By Elizabeth Thompson

Around 8 p.m. on Monday, Nov. 22, a man incarcerated at the Alamance County jail was found unresponsive. Jail staff administered naloxone, an opioid overdose reversal drug, and he was transported to the Cone Health Alamance Regional Medical Center, according to the jail.

This man, Craig Hodge, overdosed on drugs, according to the jail incident report. He survived his overdose. 

Less than an hour later, jail staff found a second man unresponsive, a 21-year-old named Gerard Barnes. Staff and local Emergency Medical Services were unable to revive Barnes. He died.

At the time of the jail’s press release, Barnes’ official cause of death had not been announced by a medical examiner. That investigation could confirm whether Barnes also overdosed. 

That same day, a third man incarcerated in the Alamance jail, Torre Jamel Haith, was found in possession of a baggie “containing a small amount of powder substance which tested positive for fentanyl,” according to the jail. He was charged with a felony for possession of drugs on jail property.

Alamance County Detention Center spokeswoman Michelle Mills confirmed that another person was also found unresponsive two days before Barnes died. But she couldn’t confirm if that person overdosed.

“As far as I know, we didn’t receive a toxicology report on that inmate so there is limited information that can be released,” Mills said in an email.

While there was an incident report for the overdose that occurred before Barnes died, Mills said, incident reports are not necessarily written up every time it is suspected a person might have overdosed.

“Incident reports are for crimes,” Mills said, “so they wouldn’t necessarily have an incident report – it may just be medical records for that inmate.”

Incarceration not treatment

The cluster of overdoses at the Alamance jail come at a time when there have been a record number of overdose deaths in the United States — and in North Carolina.

An average of more than eight North Carolinians died every day of 2020 from a drug overdose, according to the North Carolina Department of Health and Human Services. More than 28,000 North Carolinians died of a drug overdose from 2000 to 2020.

This map shows the rate of drug overdose deaths in North Carolina in 2020. Map courtesy of the NCDHHS Opioid and Substance Use Action Plan Data Dashboard.

There has been movement at the state and national level to help people with opioid use disorder, including funds in the state budget for addiction treatment and recovery and settlement money coming into North Carolina as a result of Attorney General Josh Stein’s lawsuit against major opioid manufacturers.

But people with opioid use disorder often end up in jail rather than treatment. 

Federal data show that as much as 85 percent of the prison population either has a substance use disorder or was arrested for crimes related to drug use.

In the state’s jails, which are controlled by county sheriffs and often lack comprehensive oversight, opioid overdoses are not uncommon. Local jail deaths due to drugs or alcohol intoxication have more than quadrupled across the country from 2000 to 2018, according to national data

“We incarcerate people for the crime of mental illness and the crime of substance use disorder,” Evan Ashkin, professor of family medicine at the school of medicine at the University of North Carolina at Chapel Hill previously told North Carolina Health News.

But it’s almost impossible to know the total number of incarcerated people who overdose. While overdose deaths that occur in jails are reported in North Carolina, the number of non-fatal drug overdoses in jails is almost impossible to track. 

Tracking jail deaths

Disability Rights North Carolina (DRNC) collects statewide records to track jail deaths, from suicides, natural causes, violent deaths and overdoses. Even with public documents, it can be tricky, and there’s little to no record of nonfatal overdoses or suicide attempts.

They often have to wait for a myriad of different reports to come back to truly identify the actual cause of death, said Luke Woollard, attorney for DRNC. An autopsy with a toxicity screening is required to rule a death as an overdose. 

It is most common for a person to overdose if they have entered the jail soon after consuming drugs, Woollard said. For example, a person may have ingested a large amount of drugs to try and hide them upon their arrest. If staff does not check on them, they can die in a cell alone.

It’s also possible, but less common, for someone to bring drugs into the jail and die from overdose.

Methods of treating people with substance use disorder are also inconsistent in the state’s jails

Some jails provide medication-assisted treatment (MAT) programs where detainees are allowed to continue taking or are prescribed medications such as methadone or buprenorphine, which allow people with substance use disorder to get off harmful street drugs without going through withdrawal. 

Other jails offer no such treatment, forcing people into withdrawal while in custody. Opioid withdrawal usually looks like a flu-like illness, including symptoms such as vomiting and diarrhea, which can lead to dehydration. It’s an unusual occurrence but left untreated, people can die from those symptoms.

“Somebody comes in,” Woollard said, “and the ones we see, often they’re either noted as being in Percocet withdrawal or some sort of withdrawal, and it’s the same issue. They have serious medical problems over a number of days, and then eventually just sort of succumb to them.”

Forcing people through withdrawal also lowers their tolerance over time. This can be a problem once people are released, said Susan Pollitt, supervising attorney for DRNC. A study by UNC Chapel Hill researchers found that incarcerated people in North Carolina were 40 times more likely to die of an opioid overdose within the first two weeks after release than someone in the general population.

There’s another complication to tracking how many people overdose in jail. If the person dies outside of the jail facility — whether because they were quickly discharged or en route to the hospital — the jail staff does not generate a report.

“We take a lot of steps to try and stop this,” Woollard said, “but it is still fairly common thing for jails to try and take somebody who died from suicide or overdose, get them while they’re in really bad shape but on route to a hospital, try and get them posted bail or something, so that they can say they weren’t in custody to avoid all of this reporting that they’ve had to do.” 

And if there is a suicide attempt or overdose that doesn’t result in death, no documents are generated, Pollitt said.

A bill to record attempted jail suicides

After a 17-year-old died in the Mecklenburg Jail North Juvenile Detention Center, state Rep. Carla Cunningham started to research jail deaths due to inadequate medical care.

“I started looking at it closely and saw that yes, these things were happening in facilities,” Cunningham said in an interview with NC Health News. “And that it really is not a lot of oversight or a collection of the data … The information is there, but you’ve got to dig for it.”

Cunningham filed a bill at the state legislature in May which would have required the state Department of Health and Human Services to conduct compliance reviews following reports of an attempted suicide.

Cunningham, a registered nurse, said that in health professions, preventative measures are paramount to reducing harm. If someone comes into a medical setting who is suicidal, health professionals know to be on high alert.

But jail staff may not have the medical training that nurses do, Cunningham said

“That is still a responsibility that they have,” she said, “and if they aren’t able to fulfill that, then someone else needs to be stepping in and helping them understand the training, helping understand how to apply it and understand how to be more preventive in those steps.”

Cunningham’s bill went nowhere this year. She said that one reason it may not have moved forward through the legislative process could be because some legislators didn’t want to put “additional stressors” on sheriffs. Cunningham said she doesn’t consider having more of a paper trail to be a stressor. 

She noted data is key in the medical field.

Without comprehensive data on overdoses in the state’s jails, it’s hard to tell how many close calls there have been, which is a problem, even as overdose deaths tick up across the state, partly due to the introduction of fentanyl into the drug supply. 

More powerful drugs like fentanyl mean a greater risk for a fatal overdose in jail. The public will get a record then, but that means another person will be dead.

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Elizabeth Thompson is our Report for America corps member who covers gender health and prison health topics. Thompson is a UNC Chapel Hill graduate who has covered Texas politics for The Dallas Morning...

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