Candidate Number: Pen 1309 Sam Baker Homerton College, University of Cambridge Supervisor: Dr. Ben Crewe An Examination of the Reasons that Prisoners use Spice (Synthetic Cannabinoids) Submitted in part fulfillment of the requirements for the Master’s Degree in Applied Criminology, Penology and Management. Number of words (excluding references): 16128 January 2015 Abstract Synthetic cannabinoids, often referred to as ‘spice’, are a type of drug and a subset of the growing group of new drugs collectively known as ‘New Psychoactive Substances’ or ‘Novel Psychoactive Substances’ (NPS). While a number of such drugs have now been classified under the Misuse of Drugs Act, some remain legal in the community and are often seen as a legal cannabis substitute. Despite their legal status and poor public awareness, there is mounting concern amongst those working with users over the health risks inherent in the use of such drugs. There is also growing concern among those working in prisons over the perceived proliferation of spice use therein. However, as there is almost no research into the use of such drugs in prison, very little is known about their true prevalence and the reasons for their use by prisoners. Practitioners also suggest that there may be factors unique to prisons driving the use of spice by prisoners, particularly the fact that Mandatory Drug Testing (MDT) does not currently detect it. This research examines the prevalence of spice use in one prison (HMP&YOI Rochester) as well as the prisoner’s reasons for using it. It employs a mixed methods research design, including a small number of qualitative interviews, with prisoners who report having taken spice, followed by a wider survey of a sample population of the prison. The research suggests that spice is now the most prolific drug in the research prison. The findings support the suggestion that the failure of Mandatory Drug Testing to detect spice encourages its use, but also suggest that prisoners give comparable weight to a perception that spice use makes time appear to pass more quickly. 1 Acknowledgments I would like to thank my supervisor, Dr. Ben Crewe for his advice and support, both in relation to the course and personally and for his completely unrelated, yet thoroughly enjoyable discourse on scientific method. I would also like to acknowledge all of the academic staff at the Institute of Criminology for their teaching and the administrative staff who made everything on the course run so smoothly. There are many colleagues within the National Offender Management Service with whom I have had discourse that shaped my thinking on this topic. Special credit is due to the Governor and Deputy Governor of HMP&YOI Rochester, Andy Hudson and Dale Abercrombie for their continued support and for encouraging me to undertake this study. Finally, I would like to thank the prisoners who contributed to this study, especially during the qualitative phase. Declarations This thesis is not more than 18,000 words in length (including notes, excluding any relevant appendices and the bibliography). This thesis has not previously been and is not concurrently being, submitted for any purpose other than the M.St. examination. Except as indicated by specific references to, or acknowledgements of other sources, this thesis is my own original work 2 TABLE OF CONTENTS 1 1.1 1.2 1.3 INTRODUCTION About spice Spice in prisons Research questions 4 5 5 2 2.1 2.2 2.3 2.4 2.5 2.6 LITERATURE REVIEW Literature review introduction Spice Risk relating to spice use Drugs in prisons Legality Mandatory Drug Testing (MDT) 7 7 8 9 11 13 3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 RESEARCH METHODS Research questions Research design and methods Phase 1 – Qualitative interviews Development of the survey instrument Phase 2 – Survey Data analysis Other considerations 16 16 19 20 22 24 24 4 4.1 4.2 4.3 4.4 4.5 4.6 4.7 QUALITATIVE RESULTS Participants First experiences of spice Effects of spice Reasons for use Addiction and debt Awareness of risks The impact of being in custody 27 29 30 33 35 38 39 5 5.1 5.2 5.3 5.4 5.5 QUANTITATIVE RESULTS General information Section 2 – Drug use Section 3 – Using spice in prisons Section 4 – About spice Additional comments 41 41 42 44 48 6 6.1 6.2 6.3 6.4 6.5 DISCUSSION To what extent is spice prevalent in prisons? Why do prisoners choose to use spice? Do prisoners understand the potential risks of spice use? Does being in prison have a bearing on the decision to use spice? Is spice use supply or demand driven? 52 54 55 56 57 7 CONCLUSIONS 59 8 BIBLIOGRAPHY 61 9 APPENDIX (SURVEY INSTRUMENT) 64 3 1 – INTRODUCTION 1.1 About spice Synthetic Cannabinoids (often referred to as ‘spice’) are man-made chemical compounds that interact with the cannabinoid receptors in the human brain. These are the same receptors that THC (Tetrahydrocannabinol), the active ingredient of cannabis, interacts with. The chemicals are most often (although not exclusively) sprayed onto dried plant matter and then smoked, creating a common perception that they are a cannabis substitute. Synthetic cannabinoids are a subset of the growing group of new drugs collectively known as ‘New Psychoactive Substances’ or ‘Novel Psychoactive Substances’ (NPS). Since their creation a number of Synthetic Cannabinoids have been regulated and banned in the UK, but manufacturers have been able to synthesise new compounds that circumvent the ban. The products are sold over the Internet or in shops, often under the guise of pot-pouri or incense. Packaging usually warns against human consumption, despite the product’s clearly intended use. ‘Spice’ was the brand name of one such product (there is a suggestion that the name may have been based on a fictional narcotic in the motion picture ‘Dune’). Spice itself is now illegal in the UK, but the name has become widespread as a collective term encompassing all such products and is frequently used as such in academic literature. Throughout this paper, unless otherwise stated, the word ‘spice’ is used as a noun to refer to any product comprised of plant matter that has been sprayed with synthetic cannabinoid receptor agonists, regardless of the marketed brand name. 4 1.2 Spice in prisons Spice is growing in popularity in the community. The number of new substances that have been detected has increased steadily over the last few years. The United Nations Office on Drugs and Crime has reported that synthetic cannabinoids made up 40% of the New Psychoactive Substances reported in Europe. (UNDOC, 2014) They also noted that, in Europe, “While new psychoactive substances prevalence levels remain low, there may be potential for rapid increase in its use among certain subpopulations.” (UNODC, 2013 p3). Although prisons were not one of the subpopulations referred to, they may provide another example of where a new drug finds particular popularity amongst a niche population. Research into spice use in the community (Every-Palmer, 2010, 2011, Mir et al, 2011, Lapoint et al, 2011, Pierre, 2011) is beginning to highlight potential health concerns inherent in spice use and these risks may transfer into the custodial setting. There is also a possibility that the custodial setting itself may have a bearing on decisions to use spice. As previously mentioned, spice is not detected by Mandatory Drug Testing. As it is also cheap and easy to purchase, often legally, it may also be attractive to those involved in the trafficking of drugs into prison. In his 2013-2014 annual report, HM Chief Inspector of Prisons, Nick Hardwick, reported that spice use was cited as a concern in 37% of the adult male prisons inspected that year. (HMIP, 2014) 1.3 Research questions The questions that this research aims to answer are ‘To what extent is spice prevalent in prisons?’ and ‘Why do prisoners choose to use spice?’ It also explores the secondary questions 5 ‘Do prisoners understand the potential risks of spice use?’ and ‘Does being in prison have a bearing on the decision to use spice? 6 2 – LITERATURE REVIEW 2.1 Literature review introduction There is a body of literature on the use of drugs in prison, but spice is a relatively new phenomenon and, while there is emerging literature available on its use in the community, the same is not true for its use in custody. While there may indeed by some common motivators for spice use across different settings, there are some factors unique to the custodial setting that may have a bearing on its use therein. While the evidence base is not yet extensive, there is mounting evidence that spice use may have significant health risks over and above those presented by cannabis. In this literature review, I first explore some of the technical literature regarding spice and its mode of operation as well as some of the reasons for it use and popularity in the wider community, before exploring literature regarding potential risks associated with its use. I then explore some literature regarding drugs more generally in prisons, before looking at the legality of spice and, finally, potential links with drug testing. 2.2 Spice Spice is sometimes called ‘synthetic cannabis’, but this is not technically correct, as the psychoactive ingredient is not a copy of Tetrahydrocannabinol (THC) found in cannabis. Instead, spice contains one or more alternative compounds that react with the same cannabinoid receptors in the brain. Such compounds can be more potent than THC and may possibly combine with receptors in a different way (Huffman & Padgett, 2005, Atwood et al, 2011). Indeed, there is evidence that whereas THC is a partial agonist of the cannabinoid receptors, spice compounds are generally full agonists, which means that the effects can be longer lasting and negative effects more severe (Atwood et al, 2011). 7 Fattore & Fratta (2011) suggest a number of reasons that may explain the growing popularity of spice in the wider community. Firstly, it produces psychoactive effects that have been reported as similar to, or stronger than, cannabis (consistent with its higher potency). Secondly it is legal (although, as explained later, that could be debatable). Thirdly it is easily available and attractively marketed. Fourthly, it may be perceived by users as safer and, finally, it is not easily detected in urine and blood tests. Vandrey et al (2012) carried out an Internet survey, to which 168 spice users responded. The following reasons were given for use: curiosity (78%), liking effects (58%) and relaxation (48%). 30% of the respondents endorsed using spice to avoid drug test detection. 14% believed that the fact that the products are sold in stores must mean they were safe for human use. 2.3 Risks relating to spice use The potential belief by users that spice is safe is worth exploring here as there is a growing volume of evidence that suggests that this may not be the case. There are increasing reports of spice-linked psychosis. For example Every-Palmer (2010) reported the mental states of five patients significantly worsening after spice use, before carrying out an exploratory study of fifteen patients (2011). She concluded that “Almost nothing is known about the pharmacology and toxicology of compounds such as JWH-018, however, it seems that they can cause psychosis in vulnerable individuals” (Every-Palmer, 2011:156). Similarly, Hurst et al (2011) reported ten cases of new onset psychosis in patients who had smoked spice. These examples are also cited alongside five others by Pierre (2011:56) who suggested that “collectively, these reports suggest that synthetic cannabinoid intoxication is associated with acute psychosis as well as exacerbations of previously stable psychotic disorders, and also may have a propensity to trigger a chronic psychotic disorder among vulnerable individuals”. 8 Furthermore, Zuardi et al (2006) noted that, while THC in cannabis can cause anxiety and psychosis type symptoms, cannabis also contains a substance called cannabidiol, which has an anti-psychotic effect (indeed this compound is showing promise for the treatment of schizophrenia). Fattore & Fratta (2011) point out that the absence of cannabidiol in spice could increase the psychosis risk. Fattore & Fratta (2011) also summarised evidence of a number of other negative effects of spice including dependence, emotional alterations and cognitive deficits. In addition to this they also highlight instances of nausea, as well as extreme pulse rates, blood pressure and cardiac ischemia, which are potentially fatal. There is further literature that points to a possible cardiac risk associated with spice use. One report lists three case studies of otherwise healthy teenage males who presented with myocardial infarction in the days after using a synthetic cannabinoid. Myocardial infarction is very rare in this age group and a link with synthetic cannabinoid use is suggested. (Mir et al, 2011) Another report concerns the case of an adult male who ingested a powder and suffered seizures and supraventricular tachycardia. The powder was analysed and found to contain a synthetic cannabinoid. (Lapoint et al, 2011). There have been examples of prisoners being treated in hospital, for example, a recent news article reported that three prisoners were hospitalised from HMP Dartmoor after taking a legal high (BBC, 2014). 2.4 Drugs in prisons Drug use in prisons can differ from use in the community, or at least has some additional dimensions. The custodial setting can, depending on circumstances, either promote or deter drug use. Wheatley (2007) summarises various explanatory models for drug use in prison. In 9 the ‘self medication’ model, prisoners may use drugs to deal with various ailments, some of which (eg depression, sleep deprivation) can be exacerbated by imprisonment. In the ‘time management’ model, drug use is used to either pass or ‘manage’ time. Cope (2003) examined the relationship between time and prisoner drug use, exploring the way that prisoners used drugs as a means to manage time. She argues that custody can change perceptions of time. Time is normally in the background, but “When the control of time becomes more overt and oppressive, the experience of time moves from ‘practical’ to ‘discursive’ consciousness and becomes the explicit focus of attention” (p163). Furthermore, Cope argues that prisoners suspend time – they consider that time spent in prison is not part of their life which will resume on release. It therefore becomes important to be able to exercise some control over time in prison and using cannabis was a way to achieve this (by promoting sleep). She notes the important point that this effectively changes the focus of users drug use, as outside, cannabis was not primarily used for its sedative qualities. In the ‘social network’ model, involvement in the networks that are necessary for drug misuse provide a sense of belonging and connection for prisoners which counters the sense of isolation inherent in custody. Mjaland (2014) examined relationships between drug users in a Norwegian prison and reported on a culture of sharing. In effect, prisoners would gift drugs to each other in the hope of reciprocation and thus drug supply was less market orientated than has been reported elsewhere (Wheatley, 2007, Crewe, 2005). Such actions served to form tighter social bonds between users. Mjaland acknowledges that such practice may be unique to the circumstances in the particular prison studied, but argues it is too simplistic to just consider it the result of ‘exceptional’ prison conditions. 