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The Journal Gazette

Sunday, October 23, 2016 4:53 am

State has no detox standard

Jamie Duffy | The Journal Gazette

Arrested and separated from their narcotic of choice, Allen County Jail inmates are left to sweat it out on their own.

But detox in Allen County, where inmates go through withdrawal cold turkey, is no different than in DeKalb County or any number of jails.

There is no state-required detox protocol in Indiana. Each county chooses how it deals with inmates who are in withdrawal, said Stephanie Spoolstra, executive director of addiction recovery services for the Indiana Department of Correction.

In the Allen County Jail, jail officers check on an inmate every 15 to 30 minutes, and the nursing staff takes an inmate’s vital signs every four hours, said Capt. Steve Stone, public information officer. Doctors are called if there’s an emergency.

Surveillance of detoxing inmates is one more thing a jail officer is required to do during a shift, Stone said, and the jail has seen a rise in drug usage and detox, although no numbers are kept.

"We’re not going to stand by and do nothing," Stone said. "They get the medical care they need, but we’re not a health care facility."

The state "does not monitor, supervise or have any oversight of what they are doing," Spoolstra said, although the state and the counties work collaboratively.

Clinical practice guidelines issued by the Federal Bureau of Prisons suggest conducting a physical examination that would include an evaluation of the inmate’s vital signs and a cardiopulmonary status for evidence of fever, heart murmur or other problems and a "focused examination of the skin for signs of scarring, atrophy, infection."

The guidelines also suggest laboratory tests including a complete blood count and blood tests, urine tests and a pregnancy test for women, among other screenings.

Using medication for detoxification is suggested as standard care for individuals with opiate dependence, the guidelines state.

Ideally, a gamut of meds would be used, including methadone, clonidine, nonsteroidal anti-inflammatory agents for pain and fever, antidiarrheals and anti-emetics to control gastrointestinal symptoms, benzodiazepines for insomnia and restlessness, and buspirone for reducing anxiety.

Generally, opiate withdrawal is not dangerous except in "medically debilitated individuals and pregnant women," according to the guidelines.

DeKalb County Jail Commander Lt. Angie Ireland said the jail nurse is called in if an inmate says he or she is in withdrawal from drugs or alcohol. Alcohol detox, which is considered more dangerous, might be treated with librium, she said.

"Depending on the severity and the amount of the drug taken, she (the nurse) will then determine if we need to put them on a withdrawal protocol," Ireland said. Every four hours, vitals are checked, which includes blood pressure, temperature, oxygen levels and pulse. Inmates are offered a 6-ounce cup of water every four hours.

"We actually go to them and physically have to watch them drink water," Ireland said. The nurse then records how many ounces were consumed.

Steve Luce, executive director of the Indiana Sheriffs’ Association, said he is in constant contact with all the state’s sheriffs about the heroin and opioid epidemic and new ways to treat it.

"Nationally, all the sheriffs are having the same problem," Luce said.