Detainees with substance use disorders in police custody: Guidelines for clinical management (5th edition)

CR227, March 2020

These guidelines (the Blue Guidelines) support professionals in meeting the needs of detainees in police custody settings who have substance misuse disorders.  Those with substance use disorders who are in police custody are entitled to the same high quality and effective treatment, delivered by healthcare professionals with the appropriate competencies, as the rest of the population. Accurate assessment of associated morbidities, including 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.

Since the last edition of these guidelines there have been significant changes in the trends and prevalence of drug and alcohol problems, and in the delivery of care to those with substance use disorders. There has also been an increase in the development of guidelines and evidence-based reports, including updated reports from the National Institute for Health and Care Excellence (NICE) and the UK Drug misuse and dependence guidelines on clinical management (Orange Guidelines).

Previous editions of these guidelines were produced by a Joint Working Group chaired by Professor Hamid Ghodse, comprising representatives of the Association of Forensic Physicians (previously the Association of Police Surgeons), relevant colleges and faculties, the Department of Health, and the Home Office. This expert Working Group has now revised the Guidelines, providing updated evidence to the numerous professionals and police who are involved in the care of detainees with alcohol and substance misuse/ dependence. They stress the importance of good communication, of working closely with custody officers, and of the shared responsibility for the safety and care of detainees, with particular reference to:

  • Full participation of competent and skilled healthcare professionals (doctors, nurses and paramedics) in all aspects and at all stages of the healthcare of detainees with substance misuse/dependence
  • Providing advice to custody officers and others involved with detainees with substance use disorders
  • Comprehensive contemporaneous records
  • Appropriate sharing of information in accordance with the law and the General Medical Council’s (or equivalent) advice on professional confidentiality
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