10 In describing the ‘status’ model, Wheatley (2007) refers to Preble & Casey (1969), who suggest that drug users gain status and satisfaction from involvement in drug acquisition. However, this work is exploring drug misuse in the context of the streets of New York, not prisons. To some extent this appears at odds with Crewe (2005) who, looking at drug use in prisons specifically, found a more stigmatised view of drug users (although in this context it was heroin use that was being studied and he did highlight the perceived distinction between those who believed they controlled their drug use and addicts). Crewe (2005) instead found status afforded to those who dealt or controlled the drugs (as long as they were well enough connected to hold onto them) This leads into the ‘economic’ model, which Wheatley (2007) concedes is more a model to explain drug supply than drug use in that it describes the power and social status afforded by the control and financial power inherent in arranging the supply of drugs. 2.5 Legality Spice or synthetic cannabinoids is one category of substances, which along with a number of other substances, are often referred to as ‘legal highs’. Some organisations working to minimise harm or address substance misuse prefer the formal term ‘New (or novel) Psychoactive Substances’ (NPS) as there is an argument that the term ‘legal highs’ carries some false suggestion of safety. This said, the concept of legality is worth exploring further. Griffiths et al (2010) point out the difficulty that these substances present to authorities, highlighting the “difficult question for policy makers, both practically and morally, of whether ‘Spice’ should be addressed as a consumer protection or drug control issue” (p952) and noting “That this type of product falls into a grey area between commercial products, medicines and illicit substances also meant that there was a lack of clarity regarding which 11 agencies should take responsibility for this issue” (p952). Despite these difficulties, attempts to control spice have been taken in the UK and this legislation combined with some available research findings provides a challenge to the technical accuracy of the term ‘legal high’. The Misuse of Drugs Act Amendment Order 2009 classified a number of compounds used in varieties of spice, as well as any compound structurally derived from them, as class B controlled drugs. Alternative synthetic cannabinoid receptor agonists that do not meet this definition are used in spice products that are legally available in the UK. Dargan et al (2011) analysed a number of spice products, which they purchased both before and after the legislation change. Of 20 products purchased after the ban, they found that 17 contained a classified (illegal) agonist. While 7 products contained an unclassified and therefore legal agonist, all of these also contained classified agonists as well. In 3 products, no agonist was detected (so arguably they should not be defined as spice). A similar study by Brandt et al (2010), which focussed on ‘legal highs’ other than spice found 70% of samples still contained illegal agonists. It seems, therefore, that products sold as ‘legal highs’ may often actually be illegal, although it is certainly possible to produce ‘legal’ spice. It follows that purchasers of spice products sold in the UK, may not be buying what they intended to purchase and may, in fact, be committing an offence. What this really highlights is the extent that different spice products vary and how difficult it is to determine exactly what products contain and hence their legal status. It also highlights some of the challenges facing lawmakers as they attempt to regulate these new substances, which are adapting all the time. Griffiths et al (2010, p953) summarise this succinctly: The speed and sophistication of innovation in this area is impressive and also serves to 12 highlight the sluggishness and clumsiness of most attempts at control. ‘Spice’ itself may be a transient product, but it provides an excellent case study of how the globally connected world in which we now live is challenging existing models of drug control. 2.6 Mandatory Drug Testing (MDT) Regardless of the legal position of spice outside of prisons, it is an unauthorised article in prison. As such, being caught in possession of it renders a prisoner liable to punishment under the prison disciplinary (adjudications) process. However, for most prisoners using drugs, it is not being caught in possession, but rather the risk of being detected via drug testing that presents the greatest risk of punitive sanction. Prisoners are subject to mandatory drug testing (MDT) which includes random as well as suspicion testing of urine. These tests detect the use of illicit drugs and a positive result leads to disciplinary sanction and punishment. Spice, and other new substances are not currently detected by MDT testing. Practitioners have suggested that prisoners may be choosing to use spice, as opposed to cannabis, as MDT does not detect it. If this is the case, then, combined with the evidence that spice use carries more risk, current drug reduction strategies may actually be increasing risk of harm. When mandatory drug testing was first introduced into prisons, there was a suggestion that it may encourage the use of harder drugs such as heroin as opposed to cannabis. This was because cannabis use can be detected in urine for considerably longer periods than heroin and therefore it was argued that heroin use was less likely to result in detection. In a survey of prisoners Singleton et al (2005) found some prisoners reporting this, although Edgar & O’Donnell (1998, p39) had previously found that mandatory drug testing had had a significant 13 impact in reducing drug use in prisons and that “this was achieved - against many people’s expectations- without evidence of a major shift to the use of heroin”. Of course there are significant differences between the idea that the MDT process encourages heroin use and the idea that it may encourage spice use. Firstly, Edgar & O’Donnell’s (1998) finding leaves room for the existence of some “shift” toward heroin, but the significant reduction in drug use overall countered this. MDT does not detect spice, but does detect heroin (and other opiates), so there is no deterrence effect at all, as opposed to a reduced one. Cope (2003) had noted that the risk of MDT and subsequent sanction was a factor that countered the perceived benefits of drug taking amongst the young offenders she studied. It is possible that this effect might be removed if the sanctions were absent altogether. Secondly there is a possibility that users may see spice as more ‘interchangeable’ with cannabis than heroin (in that it is an apparently herbal substance that often has a similar mode of operation and is marketed as a cannabis substitute). Perhaps this factor would also render spice use less stigmatic than Crewe (2005) found heroin use. There is literature that considers the effect of drug testing on decisions to use spice in the wider community. Fattore & Fratta (2011) have suggested the fact that spice is not easily detected as a potential reason for the popularity of spice in the community, but also suggest that “wherever drug screening is routinely performed to guarantee abstinence from drugs (i.e., hospital or institutions carrying out detoxification, forensic psychiatric centres), people can be motivated to substitute cannabis with Spice products” (p4). Perone et al (2013) carried out a study that included qualitative interviews of twenty five spice users, finding that most sought a legal cannabis alternative to avoid drug screening and criminal sanctions and, as I previously mentioned, Vandrey et al (2012) produced findings that showed users endorsing spice use to evade drug testing. The available literature suggests, therefore, the possibility 14 that the fact that mandatory drug testing does not currently detect spice might encourage prisoners to use it as an alternative to other drugs. 