When an individual enters a jail facility, they may be experiencing or are at high risk of developing substance withdrawal. Untreated withdrawal from certain substances, particularly alcohol and benzodiazepines, can rapidly progress to life-threatening complications such as seizures or delirium tremens. Correctional facilities are mandated to provide medical management for these conditions. This care involves a structured assessment followed by specific pharmacological treatments aimed at stabilizing the patient and preventing severe complications.
Initial Medical Assessment and Triage
Upon intake, a comprehensive medical screening determines the patient’s risk level for severe withdrawal. Medical staff must gather information about the type of substance used, the quantity, the frequency, and the time of the last use. The assessment also checks for a history of prior withdrawal seizures or delirium tremens, which are significant predictors of a complicated course.
Facilities use validated clinical tools to quantify symptom severity. The Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scores symptoms like tremor and anxiety. A score of 15 or higher indicates severe withdrawal and necessitates immediate medical observation due to the high risk of developing delirium tremens.
The Clinical Opiate Withdrawal Scale (COWS) measures physical signs of opioid withdrawal, such as sweating and restlessness. Elevated COWS scores prompt pharmacological relief. These scoring systems stratify risk, determining if a patient can be managed safely in the jail’s medical unit or requires transfer to an outside hospital.
Pharmacological Treatments for Common Withdrawals
Medications provided in a correctional setting counteract the physiological effects of withdrawal and manage acute symptoms. Treatment protocols depend on the substance involved, as risk profiles vary significantly. The most urgent and potentially fatal withdrawal syndromes are managed with sedating medications that calm the central nervous system.
Alcohol Withdrawal Treatment
Alcohol withdrawal is primarily treated with benzodiazepines to prevent central nervous system hyperexcitability, which causes seizures and delirium tremens. Medications such as chlordiazepoxide (Librium) or diazepam are commonly administered due to their long half-lives, allowing for a smoother, self-tapering effect. The protocol is often “symptom-triggered,” meaning the benzodiazepine is given only when the patient’s CIWA-Ar score exceeds a set threshold, preventing over- or under-sedation.
Patients undergoing alcohol detoxification receive nutritional support, most importantly thiamine, to prevent Wernicke-Korsakoff syndrome, a serious neurological disorder. Multivitamins and electrolyte supplements are standard supportive care to address common deficiencies.
Opioid Withdrawal Treatment
For opioid withdrawal, the preferred approach involves Medication-Assisted Treatment (MAT), which uses FDA-approved medications to manage symptoms and reduce cravings. The use of MAT, particularly with buprenorphine or methadone, is considered the standard of care for Opioid Use Disorder (OUD) and is increasingly being adopted in correctional facilities. Buprenorphine (often combined with naloxone) is a partial opioid agonist that decreases withdrawal severity and reduces the risk of relapse.
Methadone, a full opioid agonist, is also used, though its administration is often more restricted as it must be dispensed through a certified Opioid Treatment Program. For shorter stays, medical staff may opt for non-opioid medications for symptomatic relief. This approach includes clonidine to help manage high blood pressure, anxiety, and sweating, and anti-nausea medications to control gastrointestinal distress.
Sedative/Benzodiazepine Withdrawal
Withdrawal from benzodiazepines carries a high risk for seizures and psychosis, similar to alcohol withdrawal. Management requires long-acting benzodiazepines, such as chlordiazepoxide, to create a slow, controlled taper over several weeks or months. Because this extended taper often exceeds the length of a short jail stay, patients with severe benzodiazepine withdrawal frequently require transfer to a facility with a higher level of care.
Legal Requirements for Medical Care in Custody
The provision of medical treatment for substance withdrawal is a constitutional requirement, not just a matter of best medical practice. The Eighth Amendment prohibits cruel and unusual punishments and has been interpreted to mean that officials cannot exhibit “deliberate indifference” to an inmate’s serious medical needs.
Since severe alcohol or benzodiazepine withdrawal can be fatal, it is considered a “serious medical need.” Failing to screen for, monitor, or treat life-threatening withdrawal symptoms constitutes a violation of an individual’s rights. This legal mandate establishes a minimum standard of care, requiring facilities to have protocols in place to manage acute substance withdrawal safely.
Limitations of Care and Post-Detox Planning
The quality and scope of withdrawal care in jail settings vary significantly due to resource constraints. Jails often lack specialized medical staffing, making continuous monitoring of high-risk patients challenging. Furthermore, the availability of all three FDA-approved MAT options (methadone, buprenorphine, and naltrexone) remains low in many facilities.
After the acute withdrawal phase, ensuring continuity of care upon release is a major challenge to prevent immediate relapse and overdose. Individuals leaving incarceration have decreased substance tolerance, placing them at a much higher risk for a fatal overdose. Effective discharge planning includes providing prescriptions for MAT and connecting patients with outside treatment providers.