A patient in jail was acting very usual. He had been there for three or four days. When he had arrived, he had an intake screening and spoke with the nurse for an hour or more. He had just a few medications and those were sent to our intake director, a physician. They were approved and ordered. He was washed and changed into his new jail clothing. A detailed medical assessment was done, including his medical history, risk factors, previous injuries, mental health history, and previous drug use. I think he thought he was going to bail out and believed he wasn’t going to be in jail long.
On this nursing intake assessment, he reported he had no medical issues or other problems. He had his wisdom teeth out when he was back in high school. He had no other surgeries or such. He had no history of drug use. To the staff, there was very little risk of any medical problems. He was placed in the admittance wing of the jail. This is where he is monitored and his charges are reviewed and a risk assessment is done.
That night, he began calling the nurses and officers every hour. Suddenly he became extremely worried about his dog. He described the dog to every staff member he came across. To the nurses, he asked to be released from jail to go take care of his dog. To the officers, he wanted repeat phone calls to his family so that they would go check on his dog. He ended up getting very little sleep.
From that point, he started to get more and more anxious. He wasn’t sleeping and started freaking out every hour. The staff tried to help him in any way they could. He was given showers, ibuprofen, Tylenol, and several other things to help including books, paper, pencils, and such. Soon mental health was called to his cell because of his behavior. In one moment he would refuse to eat or see anyone, and in the next instant, he was demanding to see the president. No one could understand what was happening. His issues and complaints were jumping from one thing to another. He began crying about his family, his job, his dog, a high-school girlfriend that he hadn’t seen in ten years, and even the Cleveland Browns’ football team.
Finally, he was placed on the provider clinic and was called down to the exam room in the section of the jail he was in. The provider would rotate sections. We have a large jail with a few thousand patients. We have a large number of staff but a gigantic number of inmates.
The patient, Jacob, was my fourth patient of the day. By this point, he couldn’t even walk into the exam room on his own. He was brought in by an officer in a wheelchair. It took two officers and myself to place him on the exam table. He was talking to the wall and really out of it. I had reviewed his chart from the moment he arrived. Nothing about his current behavior made sense. I had called a few pharmacies but he didn’t have any mental health medications. In the end, I could only come up with one thing…drug withdrawal.
I asked, “Hey Jacob. Have you ever used Meth, Heroin, or another drug?”
Jacob answered, “No doc. I don’t use that crap stuff.”
“Do you smoke marijuana, spice, vape, or any mixture of things?”
“I can promise you that I’ve never smoked a joint or shot anything up. Vaping is for losers, and I am not a loser.”
“I believe you. I’m just trying to understand why your behavior has changed so much.”
“I don’t want to be in jail.”
“Most people don’t. Where do you want to be?”
“At home with my family. Did I tell you that my family is sick?”
“I don’t think you did.”
“Really sick. Like in a bad way.”
“Who is sick? What’s going on?”
“My dog is so sick. Her name is Lucy, and she has cancer.”
“That’s horrible. What kind of dog? How old is she?”
“She is like eight. She is a basset hound. I think she has something like lymphoma.”
(At this point, I was pretty surprised at how well he was talking. At the moment, he had a great recall of events, dogs, names, and remembering lymphoma was pretty astonishing. Most patients can’t remember what medications they take.)
I said, “That’s terrible. How is she doing?”
“She’s dying. The chemo isn’t working.”
“That’s too bad. I’m sorry. That would make me want to get out of jail too. I bet you are stressed.”
“Exactly. No one will listen to me. Can you just let me go?”
“No. Sorry. The medical staff can’t let you out of jail.”
“Who is going to give my dog her meds?”
“Have you called a family member?”
“Sure. But they don’t want to light up the pot grass I have at home.”
“What is the pot grass?”
“Something my friend gave me. He told me that it would work well to help my dog feel more comfortable.”
“What is it that you do?”
“I close all the windows and I light up this pouch of the stuff. It is so relaxing and makes me and my dog pretty hungry. I also spray this oil under her tongue. I’ve tried it a few times as well.”
“Like CBD oil or something.”
“I think so.”
“How often do you light up the pot grass?”
“Several times a day. It really helps me to calm down myself.”
“Good to know.”
At some point, I ended the visit and he was moved to withdrawal monitoring. Heavy use of marijuana and CBD oil can cause side effects in some patients. That was exactly what we were seeing here. He was given some IV fluids and some medications and recovered just fine. I checked on him every day. About four days later, he had completely forgotten our previous conversation. He was more rational and calm. No mental health problems, just using some marijuana and CBD oil from his friend, to help his dog. That part was completely true.
