(This report replaces CR81, from 2001.)
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.
Most of these detainees are vulnerable individuals. Recognition of
substance misuse problems in these detainees is important and is
now receiving local and national attention. The prevalence of such
problems makes guidelines necessary for forensic physicians (police
surgeons, forensic medical examiners and forensic medical officers)
on the acceptable minimum standards for the assessment of drug- and
alcohol-dependent individuals and treatment intervention.
These Guidelines, now in their third edition, have been
updated by a Working Group under the Chairmanship of Professor
Hamid Ghodse, including representation from the Association of
Forensic Physicians, the Royal College of Psychiatrists, the Royal
College of General Practitioners, the Faculty of Accident and
Emergency Medicine, the Association of Chief Police Officers
(ACPO), the Home Office and the Department of Health. Since the
last edition there have been a number of initiative developments in
services for substance misusers and in the clinical justice system
in support of treatment and prevention. Although the outcome of
some of these initiatives is not yet clear, there is now a greater
emphasis on diverting those in conflict with the law from custodial
sentences towards treatment. This edition has taken account of
those who are sentenced to prison and those with mental disability
whose substance misuse brings them in conflict with the law.
The assessment and treatment of substance misusers present
forensic physicians with particular challenges which require skills
and experience to ensure appropriate management. Good
communication, working closely with custody officers, and shared
responsibility for the safety and care of detainees with substance
misuse problems are all important factors. In particular, the
Guidelines stress the importance of:
- Forensic physicians' full participation in all aspects and at
all stages of the health care of detainees with substance
misuse/dependence problems.
- Providing advice to custody officers and others involved with
detainees with substance misuse/dependence problems.
- Comprehensive contemporaneous records.
- Appropriate sharing of information in accordance with the law
and the General Medical Council's advice on professional
confidentiality.
- All interventions being made with an awareness that the
interests of the detainee as a patient is paramount.
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.