Michelle Teasdale, DNP, APRN, FNP-C
The opioid epidemic is an ongoing crisis in the United States. The epidemic began during the 1990s when the practice of prescribing opioids increased; however, inexpensive heroin and synthetic opioids have prolonged the epidemic. Given this situation, it is no surprise opioids are the most commonly reported drug used by the individuals incarcerated at the correctional facility where I practice.
During the intake process, many individuals will report they swallowed heroin before being arrested. This scenario is problematic for medical staff as they are forced to determine if the heroin was actually ingested, or if the disclosure was a fabrication. This is further complicated by the fact that heroin is generally distributed in a non-opaque container, generally latex or plastic, and is not easily visible by x-ray.
During this scenario, there are only two options, refuse to accept the individual into the jail until they are cleared at the hospital, or accept them with close monitoring. Due to limited resources, the former is often believed to be the safer practice. Of course, we want to provide safe medical care, however, the liability for this decision can be difficult and frustrating. Inmates have admitted to reporting the ingestion, hoping the arresting agency will not take them to jail or will release them from custody because the charges are generally not severe enough to justify the time and expense of a hospital visit. My colleagues and I would like to develop a safe process that can be used to reduce or even eliminate the “get out of jail free card” often employed to avoid incarceration.
Naturally, any drug ingestion can be critical. I have focused on heroin because it is the most reported drug ingestion we have encountered so far. Have you experienced similar reports of drug ingestion to avoid incarceration at your facility? If you have and the individual has been accepted, other than using the Clinical Opiate Withdrawal Scale (COWS), what additional practices, policies, or procedures are used in your facilities to ensure patient safety?