Original communicationThe clinical management of substance misusers in police custody – a survey of current practice
Introduction
Large numbers of substance misusers are detained in police custody. It has been found that on average 69% of arrestees gave positive urine samples for at least one illicit substance.1 In another study (post charge for certain ‘trigger offences’), 44% of detainees tested positive for opiates and 32% for cocaine.2
The management of substance misuse detainees in police custody has been the subject of great debate with particular focus on the extent of the problem and the difficulties of assessing fitness for interview.[3], [4], [5] Of particular concern, has been a perceived reluctance for forensic physicians (FPs) to prescribe or authorise the continued administration of prescribed opiate substitution treatment in police custody.6 It has been commented,7 that not continuing a legal prescription of methadone is interfering in an unacceptable way with an individual’s medical treatment. The quality of treatment provided to substance misusers has been described as being of a cursory nature providing only minimal standards of care.
Previously, it was found that there was no common practice for the assessment and treatment of substance misusers and there was an urgent need for specific guidelines to address the arbitrary nature of practice at that time.4 Guidelines for the clinical management of substance misusers in police custody were produced 1994 – the Blue Guidelines”.8 These were revised in 2000 giving clear recommendations and a proposed management pathway regarding assessment and treatment.9 These guidelines were intended to appropriately amplify but not replace the Department of Health’s publication Drug Misuse and Dependence – Guidelines on Clinical Management.10 All members of the Association of Forensic Physicians (AFP – formerly the Association of Police Surgeons) were sent a copy of the guidelines each time they were published.
The aims of this study were to determine the current attitudes and practice of forensic physicians to the management of substance misusers in police custody to see whether there had been any change in practice since the publication of the specific guidance to assist doctors in this area.
Section snippets
Methods
The exact number of doctors working as forensic physicians in Great Britain is still uncertain. Therefore, the only accessible database is that of members of the AFP. There were 937 members in September 2003 and each one was sent a postal questionnaire. Previously, police forces have been contacted through the auspices of the Home Office Advisory Forum on Forensic Physicians to try and obtain contact details of doctors who provide clinical forensic medical services to police but data protection
Results
Questionnaires were returned from 409 members representing a 44% response rate which included 7% (n = 65) of invalid questionnaires because of retirement of the respondent or because his or her sub speciality did not bring them into contact with drug misusers leaving 347 (37%) as the valid sample. The responders represented fifty two forces in the United Kingdom, Eire and the Channel Islands.
Discussion
The management of substance misuse detainees in custody remains a controversial, but highly significant part of a forensic physician’s workload. Substance misuse, including alcohol, is a factor in a substantial number of deaths in custody.[12], [13], [14] However, the patterns of drug consumption and the modes of ingestion are atypical of drug-related deaths in the UK with the most common drug identified at post-mortem being cocaine and the mode of ingestion oral.15
It is essential that forensic
Acknowledgments
This research was supported by a grant from the Department of Health. The research received support and advice from the Education and Research Committee of the Association of Forensic Physicians. We are grateful to Dr. Paul Jackson who provided the data entry and statistical analysis.
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Cited by (14)
Methadone-related death in detention
2022, Journal of Forensic and Legal MedicineCitation Excerpt :Dose assessment during maintenance therapy may be complicated, however, not only by the factors discussed above, but also by the risk of diversion of prescribed drug, use of unprescribed methadone (‘topping up’), the intensity and mode of exposure to illicit drugs, which may include illicit diamorphine (heroin), and the intensity and frequency of alcohol use. These same factors may also complicate assessment of detainees.14 In addition, there may also be delayed absorption of methadone taken by mouth due to the presence of food, the co-ingestion of drugs that delay gastric emptying, or the presence of opioid-induced gastrointestinal hypomotility.
Healthcare and forensic medical aspects of police detainees, suspects and complainants in Europe
2018, Journal of Forensic and Legal MedicineCitation Excerpt :However, in everyday practice, implementing this recommendation is problematic. In European countries, people in police custody often have symptoms of intoxication or withdrawal,2,4,22,23 in which case some consider that the examination is better performed within view of a police officer for the sake of the safety of the doctor because of possible aggressive behaviour by the detainee (prohibited by some national guidelines). From the result of the medical examination the doctor has the option to certify the fitness for custody only under certain conditions.
Detention: Medicines Management in Custodial Settings
2015, Encyclopedia of Forensic and Legal Medicine: Second EditionThe work of forensic physicians with police detainees in the Canberra City Watchhouse
2011, Journal of Forensic and Legal MedicineCitation Excerpt :The most commonly used drugs by police detainees in the UK were opiates and cocaine.3 In addition, alcohol and illicit drug use are recognised as common factors in near miss incidents and fatalities in police custody.1,4,5 This retrospective clinical audit aims to determine:
Characteristics of drug misusers in custody and their perceptions of medical care
2007, Journal of Forensic and Legal MedicineCitation Excerpt :One of the problems of assessment by the forensic physician is the difficulty in confirming the history of drug intake given by the detained person. A survey of forensic physicians showed that there are negative attitudes towards drug misuse detainees.5 Eighty percent thought that drug misusers are unreliable and deceitful.