Substance misuse in a high security hospital: Three years of urine drug testing at the State Hospital, Carstairs

Abstract

With the increasing evidence for the significant contribution to violence made by alcohol and drug misuse in people with mental disorder, there is emerging evidence of the importance and increasing prevalence of substance misuse problems in patients admitted to high security hospitals in the UK. Recorded routine voluntary urine drug screening of patients at the State Hospital, the high security hospital for Scotland and Northern Ireland, started in 1998. Results of urinalysis over the 3 years from 1 January 1999 to 31 December 2001 were examined. Out of 7,069 samples sent from 421 patients there were 712 (10.1%) positive results. The majority were false positives (672; 9.5%) due to prescribed medication, with only 40 (0.6%) true positives. All the true positive results in the admission unit were related to substance misuse prior to admission, the remaining true positive results were all within the continuing care wards, with no true positives in the rehabilitation wards. Even though the testing was not truly random, it is likely that the findings reflect extremely low levels of substance misuse within the hospital in contrast with findings from UK prisons. Whether urine testing contributes to the prevention of drug misuse within the hospital is unclear, and there are potential ethical and legal concerns about the urine testing process. It is important that high security hospitals are virtually drug free, to enable the uncontaminated assessment and treatment of mentally disordered offenders.

Attempting to Understand the Increase in the Numbers of Forensic Beds in Europe: A Multi-site Study of Patients in Forensic and General Psychiatric Services

“…Consider first the possibility of an increase in frequency of illness. In the four sites that were included in the present study and in many others (Brinded, 2000;Macintyre, McNamara, Irwin, Gray, & Darjee, 2004;Melzer et al, 2004;Mullen et al, 2000;Munk-Jorgenson, 1999;Nilsson & Persson, 1997;Schanda, Ortwein-Swoboda, Knecht, & Gruber, 2000;Taborda, Cardoso, & Morono, 2000;Taylor et al, 1998) most forensic beds are filled by men with schizophrenia or schizoaffective disorder. While a recent systematic review found no evidence of an increase in the incidence of schizophrenia, the most striking finding was the wide variation in incident rates across studies (McGrath et al, 2004).…”

An exploratory study investigating the impact of the procedures used to manage patient substance misuse on nurse–patient relationships in a medium secure forensic unit

“…It was concerning that some staff appeared to be operating outside the hospital policy and conducting UDS under direct supervision. The ethical and legal position regarding mandatory UDS is not clear (MacIntyre et al . 2004), and it may be that these staff would not be supported legally should complaints occur.…”

“…2006), ease of adulteration (Kintz et al . 2006) and lack of accuracy (Kintz 1996, Macintyre et al . 2004, Levy et al .…”

“…2008) have been identified as methodological limitations of UDS. Furthermore, the effectiveness of mandatory UDS in preventing drug use in prisons has been questioned (Gore & Bird 1998) and remains unclear in forensic units (MacIntyre et al . 2004).…”

“…Two studies in high security hospitals found that cooperation between patients and staff in relation to UDS was good (Kendrick et al . 2002, MacIntyre et al . 2004).…”