IOPC learning recommendation - management of suspected internal drug traffickers - IX/4231/19

Title: IOPC learning recommendation made under paragraph 28A of schedule 3 to the Police Reform Act 2002.
Our reference: IX/4231/19
Author: Prevention and Learning Team, Directorate of Professional Standards

IOPC recommendation

The IOPC recommends that the Metropolitan Police custody policy (Risk Management, section D5) should be amended to include specific reference to the Royal College of Emergency Medicine (RCEM) guidance on the Management of Suspected Internal Drug Traffickers (2020) which advises hospital emergency departments that a person suspected of swallowing drug packages should be observed in hospital for a minimum eight hour period, even if the patient refuses treatment.

This recommendation follows a serious injury incident when a detainee in custody was observed swallowing an unknown item which was suspected to contain drugs. Although taken to hospital, the detainee told medical staff they had not swallowed anything and they were discharged back to police custody after approximately four hours. Approximately six hours after the detainee was believed to have swallowed the item, they became unwell in custody and collapsed requiring medical treatment and a return to hospital.

MPS Response

For the reasons explained below, the MPS will be unable to implement the recommendation due to conflict between the recommendation and guidance. Despite the best intentions, the MPS are placed in an unfortunate position whereby we cannot accept the recommendation for implementation in its current form.

The Healthcare Director for Met Detention has reviewed the Royal College of Emergency Medicine (RCEM) guidance on the Management of Suspected Internal Drug Traffickers (2020) and has raised some concerns about its implementation, and therefore its inclusion in the Risk Management Section of the MPS Custody Policy.

Persons suspected of swallowing drugs are referred to in the RCEM document as packers, stuffers and parachuters and the algorithm on page 12 (Appendix 1) also includes pushers. It differentiates between symptomatic and asymptomatic patients. All symptomatic patients need to be in hospital, and this is implied in the algorithm. The algorithm for asymptomatic stuffers does state the requirement for observation for at least 8 hours post ingestion, and therefore this is in line with the IOPC’s recommendation.

However, the document does not require 8 hours observation in hospital in all circumstances such as for asymptomatic body packers who have either refused a scan, or have had a positive scan and are passing packages. The document states that these patients can be returned to custody, and therefore this would not be in line with the IOPC’s recommendation.

The algorithm only refers to admission to hospital if there is a positive scan and the individual is not passing packages. If the patient refuses treatment, the hospital is unable to detain the patient, and therefore current practice is that the individual would be returned to custody and placed on constant supervision. This would be against the IOPC recommendation of being observed in a hospital setting for a minimum of 8 hours.