15 3 – RESEARCH METHODS 3.1 Research questions The primary questions that this research aims to answer are ‘To what extent is spice prevalent in prisons?’ and ‘Why do prisoners choose to use spice?’. It also aims to answer secondary questions including ‘Do prisoners understand the potential risks of spice use?’ and ‘Does being in prison have a bearing on the decision to use spice?’ Given that very little is known about the use of spice in prisons, it is important to acknowledge the exploratory nature of this work. It has already been mentioned that practitioners believe that the lack of detection by mandatory drug testing is a key reason for the popularity of spice. Research that indirectly supports this view was presented in the literature review. This did appear to present the opportunity to form a hypothesis, however this was considered to be inappropriate as it would focus emphasis on one possible reason for spice use at the possible detriment of the proper consideration of others. As the work is exploratory, a hypothesis has not been formed. 3.2 Research Design and Methods Given the exploratory nature of this research, the initial consideration was that a flexible qualitative research design would be appropriate. The advantage of a qualitative approach is that it allows exploratory and open questions to be asked of participants, without the need for presumptions to be made about relatively unknown topics. Bachman & Schutt (2007) highlight that qualitative research has “a focus on previously unstudied processes and unanticipated phenomena” (p259). A qualitative approach also allows for more depth as 16 questions can be expanded upon and new ideas and concepts explored, or as Creswell (2003, p 181) puts it “The research questions may change and be refined as the inquirer learns what to ask and to whom it should be asked”. However, while a qualitative approach would have lent itself to exploratory work, it was considered that in this particular application it would have had a number of key limitations. Firstly, there would have been a need to identify and secure the participation of enough individuals to ensure the results had validity. It is likely to have proven difficult to recruit a suitable number of candidates within the time constraints of the study. Indeed experience in recruiting participants in the final method established this would have been the case as the number of prisoners that could be identified as having used spice, who were willing to participate was barely enough to meet the reduced requirement for that method. In addition, while a purely qualitative approach may have provided depth, I was also concerned about the generalizability of findings from the small sample size. Finally, I was concerned that identifying prisoners who had used spice would limit the sampling to those who had either been caught in possession of it, or who had suffered ill effects to the extent that prison staff had become aware of their drug use. This may have limited the sample to those who had a more negative perception of spice use and exclude those who had positive experiences or who had suffered no ill effect. While it would have been possible to advertise for participants, the response rate would have been unpredictable and again, certain groups (such as those whose spice use had so far been undetected by the prison authorities) might have been underrepresented. Consideration was also given to a quantitative approach, carrying out a survey of prisoners. This would have allowed for a much larger sample size to be used, within the available time constraints, affording greater confidence in the generalizability of results (Bachman & Schutt, 17 2007). Survey research would also allow for the anonymity of respondents, which might make them more likely to disclose information about illicit drug use. Anonymous surveys are preferable when asking about threatening topics (Neuman & Wiegand, 2000). However, the difficultly with this approach, on its own, is that it would have required the formulation of a suitable survey instrument to research a relatively unknown phenomenon. While it would be possible to draft a survey instrument, given the exploratory nature of the work, there would have been a significant risk that there would be factors involved in spice use that were unknown and therefore not given proper consideration in the survey. In an attempt to draw on the strengths and mitigate the drawbacks inherent in both quantitative and qualitative approaches, the method deployed was a mixed methods approach - specifically an exploratory sequential design (Creswell, 2003, Creswell & Plano Clark, 2007). In this model an initial qualitative study is used to inform a second quantitative survey phase. Creswell & Plano Clark (2007, p75) suggest that this model may be appropriate when “measures or instruments are not available, the variables are unknown, or there is no guiding framework or theory” and that “this design is particularly useful when a researcher needs to develop and test an instrument”. Both of these points are particularly applicable and it was considered that this method provided the best solution for answering the research questions. It allowed for the initial qualitative phase to probe and establish potential (and, at that point, unknown) factors and for the results of this phase to inform the survey instrument used. It therefore allowed for the strengths of both qualitative and quantitative research to be drawn upon. 18 3.3 Phase 1 – Qualitative Interviews In the initial qualitative phase, Prisoners who were already known to have used spice in prison were interviewed. During the course of his occupation the researcher became aware of these individuals and approached them to seek their participation. It was possible to secure the participation of four such prisoners. In each case, to ensure fully informed consent was secured, an information sheet about the research was provided and the researcher also talked this through with each participant. Participants also signed a consent form prior to their interview. The interviews were carried out in a private room and in all cases the interviews were recorded with participant consent. During the interviews questions were asked in a semi-structured way that focussed on the key areas of drug use and spice use in particular, but that allowed participants to expand on answers and add ideas through open discussion. The interviews were transcribed in full. Some potential reasons for taking spice have previously been identified and mentioned in the literature review (Fattore & Fratta, 2011), and these were used along with practitioner knowledge to develop an initial draft of a survey instrument. While, for the reasons previously mentioned, this was not expected to be fully fit for purpose, the participants of the qualitative phase were asked to pilot it and comment on its suitability to further inform the final instrument. The results of this phase were threefold. Firstly, the potential reasons for spice use were extracted from the data. Secondly, the pilot survey comments were collated and, thirdly, the qualitative results were treated as an independent source of relevant data. The first and second of these will be explored in this chapter as these results formed part of the 19 methodology rather than data intended to answer the research questions. The exploration of the data in its own right is presented in the results chapter. 