Synthetic cannabinoid use in an adult male prison in the UK.

INTRODUCTION: Synthetic cannabinoids (i.e. Spice) are a major public health problem in UK prisons, however, research in this area is limited. Here we aimed to draw comparisons between people with and without experience of using synthetic cannabinoids in prison, to characterise the features of, and motivations for use within this setting and evaluate support for different treatment interventions. METHOD: Questionnaires were administered to 122 people in a category-B prison for adult males in England between July 2022 and March 2023. Participants were asked questions related to their sociodemographic and custodial characteristics, use of synthetic cannabinoids (and other drugs) inside and outside of prison and psychological distress was measured via the Brief Symptom Inventory (BSI-18). Those that had ever used synthetic cannabinoids in prison completed additional questions related to features of use, motivations for use and support for various interventions. RESULTS: In total 46.7 % (n = 57) of participants reported use of synthetic cannabinoids in prison and this group experienced significantly greater levels of psychological distress compared to those reporting no use (mean (± standard deviation) BSI-18 scores = 23.7 (±16.7) vs 12.8 (±13.6), p < 0.001). Participants mostly reported using paper-based preparations (77.4 %) and use via e-cigarettes (75.9 %). The most strongly endorsed motivations for use included to alleviate boredom (91.1 % strongly agree/agree), to make the sentence pass faster (89.3 % strongly agree/agree) and to cope with stress (80.4 % strongly agree/agree). The interventions that received most support were strategies to better manage time and medication to manage withdrawal. CONCLUSIONS: The use of synthetic cannabinoids in UK prisons typically involves the use of paper-based preparations via e-cigarettes, and use is associated with greater levels of psychological distress. Motivations for use were mostly pragmatic (e.g. to alleviate boredom or cope with stress) and interventions should prioritise increasing the time individuals spend out of cells and in meaningful activity.

Non-cancer pain clinic in three English prisons: understanding prisoner needs and prescribing practice in relation to chronic non-cancer pain (CNCP).

PURPOSE: Prisoner access to opiate-based analgesics and gabapentinoids is a concern to prisons through illicit trading. The purpose of this paper is to describe patient needs following introduction of nine pilot chronic non-cancer pain (CNCP) clinics for chronic pain in three prisons (two male and one female) in the South of England. The study evaluated the effectiveness of this model and assessed the wider practical implementation issues. DESIGN/METHODOLOGY/APPROACH: Clinical notes were reviewed for 63 consultations, anonymised and recorded for secondary analysis. FINDINGS: Alongside CNCP, high levels of substance misuse, physical and mental health histories were noted, especially for female patients. Amitriptyline, pregabalin, gabapentin were the main frontline analgesics prescribed prior to assessment. A total of 41 per cent of patients did not change their medication following the consultation; 25 per cent had their medication increased or reintroduced (greater for women prisoners); with one-third (33 per cent) of patients reducing the prescription of strong opioids and gabapentinoids. Significant differences were noted between male and female patients. Prisoners were amenable to changes in medication to facilitate access to work and other therapeutic interventions. SOCIAL IMPLICATIONS: The prescribing of analgesics has largely been couched in terms of disruption to the prison regime through illicit trading. This study highlights the need to place CNCP within wider contexts of substance misuse, physical and emotional health. There is an opportunity to develop a rehabilitative rather than palliative approach to pain management. Gender specific approaches for female patients should be considered. ORIGINALITY/VALUE: Few studies of CNCP have been conducted within a prison environment.