High Stakes

2. The Rise of NPS

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“Spice is the perfect prison drug; you take a puff and eight hours later you wake up.”1

Since 2012 we have seen a meteoric rise in the supply and use of a group of novel psychoactive substances (NPS) called synthetic cannabinoid receptor agonists (SCRAs), more commonly referred to as spice. NPS are, in many ways, just new drugs within a long history of drug use in prison, but they also pose unique challenges in the context of our currently understaffed and unsafe prisons. NPS have been labelled a cause of violence by some, and a symptom of cuts and overcrowding by others. HM Inspectorate of Prisons calls NPS “the most serious threat to the safety and security of the prison system.”2

Over the last 10 years organic chemists have greatly accelerated the rate at which psychoactive substances are discovered

What are NPS?

“Conventional supply-reduction strategies used by governments around the world to stem the production, use and trade of illicit drugs, have led drug users to seek alternative, legal supplies of psychoactive substances. Governments are facing progressively more complex challenges in responding to these new drug-markets.”3

Over the last 10 years organic chemists have greatly accelerated the rate at which psychoactive substances are discovered. Business people have exploited the high-demand for popular illicit psychoactive substances by bringing these novel drugs into new markets, to meet demand with a legal supply of drugs with similar effects. The most popular illicit drug in the world is cannabis. Therefore, a great deal of the innovation has focused on drugs, which react with the same systems in the brain.

We now know of over 200 different SCRAs available on the international market, making them the largest group of NPS.4 SCRAs are a large and chemically diverse group of molecules with some functional similarity to natural cannabis. They are frequently sprayed onto dried plant material and smoked to imitate herbal cannabis. These drugs have risen to become by far the most popular drugs in English prisons.

SCRAs are often vaguely referred to as NPS or by a trade name such as spice, but what particular brands contain varies widely, and brand names are not reliable indicators of content. Constituents and dosages vary greatly, both between products and between different batches of the same brand. Much of this is driven by reactive prohibition of individual substances, leading producers to new, less well understood substances. Wide ranging differences in strands include metabolism, potency, toxicity and duration of effects.5

Why the shift to NPS?

“It is an ideal prison drug because it can’t be detected, doesn’t smell and passes the time. Downside – it makes you very lazy. I couldn’t smoke it outside coz I would get nothing done.”6

In prison, where efforts to reduce the supply of traditional drugs are most keenly felt, and where demand for drugs is extremely high, NPS were always likely to establish themselves in the market. NPS have in general been most popular with vulnerable groups such as young people, the homeless and prisoners due to cost, availability and intensity of effect. Nicknamed ‘the bird killer’, SCRAs are a very good product to meet the particular type of demand in custodial institutions, the demand to make long, boring and often painful prison sentences pass quicker.

“NPS have radically changed the prison environment since 2012. I was in prison at the time they started coming in. I saw the very first consignments arriving on the wing. It has now reached epidemic proportions.”7

According to a recent survey by User Voice, 33% of prisoners self-identified as having used spice within the last month.8 In many prisons the figure is likely to be much higher than this. Obtaining accurate data on the issue is difficult due to the clandestine nature of prohibited drug use in prisons. It is now so commonplace that many prison staff report having become desensitised to shocking incidents, including violent convulsions and seizures.

Rather than guiding drug users to less harmful drugs, drug policies within prisons are instead driving drug use in the opposite direction. Where once the smell of cannabis was part and parcel of men’s local prisons, that smell has now been replaced by a far subtler beast; odourless, synthetic chemicals.

When these drugs arrived on the market, there were no tests to detect whether people had used them, whereas natural cannabis stays in people’s systems for up to a month and could lead to extra days in prison or other punishments if caught. NPS are also easier to get past prison security apparatus due to their small size, and difficulties in detecting many of their substances. Legally-produced, high-potency SCRAs can be produced in bulk (predominantly in China and India) for very low cost and the mark-up is significant. It is these high margins, coupled with a low risk of capture for suppliers that has fuelled the growth of the market.

