Drugs

Drug use is now so ubiquitous in Western society that any examination of a potential detainee by a forensic physician must include a careful evaluation of drug use whether in the past or recently. The skill of the forensic physician will undoubtedly be stretched to the full in the evaluation of the history given, and this is discussed fully in Chapter 10. The failure to identify a drug abuser who then suffers from withdrawal while in custody is just as potentially life-threatening as the failure to continue a detainee's prescribed medication.

In terms of deaths in custody, all drug use, whether social, abusive, or therapeutic, is relevant (13), and the possibility that a detainee may have abused just one drug or a combination of drugs with or without alcohol before death must be positively excluded. A full drug screen on blood and, if available, urine is imperative. Some laboratories will also examine samples of bile and/ or liver to detect evidence of previous drug abuse.

The management of acute drug intoxication is a matter of clinical judgment, but with adequate medical care, it is unlikely that, except in exceptional circumstances, drug intoxication alone will to lead to sudden death in custody.

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