5.1 Chronic overcrowding has been described as one of the most debilitating problems for the SPS, but the problem of drug misuse is proving to be as much a scourge, as individuals with addictive habits continue to flood into its cells. Further crimes are then committed though the smoking, ingesting or injecting of illegal drugs, which are smuggled to prisoners in very small packages via a number of routes. It is said that week-end boredom, which is a feature of so many prison regimes, may contribute to demand.

5.2 The drugs which arrive in prison have to be paid for, often at the expense of further offences in the community, and many serious injuries are also inflicted as a result of external and internal drug dealing. In the longer term, there is an even greater cost if prisoners are released into the community with addictions which require more crime to pay for them, leading to the possibility of re-imprisonment and yet more overcrowding. The implications for public health are also considerable.

5.3 We are, however, beginning to conclude that the recent introduction of random MDT has provided the firm base from which much closer focus can now be mounted on the various connecting issues. This will require a renewed recognition that imprisonment can represent a very significant opportunity to wean a number of prisoners off drugs, especially as many more prisoners are now saying that they would like to break free from drugs and the corrosive environment which is created by them. For others, there is the opportunity to face up to reality and to begin to engage in harm reduction or stabilisation.

5.4 Prevention is better than cure and the SPS has directed a great deal of attention towards this; however, we believe that intelligence gathering still requires greater co-ordination and that searching at a number of locations could be much improved, including the use of more up-to-date technology. Education and reduction strategies are equally vital in the longer term but these now need to be enhanced with a system of incentives, whilst throughcare arrangements also need to be far more cogent. These could produce a rolling effect, whereby many more prisoners are able clearly to see the advantages of staying off drugs.

The Size of the Problem

5.5 A lack of information makes it difficult to assess the scale and true nature of drug abuse in Scottish prisons. Although MDT results are now starting to provide more informed statistics, we currently have to rely on largely anecdotal reports in order to assess the size and nature of the problem. MOs and Nurse Practitioners could only extrapolate from the numbers whom they saw at surgeries. Some stated that there was "a significant medical problem" in the direct presentation of drug addiction symptoms, though they were unable to determine whether individuals had arrived with these habits or had acquired them in custody. The opinions of Governors-in-Charge varied but recently more have been observing that there were "difficulties" in their establishments. The consensus among prisoners was that the drugs problem was no greater than that found outside, which could be an accurate perception of the situation depending on what is considered ‘normal’ - for example, many consider that cannabis is not, or should not be construed as a drug. However, what is clear is that there has been an increase in the number of prisoners being charged as a result of illegal drug activity (though some of this could be attributed to MDT).

5.6 Early results taken from MDT at HMPs Edinburgh and Perth indicate a figure of 44-46% for those testing positive. However, there were prisoners at a number of locations who said that between 70 and 80% were resorting to drugs at some stage in their sentence. Other indicators tend to support these higher figures; for example, the observations of various addiction workers and the number of prisoners being admitted to local hospitals with drug induced seizures. The high level of prescription drugs is another possible indicator, these often being associated with abuse or withdrawal problems. Whichever figure is correct, it is probable that the extent of abuse in prison is much greater than in the rest of the community due to the concentration of those previously involved in the drug culture, coupled with what would appear to be reasonably easy access to drugs. We estimate, therefore, that nearly every Scottish prison establishment now contains a population which has a significant drug problem. Some are long term prisoners - eg, at Shotts or Glenochil - but because of their high throughput rates, there are also concentrations of users in prisons such as Aberdeen, Barlinnie, Edinburgh and Perth where remand prisoners are held. Most open establishments also contain a proportion of abusers, despite the fact that before arrival there, individuals have signed a contract to remain drug free.

5.7 The nature of substances involved varies considerably and a divide in usage among the wider community is apparent between the West and East of the country, a division which is then reflected in prisons. Most prisons would appear to contain the following groups of abusers:

5.8 The reasons for drug taking may be no different to those found in the wider community - i.e. ranging from enjoyment or continuing a habit begun outside to problems with stress or poor coping skills. However, some may have a need to find relief, albeit temporarily, from the pressures of imprisonment whilst the temptation to opt for anti-depressants may also be difficult to resist. This is especially true at weekends when there is little to relieve the monotony, particularly as work and the majority of programmes finish on a Friday afternoon.

