HMIP Annual Report 1997-98

5. Drug Abuse

Introduction

5.1 As indicated at paragraph 5.5, random MDT results are confirming that most prisons contain a population which has a drug problem, though this should come as no surprise. For example, a recent EU report, which compared the findings of different national surveys on drug abuse, found that one in eight adults in Britain were using cannabis, whilst users of heroin were said to account for 70% of all people treated for drug addiction. In parallel, a recent Scottish Select Committee has estimated that drug related crime may be costing as much as £936 million per year.

5.2 It would appear, therefore, that the criminal and drug cultures are closely interrelated, with the latter well established before most individuals arrive in SPS establishments. Subsequently, one of the prime purposes of imprisonment is the requirement to prevent individuals committing further crime. However, the smoking, ingesting or injecting of illegal drugs in prison represents a considerable escalation in criminal activity. Illegal drugs also have to be paid for, often at the expense of additional offences being committed by supporters in the community, whilst many serious injuries can be inflicted as a result of drug dealing.

5.3 In the longer term, even greater costs are incurred by us all, if prisoners are released into the community with ongoing drug habits, as they may resort to crime in order to pay for them. This leads to the possibility of re-imprisonment and further increases in prison numbers - ie there are strong connections between drugs and overcrowding.

5.4 We believe, however, that the SPS may itself be able to contribute to a reduction in future overcrowding by developing its efforts to educate all prisoners on the harm caused by drugs and alcohol and by weaning more prisoners off drugs whilst they are in prison. In particular, the combination of random MDT, education on substance misuse, addiction programmes and a simple system of incentives for those who eschew drugs could well help turn the tide, though methods to stop supplies must still be accorded top priority. However, individual establishments will be unable to manage all this totally on their own and much greater co-ordination will be required at all levels, if there is to be more cost effective use of resources on behalf of the community at large. (see also paragraphs 5.17, 5.21 and 5.23.)

The Size of the Problem

5.5 Random MDT has now been in operation in every SPS prison for at least a year. Consolidated results* are shown in the table below:

*These figures take no account of those tests which were positive but later discounted, for whatever reason.

Overall SPS figures - March 1998 - 26%.

- Average for year - 29%.

Comment

5.6 Although MDT results are now beginning to provide much more informed statistics, it is still difficult to assess the exact nature of drug abuse in Scottish prisons. For example, some prisoners when asked for their views, will tend to exaggerate abuse levels, whilst others will play them down, for their own reasons. Others have difficulties in defining what constitutes an illegal drug, with many prisoners stating that there is no difference between the use of cannabis and alcohol.

5.7 During the course of this year and in previous years, addiction workers, staff and prisoners have told us that as many as 70% or even 80% of prisoners could be resorting to drugs at some stage in their sentence, a figure which is well in excess of what random MDT figures are indicating. The Researchers, Drs Bird and Gore, have also stated that the actual level of opiate abuse could be higher than indicated by the tests, as heroin has a half life of only three days. For example, if taken on a Friday, users could be clear by Monday, especially in those prisons which do not operate testing at the week-end. Prisoners consistently told us that more individuals were switching to opiates because they had heard that cannabis persists in the system for up to three weeks. There may well be an element of truth in this, but we think that the drugs which prisoners choose will tend to be much more closely linked to what is actually available at any given time. In addition, consolidated MDT results for the year do not show any significant upward trend in the use of heroin across the SPS, though levels are much higher than comparable figures in the rest of the U.K.

5.8 The nature of substances involved varies considerably, but most prisons would appear to contain the following groups of abusers:

• Occasional or recreational users of mainly class B drugs such as cannabis. These are probably still the largest group.
• ‘Pickers and mixers’, who regularly use class A and B drugs such as heroin, temgesic and temazepam. Any use of heroin is particularly worrying, as this substance has no redeeming features; it is extremely addictive and encourages further crime either in or out of jail.
• A small core of injectors.

How Drugs get into Prison

5.9 Many dealers regard the risks which they run to be well worth the dangers of detection and so Governors face a twin threat from them and from the demands of individual prisoners. In turn, the dilemma is how to stem this constant tide of illegal drugs, without resorting to methods which would wholly and unfairly penalise those who are not involved.

5.10 Drugs are introduced to prison by a large variety of methods; for example, they can be passed during visits, thrown over perimeter walls or pushed through fences. They may be wrapped in clingfilm, held inside the body and brought in by admissions or by remand prisoners returning from the Courts. In addition, there is considerable scope for them to be hidden in the many trades vehicles which come into prison each day.

5.11 All drug finds are reported to the police and criminal charges follow if there is sufficient evidence to support them.