3.4 Development of the Survey Instrument As previously mentioned an initial draft instrument was piloted on the qualitative interview participants. It included general demographic questions (age and ethnicity) as well as some background questions on the use of drugs in general, both inside and outside of prison. For those who reported using spice in prison it explored the importance of a number of factors (which were developed from the theoretical/hypothetical reasons previously mentioned), before asking the respondent to identify the single most important factor in choosing to use spice. Final questions asked for the respondent’s views on the safety of spice and whether they would still have chosen to use spice had they not been in prison. This section was designed to allow for comparison with some existing findings with regards to views on safety from research of the general population. (Fattore & Fratta, 2011, Vandrey et al, 2012) It also explored the effect that imprisonment was having on drug use decisions. In the draft survey, the question that asked about the relative importance of the reasons for using spice presented them in a table format Likert scale format with the reasons along one axis and relative importance along the other. Respondents were expected to tick the corresponding box. All four pilot participants experienced difficulty in understanding this concept. Other than this point, and the fact that it missed some variables (see below), all four found the survey straightforward. From the qualitative phase, three potential reasons for spice use were identified that had not been considered and included in the draft survey. The first was that it was addictive (this may 20 seem an obvious point, but it had been missed). The second was that spice may be used to make time pass quicker. Reflection on this concept led to the work of Cope (2003), which is mentioned in the literature review. Finally, spice was considered to be attractive, compared to other drugs, as it does not have a strong smell (and is therefore less likely to attract the attention of prison staff). The most fundamental question in the survey was the one that asked the relative importance of each reason for using spice in prison. The three new reasons were added to this question. Consideration was given to asking this question of all respondents, regardless of whether they reported using spice or not by asking why ‘prisoners choose to use spice’. This would allow for subsequent analysis that differentiated between users opinions on why prisoners used spice as opposed to non-users. The rationale here was that the views of other non-user prisoners may be well-informed and constitute valuable data. However the data collected from users would be less credible than if a purer “why do you choose to use spice” question was asked (including both questions and asking participants to answer one only was considered too complex). Ultimately the latter “why do you choose to use spice” question was included and non-users asked to skip to the next section. In response to the pilot feedback, the structure of the question was changed to remove the table format and present each reason as a statement (eg I used spice because it is relaxing) with a five point Likert scale next to each. This question allowed for the relative importance of each reason for spice use to be determined, but it also allowed for multiple results to be given the same weight. For example, if the majority feel that the ‘legal’ and ‘cheap’ factors were very important, it may mask the fact that almost all feel that ‘legal’ is the most important. As a result a second question presented the reasons again and asked respondents to pick the most important. This second question was asked of all respondents in the less pure “what is the most important reason for prisoners using spice”. This allowed for non-users views to be collected, with the assumption 21 that users will give the reason most important to them unless they have good grounds to think there is a stronger one that applies to ‘prisoners’ in general (in such cases it is argued this view would likely be well informed). The section of the survey that focused on safety was also refined. Questions were added to ask for views on safety comparing spice to heroin and cannabis and also asking respondents for views on its addictiveness. The qualitative phase revealed prisoners using the term ‘rice attack’ (rice being an alternative word for spice) to describe having fits and/or loss of consciousness following spice use. Questions were added that asked whether respondents were familiar with this term and whether they had witnessed anyone suffer a ‘rice attack’. A free text box asking if there was anything else respondents would like to say was added at the end of the survey. Finally a question was added to the general information section asking about offence type to allow for any correlation between spice use and offence types to be considered. 3.5 Phase 2 –Survey The quantitative phase survey was conducted in classrooms and activity areas within the prison. The survey was distributed to prisoners by teachers/instructors who had been given a briefing on the research method and aims. This allowed for groups of prisoners to be addressed in person and given an explanation of what the research was about before asking for their assistance in completing the survey, help was available from teachers for those who needed literacy support. Consideration had been given to seeking a wider sample size, distributing the survey to all prisoners in the establishment and asking them to return it via the internal mail (akin to a postal survey). While this method would be less time intensive and the addressed sample more representative of the establishment population, the expectation was that it would 22 provide a much lower response rate. (Bachman & Schutt, 2011, p238). The chosen method should still address a broadly representative sample (classes and activities are comprise prisoners drawn from across the population, with no significant defining characteristics), but with a much higher response rate (as surveys would be issued in a class setting, with encouragement to participate and no other concurrent activities to distract participants from doing so). While both may have provided a similar volume of data, the data from a high response from a broadly representative method is preferable to a low response from a truly representative sample. To quote Black (1999:134) “to justify external validity, there will be a need to counter criticism of non-responses by providing evidence that any non-response has nothing to do with the research or the instruments”. Given that the subject matter of this research is a sensitive topic, it is possible that a low response rate would skew the data significantly (see also Fowler, 2002, Chapter 3). This is why an approach that sought to maximise the response rate was chosen. The survey included an information sheet that explained the purpose of the research and that participation was entirely voluntary. It also provided assurance that the survey was anonymous and re-assurance on this point was provided by teachers. Despite this, there were occasions where prisoners voiced concerns that the aim was to identify them via DNA or finger prints on the surveys and they discouraged others in the class from participating. There were other prisoners who perceived participation as ‘grassing’ (informing on others) and they discouraged others too. The influence that such prisoners could exert on their class was found to be substantial. The survey was made available to approximately 130 prisoners and 67 responses were secured. It was originally hoped that 100 responses would be secured. Because of this a decision was taken to approach other prisoners outside the classroom setting who were employed as cleaners and ask them to complete the survey. This group of prisoners were deemed similarly representative of the population. 