At county jail, opiate epidemic forces a new way of thinking

MANSFIELD — On a summer Friday night at the Richland County Jail, a Mansfield police officer brought in a 36-year-old Mansfield woman on a drunkenness charge.

Police and jail staff thought she'd probably just had a little too much to drink. They could smell the alcohol on her, and she couldn't stand up on her own.

She told jail staff her name and age and that she'd been in the jail before.

But when she was taken into the restroom on July 14, an officer could soon tell something was wrong, something more than just drunkenness.

The woman's pupils weren't reacting to a flashlight.

She admitted to smoking or swallowing something, but she wouldn't tell officers what, saying they didn't care about her.

She was brought back out into the main booking area and sat down on a concrete bench.

Officers sat on either side of her, holding her up. She couldn't keep her eyes open.

The woman's left hand seized into a claw. Her head bobbed down to her chest. She was starting to overdose.

Officers lowered her onto a green vinyl mat.

She was foaming at the mouth, drooling and moaning. Her face was red and puffy, and her lips were turning blue.

A jail nurse later speculated she had smoked posh laced with either fentanyl, which is 50 to 100 times stronger than morphine, or carfentanil, which is 10,000 times stronger than morphine and 100 times stronger than fentanyl.

A Mansfield Fire Department squad arrived to transport the overdosing woman to OhioHealth Mansfield Hospital. She received five doses of naloxone and was put on a ventilator.

Doctors didn't know if she'd make it. 

According to a Mansfield News Journal obituary, the woman died July 31 at a Columbus hospital.

Overdoses like these don't happen often at the Richland County Jail, but they happen more often than they did in the past.

And though the woman used before she came into the jail, jail administrator Capt. Chris Blunk said the jail's new body scanner is working to prevent any potential future drug use or overdoses inside the jail's walls.

Treatment programs designed to get inmates help both while they're in jail and after they get out are offered to combat the opiate epidemic.

Body scanner

Blunk said the issue came to light for jail staff in July 2016, when five women overdosed in a housing unit in the jail. They were revived with naloxone and taken to the hospital for suspected heroin overdoses.

“We had a couple (overdoses) here and there before that, but nothing of that magnitude," he said.

The July 2016 incident led to serious discussion of adding a body scanner to the 266-bed-capacity jail to detect drugs or other contraband, said Blunk, who's been the jail administrator for four years.

The scanner started operating April 25, funded with a $100,000 donation from an anonymous donor and a $112,000 grant from the Richland County Foundation.

Blunk said inmates with reasonable suspicion of having contraband hidden somewhere on or in them are scanned as soon as they come to the jail.

Reasonable suspicion would include offenders with a history of drug offenses or offenders who act strangely on the way to the jail, such as moving around a lot in the backseat of a cruiser.

“We use that as reasonable suspicion to at least scan them,” he said.

If there is no reasonable suspicion, offenders will be scanned before they enter one of the jail's housing units, joining the jail's general population.

The only inmates who aren't scanned are pregnant or can't stand.

Inmates whose scans show something irregular or suspicious and refuse to remove it or tell officers what it is are kept in what's called a dry cell in the jail's booking area.

They're kept by themselves so any potential contraband can't make their way into the jail's general population, Blunk said.

A few hours later, the inmates are re-scanned to see if the object is still there.

If it's not, the object could have been a biological substance or the inmate could have flushed it down the toilet in the cell, although no inmate has ever been known to do that, Blunk said.

“We can’t sit with them every second of the day," Blunk said. 

If the object no longer shows up on the scan, the inmate is then cleared to enter the jail's general population.

Blunk said there have been 29 reasonable suspicion cases since the scanner was installed.

He said officers are not able to perform body cavity searches, which require a warrant. 

“We’re having a very difficult time getting any kind of body cavity search warrant," Blunk said.

Under the Ohio Revised Code, a body cavity search can only be conducted by a physician, registered nurse or license practical nurse registered or licensed to practice in Ohio.