Effects on Prison Life

(i) Violence

5.12 The relationship between drugs and violence can be difficult to evaluate as the investigation of incidents does not always receive the co-operation of prisoners. Nevertheless, we have been told that a number of assaults in recent years have been drug related. (See also paragraph 7.5)

(ii) Self Harm

5.13 It is thought that painful or untreated withdrawals from illegal drugs can lead to suicide attempts, more especially in the early stages of custody, though medical and specialist staff do their utmost to treat such symptoms. However, these can be masked by the drugs, whilst there may be additional dilemmas over the appropriate clinical response to poly drug abuse or where the prescription of methadone is involved. Protocols for the distribution of methadone continue to vary, depending on the view of individual MOs at establishments, though efforts to reach a more standard arrangement across the SPS have been ongoing for some time; in this respect, remands appear to be most at risk. (see also paragraph 5.28)

(iii) Overcrowding

5.14 The effect of punishments resulting from random MDT should not be underestimated. Over the course of a year, there will be a significant increase in the prison population which results directly from the extra days in custody which have been awarded for drug misuse.

(iv) Health Risks

5.15 It is thought that there are still pockets of injectors in some prisons. Many of these individuals are thought to be injecting heroin because it is said to have a quicker effect when taken intravenously (though they will be aware that the sharing of needles increases the risk of acquiring and transmitting HIV or Hepatitis). Serious fits or seizures can be caused by withdrawal from benzodiazepines.

SPS Substance Misuse Strategy

5.16 The central SPS substance misuse strategy is aimed at reducing the supply of drugs, reducing the demand amongst prisoners and minimising health risks. This is replicated at establishment level, though recent inspections have shown that individual responses can vary quite considerably. In our experience, those with the most effective strategy will tend to be where there is sound co-ordination in all areas and which is being directed at Deputy Governor, or equivalent level.

5.17 More recently, HMP Edinburgh has appointed one experienced Manager whose sole aim is the co-ordination of the establishment’s substance misuse strategy. In due course this will reap considerable dividends, though we believe that such an appointment should now be replicated at SPS HQ level, thereby greatly enhancing the work of the newly established SPS National Drug Strategy Group.

(i) Reducing Supply - Deterrence and Punishment

5.18 Intelligence. The interception of packages of drugs is now relatively common-place, as staff are becoming much more skilled in physical searches, electronic surveillance and careful intelligence gathering. At establishment level, intelligence teams often work in tandem with the police and other local agencies and routine activities can include the targeting of dealers and certain families. However, it is suggested that the appointment of an intelligence co-ordinator at SPS HQ would be of considerable value to the police and would greatly enhance a more strategic approach at national level. (We understand that some software and systems are now being introduced in Custody Division for this purpose.)

5.19 Random MDT. Random MDT has now been in operation at all Scottish prisons for over a year and aims to identify those who misuse drugs and to act as a deterrent. Sanctions are applied to those who test positive and wherever possible, access to education and addiction programmes should also be available - though we have noted that this is by no means consistent.

5.20 In general, we see random MDT as a useful tool in helping reduce substance misuse, with there being some early evidence from annual statistics that the introduction of these tests has led to a number of prisoners either stopping or modifying their habits. This would seem particularly to apply to cannabis users, where up to a third may have reduced their intake, which means that there should now be a much lower number of prisoners who choose to use this substance on a regular basis. This must be seen as a harm reduction success.

5.21 Many more individuals have also been coming forward during inspections to tell us that they would like to break free from drugs and the corrosive environment which is created by them. Nevertheless, we believe that the scale of punishments for failing MDT tests should be revisited. For example, a number of individual Governors are thought to believe that the penalties for being caught with heroin should be increased relative to those for cannabis, a view which we support but which will need central direction. There is an additional case for reviewing the potential and further development of MDT in other areas, particularly in relation to sentence planning, offending behaviour, future security categorisation and many other aspects of prison life which are related to the criteria which enable prisoners to make progress within the prison system.

5.22 Indeed, now that random MDT has been running for some time, there may be a need completely to review and redirect MDT by targeting only those who pose the greatest threat to secure custody and those who are most in need of the opportunity for change. (At present, there is some merit in the argument that it would appear to work most effectively against those with the least harmful substance abuse.)

