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RSAT Forum > Monthly Discussion > May 2023: Alcohol and Drug Withdrawal-Related Deaths View modes: 
skeller - 5/12/2023 9:41:57 AM
May 2023: Alcohol and Drug Withdrawal-Related Deaths

Question: Can withdrawal from alcohol and drugs be lethal?

Answer #1: Yes. And this presents a real challenge as jails have become, by default, the largest detoxification centers in the United States. 

According to the National Institutes of Health National Library of Medicine, while more than 50% of people with a history of alcohol abuse can exhibit alcohol withdrawal systems when they stop drinking or decrease consumption, only 3% to 5% exhibit symptoms of severe alcohol withdrawal, defined as alcohol withdrawal delirium, more commonly known as delirium tremens (DT).  It is known to occur as early as 48 hours after abrupt cessation of alcohol in those with chronic abuse and can last up to five days. It has an anticipated mortality of up to 37% without appropriate treatment. It is crucial to identify early signs of withdrawal because it can become fatal (A. Rahman, 2022). Similarly, opioid, benzodiazepine and methamphetamine withdrawal can also be life-threatening to differing degrees. Opioid withdrawal occurs when a patient who is dependent on opioids suddenly reduces or stops taking opioids. It can also be caused when a patient has an opioid in his/her system and is given an opioid partial agonist like buprenorphine or antagonists like naloxone or naltrexone. While death is a rare side effect it must be considered in responding to withdrawal. Often it is not the drug itself that causes death but the results of the chemicals leaving the individual’s body. The side effects and withdrawal symptoms can be so severe that the body ceases to function or operates at a highly diminished capacity. Quitting opioids “cold turkey” gives the body no time to adjust and can do harm. Persons with an underlying medical condition are at the most significant risk for death. Opioid withdrawal has also been linked to suicide as has withdrawal from methamphetamine. Death related to withdrawal from methamphetamine while not typical can result in severe symptoms of depression and suicidal ideation which can lead to self-harm and death.

Answer #2:The Bureau of Justice Assistance and National Institute of Corrections has worked with a task force of medical, correctional and other experts to come out with new jail withdrawal guidelines. They can be found at:

According to the Bureau of Justice Statistics, Jail Inmates in 2020-Statistics Tables, 56% of jails hold fewer than 100 individuals. These jails must often rely on non-medical personnel to screen people entering who are under the influence of alcohol and a variety of substances that may require withdrawal management to prevent life threatening conditions and drug precipitated suicides. The Guidelines urge less medically resourced jails to train custody staff to meet the guidelines and/or to establish connections with telehealth resources to support clinical assessments. “Well-trained custody staff can provide support for onsite tasks, such as taking vital signs. The telehealth provider is responsible for determining if telehealth is appropriate or when an in-person visit is needed.” Telehealth can also support access to FDA approved OUD medications.

Individual sheriffs may consider enlisting their colleagues across their state to pool resources to establish a telehealth resource available to all of the state’s jails 24/7.  By sharing costs, the sheriffs could ensure each and every jail has access to expert medical addiction specialists and resources the jail staffs can rely on to be there to advise and assist them when needed. Not all medical personnel, including physicians, are trained in addiction medicine and withdrawal management. However, across an entire state, the sheriffs should be able to assemble a singular resource meeting each jail’s need to meet the BJA/NIC withdrawal guidelines.