Publication Health and Care Justice 10 May, 2016

New psychoactive substances

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Reform held a roundtable on 'New psychoactive substances: a case for integration between health and criminal justice services' on 9 May 2016. Nigel Newcomen CBE, Prisons and Probation Ombudsman, was one of the lead speakers. Below is an edited version of his opening remarks on the subject.

My role is to investigate all deaths in prison custody in England and Wales to establish the facts, help the bereaved family understand what happened, support the inquest system and identify learning.

I also join up the dots from individual investigations to produce learning lessons publications. In July 2015 I published a bulletin on the emerging threat to safety in custody from new psychoactive substances (NPS). Today, I’d like to give an update.

NPS are a wide array of relatively new and regularly changing substances, for which testing is in its infancy.  And, of course, many NPS are readily available in the community and most are cheap. These features compound the difficulty of reducing supply and demand for NPS in prisons. They also make it difficult to draw firm conclusions about health impact and links to fatalities.

The July 2015 bulletin focused on synthetic cannabinoids (Spice or Black Mamba). It was cautious about drawing conclusions, but adds to the increasing evidence that NPS pose dangers to both physical and mental health, including links to suicide or self-harm. Staff and other prisoners may also be at risk from users reacting violently to the effects of NPS.

Fast forward to May 2016 and we have now identified 39 deaths in prison between June 2013 and June 2015 where 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 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 may have played a part. In one case, for example, the prisoner died of a heart attack after taking NPS and our clinical reviewer considered that NPS may have been the trigger for the attack. One death was a homicide of a prisoner involved with NPS by another prisoner suspected of smoking NPS. The remaining 28 deaths were self-inflicted. Some involved psychotic episodes potentially resulting from NPS, for others NPS appeared to exacerbate vulnerability.

So what is to be done? Our work on NPS has added to the increased concern that these substances pose serious risks in prison. We have highlighted five areas of learning. ·

First, supply needs to be reduced. Trafficking in NPS needs to be tackled by effective local drug supply and violence reduction strategies.

Second, staff awareness needs to be increased. Prison staff need better information about NPS, and how to spot that a prisoner is taking them.

Third, governors need to address the bullying and debt associated with NPS robustly.

Fourth, drug treatment services need to address NPS use and offer appropriate monitoring and treatment.

Fifth, demand for NPS among prisoners needs to be reduced, with prisons and healthcare providers ensuring that there are engaging education programmes for prisoners that outline the risks of using NPS.

Commendably, prison and health care services have begun to act on this learning. But there is a long, long way to go. Meanwhile, as one prisoner put it to me: “spice is a bird-killer, but we need to tell people it’s also a prisoner killer”.

Nigel Newcomen CBE, Prisons and Probation Ombudsman