Tackling drug use in prisons is important for addressing a range of criminal justice and health outcomes, including improving prisoner health, reducing drug-related offending and reoffending. It also serves to protect communities; lowering public health risks from blood borne viruses and overdose when prisoners are released.
Compared to the general population, individuals entering the prison system are disproportionately affected by a wide range of health and social inequalities including drug, alcohol and mental health problems. Prison based substance misuse treatment services play a critical role in supporting prisoners to overcome their drug and alcohol problems in addition to addressing their wider health issues
These services, along with prison healthcare, are now dealing with a significant increase in the use of new psychoactive substances (NPS), or ‘legal highs’.
NPS are a new breed of synthetically produced substances designed to mimic the effects of traditional illegal drugs. They are not safe or approved for human use, and the user cannot be sure of the contents of a specific batch which can make them incredibly dangerous.
Project NEPTUNE, developed in 2015 to ensure effective clinical management of NPS-related harms, divides these drugs into four categories: synthetic cannabinoids, depressants, stimulants and hallucinogens.
Increasing NPS use in prisons
The report “Changing patterns of substance misuse in adult prisons and service responses”, published by HM Inspectorate of Prisons in December 2015, highlights that two-thirds of prisons reported having a “significant issue” with NPS in 2014-15 compared to one-third in 2013-14. This reflects the wider increase in their availability and use in the general population. In Europe, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) identified 41 new substances in 2010 and 101 in 2014.
This trend presents prison and healthcare staff with a set of new and difficult challenges, as NPS use is resulting in significant levels of violence and health problems.
The majority of NPS circulating in prisons are synthetic cannabinoids, with the most widely recognised being Spice and Black Mamba. Prison seizures of Spice increased from 15 in 2010 to 430 in 2014.
The increase in NPS use has a significant impact on the day-to-day workload of healthcare staff in prisons as a result of dealing with unwanted reactions from drug use, especially from the use of Spice. Some of the extreme adverse effects of synthetic cannabinoids such as convulsions, temporary paralysis, rapid heart rate, aggression and psychosis require an immediate response and may require transfer to hospital. These effects can be long lasting, and custody and healthcare staff may have to manage the consequences for months following the initial presentation.
NPS and the law
Many incorrectly believe that new psychoactive substances are currently legal, due to them unhelpfully being referred to as ‘legal highs’. Many of these substances are in fact illegal, and there have been other significant changes to legislation on NPS in the past year.
In January 2015, new guidance from the Ministry of Justice clearly set out measures available to prison staff to deal with NPS. These include a range of penalties for prisoners as well as specialist dog teams trained to detect synthetic drugs and a Public Health Monitoring project to analyse up to 10,000 urine samples for the presence of synthetic drugs.
The Psychoactive Substances Bill, which is currently progressing through parliament, will make it an offence to produce, supply, possess with the intent to supply, import or export psychoactive substances and provide the police and local authorities with powers to respond to the supply of NPS, including stop and search and prohibition notices.
The challenge for healthcare staff
As with all illicit drug use in prison, the covert nature of NPS use, the unpredictable effects of the drugs and the delay in seeking medical help all combine to have a significant impact on healthcare staff.
A new toolkit from PHE aims to support both custodial and healthcare staff by providing information about the extent of NPS use and the properties of the various categories of NPS, as well as advice on managing the problem. The key recommendations include:
- Establish accurate data on the prevalence, use and effects of NPS to help determine successful management of the problems associated with these drugs.
- Form an integrated response by custodial and health and psychosocial care staff, underpinned by a campaign directed at prisoners and visitors describing the consequences and sanctions for possession and use of NPS.
- Address presenting behaviour or symptoms appropriately, irrespective of whether prisoners are suspected to be under the influence of NPS or not. Where there are questions about prisoners’ mental capacity when under the influence of NPS, staff should apply the principles set out in the NHS Choices consent to treatment guidance.
- There are no specific pharmacological treatments for the adverse effects of NPS and care should be directed at symptoms, supported by advice from the National Poisons Information Service and its online toxicology database.
- Longer term treatment should involve appropriate clinical and psychosocial support as described in the Project NEPTUNE guidance document
- As well as developing this toolkit, PHE is currently undertaking a training programme in prisons in the North West, and plans are in place to roll out this training nationally between January and April 2016. This programme provides prison staff with the knowledge and tools to effectively react to issues of NPS use within the prison population.
A significant and developing market for NPS is a serious public health concern, not just for prisoners who use NPS but for the wider community. As the government works to combat both the supply and demand for NPS across the prison network and wider society, we must make sure we have the right information and tools to treat the effects of NPS use, and support those who suffer long-term effects, whether from addiction, or wider health issues such as infection.
All prisoners are able to undergo detox and achieve abstinence. The decision to do so would be made in consultation with a clinician and considers a range of factors including; any treatment they underwent within the community, any history of mental health problems and whether they are in custody for a limited time only.
PHE continues to work with and support the NHS, health workers and local authorities to tackle this relatively new phenomenon – one that is likely to change and evolve at rapid pace.
Image: CDC