The Right to Not Die: Benzodiazepines in the Criminal Justice System

More and more instances are being reported in the news of people dying from benzodiazepine withdrawal while incarcerated for relatively minor offenses.

Take Jesse Jacobs, a 32 year old Texas man prescribed Xanax for an anxiety disorder. He was sent to jail for 30 days for a driving while intoxicated conviction. While in jail, Jacobs died from Xanax withdrawal.

His death has resulted in a hefty lawsuit, and has enraged the ACLU, stating “A part of this is familiar to us is jails often fail to identify with withdraw symptoms, and it can be deadly. We are not talking about people on heroin; everyone knows that can be deadly to withdraw from.”

Another deceased inmate in Michigan, serving time for a traffic ticket, is another gruesome story. David Stojcevski, 32, who was on Xanax, and several other medications, died 16 days into his 32 day sentence. His death and the preceding events were caught on video, which illustrates the potentially excruciating and deadly process that sometimes occurs with benzodiazepine withdrawal. His death has resulted in a 30 million dollar lawsuit.

These are just two recent examples of many inmate deaths from benzodiazepine withdrawal. It is impossible to predict which inmates will die and which will not from an abrupt withdrawal from a benzodiazepine. Because death is a risk of benzodiazepine cessation, a slow taper is the only humane way to prevent deaths.

This has prompted some jurisdictions, such as Cuyahoga County, passing Sean’s Law. The law is named after Sean Levert, who died in jail from benzodiazepine withdrawal. Many other counties have no benzodiazepines policies, or unsafe ones. Variations in policy from jurisdiction to jurisdiction make non-consensual benzodiazepine withdrawal while incarcerated an unpredictable risk for prescribers and patients. Informed consent is essential at the beginning of benzodiazepine treatment so that the patient can access their own lifestyle with the diminishing benefit of long term benzodiazepine use and decide for themselves if the prescription is a risk they want to take.

Clearly, the first step to prevent death from benzodiazepines withdrawal is to never become dependent on benzodiazepines to begin with. Prevention of dependency on benzodiazepines starts with adhering to prescribing guidelines, which would require doctors to only prescribe benzodiazepines for 2 to 4 weeks or less. These guidelines are largely ignored my medicine today. We cannot know, in any predictable fashion, which patients can abruptly stop a benzodiazepine without risk of death, or injury, and which will be injured or die. We cannot foresee the future or what circumstances patients may face. We cannot predict when or where these patients may find themselves in a situation where they cannot access their prescribed benzodiazepine, such as an arrest or incarceration.

What we do know is both Jesse and David, and many others, would most likely be living today had they not been dependent on a benzodiazepine in the first place, or removed from one abruptly from a jail. We also know how to prevent benzodiazepine deaths. But we have to stop ignoring the problem, and take action.