What are new psychoactive substances?
New psychoactive substances (NPS, or “legal highs”) are compounds designed to mimic existing established recreational drugs. They can be grouped into four main categories: synthetic cannabinoids, depressants, stimulants and hallucinogens.
- Synthetic cannabinoids include a large number of drugs. The best known and most widely used are Spice and Black Mamba.
- Depressants include drugs like GHB GBL (gamma butyrolactone) and ketamine, which has dissociative effects in addition to its depressant effects.
- Stimulants include drugs like MDMA (3,4-methylenedioxymethamphetamine), better known as ecstasy, and ecstasy variants such as PMA and PMMA.
- Hallucinogens include drugs such as LSD (lysergic acid diethylamide) and assorted tryptamines and phenethylamines.
Spice: what is it?
Spice is the name given to a synthetic cannabinoid. Prior to the introduction of the Psychoactive Substances Act 2016, Spice was often referred to as a ‘legal high’ and was available to purchase ‘legally’ in shops and online for around £10 a gram.
Historically, Spice has mainly presented in the form of dried green plant matter, which can mislead inexperienced users into treating it as cannabis (in terms of quantity used). However, the plant matter is just a vessel for the substance. Leaves are sprayed with the active compound, they do not naturally contain the active ingredient.
To avoid detection within the custodial estate, there has been a recent spike in letters and cards being sprayed with the liquid Spice compound, left to dry and then being sent in via the normal post process.
Because Spice is scentless, it can be extremely difficult to detect. Often drug detection dogs or random testing is the only way to detect the compound on any suspected items sent into the establishment.
A common misconception in the past has been to attribute Spice with cannabis – due to it being a cannabinoid. However, whilst cannabinoids interact with the same receptors in the brain, the effects of Spice often differ hugely from Cannabis and can lead to extremely unpredictable behaviour from the user; especially in a controlled setting such as a prison establishment or secure unit, for example.
Slang names for Spice that you might hear on the wing include: “mamba”, “bird killer”, “rice”, “katie price”, “X”, “green heroin”, “mandown”, “pot pourri”, “dank”, “incense”, “zombie”, and “spiz”.
Known effects of spice
Spice is a dangerous drug and can cause significant physical and mental health challenges.
For acute users, symptoms include convulsions, paralysis, psychosis, extreme bizarre behaviour, elevated heart rate (tachycardia), and aggression. Treatment includes symptom-directed supportive care, may require medication for agitation, convulsions, or psychosis. If symptoms are persistent or severe transfer to hospital may be necessary.
For chronic (persistent, long-term) users, symptoms include psychosis, aggression, loss of weight, decreased hygiene/general health, reported dependence/withdrawals. Treatment includes psychosocial and other appropriate support. Ongoing medication, where appropriate, for enduring symptoms.
Risks of using spice
Figures from the Crown Prosecution Service show that there have been 504 offences relating to Spice and other NPS’ since a new law came into force in May 2016 that criminalised their production, sale and supply.
Consumption
The largest known risk in regards to Spice use is that there is no controlled consistency in strength between one batch and the next.
A simple analogy of this would be buying two bottles of the same-named alcohol from the same seller and price- but not knowing that one is 18% volume while the next is over 90% volume.
The user would likely use both bottles of alcohol in the same manner and at the same rate, despite the difference in potency. By default the risks would hugely increase if they were to unknowingly consume the stronger one at the same rate as the weaker one.
An episode following the ingestion of a high dose is often referred to as a Spice Attack. Unfortunately there are an increasing number of reports of vulnerable prisoners (mental health issues/debt) being coerced into taking high doses of Spice in order to test the strength of batches and/or to display the symptoms of a Spice Attack for the amusement of others.
Psychological dependence
Evidence suggests that Spice use is far more prevalent in the prison estate than in the community. Furthermore it is suggested that use of the substance can become so addictive and destructive, that it often leads to a complete loss of motivation to maintain things such as personal hygiene and achieving goals.
