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Drug abusers who die during arrest or in custody

The Police Complaints Authority of Great Britain recently announced that 56 prisoners had died in custody in 19971. The rate, roughly 0.1 per 100000 citizens per year, is surprisingly similar to the rate in California, where 35 to 40 such deaths are recorded annually2. The vast majority of the these deaths, both in California and in the UK, are suicides, but in the USA many of the remaining deaths are drugrelated. Suicides are often preventable. Given appropriate resources, custodial officers can be trained to recognize potential suicides and see to their wellbeing. Drug-related deaths are more difficult to prevent. Depending upon when they occur, drug-related deaths in prisoners can be divided into four different categories: (1) death during arrest and transport; (2) death within 12 hours of arrest; (3) death after 12 hours but while still on remand; and (4) death after trial. Excited delirium in chronic stimulant abusers is the principal cause of death during arrest and transport. Death from massive overdose in drug smugglers and dealers is the principal cause during the first 12 hours. Deaths that occur after 12 hours are almost always related to withdrawal, or other natural causes. Even with optimal care, many drug-related deaths cannot be prevented. Drug dealers who swallow the evidence at the time of arrest stand a good chance of dying, as do chronic stimulant abusers suffering from excited delirium. Survival in these cases is theoretically possible but, given the ineffectiveness of current remedies, it is not likely. Thus drug-related deaths fall into a different category from readily preventable deaths such as those related to drug withdrawal, suicide, and other natural causes, and must be considered separately.