Do Police Arrestees Substitute Legal Highs for Other Drugs?

Background

Some commentators have suggested legal highs (LH) might reduce existing illegal drug use and contribute to lower drug-related harm. However, no studies have specifically investigated substitution between LH and other drugs.

Aims

To explore the extent to which police detainees substitute LH for illegal drugs

Method

A total of 848 detainees at four central police stations were interviewed about their drug and LH use. Detainees were asked what impact their LH use had on their other drug use (i.e., ‘no change’, ‘more’, ‘less’ or ‘stopped’). The detainees were placed into four groups: (i) no LH use; (ii) LH use and ‘no change’ in drug use; (iii) LH use and ‘more’ drug use; (iv) LH use and ‘less’ or ‘stopped’ drug use. Demographics and levels of drug use in the past month were compared between groups.

Results

Ninety-six percent of the LH using detainees had used synthetic cannabinoids (SC), and, of those who reported substituting a drug, 94% had substituted (natural) cannabis. Overall, 54% of the detainee sample had not used SC, 34% had used SC but not changed their cannabis use, 9% had used SC and used ‘less’ or ‘stopped’ cannabis use, and 3% had used SC and used ‘more’ cannabis. The SC users were more likely to have recently been in drug treatment. All those who used SC had higher cannabis consumption regardless of substitution behaviour. The SC users who used ‘more’ cannabis also used more methamphetamine and ecstasy.

Conclusion

Twenty percent of those who used SC and cannabis reported reducing or stopping their cannabis use while 5% increased their cannabis use, suggesting a modest overall reduction in cannabis use. Further research is required to quantify the magnitude of substitution changes, the impact on drug-related harm, and extent to which substitution occurs for other LH and other populations.

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By:  Chris Wilkins, Karl Parker, Jitesh Prasad, Sonie Jawalkar

Corresponding author. SHORE & Whariki Research Centre, College of Health, Massey University, P.O. Box 6137, Wellesley Street, Auckland, New Zealand, +64 9 366 6136. www.shore.ac.nz.

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Advancing Medical Professionalism in US Military Detainee Treatment

Summary Points

• The United States Department of Defense and Central Intelligence Agency (CIA) promulgated policies and requirements that required health professionals to participate in the mistreatment of counter-terrorism detainees through participation in such practices as abusive interrogation and force-feeding of detainees, in violation of ethical standards established by associations representing the health professions.
• A report of the Defense Health Board to the Secretary of Defense on military medical ethics released in 2015 found that the Department of Defense “does not have an enterprise-wide, formal, integrated infrastructure to systematically build, support, sustain, and promote an evolving ethical culture within the military health care environment.”
• The Board also found that ethical codes promulgated by the health professions, including the duty to avoid harm, provide a sound basis for military medical practice, even taking into account the unique challenges often faced by military health professionals in reconciling the military mission with patient needs.
• The health professional community should urge the Secretary of Defense to adopt and implement the recommendations of the Defense Health Board, rescind directives authorizing participation of health professionals in interrogation and force-feeding because they are inconsistent with professional ethics, and provide ongoing advice and support for the reform process. 

Principles of ethical conduct are essential to clinical practice and the social legitimacy of the health professions. The professions derive the obligations of health professionals from moral principles, the traditions of medicine, and a social contract with society. They reflect these obligations in codes adopted by professional organizations. As the Defense Health Board, an independent Federal Advisory Committee to the Secretary of Defense, recently recognized in a review of medical ethics in the United States military, health professionals in the armed services must adhere to these professional obligations even as they face responsibilities to accomplish the military mission [1]. The Board’s affirmation of these obligations, most notably first loyalty to the patient ([1]; [2], Principle VIII and Opinion 10.015; [3], Principal A and 3.04; [4], Provision 2 and section 2.1; [5]), along with its recommendations for structural reform in military medical ethics, has implications for health professional participation in intelligence and security functions in connection with counter-terrorism detainees. Adopting its recommendations would restore the integrity of military medical ethics and require rescission of requirements that health professionals participate in interrogation and force-feeding of detainees. It is incumbent on the profession to support the Board’s recommendations and urge the Secretary of Defense to adopt them.