How Drugs get into Prison

5.9 Whilst there is a clear demand for drugs in prison, there are also many dealers who regard the calculated risks which they run in the buying and selling of drugs as worth the danger of detection. Governors therefore face a threat from both directions when trying to stem the flood of illegal drugs, without resorting to methods which would penalise those who are drug free. Drugs can enter a prison by a number of methods; for example, they can be passed surreptitiously during visits, thrown over perimeter walls or pushed through fences. They can be cleverly disguised to look innocuous or they can be wrapped in clingfilm and swallowed or hidden inside the body either by admissions or by remand and other prisoners returning from Court. There is also considerable scope for them to be hidden in the large variety of trades vehicles which have to enter prison grounds and prison staff are occasionally accused of trafficking in drugs, though any such allegations are rigorously investigated by the police. As a matter of routine, all drug finds are reported to the police and if there is sufficient evidence, criminal charges will follow.

Effects on Prison Life

(i) Violence

5.10 Violence can stem from a number of factors, including frustration, bullying or feuds which have originated outside the prison and could be as a result of the loss of or the failure to obtain substances or financial competition between rival factions. The relationship between drugs and violence is therefore difficult to evaluate, particularly as investigations into violent incidents do not often receive the cooperation of prisoners. What is clear, however, is that a considerable number of incidents are drug related and have an effect beyond those immediately involved - for example, medical and nursing staff may be intimidated for prescription drugs and it is also accepted that many families and friends are forced into smuggling. Figures for serious assaults across the SPS increased from 50 to 108 in 1995-96 and included two violent deaths; in 1996-97 the number of assaults rose to 127.

(ii) Self Harm

5.11 Sustained abuse of the drug LSD and probably benzodiazepines, can lead to psychiatric damage, whilst painful or untreated withdrawals from other drugs may lead to suicide attempts, especially in the early stages of custody. Medical and specialist staff do their utmost to treat such symptoms, though these may be masked by the drugs, and sometimes there can be dilemmas over the appropriate clinical response, either where poly drug abuse is involved or over the prescription of methadone.

(iii) Health Risks

5.12 Most drugs are smoked, sniffed or swallowed; however, there are still pockets of injectors, despite the fact that some prisoners have modified their behaviour in recent years. There is in fact anecdotal evidence which indicates that some individuals may be taking heroin instead of cannabis, largely because it does not remain in the system for as long and could therefore escape random MDT detection. However, as heroin is said to have a quicker effect when taken intravenously, this might be increasing the temptation to inject, even although those who are willing to share needles can expect to suffer the risk of acquiring and transmitting HIV or Hepatitis.

5.13 Fits or seizures are caused by the withdrawal from benzodiazepines and these were a fairly common occurrence among women prisoners at Cornton Vale, until there was a recent major change in prescription policy. However, these cases are also encountered at other prisons, with the more serious cases presenting extra costs as additional prison officers are needed to escort them to hospitals in the community.

SPS Anti-Drug Strategy

5.14 The SPS anti-drug strategy aims to reduce:

(i) Reducing Supply - Deterrence and Punishment

5.15 Intelligence. The interception of drug packages by prison staff is now fairly common-place, as staff become more skilled in physical searches, electronic surveillance and careful intelligence gathering. Working with the police and other local agencies, routine activities now also include the targeting of dealers or certain families. However, we believe that the concept of dedicated Drug Intelligence teams should be extended to every prison and that such teams should work to the manager with responsibility for the overall anti-drug strategy in the establishment. There might also be merit in appointing one overall strategic co-ordinator or intelligence team at SPS HQ.

5.16 Random MDT. Pilot MDT schemes were set up early last year at Edinburgh and Cornton Vale and these were followed by a rolling programme which extended the initiative to all prisons by March 1997. The introduction of MDT has therefore been remarkably swift and for this, the SPS deserves great credit, especially as there had been no budget for the initial costs. The purpose built facilities which are now a feature of every prison are equally impressive and our recent inspection reports have remarked on the professional training and commitment of MDT staff.

5.17 Despite various forecasts to the contrary, there has been very little direct trouble from prisoners following the introduction of MDT, though there has been a rise in complaints about some aspects of its use. Early indications are that it could prove to be a very powerful tool in the fight against drugs.

5.18 Under current legislation, there are five conditions which might prompt testing:-

The testing programme is based on urine analysis and identifies those prisoners who have recently abused drugs. For those who test positive, sanctions are applied with encouragement to access education and addiction programmes.

5.19 Prisoners who provide a positive sample or who refuse to provide one, are dealt with under the disciplinary system and appear before the Governor. Sanctions can include the forfeiture of a range of privileges, but normally involve an increase in the length of sentence by the imposition of added days. Governors can award up to 14 days for each offence though these can be suspended for a period to encourage the individual to seek help. Should any subsequent test prove positive, the original award is usually activated and added to the second offence.

