CINCINNATI -- The Hamilton County Justice Center could become one of the first jails in the state to allow inmates who are chronic heroin users to detox from the drug with medical help.
County commissioners will consider a more than $500,000 plan Monday that would create an 18-bed chemical detox unit on the third floor of the Sycamore Street jail.
It’s a proposal Sheriff Jim Neil and Major Charmaine McGuffey have been working on for more than a year now— one they say can save lives. Inmates enter jails across the country addicted to heroin and die from medical complications in jail while they detox without help.
“What we’re currently doing is not working so we need to step up our game,” Neil said.
A chemical detox usually lasts between five and seven days, experts say. It’s when medical providers give the patient medications to address each symptom associated with the drug withdrawal to ease the pain, and then taper them off those drugs.
"They're not your typical drugs like Tylenol or Ibuprofen,” said McGuffey, head of the Hamilton County Justice Center. "They are actual drugs that will allow your body to still get that same kind of stimulus but less and less and less of it so that as you're withdrawing, you don't feel like you're going to die."
There’s no option like that at the Hamilton County Justice Center right now or at most other jails in the state, which means inmates suffer through withdrawal symptoms on their own.
"They stay in their cells a lot because you're too sick to come out. The other inmates tend to help them with their detoxing process,” McGuffey said.
Here's The Plan
With just 18-beds in the proposed medical unit, there's not room for every heroin user to receive that level of care — especially when about half of the jail’s inmates last year were addicted to the drug, Neil said. But a new batch of inmates would have access to the detox center about every week.
“Eighteen is not enough, but that’s all we can do for money reason and space reasons,” Neil said. “Eighteen is better than zero."
Jail medical staff would assess incoming drug users, and single out the people who are in the worst shape medically. Those who do not qualify must detox on their own among the general population as they do now.
“(The ideal candidates are) chronic users,” Neil said. "The effects of the drug have ravaged the body and deteriorated the bodies to the extent that it could be difficult to detox them any other way.”
McGuffey said it’s not possible to chemically detox males and females in the unit at the same time, so the plan is to first roll out the service to women.
“As a population, women present a whole host of medical problems that men don’t typically bring to the table,” she said. “Women are much more challenging in the environment because of multiple medical issues, because of their mental health issues, because of the fact that they’ve probably been out there working in the sex trade."
Three women died at the jail this year alone, McGuffey said, but she can't pinpoint if it was the detox that killed them.
"They were all chronic heroin abusers when they came into our jail, and they died of the complications from the chronic heroin use,” she said.
It’ll take six deputies to cover the dormitory-style unit full-time, in addition to specially-trained medical providers who would administer the drugs and provide medical care, McGuffey said.
If commissioners approve the plan, it would cost taxpayers about $500,000 just to build out the vacant third-floor area that used to house a computer investigations unit. There are also additional costs associated with the jail's medical contract and deputy salaries, but they haven’t been released.
The proposed area is now a conference room, and it would need to be re-built to meet minimum jail standards. Watch the video below to tour the space.
Inmates would get more than medication during their time in the chemical detox unit, Mcguffey said. They would have access to treatment resources, too
“In that five to seven day period, she’ll be introduced to some peer counseling and after she comes out of our detox unit and transitions into a healthier unit, she’ll continue with our peer counseling,” McGuffey said. “We can connect her to programming in the jail while she’s captive for us and then hopefully extend that when she leaves the jail so she has support."
The Center for Chemical Addictions Treatment, also known as the CCAT House, is the only facility in the region that currently has a chemical detox program. The center has 59 beds — 40 that are used for chemical detox — and a 28-day residential addiction treatment program.
McGuffey said Hamilton County jail officials toured that facility and a chemical detox program at a Louisville corrections center in preparation for their proposal.
What Detoxing From Heroin Feels Like
Detoxing from heroin alone is extremely painful, but usually not life threatening, medical experts say. But when abusers also depend on other drugs or alcohol, the natural detox process can kill them.
“When you come off of heroin, it’s like a super bad case of the flu,” McGuffey said. "Sometimes a super bad case of the flu kills healthy people, so you can imagine someone that’s been out on the street all this time, living hand to mouth and what it might do to them.”
Dr. Deborah Frankowski, medical director at the CCAT House, said opiate withdrawal symptoms are so uncomfortable that most people who try to detox on their own outside of jail don’t make it past day two. In fact, most of her chemical detox patients tried going “cold turkey” several times before seeking medical help.
"We hear horror stories about it. It makes them feel hopeless that they can’t get help, and it’s not very humane frankly,” Frankowski said.
They feel helpless because the absence of a drug that they’re so used to taking puts their body into overdrive, she explained. They experience an elevated heart rate and high blood pressure, severe sweats and chills, restlessness, nausea, vomiting and a host of other symptoms.
“We’ve been talking to the jail about this for quite a while. The hope is that if you can keep people comfortable enough to get them through it, then they’ll be open-minded enough to some treatment,” Frankowski said.
Neil said he thinks the plan will get inmates on the right path to dealing with their addiction, and it could help their children, too.
“Hopefully with education and prevention, we can stop a whole generation from even getting started with this drug. But we have to deal with the ones that are already affected," he said.
But Neil and McGuffey first have to convince county commissioners that the community will see a return on the expensive investment.
“If there wasn't a dollar amount cost, we'd do it tomorrow,” said McGuffey. "Nobody's opposed to medically detoxing inmates. But what we are looking at is how much does it cost the taxpayers to do it?"