Taleed El-Sabawi’s Death by Withdrawal exposes how U.S. jails and prisons perpetuate structural violence by denying evidence-based medical care to individuals undergoing withdrawal, resulting in suffering, suicide, and death that contravene Eighth and Fourteenth Amendment protections; grounded in constitutional jurisprudence—particularly Estelle v. Gamble—and bolstered by clinical consensus on withdrawal as a serious medical condition, El-Sabawi meticulously argues that failing to administer medications like methadone or buprenorphine amounts to deliberate indifference and thus constitutes a constitutional violation, not a mere lapse in care or professional discretion; the article establishes that unmedicated withdrawal is not only agonising and physically hazardous but also statistically correlated with post-release overdose and suicide, disproportionately affecting Black and Latinx detainees due to systemic pretrial detention biases; drawing on DOJ investigations, federal guidelines, and firsthand carceral testimonies, the author outlines three recurrent violations: absence of withdrawal protocols, protocols lacking medication, and protocols deploying non-evidence-based drugs such as clonidine in place of standard MOUD; through case law from Farmer v. Brennan to Harper v. Lawrence County, the article demonstrates that carceral institutions’ refusals to treat withdrawal are often not incidental but embedded in punitive policies—policies which remain largely insulated from accountability due to stigma against addiction and bureaucratic resistance to controlled substances; El-Sabawi insists that evolving standards of decency—measured by federal guidelines, clinical best practice, and a shift toward dignity-based health care in custody—demand not only withdrawal protocols but MOUD initiation and continuity of care post-release; citing judicial reluctance and legislative inertia as obstacles, the article concludes with a powerful reminder: people do not forfeit their right to medical care when they lose their freedom, and any failure to provide such care—especially when withholding it causes preventable death—is nothing short of state-sanctioned cruelty masquerading as clinical ambiguity. El-Sabawi, T. (2024) Death by Withdrawal. 71 UCLA Law Review 378. https://www.uclalawreview.org/death-by-withdrawal