5.20 Further Development of MDT. We believe that the present MDT system provides an appropriate balance between punishment and treatment and there is early evidence that the scheme has already led to a number of prisoners either stopping or modifying their habits. However, the scale of punishments may have to be revisited at some later stage, as individual responses can vary greatly with a concomitant effect on deterrence. Equally, there is a case for reviewing its potential and further development in other areas now, particularly in relation to sentence planning, offending behaviour, future security categorisation and many other aspects of prison life. In our view, the next step should be the introduction of drug related behaviour in the criteria which enable prisoners to make progress within the prison system. Prisoners who reject drug abuse or who are making genuine efforts to do so, should receive appropriate incentives; on the other hand, those who continue to abuse drugs or refuse to cooperate fully in drug treatment programmes should be subjected to the most basic of regimes. We noted recently at Glenochil, for instance, that prisoners who were located in a drug free area in ‘C’ Hall did not wish to follow the normal progression system if it meant a return to areas where drug abuse was rife. We believe that there is likely to be a large body of similarly minded prisoners throughout the SPS system and in our opinion, they should not be disadvantaged by their stance. As is already recognised in anti-bullying strategies, care needs to be taken to ensure that the perpetrator is the one to be dealt with, rather than the victim; a similar approach should be considered in relation to managing the drug issue.

5.21 Improved Searching. The SPS has developed a wide variety of responses in order to deal with the large numbers of visitors who are permitted to enter its establishments - for example, over 56,500 visits were made last year at HMP Edinburgh alone. With the introduction of MDT, we believe that an opportunity should now be taken to introduce a more vigorous approach to the searching of visitors and staff at every prison location, including the use of more sophisticated detection equipment. Trades vehicles also require much closer scrutiny and wherever possible, efforts should be made to reduce the number making routine visits. At the same time, there is a need to improve the briefing of visitors by prison staff - at present, there is too much reliance on notices. Better personal contact could in our view lead to more visitors having a fuller understanding of the many penalties involved in drug abuse and more importantly, the benefits of not doing so (including reference to incentives - see paragraph 5.29).

5.22 Meanwhile, the approach to the searching of prisoners varies; some establishments operate a policy of strip searching every prisoner after every visit, others operate a policy of random strip searching. As to whether invariable or random searching is more effective, the evidence shows that comparatively few items are actually retrieved during strip searches, though we believe that the mere possibility of being strip searched represents a significant deterrent to many prisoners who are therefore discouraged from opportunistic smuggling. In our view, therefore, the deterrent value of strip searching is as well achieved by random searching as it is by a policy of strip searching all.

5.23 Sniffer dogs are still being used - three are centrally based at Cornton Vale, though the SPS is presently assessing their comparative value in relation to MDT.

5.24 Closed Visits. Prisoners who abuse the privilege of open visits by participating in drug smuggling are invariably placed on closed visit restrictions, a policy which we wholly endorse. Its application should, however, be consistent at all establishments; the number of closed booths must also match demand, which could mean that more will have to be installed at some locations.

(ii) Reducing Demand - Encouragement

5.25 Needs. Previous drug history should be assessed shortly after any prisoner enters SPS custody, so that subsequent needs for detoxification, counselling and education are clearly identified at the earliest possible stage. However, we believe that in order to do this properly, the reception and induction phases may have to be extended at most prisons. (Such a system has already been introduced at Cornton Vale as part of a new anti-suicide strategy which concentrates on remands.)

5.26 Education. We support the view that education and rehabilitative programmes offer much the better long-term solutions. These aspects are continuing to develop across the SPS with many establishments now adopting a team approach, which involves psychiatrists, psychologists and specially trained Discipline staff all working together with MOs and nurses. This is routine, for example, at the Allermuir Unit in Edinburgh with similar systems now in operation at Glenochil and Perth. It is very encouraging to note that the problem is no longer being treated as a purely medical issue.

5.27 Detoxification. Some prisons are now able to offer drug reduction programmes which invariably operate in conjunction with rehabilitation programmes. Due to a shortage of resources, however, these may only be available to those with chronic or very serious drug problems which means that many prisoners, including remands, are being missed. Most courses involve the prescription of methadone on a reducing basis as a replacement for opiates but there are those, including some MOs, who view that treatment as being harmful. Consequently, protocols have not been established on a consistent basis at every prison in the SPS. Some establishments have also been turning to lofexidine which is said to produce a quicker - if more expensive - result. Meanwhile, an approach involving total abstinence is in operation at Low Moss.