5.23 Other aspects of random MDT which might further be explored include:

• A more equitable scale of punishments across all SPS establishments.
• The need for MDT units to work closely together with the overall SPS and establishment substance misuse strategies. (We have noted some who are tending to work in isolation.)
• Better information collation systems - some management teams are very good at collating information, others are not. More time also needs to be spent in developing this analysis and in producing reports. (If skills do not exist at all local establishments, perhaps a centrally based researcher is required.)
• Frequent testing to be linked to incentive schemes (and the awarding of days back).
• Week-end testing to be much more random.
• More frequent and suspicion testing might be the most effective way of targeting those prisoners who are the most disruptive to the penal system.
• Consideration should be given to much more use of reception testing. (Unless it is known how many arrive with a substance misuse problem, all subsequent analysis tends to be guesswork.)
• Finally, the information which MDT is now providing should be used in better establishing a priority for the allocation of resources (for example, see table at 5.39). In the past, it would appear that MDT may have come as a "bolt on" to resources which had already been allocated.

5.24 Improved Searching. A large number of visitors are now permitted to enter prisons and the SPS has developed a wide variety of responses in order to deal with them. Nevertheless, we welcome more vigorous approaches to the searching of prisoners, as for example was witnessed during our inspection of HMP Aberdeen, where the Governor had adopted an extremely tough stance. This was well publicised and accepted by prisoners and their visitors (albeit somewhat grudgingly). We think that the briefing of visitors by prison staff could also be much improved. For example, better personal contact might lead to visitors having a clearer understanding of the penalties involved in smuggling - and more importantly, the benefits of not doing so.

5.25 Closed Visits. Prisoners who abuse the privilege of open visits by participating in drug smuggling are placed on closed visit restrictions.

(ii) Reducing Demand - Encouragement

5.26 Needs. Recent inspections, for example at Low Moss, have led us to believe that the reception and induction phases may have to be extended at a number of locations, so that previous drug history can be more fully assessed when prisoners first enter SPS custody. This will mean that needs for detoxification, counselling and education are identified at the earliest possible stages and resources allocated in a much more coherent fashion.

5.27 Education. Most authorities involved in drug work agree that education and rehabilitative programmes offer much the better long-term solutions. The majority of establishments are now adopting approaches which involve psychiatrists, psychologists and specially trained Discipline staff working in conjunction with MOs and nurses.

5.28 Detoxification. Many prisons are now able to provide drug reduction measures which operate in conjunction with rehabilitation programmes. However, chemical detoxification may only be available to those with chronic or serious drug problems and this means that many individuals with a problem are being missed - for example, remand prisoners or those with short sentences. Detoxification may involve the prescription of methadone on a reducing basis as a replacement for opiates, though there are those, including some MOs, who view this treatment as being harmful. More recently, some establishments have been using lofexidine, which is said to produce a quicker though more expensive result.

5.29 We have also inspected an approach at Low Moss which involves groups of prisoners practising total abstinence, an idea which might usefully be extended to some other prisons.

5.30 Drug Free Areas. Many Governors now believe that individuals who have completed a detoxification or rehabilitation course should be able to return to a drug free area, so that further temptation (and the concomitant waste of resources) is avoided. Though these can be difficult to provide in prisons which are overcrowded, we have been greatly heartened by an increase in the number of drug free Halls which are now becoming available. These include two Halls at Edinburgh and Perth, with similar facilities reported at Cornton Vale, Aberdeen, Inverness, Longriggend and Glenochil. Four drug free dormitories have also been established at Low Moss and a drug free Hall is to be made available at Barlinnie. We strongly endorse the momentum which has now been created by these establishments and which is well supported by a centrally directed policy.

5.31 Incentives. Those who reject drug abuse or who are making genuine efforts to do so, should receive appropriate incentives. Further momentum in the drive to encourage prisoners to come off drugs might be achieved by increasing visit entitlements to those who are free of drugs, or by providing higher pay rates for those who are working in drug free worksheds. Some prisoners might even prefer simpler incentives, like a certificate which they could show their family indicating they were now free of drugs. It might also be possible, in the longer term, for television to be made available in the cells of 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 would also greatly reduce the boredom which is said to be associated with drug abuse. (Most prison regimes end in the early afternoon on Fridays and do not recommence until Monday morning.)

5.32 Family outreach. It is probable that families have the most to fear from those who are released with addictive habits, whilst prisoners themselves are often worried that their family will find out that they are taking drugs. We do not believe that these influences and the effect they could have on prisoner behaviour are being fully recognised. In our opinion, the power of family persuasion could greatly speed up change and harm reduction, especially among those who are serving medium or longer term sentences. FCDOs ought to consider briefings which make families aware of the drug rehabilitation programmes on offer so that in turn, they might actively encourage partners, sons or daughters to participate in them. Similarly, pre-release briefings for families might 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 overall aim must be to help these individuals get off and stay off drugs for as long as possible.

