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Drug Use Likely Behind Steep Rise In ER Visits For St. Louis County Inmates

St. Louis County jail
File photo
The St. Louis County Jail is located in the Buzz Westfall Justice Center in Clayton, Mo.

The Buzz Westfall Justice Center in Clayton is sending twice as many inmates to the hospital for medical emergencies as it did in previous years, according to health officials. 

That’s likely because more inmates are coming into jail with drug addictions, said Dr. Emily Doucette, acting co-director of the St. Louis County Department of Public Health. Four in 10 inmates have withdrawal symptoms at their initial booking, said Doucette, whose department provides health care at the jail. 

Additionally, they increasingly have multiple substances, such as alcohol, tranquilizers and opioids, in their system, she said.

“What we’re seeing much more than we used to, even last year, is patients coming in that test positive for five or seven or 10 drugs of abuse instead of just one,” Doucette said. “And so those become very medically complex situations with withdrawals from lots of different substances.”

This year the jail is on track to send 340 inmates to the hospital in what are called emergency transfers, which take place when an inmate has an acute medical emergency that can’t be treated at the jail.

That’s double the rate of the previous three years, Doucette added.

The state’s opioid addiction crisis is playing out on a larger scalewithin jails and prisons.

Criminal offenders have rates of addiction and drug abuse more than four times that of the population as a whole, according to the National Institutes of Health. St. Louis County officials estimate nearly 1 in 5 inmates in the Westfall Justice Center are addicted to opioids.

“When people come into incarceration, they’re usually actively using,” Doucette said. “They are at a state of homeostasis for themselves, in that they’re used to using a substance and are relatively stable.”

Many of the emergency transfers occur within the first weeks an inmate is at the jail, when a patient starts to suffer physical withdrawal from that homeostasis, she said.

The top diagnoses among transferred patients are withdrawal and overdoses, chest and cardiac conditions, gastrointestinal symptoms and seizures, which are often related to drug use, Doucette said.

She doesn’t think the increase in emergency transfers is due to negligence on the part of prison physicians. When inmates arrive at the prison, they’re given a screening to see if they’re medically fit for incarceration.

However, many inmates have chronic health problems, such as addiction, that can flare up within days, said Fred Rottnek, a St. Louis University professor who was the medical director of the health department’s corrections medicine program from 2001 to 2016.

“The majority of folks who are at the jail are people who do not have regular access to health care, so we’re talking about folks who might have chronic conditions that have not been diagnosed or treated out on the street,” he said.

People coming into the jail also might not be forthcoming about their drug use during intake, he said.

“There’s a lot of things going on in the body of a person that comes into jail,” Rottnek said. “On top of that, if the information is not shared accurately or thoroughly on the part of the arrestee or the inmate, bad things can happen with detox. All of these things keep adding up to what makes a lot of these emergency transports happen.”

Rottnek agrees with Doucette in that mixes of both illicit and prescription drugs are likely behind the increase in medical crises at the center. Emergency room physicians are seeing that problem in non-incarcerated patients too, he said.

The health department is making attempts to keep up with the rising number of addicted people inside the jail, Doucette said. It will soon be offering medication-assisted treatment to inmates inside the justice center.

The county also announced this week it has named former Centene executive Valerie Nelson as chief operating officer for corrections medicine. The county created the new position to better coordinate health care within the corrections system.

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Sarah Fentem is the health reporter at St. Louis Public Radio.