New psychoactive substances in prisons: high and getting higher.

On May 25, 2016, the UK Government introduced a nationwide automatic ban on substances referred to as legal highs or new psychoactive substances (NPS), which includes a wide range of already well-known substances (such as synthetic cannabis or “spice” and nitrous oxide, also known as laughing gas). The new laws—that criminalise the production, distribution, sale, and supply of NPS—automatically ban “in advance” any NPS. The UK government decided that, because it is impractical to introduce separate bans for every new psychoactive drug that enters the markets (with thousands of potential bans), the new law eff ectively bans everything that can be called a psychoactive substance. The prison population is especially vulnerable to the impact of these substances, just as it is to any other health-related epidemic, in particular those that require substantial additional resources to mount any kind of eff ective response. NPS fall exactly into this category— additional searches are needed to prevent NPS entering the prison system, and when a prisoner or group of prisoners becomes intoxicated, as is being reported more commonly, the risk of violence towards themselves, to other prisoners, prison staff , and even visiting family and friends can increase. The UK’s Prisons and Probation Ombudmsan Nigel Newcomen, who oversees the country’s penal system, says 39 deaths have been identifi ed in prisons between June, 2013, and June, 2015, in which the prisoner was known, or strongly suspected, to have been using NPS before their death. The links to the deaths were not necessarily causal, but nor can they be discounted. Of these deaths: two have no offi cial cause of death; two were the result of drug toxicity, and the drugs included NPS; six were the result of natural causes in which NPS might have played a part. In one case, for example, the prisoner died of a heart attack after taking NPS that might have triggered the attack. One death was a murder of a prisoner by another prisoner who was suspected of smoking NPS. The remaining 28 deaths were selfinfl icted. Some involved psychotic episodes potentially resulting from NPS, and for others, NPS seemed to have exacerbated vulnerability. Still, the acute eff ects of NPS are only one part of the story. The use of NPS can lead to a variety of mental health problems, including depression and self-harm. And these are only the medical problems; the knock-on non-medical eff ects of NPS use can be just as devastating, such as violence related to supply and demand of NPS, and prisoners (whether addicted or occasional users) building up huge debts to pay for these substances that they cannot repay. A report by the UK charity the Rehabilitation for Addicted Off enders Trust (RAPt) showed a seven times increase in the number of prisoners seeking help for NPS use in just 1 year, from 2014 to 2015. RAPt, which helps people with drug and alcohol dependence both in and out of prison, say the problem is spiralling out of control. “The impact of new psychoactive substances, such as spice, in prisons continues to be deeply concerning,” says Mike Trace, CEO of RAPt. “The serious health problems that can result from smoking spice can be horrifi c and life changing, and there is preliminary evidence showing that people are becoming addicted to these new substances. And that’s not to mention the widespread violence caused by the lucrative market in prisons, and debts built up by users”. The UK’s National Off ender Management Service (NOMS), an Executive Agency which is funded by the country’s Ministry of Justice, has started taking action to deal with NPS, including the training of more than 100 specialist dogs to detect some of these substances, an internal prison radio campaign containing fi rst-hand prisoner accounts to warn prisoners of the dangers and sanctions they face if using NPS, and extra training for prison governors and all their staff . The NOMS supports the new blanket ban of NPS legislation, claiming that it will make it easier, for example, for staff searching visitors to confi scate items. A Ministry of Justice spokesman told The Lancet Psychiatry: “We are working closely with health partners to tackle the harm of new psychoactive substances and other substance misuse, and to provide staff with the tools and information they need and ensure that all prisoners and visitors are aware of the very serious risks that substance misuse brings. This has included revisions to Prison Offi cer Entry Level training and working with Public Health England to develop a toolkit for clinical and operational staff and training to support it.” However, RAPt have called for a dedicated drug recovery wing in every prison, where prisoners are committed to a drug-free environment, achieved through a combination of security, testing, and incentives alongside intensive programmes that work with prisoners with the aim of stopping drug use completely and remaining drug free. The charity says that only 30 of the UK’s 125 prisons have a drug recovery wing, and even in those the level of commitment and resources varies across institutions. “This is a fast changing new challenge and the prison service and drug treatment services are committed to working together to tackle it quickly and eff ectively,” says Trace. “Increased security and testing are important, For more on the Prison and Probation Service Obmudsman’s views on NPS see http://www.ppo.gov.uk/ ombudsman-speaks-at-reformroundtable-on-newpsychoactive-substances/