5.33 Throughcare. Prison management has a duty to ensure that prisoners who have previously had a recognised addiction problem are given some support on arrival in prison; for example, if they have been maintained on a substitute opiate prescription. Similarly, those who have received support during their sentence ought to be given every assistance in the period immediately leading to their release. However, this latter process does not always receive the priority it deserves, partly because SPS establishments tend to concentrate their efforts on the earlier stages of sentence, which are important for discipline and control. As most abuse starts and continues within the community, we believe that statutory and voluntary agencies must be involved, more especially in the pre-release aspects.

5.34 It should not be forgotten that alcohol plays a very significant role in repeat crime and for this reason we believe that awareness training should be included in most pre-release arrangements.

(iii) Minimising Health Risks

5.35 The considerable efforts which are devoted to minimising health risks in prison are mainly directed towards education. For example, all prisoners are given the opportunity to see an HIV/AIDS video on induction and Officers trained in HIV counselling are on hand to advise prisoners throughout the various stages of sentence. Disinfectant tablets are also made available in an effort to keep needles clean.

5.36 Testing for HIV is not compulsory in prison which means that it is difficult to make an accurate assessment of the problem, though anonymous surveys (such as those conducted by Drs Bird and Gore) are helping to measure changes. These and other sources indicate that the prevalence of AIDS-related illnesses may not be as great as was feared several years ago, though there are no grounds for complacency.

5.37 Drug injecting can also lead to infection from Hepatitis B, though wider immunisation at individual establishments could offer high returns. More worryingly, it is likely that Hepatitis C will become the major communicable disease in prisons by the end of the century.

5.38 Deaths After Release. A study recently published in the Lancet extrapolates that of 36,000 releases from Scottish prisons, upwards of 37 prisoners are likely to die from drug overdoses per annum. These are likely to occur in the first few days or weeks after release and 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. This can lead to lower tolerance levels to a variety of drugs, including methadone. In our view, therefore, it is vital that the education of prisoners on the risks involved is properly addressed prior to their release. More recently, the SPS has been issuing some pre-release packs for this purpose. Consideration may also have to be given for the fast tracking of some individuals into community based treatment programmes that include substitute prescribing.

Allocation of SPS Anti-Substance Misuse Resources

5.39 The table below shows where resources are now being deployed:

p/t = part time

f/t = full time

5.40 Our main observations on the above are as follows:-

• There would appear to be a need for a national audit on the service provision at each establishment and for there to be an evaluation of the various programmes available.

• Young offenders have the greatest potential for longer term recidivism and should be amongst the highest priority for resources. However, this does not appear to be the case at either Polmont or Dumfries and there should be a significant shift of resources at both locations in future, more especially the former (where there also needs to be a more broadly based pro-active anti-drugs strategy).

• Similarly, the larger remand prisons could do with more resources, as this is where the greatest throughput of prisoners and abusers is likely to be. Additionally, there would appear to be a lack of consistency in the treatment of remand prisoners. Indeed, some can be almost totally ignored, mainly because of a shortage of resources (whereas the most effective intervention work is likely to be that which is carried out amongst those who are returning to the community within a relatively short time - ie many of those listed in this, and the preceding paragraph).

Conclusions

5.41 We believe that in the interests of crime reduction and public health, every opportunity should be taken to reduce the number of abusers and to help individuals to modify their habits whilst in prison. Reducing supplies must continue to receive top priority, though education on substance misuse and addiction programmes offer the more attractive solutions in the longer term. Some basic measures to offset week-end boredom are also required.

5.42 We see random MDT as a useful tool, its introduction having created opportunities to re-focus on the many issues which are associated with drug abuse, though some aspects of its use now merit some review. This, together with the practical realisation of a range of largely inexpensive incentives, could help encourage more prisoners to become free of drugs, especially if the power of their families could be better harnessed to influence change. Additionally, throughcare arrangements for all abusers should be improved, more especially at the pre-release stages. All these aspects will now require much greater co-ordination at all levels, though the establishment of an SPS National Strategy Group should help address this.

5.43 Similarly, the future allocation of resources should take account of the fact that young offenders ought to be receiving much higher priority, as they have the greatest potential for further drug misuse and recidivism. Remand and some short term prisoners deserve far better attention.

5.44 Substantial progress in limiting drug misuse in prison is greatly inhibited by the problem of overcrowding, especially where this hinders the creation of more drug free areas. A reduction in overcrowding would be the greatest help of all and as suggested elsewhere in this report, might best be achieved by the use of more community disposals, diversionary schemes and drug treatment and testing orders.

5.45 Prisons might reduce overcrowding themselves: this could be achieved via substance misuse programmes which focus on reducing individuals’ habits before their release into the community, as these might lead to less repeat crime and subsequent imprisonment.

5.46 The combination of these and other measures, when implemented in all prisons, could have a significant impact on one of the greatest scourges which is now facing most communities throughout Scotland.