34 further responses were 23 secured for a total of 101. To test validity of the sample the two batches were compared to one another with regard to the numbers of respondents reporting spice use in prison, spice use in the research prison and current spice use. There was not a significant difference between the batches. 3.6 Data Analysis As previously mentioned, the qualitative interview data was analysed to identify any potential reasons for choosing to use spice and to ensure that these were included in the survey instrument. The data that was collected by the survey comprised a variety of data types, including nominal, ordinal and scale data. Some of this data was meaningful when simply presented as raw percentages and is presented as such in the results section. The data was also analysed using the SPSS (Statistical Package for the Social Sciences) software. Qualitative interview data is also presented in the form of narratives or stories that afford the opportunity to understand the background and insights of some spice users. Qualitative results are also referred to in the discussion section where they are relevant to the quantitative results. 3.7 Other Considerations The researcher is an operational manager in HM Prison Service, who was in the post of Head of Residence and Services at HMP/YOI Rochester at the time of the research. The research was undertaken at HMP/YOI Rochester and the disadvantages of carrying out research in the prison the researcher was employed in were weighed against the benefits of doing so. The researcher did not have the authority to authorise research at HMP Rochester - this lay with the Governor, so there was no conflict of interest in this respect. As a senior manager in the 24 prison, the researcher was known to many of those he was seeking to interview or survey. There was a risk that it would be difficult for prisoners to disassociate him from his usual role and that this would make it more difficult for them to trust him. This was more applicable in the qualitative phase, as it was mitigated in the quantitative phase by using an anonymous survey. Despite this concern, the interviewees were very open and articulate and keen to tell their story. The research model required that the researcher identify and approach known or suspected users of spice. It may not have been appropriate or permitted for the researcher to access intelligence systems to do this and he therefore relied on his own local knowledge of prisoners to identify potential participants for the qualitative phase (something that was best achieved on an ad-hoc basis as opportunity arose during the researchers duties). Care was taken to ensure that potential participants understood that there was no obligation to participate. As the method deployed a survey in activity areas of the prison it required some support and co-operation from staff to support the logistics of this and, while it would have been possible to have secured this elsewhere, it was more easily secured at HMP/YOI Rochester. Practitioners believe that spice use is quite prevalent at HMP/YOI Rochester. This has both positive and negative consequences for the research. On the positive side it has influenced the decision to carry out the study at Rochester as, if this belief is substantiated by the empirical findings, it increases the probability that the research will collect good quality data on the reasons for spice use. However, if spice is particularly prevalent in the prison it may be difficult to draw general conclusions on prevalence in prisons in general. This limitation is inherent in carrying out the research in one site. Factors such as location and effectiveness of local security and drug reduction measures may all impact on supply and demand for drugs in 25 individual prisons. By way of example, Edgar & O’Donnell (1998) found significant differences in levels of drug use between prisons. This could only really be mitigated by carrying out research on a larger scale, but this is not within the scope of the resources available. With this limitation aside, the results of the research that relate to the reasons for spice use should be generalisable to the wider population of the prison estate. The majority of the reasons being considered are constant across establishments (with the exception of the availability of supply). It is therefore argued that if the sample is of sufficient size it should be generalisable, certainly to prisons with similar demographics (however it is worth noting that the sample will necessarily exclude some key categories of prisoners, such as women for example). Aside from the standard concerns with regards to informed consent, confidentiality and anonymity, there is an additional ethical consideration of note. The nature of the research meant that the data collected would ordinarily be considered security/intelligence material and this required clarity on how it would be handled. Interview participants were advised in writing that any information they provide about their use of controlled drugs would not be disclosed and all such information would be kept confidential and only used in an anonymised way. It was also made clear that if they disclosed information on crime other than drug use then this might be disclosed. This was made explicit on the consent form that was used for the interviews. This consideration was not so relevant for the quantitative phase as the survey was anonymous and did not ask questions that were likely to gather collateral information. Drug use may also be a sensitive topic and it was possible that it might have invoked an emotive response in participants. Information was provided in writing about avenues of support available for drug dependence. 26 4 - QUALITATIVE RESULTS This chapter presents the results of the qualitative interviews. Four prisoners were interviewed and, while the primary purpose of this phase of the research was to inform the survey instrument, the interviews did provide an interesting perspective on the spice phenomenon as well as a source of data that was relevant in its own right. 4.1 Participants There were four participants. Benny was in his mid-twenties. He had first used cannabis at age 12 and had progressed to amphetamines and cocaine at 14. He later progressed to crack and heroin. Benny gave an account of how his drug use had originally been a social activity where the objective was to feel good and to seek the ‘high’, but that by the age of 18 he was taking drugs alone and saw this as an escape from reality. He described his low self-esteem and considered himself to be somewhat weak, but said that drugs made him feel stronger and he became ‘someone who can look after themselves’: I mean I’m not afraid of consequences, but when I am sober all I’ve got is consequences and I don’t care, about looking like a wuss. I’ve done so many things when I’m drunk, I’ve never been arrested sober or un-intoxicated. But yeah, so I’m two different people, Jekyll and Hyde. But the lifestyle that I live, typical council estate, drinking and pub brawls sort of thing, that’s the person I have to be to survive. Benny was serving his third custodial term and believed that his drug use was a primary factor in his offending. He said that on previous sentences he had been very successful in 27 abstaining from drugs and “coming out looking a million dollars, ready for the world, with no habits”. Stewart was in his late twenties. He had first used cannabis at age 11. By adulthood he was addicted to heroin and had experience of cocaine, crack