Therefore as a practitioner, it can be extremely difficult to work with and motivate an individual actively using Spice, as often their focus will not be on effectively addressing their identified needs.
Physical and mental health
Last year for the fourth year running, it was identified that the risk of seeking Emergency Medical Treatment was “higher following the use of synthetic cannabinoid products than any other substance”. Furthermore, whilst any form of substance misuse carries a certain level of risk, the unpredictability of Spice strength and the symptoms it causes from one individual to the next can leave medical staff struggling to identify the best possible treatment.
Why are our prisoners using spice?
We asked the prisoners that we work with, of varying categories across the estate, why they use Spice. They said:
- It’s relatively affordable (although it is 5-10 times the price in prison as it is in the community)
- It’s an easily accessible replacement for cannabis or other substances
- The alleviation of boredom
- A form of self-medication
- A coping mechanism
- Pleasure and enjoyment
- A desire to rapidly pass time: “It’s amazing how quick the time passes when you’re on it. You could have a spliff and all of a sudden it’s the next morning you’re getting up again.”
“Once you are stoned you kind of… all you want is more and more. When you feel it wearing off and you know it’s come to the end you just want to smoke more. You want to permanently stay under that effect.
– Prisoner
Keeping yourself safe
As frontline practitioners, it is sometimes easy to put all our energy and focus into supporting and risk-managing your service user whilst forgetting the importance of safeguarding ourselves. Make sure to follow the below procedure to ensure that you’re safe from the effects of Spice:
Check your surroundings: Before you enter a wing, landing or room, observe and scan the environment. If you see smoke or can smell anything unfamiliar, avoid the area and go somewhere you know is safe. Spice is generally scentless however can have a metallic or a generic burning/chemical smell.
How do you feel? Seek immediate medical attention if you begin to experience any undesirable or adverse symptoms. Initially this may be light-headedness, dizziness, increased heart-rate etc.
Keep your distance: Avoid directly approaching service users if you suspect them to be under the influence of Spice. Alert an operational member of staff of your concerns and report the matter as per your local arrangements.
Keep your team informed: Use your team meetings to discuss with colleagues and line manager any new trends or behaviour you have noticed on the wings. Ensure this happens regularly and on an ongoing basis.
Tell your manager: Approach your line manager directly if you feel that Spice or any other substance misuse within the prison is negatively impacting upon your health.
“Going through a spice attack is terrifying. If it happens, remember to breathe and don’t lose sight of the fact that those intense feelings will fade. Speak to someone as soon as possible and make sure you are seen by a healthcare professional afterwards.”
– Laura De Franco, Senior Case Manager at Catch22 HMP Winchester
Reporting processes
Every organisation that works in the custodial estate needs to have a process for responding to staff impacted by Spice. Below is Catch22’s, but we encourage each organisation to develop their own procedure.
- Staff member reports incident to line manager.
- Line manager offers support, completes incident/near miss form within 24 hours and escalates to central reporting.
- Line manager to then debriefs where suitable and signpost their team member to the Catch22 Employee Assistance Programme or local employee representation.
- Staff member to be granted time to engage with their GP/hospital to safeguard against any possible negative impact upon their health.
- Line manager to offer ongoing additional support/ emotional wellbeing checks and keep under review for as long as is deemed necessary.
Best practice when working with prisoners
Identifying Spice use amongst prisoners can be more difficult than other prohibited activity. The following may help you to spot the signs and help support those affected:
- Changes: Look out for noticeable changes in behaviour and physical appearance; i.e weight loss, becoming withdrawn from social interaction or confusion.
- Challenges: Positively challenge known/suspected Spice use. Assure prisoners that support is available.
- Referrals: Make referrals to substance misuse providers for psychosocial interventions, including one-to-one and support groups.
- Partnerships: Ensure you are working closely with substance misuse, healthcare and offender management providers. To properly address drug use you need all these teams to be involved.
- Harm reduction: Provide basic harm reduction advice, as a minimum, for those prisoners unable to engage fully with psychosocial support.
- Create advocates: Engage prisoners in supporting education and awareness campaigns.
