and benzodiazepine. “He said it wasn’t great, but its medication,” said F.B. “It’s something, better than nothing.”


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