I was in extreme heroin, cocaine, and Xanax withdrawal. I was put into booking with 8 other guys waiting to get processed. They put me in the jail-issued tan jumpsuit. I remember curling up in a ball on the floor shivering as the first stages of withdrawal started to set in. The next 30 days were 30 of the worst days of my life. Detoxing in jail is miserable, and that’s saying it mildly.
What It’s Like To Detox In Jail
The treatment provided in jail will depend on what substances a person is detoxing from. When a person is detoxing from heroin, cocaine, meth, suboxone, or methadone they will receive minimal treatment because in most cases the withdrawal from these drugs is not fatal. If the individual is detoxing from alcohol, benzodiazepines (Xanax, Klonopin, Ativan, Valium, etc), or any other substance that has a potentially lethal detox, then the jail provides a higher level of care.
The jail system is set up to make sure the person receives healthcare and also makes sure they don’t die during their detox. Besides those basic treatments, in most cases, it’s just a matter of time. The best thing for any person detoxing from drugs or alcohol is time. Whether a person is in jail or a rehab there is only so much the medical staff can do for them. The addict’s body just needs time to rid itself of the substances and return to a normal state of function.
Certain counties around the country have started providing inmates with detox medication when they enter jail in withdrawal. Suboxone is a medication used to treat heroin and opioid addiction and it relieves many of the withdrawal symptoms of heroin or any opioids. Suboxone also helps fight opioid drug cravings.
Inmates withdrawing from alcohol, benzodiazepines, cocaine, meth, and almost all other drugs will get some generic pain relief medicines. But there is no equivalent of suboxone for those substances.
Pros and Cons of Detoxing In Jail
Pros:
- 24/7 health care. Nurses, doctors, and counselors are always available to help.
- No or limited access to drugs. (Hopefully, there isn’t access to drugs in your county jail)
- Some treatment. (Certain jails have mandatory treatment programs, others have outside groups like AA bring meetings in. Typically the AA meetings are optional.)
- 3 hots and a cot. (Some addicts are homeless. Detoxing in jail provides them with 3 square meals a day and a bed to sleep on every night.)
Cons:
- Limited contact with personal support.
- Lack of stimulation in jail. (Many addicts will get a burst of energy once the initial withdrawal is over. They may want to work out, go for a hike, get a job, or do other things to rebuild their lives. In jail, they’re unable to do most of this.)
- Limited access to treatment and medication. Some jails now provide detox and craving medications like Suboxone and Vivitrol, but many don’t.
- Some/limited treatment programs. (Programs like AA bring meetings into many county jails around the country.)
- Increased anxiety, depression, and stress from being locked up. (In my experience the anxiety of going through this in jail and facing prison made it substantially worse.)
Detox/Medical Unit
The detox unit was split into 3 sections. Section 1 was a fishbowl set up. A big room with 8-10 beds next to each other. Guys who were the lowest risk and least likely to need medical attention were put in here.
The second section was single cells on the side hallways. This is where I was. These cells are for guys coming off heroin, cocaine, meth, and other drugs that are usually nonfatal.
The third area was a group of cells in a half hexagon shape with clear plastic doors. These cells were for guys coming off alcohol and benzodiazepines or guys who were suicidal. These cells had a guard in front of them 24/7 monitoring them to make sure they didn’t go into a seizure, cardiac arrest, or try to hurt themselves.
First 3-5 Days
When the nurse stops by your cell and sees you hunched over in the fetal position on the floor laying in your own vomit her questions are simple: How are you feeling? Are you going to try and kill yourself? Are the symptoms getting any better? and finally the big one Tylenol or Ibuprofen? I could take that whole bottle of Ibuprofen and it wouldn’t make a dent in my pain. There is not much the nurse can do for people in withdrawal.
The detox cell is a small simple cell with nothing extra in it. There is a toilet, sink, bed, and in most cases a mattress, pillow, and blanket. If the person is suicidal than they don’t have a mattress, pillow, blanket, or jumpsuit. They are provided a suicide vest, paper blanket, and paper pillow. These cells usually have a plastic coating on the cell bars and a smooth concrete floor. This makes it easier to clean up all the vomit, and other bodily fluids.
During this period it’s pretty simple. You’re gonna be thrown in a cell and kept there until the worst part of the withdrawal is over. This first week is usually when the vomiting, diarrhea, cold sweats, and other severe symptoms will be at their peak. For all the symptoms and info on heroin detox click here.
Days 5-10
Days 5-10 are typically when you start to get to the downward part of the physical detox. According to americanaddictioncenters.org Heroin withdrawal symptoms typically peak at around 1-3 days and then start to recede after that. In my experience, I would extend their timeline out. My symptoms peaked at around 3-4 days and on day 5 started to slowly get better for the next few days.
Depending on your symptoms around day 3-5 the jail will move the inmate out of the detox/medical unit into a regular unit. This adds a whole new element to the detox/withdrawal experience.
Some of the positives of going to a regular unit during detox are, allowed out of the cell for about 8 hours a day. There were 2 TVs and lots of card tables. Having something to do and a little room to walk around was a huge help for me during withdrawal.