5.28 Drug Free Areas. Individuals who have completed a detoxification (or rehabilitation) course should be able to return to a drug free area, so that further temptation is avoided. However, because of the current overcrowding situation in the SPS, it is extremely difficult to provide any space, with the situation being particularly acute at prisons such as Barlinnie, Edinburgh and Perth, where there is also a large remand population. Elsewhere, however, some Governors have now started to react to demand by providing drug free areas - for example at Low Moss and Glenochil. This momentum should be kept going but may require a policy which is centrally directed, rather than one which relies on purely local solutions being provided by individual establishments. In the longer term, it might even be possible to create an entirely drug free prison within the closed system - Friarton being a prime site for this because of its prisoner selection system, its low security category status and its compactness.

5.29 Incentives. The next few months could prove to be an important time for the greater development of incentives. Considerable momentum in the move to encourage prisoners to come off drugs might be achieved by increasing visit entitlements to those who are or remain free of drugs or by providing higher pay rates for those in drug free workshops. Another example is that television could be made available in cells for those who remain drug free - and withdrawn if the privilege is abused. The development of more sport, physical education or access to library and education facilities at week-ends could also greatly reduce the boredom which can be associated with drug abuse. Similarly, establishments might consider the introduction of a timetabling approach to regimes (see also paragraph 7.16). Every encouragement should be given to those men and women who eschew drugs, whilst increased sanctions should be imposed on those who continue to abuse.

5.30 Family outreach. It is thought that only a small proportion of families are responsible for smuggling. Most families, in fact, have the greatest to fear from those who are released with addictive habits, but we do not believe that their influence on prisoner behaviour has been fully realised. In our opinion, a twin track approach, using the power of family persuasion in addition to what is already being achieved by prison staff, could greatly speed up change, especially among those who are serving medium or longer term sentences. For example, FCDOs ought to consider introducing briefings which make families aware of the drug rehabilitation programmes on offer so that in turn they might encourage their partners, sons or daughters to participate in them. Similarly, subsequent briefings, perhaps at the pre release stage, could be targeted at providing a better understanding of what the prisoner has been taught, coupled with instructions on how to obtain further help in the community in the event of relapse. The aim of these initiatives - which would cost very little to introduce - should be to help individuals get off and stay off drugs for as long as possible, thereby reducing the number of future victims of crime (some of whom could be the prisoners’ families themselves). In this respect, we are delighted to see that such an approach is being developed at Shotts, where the family outreach programme has been extended to include involvement in its addiction programmes.

5.31 Throughcare. Throughcare should involve a recognition of the following elements:-

5.32 We believe that prison management has a duty to ensure that prisoners who have a recognised addiction problem or who have received support during their sentence, are given every assistance and support on their release. To ensure that this happens, contact with the various outside drug agencies should be established well before release. We are concerned that this is not always receiving the priority it deserves, partly because the SPS looks to the release of a prisoner as the end of its responsibility and tends to concentrate its efforts on the earlier stages of sentence, which are important for discipline and control. Meanwhile, some statutory and voluntary bodies only become involved as the release date approaches (or passes), with a concomitant risk that individuals may slip through and miss the opportunity of support and assistance, at what is probably the most crucial time. As most abuse starts and continues within the community, we believe that a greater onus lies with the external agencies to become more involved, especially in the pre-release aspects. The recently formed community Drug Action Teams may help bridge this critical gap.

5.33 Some community agencies are, however, actively involved in helping prisoners with drug problems whilst in prison and in the community: these include the Scottish Drugs Forum, Narcotics Anonymous, Calton Athletic Recovery Group, Simpson House, Phoenix House Project and many others.

5.34 It should not be forgotten that alcohol can play a significant role in repeat crime in the community. Awareness training for this should therefore be included in all pre-release arrangements.

(iii) Reducing Health Risks

5.35 Testing for HIV is not compulsory in prison and thus it is difficult to arrive at an accurate assessment of the problem. However, anonymous surveys such as those conducted by Drs Bird and Gore on behalf of the Medical Research Council are continuing to help chart the changing situation. From these and other sources, it is believed that the prevalence of AIDS related illnesses may not be as great as was initially feared. However, those prisoners who go on to develop AIDS, with its associated medical complications, are likely to take up a considerable - and disproportionate - share of prison medical resources.

