Medico-legal management of drug abusers and significance of introducing an effective multidisciplinary team

Introduction

When drug misusers are produced before forensic practitioners, the police expects opinions on intoxication, fitness for an interview, drug searches, referral for rehabilitation etc.In Sri Lanka, according to “Drug-dependent persons (Treatment and Rehabilitation) Act, No. 54 of 2007”, the forensic practitioners are expected to give their opinions with scientific reasoning. Therefore, when giving opinions on drug abusers, forensic practitioners face many practical problems.

 

Objectives

To evaluate the outcomes of medico-legal examinations of drug abusers presented to the Office of the Judicial Medical Officer, Provincial General Hospital, Ratnapura in 2017 and to develop an effective multi-disciplinary program to manage the same in Sri Lanka. 

 

Background history

The objectives of the police were to obtain opinions on intoxication, addiction and refer to rehabilitation centres etc. Twenty-three drug misusers were produced for medico-legal examinations. Two denied drug misuse. In 19, the average time interval between arrest and producing was three days. In seven, there were no stigmata of abuse other than tattoos. One cannabis misuser had a psychiatric illness. Following examination and psychiatrist referral, the remaining 22 did not have evidence of acute intoxication or features of withdrawal syndrome. None of them was found to be drug-dependent and the referral for rehabilitation was not indicated.

 

Conclusions

Similar to the cases of child abuse, it is necessary to develop a multi-disciplinary follow-up system. A ‘pre-arrest referral scheme’ for drug misusers in the community and ‘post-arrest referral scheme’ when in custody. This can be further strengthened by adding a scientific test. Then the forensic practitioners will be in a better position to give opinions on drug dependency.