Inmates in withdrawal

Although the jail does not normally see overdoses, inmates suffering withdrawal are more common, Blunk said.

Jail staff started tracking withdrawal numbers in March, shortly before the scanner was installed.

The numbers are broken down into treatment for opiates, like heroin, oxycodone or fentanyl; benzodiazepines, or "benzos," like Valium or Xanax; and alcohol.

The numbers are also broken down into severe treatment cases that could lead to emergency medical treatment and less severe cases the jail monitors.

In July, the jail monitored 26 opiate withdrawals, seven benzos withdrawals and 11 alcohol withdrawals.

In the same month, the jail treated five opiate withdrawals, one benzos withdrawal and one alcohol withdrawal. Three of the five treated opiate withdrawal patients in July were pregnant.

In August, the jail monitored 10 opiate withdrawals, nine benzos withdrawals and seven alcohol withdrawals. Staffers treated four opiate withdrawals, three benzos withdrawals and one alcohol withdrawal.

People suffering severe withdrawal symptoms are started on a medication protocol, including naltrexone, or Vivitrol, which blocks the brain's opioid receptors and prevents users from getting high; clonidine, which lowers blood pressure; and dicyclomine, or Bentyl, which treats irritable bowel syndrome.

Offenders in severe withdrawal can be transported to the emergency room for treatment, as the jail's doctor comes in only once a week.

Offenders in withdrawal are kept in the jail's booking area, where officers can keep a closer eye on them. Their vitals are checked three times a day, and they're given lots of fluids.

Jail as treatment center

Blunk, who started working in the jail 19 years ago as a corrections officer, noted as the area's opiate epidemic has worsened, the jail's treatment of offenders in withdrawal has changed, too.

“Fifteen years ago, alcohol withdrawal was probably highest," he said. "And slowly, opiate (withdrawal) is pretty much taking it over."

Blunk said help is available to any inmate who wants it.

“The help is there. It is there. It’s available. It’s just a matter of whether they wanna take advantage of it," he said. "If you haven’t decided in your heart that you wanna get off of it, you’re probably not gonna get off of it."

He said the jail offers drug and alcohol support groups, Narcotics Anonymous and a life-coping skills group.

Catalyst Life Services began working with the jail in March 2014, said Catalyst director of operations Erin Schaefer. 

Schaefer said up until the end of July, two employees were working with inmates. But at the end of July, Catalyst added three additional staff members to meet a growing demand for services in the jail.

She estimated more than 75 percent of the 300 to 350 inmates seen each month have some sort of substance abuse issues.

Schaefer said assumptions about cost often stop people from seeking treatment, something the staff works to dispel by explaining a sliding scale system based on income.

"It's not just walking into a door blind," she said. "That makes a big difference."

Helping inmates find recovery options before they leave gives them a better chance at sticking with it after they're released, she said.

"They're not just walking out the door without having anything," Schaefer said. "They've at least gotten access to education, they've gotten some information and they've started to go down the road toward treatment."

Blunk said the Catalyst program helps inmates know they have somewhere to go to continue that treatment once they're released.

“You’re not employed, you don’t have a job to go to, so you get into trouble," Blunk said of inmates who don't know how to get treatment after they're released.

Blunk also wants to add a job training group in the jail.

But he said it's difficult to inspire real change in the inmates' lives, as the average length of stay is 11 days.

"You’re not gonna rehab someone in 11 days," Blunk said. “The people aren’t staying long enough to get it."

He said the opiate epidemic has changed the way corrections officers and other jail staff view jails.

In the past, the focus for jails was safety and security, taking offenders to court and supervising them while they were in jail, Blunk said. But now, jails are becoming treatment centers.

"It’s a change in a way of thinking," he said. "We’re becoming more educated on withdrawals and overdoses.”

ejmills@mansfieldnewsjournal.com

419-521-7205

Twitter: @EmilyMills818

Coming Sunday

"Seven Days of Heroin," our in-depth look at one week in the midst of Ohio's opiate epidemic.