spiceThe rampant use of designer drugs in prisons is placing local ambulance services under strain as paramedics are increasingly called out to tend to criminals who have used the substances, a watchdog has warned.

In one incident involving so-called “legal highs” all of the available crews in a community had to be deployed to a jail at the same time, a report by HM Inspectorate of Prison (HMIP) found.

A large number of adult male facilities have reported incidents when emergency medical assistance had been required for prisoners who had used synthetic cannabis drugs such as “mamba” and “spice”.

Incidents are so common that inmates in a number of establishments have adopted the nickname “mambulances”.

Paramedics were called to attend to prisoners having fits, blackouts and other adverse symptoms. In some instances multiple ambulances were dispatched when several prisoners needed treatment at the same time.

The HMIP report said: “This not only put individual prisoners at risk, but also placed excessive demand on resources that were required for the local community too.

“Some prisons have required so many ambulance attendances that community resources were depleted.”

An episode at HMP Wealstun in Yorkshire was singled out.

Chief Inspector Nick Hardwick said: “They were having so many health emergencies caused by the use of NPSs (new psychoactive substances) that basically all of the available ambulances in the community on one occasion were at the prison dealing with prisoners in health crisis.

“So actually there wasn’t the resilience, if there had been something happening in the community they weren’t there to deal with that because they were in the prison.

“It is a big issue.”

A dramatic flood of NPSs into prisons has been linked to rising levels of violence and 19 deaths behind bars.

Mark Leech editor of The Prisons Handbook for England and Wales and award-winning national monthly prisons newspaper Converse said:

“New psychoactive substances now represent the greatest danger to safety and stability in our prisons, they are responsible for hospital admissions, debt, violence, segregation, self harm, and at least 19 deaths.

“The problem is that budget cuts have depleted our prison staff numbers to absolute critical levels, coupled to the fact that formal mandatory drug testing do not generally reveal their use, and the psychotic effects of these drugs on prisoners who take them – and who already suffer from mental health issues – are absolutely devastating.

“This timely report makes clear that inspectors actually witnessed prisoners who were clearly under the influence of these psychotic drugs walking the landings of our prisons, prisons which are volatile and dangerous places at the best of times, and these drugs massively exacerbate an already critical problem

“The solution is that the 2016 massive budget cuts to the prison service budget must now be scrapped and reversed.”


New psychoactive substances such as ‘Spice’ and ‘Mamba’ are now the most serious threat to the safety and security of jails, said Nick Hardwick, Chief Inspector of Prisons. Today he published a major study on the changing patterns of substance misuse in adult prisons.

The report examines the changing extent and patterns of drug misuse in adult prisons and assessed the effectiveness of the response to it. It draws on evidence of 61 adult prison inspections published between April 2014 and August 2015, the 10,702 survey responses from individual prisoners that were collected as part of those inspections, and detailed field work conducted in eight prisons between June and November 2014. As this report was being prepared, there was an acceleration in the use and availability of new psychoactive substances (NPS).

Changing patterns of drug use in the community provide a useful context for understanding drug misuse in prisons. Drug use appears to be reducing and the 2014-15 Crime Survey for England and Wales found that 8-9% of adults reported illicit drug use over the pervious year, down from 12% in 2003-04. Cannabis remains the most widely used drug.

However, there are important differences between drug misuse in prisons and the community:

  • a declining number of prisoners needing treatment for opiate misuse reflects trends in the community, although many of those requiring opiate treatment in prison have complex dependence, social, physical and mental health issues;
  • prisoners are more likely to use depressants than stimulants to counter the boredom and stress of prison life;
  • the use of synthetic cannabis and diverted medication reflects a response to comparative weaknesses in security measures; and
  • often the price of drugs is higher and the quality poorer in prison, reflecting greater difficulty of supply.

At present, some synthetic cannabis is legal to possess in the community but all forms are banned in prison. It is cheap to buy or manufacture in large quantities in the community. The difference between the price in the community and that in prison is much greater than for drugs such as opiates or cannabis, which are illegal in both settings. Despite the high mark-up, it is still relatively cheap in prisons. Current testing methods cannot detect synthetic cannabis and its composition may change from batch to batch. New tests are being developed and drug dogs are being trained to identify it, but neither of these measures are yet available in most prisons. This means that the risks involved in supply are low and large profits can be made by supplying it in bulk. Low risks, high profits and large-scale supply mean that distribution to and within prisons may be linked to organised crime.

The report describes the consequences of drug misuse in prisons:

  • the health consequences of synthetic cannabis use have been particularly severe because of its inconsistent composition and unknown effects;
  • some prisons have required so many ambulance attendances that community resources were depleted;
  • inspectors heard credible accounts of prisoners being used as so-called ‘spice pigs’ to test new batches of drugs;
  • debts are sometimes enforced on prisoners’ friends or cell mates in prison, or their friends and families outside; and
  • drug misuse damages rehabilitation.

Individual prisons need a whole-prison response to drug misuse based on a thorough needs analysis. A whole-prison approach will include measures to reduce supply and measures to reduce demand through effective treatment, psychosocial support and education. The National Offender Management Service (NOMS) has made considerable efforts to reduce the supply of and demand for drugs in prisons. New legislation is being introduced, detection of NPS is being improved by the introduction of new tests and the training of drug dogs, and a wide range of good education and information material has been produced. Despite these efforts, the Prison Service and other relevant bodies have found it difficult to keep pace with and respond to the unprecedented and rapid growth of NPS use in adult male prisons.

Nick Hardwick said:

“No-one should be in any doubt about the harm that drug misuse does in prisons. It damages prisoners’ health and sometimes causes deaths. Debt associated with synthetic cannabis use sometimes leads to violence and prisoners seeking refuge in the segregation unit or refusing to leave their cells. Profits from drug supply may be used to fund organised criminal activity in the community.

“The emergence of NPS as the main drug of choice in adult male prisons is just the most recent change in a long history of drug misuse in prisons. As responses to this new challenge become more effective, new substances or types of use will emerge to replace it. Drug misuse, of whatever type, does serious harm in prisons and in the wider community. Lessons should be learnt from the emergence of NPS at a national and local level to ensure that a dynamic, responsive and well-coordinated strategy is in place, both to reduce the harm of current use and respond effectively to future needs.”

A copy of the full report can be found on the HM Inspectorate of Prisons website at: justiceinspectorates.gov.uk/hmiprisons