Full article at:   http://goo.gl/P6bPbM

By:  Leonard S. Rubenstein

Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America

Leonard S. Rubenstein

Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, United States of America

Scott A. Allen, Phyllis A. Guze

University of California at Riverside School of Medicine, Riverside, California, United States of America

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Causes of Death among Detainees: A Statistical Study on the Casework of the Forensic Medicine Institute in Cluj-Napoca During the Period 2000-2014

BACKGROUND AND AIMS:

The detainees' right to healthcare is granted by laws, in accordance with EU directives and recommendations to which our country has consented. Prison population is a particularly vulnerable and marginalized group characterized by mortality rates different from the general population. This study aims at providing a picture of the causes of death, quality of healthcare and measures needed to reduce the number of in-prison deaths, including legal medicine expertise in view of sentence postponement/interruption.

METHODS:

The present paper is based on the statistical analysis of in-prison deaths casework recorded at the Forensic Medicine Institute of Cluj-Napoca and provided by territorially subordinated counties forensic services. The data collected cover over 15 years (2000-2014), a period long enough for significant retrospective statistical analysis.

RESULTS:

The total number of deaths among the inmates was 113, the majority of male sex (110). Distribution by age groups shows a greater incidence among inmates aged 50 to 59 years (32 cases, 28.31%), followed by those in their 40s' (30 cases, 26.54%) and 30s' (25 cases, 22.12%). The most frequent pathological causes of death were cardiovascular (53 cases) followed by tumors (26 cases) and infectious diseases. A significant number of deaths were due to violent causes (14 cases-12,38%).

CONCLUSIONS:

Special problems are raised by the high number of deaths among prisoners, especially at a young age, while the high frequency of violent deaths from self- or non-self-inflicted traumatic causes requires supervision, monitoring and continuous analysis. Despite recent improvements, healthcare in prisons still poses some problems, mainly regarding diagnosis and treatment of heart diseases, neurosurgery and cancer.

Below:  Distribution of annual North-West prison deaths in the timeframe 2000–2014

Below:  Distribution of deaths in North-West prisons

Below:  Distribution of inmate deaths in North-West prisons according to age groups

Below:  Cause of death in North-West prisons 2000–2014

Below:  Cardiovascular conditions resulting in in-prison deaths

Below:  Tumor location in in-prison deaths due to cancer

Full article at:  http://goo.gl/CcPNnf

By:  Gherman C1, Chiroban O1.

• 1Department of Community Medicine, Forensic Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.

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Addressing the Challenges of Chronic Viral Infections and Addiction in Prisons: The PRODEPIST Study

In 2010 only 30.9%, of the Puy-de-Dome prison detainees were screened for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV). Our goal was then to promote these assesments, as well as to identify addictive behaviour using FAGERSTROM, Cannabis Abuse Screening Test and CAGE tests, diagnose fibrosis by means of Fibrometer or Fibroscan in hepatic virus carriers and heavy drinkers, and perform HBV vaccinations.

This prospective study of adult detainees in the prisons of Puy-de-Dome, France, took place from June 2012 to December 2013.

Of the 702 incarcerated individuals, 396 (56.4%) were screened and 357 (50.9%) enrolled. HIV prevalence was 0.3%, HCV 4.7% and HBV 0.6%. While 234/294 (79.6%) smokers and 115/145 (79.3%) cannabis users were screened for dependence, excessive alcohol consumption was tested for in 91/179 (50.8%) cases. Fibrosis was screened for in 75/80 (93.7%) individuals selected with 16.0% presenting with moderate to severe fibrosis, 4/9 (44.4%) HCV carriers and 8/65 (12.3%) excessive alcohol consumers. HBV vaccination was given to 81/149 (54.4%) individuals with no serological markers. A total of nine HIV tests were conducted at the 57 discharge consultations, involving 215 detainees being released, all of which were negative.

The promotion of these evaluations proved beneficial, although viral screening could be achieved for only approaching half of the detainees, as could alcohol consumption assessment and HBV vaccination for those concerned. Fibrosis screening revealed lesions in HCV carriers yet also in heavy drinkers, who are typically less likely to be assessed. Consultations and HIV screening on release were found to be rarely possible.

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By: Jacomet C1, Guyot-Lénat A2, Bonny C3, Henquell C4, Rude M5, Dydymski S6, Lesturgeon JA7, Lambert C8, Pereira B8, Schmidt J2.

