TRAGEDY BEHIND BARS

Is Drug Abuse, Not Brutality, Behind Some Deaths In Custody?

MANY deaths in custody that are blamed on the police using excessive force
in restraining "difficult" prisoners may in fact be the result of the
prisoners' cocaine abuse. This provocative suggestion, from a leading
forensic toxicologist, is sure to inflame controversy over one of the most
contentious issues in policing.

Steven Karch, assistant medical examiner of the City and County of San
Francisco, is convinced that many people who die in custody are suffering
from excited delirium (ED). This condition can be caused by the long-term
use of stimulants such as cocaine. Sufferers experience a dangerous rise in
body temperature, act strangely, appear terrified, yet can show surprising
strength. Unless treated quickly, usually by packing them in ice to reduce
their body temperature, patients often die from cardiac arrest.

Many deaths from ED in custody are recognised as such. Last year, Canadian
researchers found that 18 out of 21 people recorded as dying from ED in
Ontario between 1988 and 1995 were under arrest. But at a meeting of the
Royal Society of Medicine in London this week, Karch claimed that the
documented cases are just the tip of the iceberg. He has devised a
neurochemical test for ED that he argues should be done during autopsies
whenever people die under restraint after arrest.

Together with Deborah Mash, a neurologist and pharmacologist at the
University of Miami School of Medicine, and Charles Wetli, medical examiner
of Suffolk County, New York, Karch has compared brain tissue taken at
autopsy from cocaine abusers who died of ED with tissue from people killed
by cocaine overdoses. They found that the ED patients had a defect in the
brain protein that mops up the neurotransmitter dopamine, which surges each
time a dose of cocaine is taken.

In the overdose victims, this protein had altered to become more efficient
at mopping up dopamine -- presumably an adaptive response to persistent use
of the drug. But no such changes were seen in the ED patients, suggesting
that their brains can't adapt to remove excess dopamine. At this week's
meeting, Karch also revealed that ED patients show changes in opioid
receptors in the amygdala -- a brain region associated with fear.

Taken together, these changes in brain chemistry represent a "signature" of
ED, says Karch. But this can only be detected if samples of brain tissue are
removed and frozen within 12 hours of death. The problem is that autopsies
are frequently delayed for more than I day, and even then, brain tissue is
not routinely analysed.

Karch has waded deeper into controversy by contending that police often
can't be blamed for deaths from ED in custody. "These individuals are very
sick and even with optimal medical care they don't stand much chance," he
claims. Karch also argues that a recent rise in the number of deaths in
British police cells (see Figure) could be linked to an upsurge in cocaine
use in Britain.

These conclusions are rejected by many campaigners on the issue of deaths in
Custody. "Over the years, excited delirium has been a kind of smoke screen
for restraint-type deaths," argues Deborah Coles of Inquest, a London-based
group.

Whether or not Karch is correct in identifying ED as an underdiagnosed
problem, other experts believe the emphasis should be on changing police
practices to avoid forms of restraint that make it more likely that ED
patients will die. "The focus needs to be placed on the modes of constraint
used, getting police to use alternatives to physical restraints and, when
physical restraints are essential, to use the least dangerous approaches,"
says David McDonald of the Australian National University in Canberra.