5.36 Most of the considerable efforts which are devoted to minimising health risks are directed towards individual education; for example, all prisoners are given the opportunity to see an HIV/AIDS video on induction. Officers trained in HIV counselling are also on hand to advise prisoners throughout the various stages of sentence, this being particularly applicable at Glenochil where there is a well documented history of HIV infection. Community agencies such as the Ruchill Hospital in Glasgow also assist when funding permits. The avoidance of risk on a daily basis may also involve bleach tablets being made available to help keep needles clean. Condoms are supplied to those relatively few prisoners who qualify for home leaves.

5.37 Other drug injecting risks include infection from Hepatitis B. However, immunisation can offer high returns, though we have been told that opportunities in this area are being missed - for example only 4% of prisoners being immunised at Low Moss and Aberdeen, despite 40% having an injecting history. A worrying rise in the incidence of Hepatitis C in prison is also now becoming evident, with this likely to be the major communicable disease between now and the turn of the century. Treatment is expensive and not always effective.

5.38 Deaths After Release. There are indications that the number of prisoners who die from an accidental overdose in the first few days (or weeks) after release may now be exceeding the number of prison suicides. These deaths may be due to the fact that the actual frequency of drug taking in prison is less, or that the substances used are of lower purity. These can lead to lower tolerance levels to a variety of drugs, including methadone, on release.

Funding and Allocation of Resources

5.39 Funding for the response to drug abuse is split between the various authorities, with the period of custody largely being paid for by the SPS budget, whilst local authorities are responsible for the time after release. However, there are difficulties in the practical application of these principles, an example being the question of who should pay for those addiction workers who are working in prisons. Sometimes they are jointly paid out of the SPS budget and several other civil votes. However, the consequences of their pay being divided can lead to the services being withdrawn, perhaps as a result of local authority funding difficulties which can lead in turn to the abrupt suspension of prison drug treatment. Problems such as these are understandable, but coordination is fundamental to the entire strategy, the most critical aspect of which is probably ‘seamless’ funding. (Thus we do not think more funds need to be allocated, per se; rather they need to be more effectively deployed.)

5.40 Recent attention has been directed by the SPS towards the establishment of proper resources for MDT in all its prisons. We believe that this aspect is now well covered but consider that the allocation of rehabilitative resources should be re-visited. The table below shows our understanding of where resources are currently deployed:

Click to view table (31KB)

5.41 Our main observations are as follows:

Conclusions

5.42 The creation of a drug free prison system is probably as unrealistic as the creation of a drug free society. However, every opportunity should be taken to reduce the number of abusers or to help them modify their habits whilst in prison, mainly in the interests of crime reduction and public health. Reducing supply must continue to be a priority in the short term, though strategic intelligence and targeting in the SPS is due further improvement. Following the introduction of random MDT in all Scottish prisons, education and rehabilitation may offer the best solutions in the longer term, with some adjustment now required.

5.43 MDT has the potential to be a very powerful tool in the fight against drugs and its introduction has created valuable opportunities for a complete re-focus on the many issues which are associated with drug abuse. It is, in fact, probably the greatest opportunity there has been in recent years and the momentum it has provided should not be dissipated. The quick and practical realisation of a range of largely inexpensive incentives could therefore be of enormous importance in the next few months. These might encourage many more prisoners to become drug free and could significantly speed up the movement towards permanent drug free areas. A start should also be made to improve family outreach, with the mix of all three (viz, MDT, incentives and family) constituting a powerful force for change. This will be even more potent if methods to combat week-end boredom are also included.

5.44 Adjustments to the future allocation of resources should take account of the fact that young offenders should be receiving higher priority, as they have the greatest potential for further drug misuse and recidivism. Remand prisoners, particularly at the larger establishments, also need much more attention. On the positive side, it appears that the resources now allocated to the women’s prison at Cornton Vale are at last reflecting the particular needs of its population, many of whom are poly drug users.

5.45 Throughcare arrangements require much more thorough attention - especially in the pre-release and release phases. Future arrangements might include an examination of how funding could be better coordinated; for example, drug action teams might be given financial responsibility from the pre-release stage onwards. In general, the avoidance of ‘penny packeting’ of resources is of fundamental importance to the authorities’ response.

5.46 Substantial progress could be affected by the problem of overcrowding, as this might hinder the further establishment of drug free areas. A reduction in overcrowding would be the greatest help of all and as suggested at paragraph 4.20, might be achieved, in part at least, by the use of more diversionary schemes.