cocaine, ecstasy, and amphetamines. Stewart described a bad upbringing and childhood that he wanted to forget as the main reason for his use of drugs saying that drugs ‘put a little marker in your head, if you like, to block out bad stuff and that’. Stewart said that a lack of external support combined with his drug addiction were the principal reasons for his offending, which was mainly acquisitive crime. He was two years into his eleventh custodial sentence and had been in a number of prisons. Leonard was in his mid-thirties. He had first used cannabis in his early teens and had progressed to heroin and crack cocaine at 16. He described these as his drugs of choice outside and recounted how he followed a cycle of addiction and crime to feed his drug use. He had been in and out of prison since he was 15 and said that each time he came to prison he was able to get himself off drugs, but that on release he would start using again. Leonard told how he used drugs to take away the pain of his childhood and to forget about things. Leonard had extensive experience with drugs including ecstasy, crack cocaine, heroin, cocaine, Subutex, and Valium. John was in his early twenties. He described how he had been exposed to drugs at a very young age and recalled memories of smoking drugs with his father when he was seven or eight years old. He described how he stopped using drugs when he started secondary school and that he became a promising athlete before using cannabis at the end of secondary school. He said ‘gradually, over time like, it lured me in and yeah it’s taken everything away, messing 28 everything up’. John described how he then experimented with most drugs, but always avoided heroin and crack cocaine as he had seen the harmful effects of these drugs during his childhood. He described his reason for drug use in general was that it made him ‘feel a little bit different for a period of time. That difference makes you feel, it’s just enough to break it down a bit and just take away that reality’ However he also said that at times he took drugs as a ’social thing’, because he was bored or because he ‘just wanted to’. John was serving his third custodial sentence and had been seven prisons, three of them on this sentence. 4.2 First experiences of spice Participants were asked about when they had first come into contact with spice. Despite his extensive history of drug use, Benny said that had not even heard of spice until he was in prison on his current sentence. He had some personal issues that were upsetting him and was in “self-destruct mode” and felt “it don’t show on your MDT, who is going to know, I can afford this time”. Stewart had first tried spice at Rochester. Although he had heard of it before, he had been dissuaded from using it by its legal status: It just didn’t really appeal to me because I didn’t think it would do nothing to you because if they are selling it in shops and stuff then surely there’s got to be someway its ok. Like, coz, I didn’t really think, like it would do much to you, so it didn’t really appeal to me. It would just be safety cannabis in a way. Describing his first use of spice, Stewart said it was ‘just there’ and he was offered a free go and as it is not detected on drug tests he felt there was no reason not to try it. 29 Like Benny, Leonard had also not even heard of spice until he was in prison on his current sentence where he encountered it at HMP Guys Marsh. He initially took it out of curiosity but reported an unpleasant initial experience, saying ‘it sent my head do-lally to be honest with you’. John had been at Rochester for a couple of years and first came across spice there. He also reported an initial curiosity being behind his first use. 4.3 Effects of spice Describing the effects of spice, Benny reported an initial effect of heart racing (tachycardia is a commonly reported side effect of spice use) and a sense of paranoia, both of which he described as unpleasant. He described the effects as very intense with a very quick onset. While the paranoia remained, the other effects would mellow and begin to feel similar to being ‘stoned’ on cannabis. He also described a sense of losing 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 Stewart explained that when he first used spice it had made him paranoid and that ‘it very nearly drove me insane’. However, he explained that he quickly built a tolerance to the paranoia effect, but that this tolerance meant the effects only lasted 20 minutes before you needed to ‘top up’, as opposed to 45 minutes when he first started using it. Stewart also reported other side-effects such as coughing up blood, memory loss and indigestion. He also reported occasions where he had been rendered unconscious and that on one of these he had 30 been taken to hospital by ambulance. He explained that, on this occasion, he had taken spice through a pipe, as he did not have access to tobacco and his next recollection was coming round in hospital. He explained that this was what prisoners referred to as a ‘rice attack’, albeit a particularly bad one. He explained that such episodes are fairly common and that he had experienced a few personally. Stuart explained that these ‘rice attacks’ usually consisted of fainting and sometimes convulsions, but that that they usually passed in a minute or so. Stewart also explained that there were positive effects from spice use, including a mellow feeling and increased sociability. Despite an initial bad experience, Leonard smoked spice on two other occasions. He described one of these experiences as follows: When I’ve smoked spice, it makes my head think silly things. It’s a very weird drug, it can make you paranoid. I’ve had it before and I’ve laid in the bed and I’m thinking I’m going to have a heart attack, thinking I can’t breathe and things like that. People think it is a good thing that you’re smoking it all the time, but I think it’s very dangerous. Leonard also described how he witnessed a friend using spice: I got a good friend on another wing and he was smoking it all the time and I’ve walked into his cell when he has been in there with three, four people and they’re all smoking it and I’ve looked at them all. He couldn’t even look at me, coz he’s that out of his face and he is, like, as white a ghost. I’ve just looked at them all in the cell and I’ve just shook my head at them and thought do you know what, I can’t be doing with all that and just walked off. 31 John gave a vivid account of the effects of spice use and also described how they can be quite variable: The first two minutes can be really intense, but the thing is with spice, there are loads of different brands but even if you have that one type of spice every time that you smoke, a joint can just have different effects, do you know what I’m saying? Every time you smoke a joint it’s getting you high like a way that you have never been high before. When you smoke it there’s always like that thing that you’re thinking about ‘right, how is this one going to hit me’, they are all different when you smoke it. It’s always as intense but they’re different. They do hit you differently. Some of them it’s like an electronic buzz you can literally feel it in your body like. You can’t move, sometimes it’s like something is trying to come out of you and you can’t control it, like you literally have no control over your body. I had a couple a dreg of a little one like, I think. John was able to give a very vivid account of a bad experience he had using spice: I had a couple a drags one called Exodus and one called Pandora’s Box but I only had one tobacco, just one roll up. Normally the amount of spice that I had two drags probably about, I don’t know 0.1 or 2 grams because it’s really light stuff. But I mixed them