====== Patients in Special Categories ======

===== ACUTE SETTING =====

In the acute setting, there are two special situations:

==== People in custody (usually being held in a police station) ====

  * Avoid admission if at all possible
  * Do not provide or prescribe narcotics
  * Give appropriate symptomatic treatment and give instructions to the police about any possible complications. Formal detoxification will not be possible
  * If the patient is on methadone, tell the police to contact the methadone clinic at the next opportunity

{{:wikitox:forensic_considerations.pdf|Forensic Considerations.pdf}}  [30 KB]


==== Emotionally distressed, brain damaged, or psychiatrically disturbed patients ====

Specialist help should be sought. Contact the Liaison Psychiatry Service and/or the Alcohol and Drug Unit for advice.

===== OUTPATIENT SETTING =====

In the outpatient setting the most common problem is:

==== Patients with chronic pain on prescribed narcotics ====

These patients will almost always have had a pain management/drug use strategy made for them in the past which should be documented. Each case will have to be treated on its merits, but the following strategies are suggested.

  * Contact Drug and Alcohol Unit or Pain Clinic - ask if the patient is known
  * Obtain old notes
  * If the patient has back pain or pancreatitis, and the pain has become sufficiently severe to need opioid narcotics,

they probably need admission.

If there is a policy of allowing the patient narcotics on an outpatient basis, there will always have been a rationing arrangement which will be recorded in the medical record. Therefore, if narcotics are given, this should be recorded and the specialist unit and the patient's GP should be notified at the next opportunity.