An officer cannot diagnose an overdose from behind a cell door, and does not need to. The job is to recognize that something has changed, that a person is deteriorating, that breathing is not right, and to act, because with an overdose every minute counts.
Custody does not have to name the drug. Custody recognizes the emergency. You respond to the medical symptoms in front of you and investigate the behavior later, because you cannot undo death.
You cannot diagnose someone who may be overdosing from behind a cell door, and you do not have to. You do not need to know exactly what drug a person took to recognize that something is seriously wrong. The responsibility is the recognition: that the behavior is abnormal, that the condition is deteriorating, that breathing is not right, that something has changed. Then you act. One of the most dangerous moments in the job is not knowing the condition of someone behind that door and having to open it anyway, into a situation that may be vulnerable or hostile. You still have to act, because if it is an overdose, every second counts.
Overdoses do not always look like the convulsions and collapse that film and television show. That happens, but it is not always where it starts. Sometimes the first sign is someone who seems unusually tired, or is sitting with their head hanging down, or is standing one minute and cannot keep their balance the next. Sometimes another person on the unit is the one who calls out that something is wrong. No two people act the same way under the influence, and the same person may act differently each time. We should never assume that an unresponsive person making a snoring, choking, or gurgling sound is simply asleep. Those are signs of severe trouble.
Corrections professionals spend hours every day around the same population, and that gives us an advantage the outside emergency responder does not have: we know what normal looks like. If someone walks to breakfast every morning and suddenly cannot stand, that is information. If someone normally talks constantly but suddenly cannot stay awake long enough to answer a question, that is information. If someone was in the day room fifteen minutes ago and is now on the floor unresponsive, that is information. A baseline for each person and each unit is what turns a glance into a warning.
Fentanyl and other powerful opioids have changed the overdose environment, and opioid overdose is especially dangerous because opioids can suppress the body's drive to breathe. You may see a person who cannot be awakened, breathing that is extremely slow or shallow, or breathing that becomes irregular with long pauses. You may hear choking, gasping, gurgling, or snoring sounds. The person may go limp; the skin may be pale, gray, or bluish, particularly around the lips and fingernails; the pupils may be pinpoint. The hardest part to remember is that an opioid overdose can look quiet. The person may not be yelling or fighting or making a disturbance. They may simply appear to be asleep.
Because an overdose can look like sleep, proper rounds, observations, and welfare checks are what stand between a routine night and a death in custody. Walking past a cell door and seeing a body on a bunk is not, by itself, a welfare check. You have to observe enough to determine that the person appears to be breathing and functioning normally, in accordance with the facility's procedures. If something does not look right, investigate it. The sources are varied and constantly changing, from substances brought in to ordinary chemicals misused inside a facility, so the signal to watch is not the drug, it is the person.
A real risk in corrections is the habit of attributing everything to behavior: he is just high, he is doing it for attention, he is faking. Even if you believe someone may be exaggerating, you respond to the medical symptoms in front of you. You can investigate the behavior later. You cannot undo death. Experienced staff have all seen people manipulate a situation, but experience should make us more observant, not more dismissive. Doing the same checks every day for five years does not mean today is not the day something goes wrong.
A simple way to hold it together on rounds is live, breathing bodies. Are they awake and able to respond: can you wake them, give clear directions, and get a meaningful response, not just a twitch or a hand moving? Is the breathing normal, or is it slow, shallow, irregular, with long pauses or gurgling and snoring sounds? Can they follow instructions, answer a simple question, stand normally? And the last question that matters most: what has changed in this person since the last time I saw them, fifteen or thirty minutes ago? Did someone report suspicious activity, were suspected drugs found in the area, did the person become lethargic after returning from recreation, visitation, court, or intake? Those patterns are the difference between documenting an overdose and documenting a death.
The safest operation is the one where custody, medical, supervision, and technology work from the same information. Safety Intelligence extends observation into the hours between rounds, shortening the time between a person's condition changing and a staff member becoming aware of it. Ask how a Safety Intelligence Audit applies at your facility.
Related: Withdrawal and detox, medical response, human in the loop, the methodology.
