Go to jail. Die from cold-turkey benzodiazepine withdrawal.

There is an alarming trend happening in correctional institutions where prescribed benzodiazepine-dependent patients are being denied their long-term benzodiazepine prescriptions, leading to forced cold-turkey withdrawals and subsequent deaths. The jail then usually denies culpability. Sometimes there are lawsuits filed (and won) by the surviving family members of the victim. This is inhumane and unacceptable negligent medical “care”. Some of the offenses for which these now-deceased individuals were incarcerated were minor, to include things such as unpaid traffic violations. Below, a few of these cases highlight this negligent trend:

 

Jesse Jacobs

Jesse Jacobs, a 32-year-old (at the time of his death) Texas man prescribed Xanax for an anxiety disorder.  He was sent to jail for 30 days for a driving while intoxicated conviction.  While in jail, Jacobs died from Xanax withdrawal. His death has resulted in a hefty lawsuit, and has enraged the ACLU, stating that “A part of this is familiar to us is jails often fail to identify with withdraw symptoms, and it can de deadly. We are not talking about people on heroin; everyone knows that can be deadly to withdraw from.”

David Stojcevski

David Stojcevski, who was 32 at the time of his death, is another now-deceased inmate in Michigan who was serving time for a traffic ticket, is another gruesome story.  Stojcevski was on prescribed Xanax, and several other medications, and died 16 days into his 32-day sentence. His death and the preceding events were caught on video, which illustrates the excruciating, deadly process that benzodiazepine withdrawal can be.  This also has resulted in a 30 million dollar lawsuit.

Sean Levert

Cuyahoga County in Ohio passed Sean’s Law, named after singer Sean Levert, who died in jail from benzodiazepine withdrawal, which is a policy to protect those on benzodiazepines. Levert, 39, was jailed on March 24, 2008 for owing nearly $90,000 in child support to three children from previous relationships. He died after being denied his prescribed anti-anxiety medication, Xanax, the entire time he was in jail. A coroner’s report said Xanax withdrawal contributed to Levert’s death. The widow of Sean settled her lawsuit against the county and the company that oversees medical care in the jail for $4 million. Other counties have no policy or unfavorable policies, regarding the potential danger of abrupt benzodiazepine cessation by way of denying inmates their medications of which they are dependent.  These variations in policy from one jurisdiction to another make the jailing of iatrogenically dependent benzodiazepine patients an unpredictable risk for both prescribers and patients.  For this reason (and many others), informed consent is essential at the time of initiation of benzodiazepine treatment so that the patient can fully access their risks.

“Sean’s Law”:

A Plain Dealer review showed the Cuyahoga County Jail did not have a formal policy for deciding if inmates should get their prescription medications shortly after arrival. Decisions were made on a case-by-case basis, with many prisoners having to wait up to three days before being evaluated. Some inmates had to wait up to two weeks before seeing a doctor who would decide if they should be given medicine they had been prescribed.

As a result, the jail adopted a policy exactly one year after Levert’s death, saying that inmates taking anti-anxiety drugs should be given those drugs once their prescriptions are verified. If the prescription can’t be verified, the inmate should be scheduled to see a psychiatrist that day or the next.

“Sean’s Law,” named for the singer and sponsored in the Ohio General Assembly by State Rep. Barbara Boyd, D-Cleveland Heights, would require every county jail to give each inmate a medical, dental and mental health screening on arrival.

John Patrick Walter

John Patrick Walter was allowed to slowly and painfully expire from a benzodiazepine cold-turkey withdrawal in Fremont County jail. He had not been formally charged with a crime but was taken into custody after an altercation with an acquaintance. He could not afford to pay his bond and died in jail on April 20, 2014. His family filed a lawsuit which contends that he died of withdrawal from Klonopin after 18 days of suffering. On multiple occasions, Walter was strapped into a restraint chair, where he was tased and pepper-sprayed over his histrionics. But he did even greater damage to himself, kicking and hurling himself against walls with such force that it is believed he broke several bones. Walter weighed 200 pounds at the time of his incarceration and, due to the withdrawal he endured, had lost between 30 and 50 pounds during his 18-day stay in Fremont County jail.

Richard White

Richard White, fortunately, did not die from his jail-initiated benzodiazepine cold-turkey withdrawal but was maimed instead. He is suing five southeastern Ohio counties claiming the jail denied him medication and care while withdrawing from an anti-anxiety drug resulting in that he jumped from a second-floor jail ledge onto a concrete floor and broke both of his legs and ankles. The Zanesville Times-Recorder reports Richard White’s federal lawsuit says White’s doctor had been tapering him off benzodiazepines before his February 2016 arrest for a parole violation.

 

WHAT NEEDS TO CHANGE?

Clearly, the first step is to adopt changes where prescribers actually adhere to prescribing guidelines to prevent patients from becoming dependent on benzodiazepines in the first place.  Were they compliant with these guidelines, doctors and other licensed prescribers would limit benzodiazepine prescription to a period of 2 to 4 weeks, the 4 week upper-limit to include the tapering off period. However, the problem lies in that these guidelines are largely ignored.  It is impossible to predict which patients can abruptly stop a benzodiazepine without risk of death or severe/protracted withdrawal.  It is also impossible to predict when or where these patients may find themselves in a situation where they cannot access their prescribed benzodiazepine. This is one of the many risks of continuing to take benzodiazepines long-term, although it must be appreciated that many patients are not given informed consent and are unaware of this at the time of the initiation of benzodiazepine prescription.

What we do know is that all of these inmate victims above (and many more people not listed) were subject to medical negligence and senseless horrific suffering and would most likely be living today had they not been dependent on a benzodiazepine in the first place, or had they not been subject to a forced cold-turkey by the jails.  We also know how to prevent prescribed benzodiazepine dependence. Unfortunately, this problem will not go away on its own and more steps towards appropriate legislation, regulations, and informed consent surrounding benzodiazepines, both in jails and on a larger scale for the general public, are badly needed.

The good news is that monetary loss due to lawsuits is historically a great motivator for change. If the correctional institutions continue to be found at fault for these deaths, they may be forced to implement policy changes which protect inmates who are physically dependent to benzodiazepines.

It is important to note that anyone who is subjected to cold-turkey after regular prescription of benzodiazepines is at risk for death and/or severe benzodiazepine injury and withdrawal. This is not just a problem in the jail but is probably seen more readily there, as inmates can’t go to the emergency room and have little to no agency over decision-making about their health while incarcerated.