title: Think drink, think drugs, think overdoses.
abstract: The police are frequently called upon to deal with people whose behaviour is disturbing the peace of other citizens. A large proportion of such people will have consumed alcohol, some will have consumed drugs and others will be suffering from mental illness. The role of the FME is to determine whether medical or psychiatric intervention is necessary for that individual. Because of the difficulty in assessing a person's mental state when they are believed to be under the influence of substances, it is commonplace for the person to be reassessed some hours after the initial assessment to enable the effect of any consumed substances to abate. However, if the toxic effects of consumed medication are not appreciated, such a delay in receiving medical care may have serious consequences. We report this case as a reminder to all forensic physicians of the clinical effects and possible grave complications associated with amitriptyline overdose. Doctors who work in custodial medicine should be alert to the possibility of an overdose of a drug with anti-muscarinic effects when confronted with a detained person who is acutely confused with clinical features suggestive of stimulant use.
authors.affiliation: The Forensic Medicine Unit, St Georges Hospital Medical School, London, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Rogers
authors.forename: M M
authors.initials: MM
authors.lastname: Stark