States in the USA have experienced a similar rises in the use of SCRAs among their prison populations, whereas other countries have largely avoided the trend. In Norway, NPS are used to a certain extent among wider society, but there is no evidence of any widespread use in prisons. There are two main proposed explanations for this: The markedly different nature of drug demand due to busier prison routines, and the lack of a commercial drug market owing to their drug-demand strategy and dynamic security approach.

Whilst some of the effects of these drugs are similar to cannabis, others are not

Harms of NPS

“The key concerns for NPS are the unknown risk-profiles of these products, the availability of these substances without controls, the lack of guidance on how to use them more safely, and the difficulties faced by medical practitioners in being unable to identify the substance taken and the best options for treatment in emergencies.”9

SCRAs are often inaccurately described as synthetic cannabis. Whilst some of the effects of these drugs are similar to cannabis, others are not, including the high levels of toxicity of many of these substances. In general, as compared to cannabis, “SCRAs are characterised by quicker onset of effects, significantly shorter duration of action, worse hangover effects and more intense visual hallucinations, paranoid feelings and behavioural disturbances.”10 Products containing SCRAs can range from those with a similar potency to cannabis, to those with potency up to 100-800 times stronger than typical cannabis.11

SCRAs are the most likely drugs to end in hospitalisation

“As compared to their natural counterpart, synthetic cannabinoids have at least three major drawbacks: they tend to be more potent than the THC that they mimic; they are more addictive; and, they do not contain any cannabidiol (CBD), which is a naturally-occurring cannabinoid with potentially anti-psychotic and anxiolytic effects.”12

In the wider community, SCRAs are the most likely drugs to end in hospitalisation, three times more so than traditional drugs,13 presenting acute problems for emergency services, first aiders, and the prisoners themselves. This high rate of hospitalisation is unlikely due simply to these drugs being innately more dangerous. Other factors increasing the potential for harm may include socioeconomic factors of the users, a lack of understanding about how to take new drugs and a lack of harm reduction techniques.

“Treatment-providers lack the necessary evidence on which to base their treatment. Paramedics work blind, so they have to make a choice between treating or not treating – both of which could result in potentially worsening the patient’s condition. Paramedics are forced to resort to ‘supportive’ care – i.e. addressing symptoms to improve patient comfort (e.g. administering tranquilisers or antipsychotics), rather than addressing the actual cause of the problem. This approach, although pragmatic, is sub-optimal and often insufficient, and in severe cases can prove fatal.”14

Very little evidence is available to help manage the harmful or dependent use of SCRAs, and best practice for treatment is still in its infancy. Many of the substances being used in prison today have had little to no research conducted on them. They are unpredictable in terms of dosage, effects and toxicity. People don’t know what they’re getting with these substances and that this is a major problem. But for a section of spice users in prison, they do know what they’re getting. They’re getting an intense psychoactive experience that will “get their head out of the bars.” For these people, the challenge is not increasing their awareness of the dangers of spice; it’s tackling their mind-set.

There are three main types of harm associated with drug use in prison, all of which need to be addressed in order to minimise drug-related harms and ensure safety and security: Firstly, harms from the drugs themselves including addiction, and physical and mental health problems; secondly, problems associated with the trade including debt, bullying, and violence; and finally, the particular harms associated with prisons, such as staff time and resources involved in policing drug use and responding to problematic drug use. In many ways the problems associated with the drug trade, and the attempts to curtail and control the drug trade are more damaging than the drugs themselves.

Debt and bullying are often ignored when considering the practicalities of drug policy despite much lip service being given to the problem that prisoners themselves describe as the main reason for violence.15 When it comes to SCRAs, the economics are more vicious than with traditional drugs. “The traditional power structures have mutated and lots more prisoners are using and running up debts.”16 Lower prices means that more prisoners can afford to run up debts. Those who cannot afford to pay their debts are often used as guinea pigs to test new drug batches, these usually vulnerable people have become known as ‘spice pigs’. Many horrific incidents of the abuse of profoundly mentally ill people being subjected to terrifying ordeals have been captured on prisoners’ mobile phones.

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