ADDICTED INMATES

IntraVenous-Drug Abusers (IVDAs) are susceptible to misdiagnosis of serious infections. Infective endocarditis and septicemia are life- and health-threatening risks of injectable drug abuse. Sharing contaminated needles is well-recognised as a source of serious chronic infections such as HIV and hepatitis B. Even in their absence, damage to the immune system results from the debility that often accompanies repeated narcotic and other recreational drug use ¹.

Major sepsis is one of many serious health hazards from drug-taking lifestyle, to the degree that IVDAs account for the majority of infective endocarditis ² involving previously healthy heart-valves ³. The annual risk of such life-threatening and destructive infection is 2-5% for intravenous street drug users ⁴.

Apart from damaging heart valves, serious infection may involve joints, bones, lungs and other internal organs, and require open-heart surgery and limb amputations, or cause death.

At penal institution admission examination of known or suspected IVDAs, nurses should routinely record presence or absence of soft-tissue sepsis in the commonly affected areas ⁵ - in order of frequency: wrist, forearm, elbow, fingers, thigh and groin.

Symptoms of sepsis may be confused with those of narcotic-withdrawal. Newly detained opiate-users may suffer from symptoms and signs of withdrawal ⁶ - agitation, drug craving, high blood-pressure and runny nose, and other symptoms that may also occur in serious generalised infection.

Guards, nurses and physicians alike may misattribute the complaints and disregard developing serious sepsis for hours, or even a day or two.

The hiding, denial, disguising and minimising that are characteristic of drug abuse may compound the problem ⁷, as may simulating withdrawal symptoms to obtain drugs for other inmates.

Even among relatively well-looking IVDAs, it is not rare for bacteria to be present in the blood, and serious illness to be occurring ⁸. Further, street-drug users are more liable to obtain non-prescription supplies of antibiotics ⁹ that they fail to disclose and that they take in a dosage sufficient to obscure pathological investigation results but insufficient to cure the infection.

Physicians in both the emergency room and penal institutions are often predisposed to give substandard care to patients with substance-abuse disorders. Despite some progress, traditional medical training continues to give scant attention to assessment and treatment of substance abuse. It is common for both emergency-room physicians and prison doctors to be influenced by negative attitudes towards drug abusers ⁷, sometimes with little awareness that those prejudices result in substandard care.

For many reasons, then, clinicians generally are not very adept at determining which IVDA patients have serious underlying illness ⁸, and this is particularly true with the heavy caseloads of emergency-room and prison practice.

Bored prisoners with access to payphones include medical malpractice lawyers in their target audience. Complaints about the adverse effects of institutional medical care are relatively common, and some inmates have a viable cause of action, at least for major nonpecuniary damages.

Copyright © 2009 Electronic Handbook of Legal Medicine