Withdrawal is a medical process, not a person simply being uncomfortable, and it can become a medical emergency quickly. Custody's job is not to diagnose it. It is to observe continuously, recognize the moment someone crosses from sick to dangerous, and get that information to medical in time.
Custody does not diagnose withdrawal. But the officer is often the first person to see someone cross from sick to dangerous, which makes continuous observation the difference between a routine detox and a death in custody.
Withdrawal is not simply someone uncomfortable because they lost access to drugs or alcohol. It is a medical process that depends on the substance, the person, and their history, and it can become an emergency fast. It is not custody's role to diagnose it or decide medication; that belongs to medical. But custody observes, recognizes, communicates, and responds, and the officer is often the first to see someone cross from sick to dangerous.
Federal guidance stresses screening, medical assessment, and regular observation by both healthcare and custody, and it recognizes that symptoms may not be obvious at admission and commonly emerge in the first 72 hours. Someone can look fine at intake and different six, twelve, or twenty-four hours later. Intake is the start of the observation period, not a box that gets checked.
People are not always forthcoming: embarrassment, fear of consequences, not knowing what they took, mixed substances, or not realizing a prescription can cause withdrawal. So a negative answer at intake cannot end our awareness. Federal guidance advises staying alert for emerging symptoms through the first 72 hours even when someone initially screens negative.
Alcohol withdrawal is the one that concerns me most. Someone can enter looking normal, then show anxiety, sweating, shaking, nausea, elevated heart rate and blood pressure, and agitation. Symptoms commonly begin within 6 to 24 hours of the last drink. Seizures can occur as early as 8 hours and remain a risk through the first 48. Severe delirium can develop around 72 to 96 hours. The person who looked fine yesterday is not automatically fine today.
People think of illegal drugs when they hear detox, but a person can be physically dependent on a legally prescribed medication, including benzodiazepines. Medication verification matters. If someone says they take a medication regularly, that information reaches medical. Severe alcohol or sedative withdrawal can progress to seizures, confusion, hallucinations, and delirium, which is no longer discomfort but a medical emergency.
Opioid withdrawal looks different: sweating, runny nose, watering eyes, restlessness, aches, cramping, nausea, vomiting, diarrhea. With short-acting opioids symptoms can peak roughly 36 to 72 hours in. Stimulant withdrawal looks different again, and we cannot assume only one substance was used. That is why staff should resist the urge to diagnose. Our job is not to decide this is opioid withdrawal. It is this person's condition has changed, and medical needs to evaluate them.
A person in withdrawal may be restless, irritable, confused, or press the call button repeatedly. It is easy to read as a behavior problem; it can be deterioration. Withdrawal is dynamic: the first 24 hours matter, the second 24 matter, the third 24 matter. Our job is not to be doctors but to be exceptional observers, know what changed, communicate it, use supervisors, medical, and technology, and when someone crosses from sick to dangerous, respond immediately.
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. Ask how a Safety Intelligence Audit applies at your facility.
Related: Medical response, suicide prevention, human in the loop, the methodology.
