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The Royal College of Psychiatrists Improving the lives of people with mental illness

CR169. Substance Misuse Detainees in Police Custody: Guidelines for Clinical Management (4th edn)

Price: £0.00

Approved: Aug 2011

Published: Nov 2011

Status: current

Number of pages: 82

Review by: 2016

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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.


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

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