• 1 Infectious Diseases Department, Clermont-Ferrand University Hospital, Clermont Ferrand F-63000, France cjacomet@chu-clermontferrand.fr.
• 2 Clermont Ferrand and Riom Prisons Medical Units, Emergency Department, Clermont-Ferrand University Hospital, Clermont Ferrand F-63000, France.
• 3 Hepatology Department, Clermont-Ferrand University Hospital, Clermont Ferrand F-63000, France.
• 4 Virology Department, Clermont-Ferrand University Hospital, Clermont Ferrand F-63000, France.
• 5 Emile Roux Centre, CDAG (Free anonymous screening centre), Clermont Ferrand F-63000, France.
• 6 Infectious Diseases Department, Clermont-Ferrand University Hospital, Clermont Ferrand F-63000, France.
• 7 Psychiatric Department, Sainte Marie Hospital, Clermont Ferrand F-63000, France.
• 8 Clermont-Ferrand University Hospital, Biostatistic Unit (DRCI Clinical research and innovation service), Clermont Ferrand F-63000, France.  

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Disease Profiles of Detainees in the Canton of Vaud in Switzerland: Gender & Age Differences in Substance Abuse, Mental Health & Chronic Health Conditions

Literature on the disease profile of prisoners that differentiates by age and gender remains sparse. This study aimed to describe the health of correctional inmates in terms of substance abuse problems and mental and somatic health conditions, and compare it by gender and age.

This study examined cross-sectional data from the Canton of Vaud in Switzerland on the health conditions of detainees who were in prison on January 1, 2011 or entered prison in 2011. Health conditions validated by physician examination were reported using the International Classification of Diseases (ICD) version 10. The analyses were descriptive by groups of prisoners: the entire sample (All), Men, Older adults and Women.

A total of 1,664 individuals were included in the analysis. Men comprised 91.5 % of the sample and had a mean age of 33 years. The other 8.5 % were women and had an average age of 39. Older adults (i.e., age 50 and older) represented 7 % of the total sample. 

Overall, 80 % of inmates were non-Swiss citizens, but the proportion of Swiss prisoners was higher among the older adults (51 %) and women (29 %). Overall, 41 % of inmates self-reported substance abuse problems. Of those, 27 % were being treated by psychiatrists for behavioral disorders related to substance abuse. Chronic infectious diseases were found in 9 % of the prison population. In addition, 27 % of detainees suffered from serious mental health conditions. 

Gender and age had an influence on the disease profile of this sample: compared to the entire prison population, the older inmates were less likely to misuse illegal drugs and to suffer from communicable infections but exhibited more problems with alcohol and a higher burden of chronic health conditions. Female prisoners were more disposed to mental health problems (including drug abuse) and infectious diseases. In terms of chronic diseases, women suffered from the same conditions as men, but the diseases were more prevalent in women.

It is important to understand the different disease profiles of prisoners by gender and age, as it helps identify the needs of different groups and tailor age-and gender-specific interventions.

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By: Karine Moschetti^128*, Pierre Stadelmann¹⁸, Tenzin Wangmo³, Alberto Holly⁴, Patrick Bodenmann⁵, Jean-Blaise Wasserfallen², Bernice S. Elger³⁷ and Bruno Gravier⁶

• 
  

¹Institut universitaire de médecine sociale et préventive, Unité d’evaluation des soins, University Hospital of Lausanne (CHUV), Route de la Corniche 10, Lausanne, 1010, Switzerland

²Technology Assessment Unit (UET), University Hospital of Lausanne (CHUV), Lausanne 1011, Switzerland

³Institute for Biomedical Ethics, Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, Basel 4056, Switzerland

⁴Institut d’économie et management de la santé (IEMS), HEC Lausanne and Département d’économétrie et d’économie politique (DEEP), University of Lausanne, Internef Building, Lausanne 1015, Switzerland

⁵Vulnerable Population Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne 1011, Switzerland

⁶Service of Correctional Medicine and Psychiatry (SMPP), University Hospital of Lausanne (CHUV), Prilly-Lausanne 1008, Switzerland

⁷Centre universitaire romand de médecine légale, University of Geneva, Geneva, Switzerland

⁸IEMS - Plateforme interfacultaire en économie et management de la santé, University of Lausanne CH, Internef Building, Lausanne 1015, Switzerland