LEBANON, Pa. (AP) — In the days following her 18-year-old daughter's first arrest on heroin charges, Stephanie Moyer took solace in thinking she would be safe in jail until she got into a treatment program.

However, Victoria "Tori" Herr sounded disoriented on a call home three days later. She feared she was dying and complained of being thirsty, her mother said.

Herr, who had a 10-bag-a-day habit, collapsed following days of severe vomiting and diarrhea at the Lebanon County Correctional Facility. She spent five days in the hospital, then died on Easter Sunday 2015.

Her case is one of at least a half-dozen deaths nationwide during the last two years involving jail heroin withdrawal, and advocates fear the number will grow given the nation's heroin crisis. Advocates find the deaths particularly troubling because opioid withdrawal, while miserable, is rarely life-threatening if medication, monitoring and intravenous fluids are available.

"This is a woman who died because she was detoxing," said Moyer's lawyer, Jonathan Feinberg, who filed a federal civil rights lawsuit Monday. "Had Tori Herr's withdrawal been treated ... she almost certainly would be alive today."

Warden Robert Karnes told Moyer that his staff followed "all operational protocols," the lawsuit says. Jail and county officials didn't return calls Monday seeking comment.


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"This is an emerging, growing problem, and it's hitting communities all over the country. That's exponentially so in jails," said Emma Freudenberger, a co-counsel on the lawsuit.

Other withdrawal deaths have been reported at jails around the country:

— In Oregon, a 26-year-old woman wrote increasingly dire notes to jail staff begging for help before she died after six days behind bars in 2014, The Oregonian reported.

— Near Detroit, a 32-year-old man lost 50 pounds during a monthlong stay in 2014 as he struggled to withdraw from methadone, opioids and the anti-anxiety drug benzodiazepine. A jail video shows him lying naked on a stone floor during what his family's lawsuit called his slow, painful death.

— In Colorado, a 25-year-old man died last year after he was prescribed a mixture of drugs to treat his withdrawal symptoms but never received them, according to his family's lawsuit.

Dr. Eke Kalu, the general medical director of the Philadelphia prison system, said quitting heroin is one of the "safer withdrawals" compared with alcohol and some other drugs. The city screens inmates to assess their need for medication or IV fluids. Officials couldn't remember an opiate withdrawal death in the past decade.

Officials at Rikers Island, in New York, have long run a methadone maintenance program, which experts believe can help detainees kick their habit and lower the risk of relapse.

But smaller jails may lack in-house medical units or sufficient monitoring. Advocates say that can amount to cruel and unusual punishment. Freudenberger believes jail officials in Lebanon should have sent Herr to a hospital earlier.

Herr was staggering by the time she was taken to the medical unit the last night there, according to Moyer's lawsuit. She was given water and Ensure, but resumed vomiting when she returned to her cell, the lawsuit said. Dehydration brought on by constant vomiting and diarrhea can lead to delirium, an electrolyte imbalance and cardiac damage. Herr also went without oxygen after she collapsed, the suit said.

"I'm not a professional, but, as a mother — Day 1 — I would have taken her to the hospital if I would have seen her vomiting or not keeping things down," Moyer said.

Herr graduated from high school in 2014 despite using heroin in the final months, something her mother attributes to her long struggle with anxiety. Moyer last saw her the day before her arrest, when they talked about an inpatient treatment program.

"I told her that her name was Victoria and that's close to 'victorious,' and I promised her she would be victorious in getting through it," Moyer said.

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This story has been corrected to show that one jail was near Detroit, not in Detroit.

<B>Caption 1:<B>

Stephanie Moyer poses for a photograph in Lebanon, Pa., Friday, July 8, 2016. Moyer's daughter Victoria "Tori" Herr died Easter Sunday 2015 following heroin withdrawal days into her first jail stint. (AP Photo/Matt Rourke)

<B>Caption 2:<B>

A photo provided by Stephanie Moyer shows Moyer's daughter Victoria "Tori" Herr. Herr died Easter Sunday 2015 following heroin withdrawal days into her first jail stint. (Stephanie Moyer via AP)

<B>Caption 3:<B>

Stephanie Moyer displays one of her daughter Victoria "Tori" Herr's dreams kept on scraps of paper in a jar, during an interview with The Associated Press in Lebanon, Pa., Friday, July 8, 2016. Herr died Easter Sunday 2015 following heroin withdrawal days into her first jail stint. (AP Photo/Matt Rourke)

<B>Caption 4:<B>

Stephanie Moyer poses for a photograph in Lebanon, Pa., Friday, July 8, 2016. Moyer's daughter Victoria "Tori" Herr died Easter Sunday 2015 following heroin withdrawal days into her first jail stint. (AP Photo/Matt Rourke)

<B>Caption 5:<B>

Stephanie Moyer reads her daughter's diary in Lebanon, Pa., Friday, July 8, 2016. Moyer's daughter Victoria "Tori" Herr died Easter Sunday 2015 following heroin withdrawal days into her first jail stint. (AP Photo/Matt Rourke)