Added Stress
Going to the regular unit on the 5th day wasn’t all great, I had a new stress factor added on. I was in jail with a bunch of people I didn’t know. A level of anxiety was added to the mix that didn’t help. Who are these guys? Which ones are safe and which ones aren’t? What are the rules? What guys are gang members? All these questions were circling around in my head and made the mental part of detox worse.
Due to this added stress and the physical misery of detox I stayed in my cell for 3 straight days even when I got to the new unit. On that 4th day, the guard opened my cell and chewed me out. He said “Alright kid, I know you feel like shit and you’re detoxing but you have to get up and walk around. You have to eat something and you have to clean this damn cell up. You’ll feel better if you get up and move around and eat so get the hell up and do something”.
I was pissed at this guard for waking me up and making me clean my cell. Ironically I ended up talking to this guard in-depth. He was one of the coolest guards at the jail. He treated all the inmates with respect and genuinely tried to help.
Days 10-20
During normal heroin detox, the physical symptoms will be mostly all gone by the 10th day. This is when a lot of the mental symptoms start to ramp up. In jail, the mental symptoms are compounded by the depression and anxiety of being locked up.
It was a disaster during this period. I had never been sober for this long since my addiction started. My brain was trying to work normally but was so fried from years of concussions and drug use that it didn’t function properly. I would try to sit and watch TV but the anxiety was too much.
During this period my brain was on repeat saying:
“Heroin where is it? How can I get some? How can I get out of here? Cocaine o yea I need some, where is it? Your in jail you idiot. How dumb are you? You’re screwed”.
Euphoric Recall
Euphoric recall refers to the tendency of people to remember past events in a positive light. During euphoric recall, people also tend to not remember the negative things associated with those past events. (source)
Euphoric recall is terrible during the first 30 days of recovery. I believe this is especially true for IV drug users. The high of injecting drugs is so powerful that the memories it creates are unbelievably vivid and real. I could think about injecting a speedball and start to sweat, drool, and shake because I could taste the drug in my mouth.
One specific event happened that triggered my euphoric recall stronger than ever. I was sitting watching TV in the regular common area of the pod (jail unit). The main door opened and a new guy walked in. He was one of my main dealers on the street. When he came over and said what up to me and we started talking. He was only doing 3 months. H started telling me about some of the new “product” he had. I went into a panic thinking about drugs.
At least 100 times I had driven to this guy’s house. Bought drugs from him, and he let me use them in his garage. Just seeing him triggered the thought of drugs. Then when he started talking about them I almost lost it. I could smell, and taste the drugs. I should have got up and walked away, but I was still in full-blown active addiction mode.
Days 20 and up
At this period the physical withdrawal from almost any drug should be done. PAWS (post-acute withdrawal syndrome) usually begins once the acute withdrawal is over. Going through PAWS in jail or prison can make it substantially worse.
Common symptoms of PAWS may include:
- Anxiety
- Depression
- Cravings
- Insomnia
- Irritability
- Fatigue
- Euphoric Recall
- Mood Swings
- Overwhelming Emotional Changes
PAWS symptoms tend to be more mental and emotional than physical. These symptoms may persist for weeks or months.
Post-acute Withdrawal Syndrome will typically continue due to the neurological effects caused by prolonged drug and alcohol use. Intense drug cravings can persist for months. Certain medications are usually prescribed to help overcome cravings.
Cravings will usually lessen and become more manageable with time. Occasionally a strong craving can hit someone out of the blue months or years into their sobriety, but this is the exception, not the rule. I have never heard anyone say their cravings got worse the longer they were sober.
**The duration and intensity of withdrawal symptoms will vary based on the number of drugs used and the period of time over which they were consumed.**
New Policies
With the opioid epidemic and drug epidemic claiming 70,000 lives a year in the US, new policies have been enacted in many county jails and prisons. I was arrested In Rochester NY. In 2013 when I was arrested the protocol was exactly as I explained above.
Sheriff Todd Baxter was elected in 2017 to be the new Monroe County Sheriff. Sheriff Baxter is very dedicated to helping people and fighting the drug epidemic. He has incorporated a detox unit with proper medical supervision and in certain cases medically assisted detox at the Monroe country jail (the jail I was in for a year). These are huge steps in the right direction even though there is a long way to go.
Many jails around the country are implementing rules and new policies like Sheriff Baxter has done. This will help make it a lot easier for addicts coming off the street and detoxing in jail.
Controversial
Many people believe giving addicts medication to help with the withdrawal symptoms is a bad idea. The idea is these addicts need to go through the pain of detox and withdrawal. If they experience the pain maybe they will decide to change and not want to go through that misery again. Sheriff Baxter received a lot of criticism when he put these policies in effect at the jail.
In the end, I believe the policies Sheriff Baxter and many other jails around the country put into effect are good. Medically assisted detox has been proven by research to be more effective in treating addiction and withdrawal. I occasionally go back and forth and think the addicts should have to go through the pain of detox. That pain is something I will never forget. I use that pain as a tool to avoid going back there.
In a perfect world, I believe maybe the addicts should get the meds that help with withdrawal on the 5th day. That way they go through 5 days of natural detox and experience the pain, while still getting the medications that are shown to help avoid relapse.