There has been a major increase in the size and scale of substance
misuse problems over the past couple of decades and a corresponding
increase in the numbers detained in police custody who misuse
substances. Most of these detainees are vulnerable individuals.
Guidelines on the acceptable minimum standards for the assessment
of drug- and alcohol-dependent individuals and treatment
interventions are necessary for forensic physicians (police
surgeons, forensic medical examiners and forensic medical
officers).
For those individuals who become casualties of
substance misuse and are in police custody, these guidelines offer
a humane response, with provision for care and treatment. They are
flexible tools designed to accommodate changes in the nature and
extent of substance misuse in the community, as well as changes in
national policy and strategy, together with new developments in the
care and management of substance-dependent individuals.
Accurate assessment of the degree and severity
of dependence, and of the need for medical intervention is
essential, because both intoxication and withdrawal can put
detainees at risk of medical, psychiatric and even legal
complications. Many such detainees have not received the treatment
and care in custody that they need because it is particularly
difficult to undertake a proper assessment and initiate an
appropriate response in the environment in which they are seen.
However, a detained substance-dependent person who is at risk of
complications is entitled to the same quality of healthcare as they
would receive in other locations.
Since the third edition there have been a
number of initiatives and developments in services for substance
misusers and in the criminal justice system in support of treatment
and prevention. There has been a greater presence and contribution
by other healthcare professionals working closely with doctors.
This fourth edition has responded to these developments.
The guidelines will be of immense value to all
practitioners in helping and supporting detainees, and to the staff
of law enforcement agencies who are involved in the care of
detainees with substance misuse problems, and will also be useful
for teaching purposes for medical and nursing staff and arrest
referral officers.
This report replaces CR132 (of the same title,
third edition) from 2006; plus CR81 (second edition) from 2001.
Contents
1. Introduction
1.1 The Working Party
1.2 The Guidelines
1.3 The scope of the problem
1.4 Changing provision of forensic medical
services
2. History and
examination
2.1 What is required?
2.2 Reliability of histories
3. Principles of medical
management
3.1 General considerations
3.2 Mental disorder
3.3 Special considerations concerning female
detainees
3.4 Special considerations concerning young
people under 18 years of age
3.5 Special considerations concerning people
with learning (intellectual) disabilities
3.6 Liaison with other agencies
3.7 Drug treatment monitoring systems
3.8 Statutory notification of addicts
3.9 Arrest referral schemes and Drug
Interventions Programme
3.10 Medical complications of substance misuse
and reducing the health risks
3.11 Prescribing
4. Fitness for interview
4.1 General considerations
4.2 Definition (Annex G of PACE Codes of
Practice Code C)
4.3 False confessions
4.4 The possible impact of substance misuse
withdrawal states on the validity of a confession
4.5 The possible effect of substance misuse
intoxication on the validity of a confession
5. Managing specific drug
problems
5.1 Alcohol
5.2 Benzodiazepines
5.3 Opioids
5.4 Stimulants
5.5 Hallucinogens
5.6 Volatile substances
5.7 Cannabis
5.8 Other substances
Appendix A: PACE Code C observation list
Appendix B: Metropolitan Police Form 170
Appendix C: Glossary