Independent investigation into the care and treatment of patient M – March 2017

It is difficult to be sure what has been used, so each situation must be managed according to the presenting problem. The most common adverse effects of NPS use – nausea, increased heart rate and agitation – will respond to simple interventions, such as encouraging fluids, a calm and reassuring approach and the use of de-escalating techniques to reduce anxiety.

If the person fails to respond, or their condition is deteriorating, they will need to be in an environment where their safety can be maintained. On assessment, this may be a place with heightened levels of observation within the prison, or transfer to hospital may be necessary.

Prison services have considerable expertise in delivering clinical and psychosocial treatments to substance misusers. Users of NPS can be offered the same range of interventions.

Prisoners who do not wish to stop using may benefit from motivational interviewing techniques to help them reflect on the part that substances are playing in their lives. Encouragement to explore the costs of using and the expected benefits of stopping might help the person incline towards a decision to reduce or quit.

Once the person is accepting of the need for change, evidence-based interventions include an individual assessment of treatment need, and both educational and therapeutic groups. This can include group work led by prisoners. Other self-help initiatives are the establishment of users’ forums, and the use of peer mentors to offer support. This is a cost-effective and informal intervention, which has the potential to reach prisoners who choose not to present to services, because the possibility of incurring sanctions for using is a barrier to seeking treatment. Peer mentors will need training and support for the role.

Preparation for release should include specific advice about the risk of relapse, emphasizing that cannabis is a less risky choice than the synthetic cannabis in NPS.

Education is the main preventative health intervention, especially in preventing the proportion of users who use NPS for the first time in prison. Topics include drug refusal skills, risks to physical and mental health, and the unpredictable effects of NPS compounds as they are composed of different types of substances with varying and unpredictable strengths. Education should be available to all prisoners without the need for them to identify as a user.

Various methods of information sharing have been adopted, such as prison radio, poster campaigns and distributing leaflets and promotional materials. This should be a priority because prisoners report only patchy access to information, with particularly low levels of information on harm reduction such as keeping safe if using, and keeping others safe who are using.

The prime time for conveying this information is at reception into the prison; partly for the prisoner’s safety but also to promote the culture that help with substance misuse issues is available. Specific vulnerabilities which may predispose to using in prison (such as past behaviours, or current mood disorder) can be detected at reception, and interventions offered.

Interventions utilising a health model, for example, adopting a harm reduction approach and viewing substance misuse as a psychological disorder, are more likely to promote the alliance between prisoners and staff which is necessary for the prison community to address widespread use of NPS.

The educational endeavour should include positive reasons not to use, such as progressing towards personal developmental goals.