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Issue In a prison in Scotland, an increasing number of incidents occurred where staff became unwell secondary to potential exposure to novel psychoactive substances (NPS) smoked by prisoners. There were high levels of concern for the safety of individual staff, and for establishment staffing. NPS use is a significant problem in custodial settings, and impacts individuals and establishments. Methods HMP and HPT led an incident response: HMP focused on prevention and direct management of incidents; HPT focused on exposure circumstances, clinical presentation and toxicological testing of symptomatic staff. A protocol was agreed between all agencies involved. Over 8 months, all incidents’ initial assessment and any subsequent clinical and toxicological results were collated and analysed by HPT. Results There were 19 incidents involving 16 staff members. Cases presented in clusters, in one instance 13 people presented over 5 days. Five presented in early 2018. Individuals reported a wide range of non-specific physical and psychological effects; some cases experienced severe impairment of day-to-day function. The most common effects were headache and fatigue but some reported sleep disturbance and confusion lasting up to 72 hrs. There were no significant clinical observations at hospital, and the 3 tests for toxicology were negative. Lessons The individuals affected by these incidents experienced physical and psychological distress, and impairment of daily functioning which impacted on the safe function of the establishment. It is unlikely staff presentations were due to toxicological effects from substances used by prisoners. It is possible their symptoms were psychosomatic. This could be further investigated, and consideration given to supportive intervention for staff affected by exposure to NPS. The investigation demonstrated excellent collaborative work between the prison, health services, and forensic laboratories in a novel investigation into NPS exposure in prisons. Key messages NPS use, and subsequent exposure to staff, is a growing issue in custodial settings. A combination of supportive interventions for staff, including reduction and mitigation of risk of exposure to NPS, plus control of substances use in prisons can help.

An investigation of putative exposure of staff to novel psychoactive substances in a prison