both together with one roll up and I smoked it and then I turned over to go to sleep, but what must have happened is I must have got up and then looked in the mirror but then I subconsciously woke up. So when I woke up I woke up looking in the mirror and straight away as soon as I woke up its like I went crazy, I went mad. I started screaming and shouting because for the first couple of seconds I didn’t understand why I woke up looking in the mirror. I didn’t know that I fell asleep it’s only later on when I found out. As soon as 32 I looked in the mirror, I woke up looking in the mirror, I started having black outs and I was just waking up in different parts of the cell and before I could scream and shout bang I was gone again. It felt like I was gone for hours, felt like I was missing for hours, I didn’t know where I was. It’s quite scary and I ended up banging on the wall. I was calling my next door and I was telling him to press the bell for me because I couldn’t, I couldn’t do nothing. He managed to do it and I got up and I was like looking in the mirror and I thought it was someone else. I didn’t know it was me, I thought it was someone else and it just, it proper messed with my head and I was thinking to myself like I’m going get sectioned. I didn’t think I was coming back, I was thinking wow this is it, I’m gonna die in a prison cell. I was just lost and I just forgot who I was and I was scared, I knew the people around me and I think where I was in the cell I was just closed in like it was just too much, it was way too much. It felt like an out of body experience but I was awake. It was really scary you know, for me, I don’t remember the last time I cried apart from when my mum passed away last Christmas, before then I hadn’t cried in about four or five years, so I’m quite a strong guy like, it takes a lot to break me, always been very mental strong through things that I’ve seen. But this one episode it was too much, way too much like literally didn’t know who I was, didn’t think I was coming back. I’m not the only person that has felt like that, loads of people always feel like it but the craziest thing about this spice thing is. It doesn’t stop you from doing it. It just don’t stop you, don’t matter how bad it can be. 4.4 Reasons for use: When talking about their reasons for using spice, some common themes emerged. Benny considered the risk of Mandatory Drug Testing a big deterrent that supported his previous abstinence from drugs in custody. He cited the fact that spice is not detected by MDT 33 and that it is cheap as his main motivations for using it. Stewart reinforced the importance of MDT in the decision making process of others: ‘they say spice on this hand, no drug test, no worries, or weed stinking out the whole landing and MDT in the morning and then extra days. You’re gonna choose the spice init, so that‘s why people do it.’ Referring to his own use of spice, Leonard thought that curiosity and peer pressure had been his key motivators, but felt that for others, ease of purchase, low cost and lack of detection by mandatory drug testing would be the main reasons for use. John also agreed that lack of detection on MDT had been a factor in his decision to use it. Stewart had used spice over a protracted period and explained how it made time go quicker. ‘That’s why I have smoked it for as long as I have, because literally, I don’t even know where my sentence has gone.’ He said that this was a reason that a lot of prisoners took spice to ‘make their time hurry up so they don’t notice it’. He said ‘time stays the same, the clock ticks the same, when you are on that stuff it feels like it don’t, it just jumps and another hours gone and another hours gone and even in your cell you’d smoke it till you go to sleep and then you wake up and ‘where was yesterday?’’. This concept of time compression was also reported by John who explained that he chose to use spice as it was as a ‘bird killer’, that is that it made his prison sentence pass quickly. Stewart also described the appeal of having something illicit that the authorities could not stop: ‘it’s basically laughing at the govs [Officers], like they can’t control it, they can’t smell it, so it’s your own and no-one can take it away from you. It’s something that you have bought, you possess, its wrong, but nothing in a way can be done about it’. With regards to the availability of spice he said ‘It’s one of the easiest things to get, it’s easier than a burn to get in here, it’s literally easier than a roll up’. 34 4.5 Addiction and Debt Benny explained that, following his initial experiences with spice, he subsequently developed an addiction to spice: 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. In terms of drugs, I found it was as addictive as crack cocaine, which is a very powerful drug for addiction. Because there is a real high, but then as it starts wearing out you got the come down effect of it, which I believe spice has. Once you are stoned and you want to remain stoned, you kind of go to any length to get it, whether you have to steal someone’s tobacco to swap it and it has that sort of impact, you just want to be stoned, stoned again.” Benny stated that he had developed some tolerance to spice and needed increasing amounts to sustain his habit. His addiction also led to him building up considerable debt. Benny also explained how spice had changed the drug trade in prison: Spice was very easily available and he had heard that this was the case in other prisons: ‘Its spread rapidly, it’s sort of like a plague now amongst the prisons’. He explained that in the past ‘you’ve got to know the people and they’ve got to trust you to get a drug’ whereas now everyone’s got it. Before, there used to be just one or two people on the wing that had access to drugs, now everyone’s got it and everyone’s buying bits off each other, big bits like grams and selling on bits to everyone else so they are all competing against each other’. 35 Stewart had also become addicted to spice. He said ‘If you smoke it for a week, you won’t know where the weeks gone, then when you haven’t got it it’s like the end of the world’. He considered it more addictive than heroin and crack cocaine. He was held in the segregation unit for a period, during which he had no access to spice. His description of this time was as follows: It felt like a week of it being a hard rattle1, like really hard. I’ve done a rattle off methadone so I know what a rattle’s like but it felt similar, like, if you know what I’m saying. It felt really similar to it and I was just like sweating up in a cell and everything. Stewart explained that the addictiveness of spice caused many people to get into debt. He said that prisoners would often run up debts they had no capacity to pay, knowing they would be assaulted as a result, but would still do it anyway as being assaulted was better than not having the drug. He explained that spice was now the main currency in prison, and that he had been able to maintain his habit as he had been paid in spice to hold contraband mobile phones, with bonus payments being made if the phone was found by staff and he ‘took the rap’ for it. He explained that he was paid £20 worth of spice a night under this arrangement, but that dealers would have paid £3 for this outside. Leonard did not use spice more than a few times as he felt vulnerable when using it, describing how he had a history of self-harm and said ‘I’m a paranoid person anyway and I think that on top with me could be a dangerous thing, I could end up doing something stupid and there’s not coming back from that.’ While Leonard was able to avoid addiction to spice, he said that he had seen people he knew very well get addicted to it and into a lot of debt. 1 ‘Rattle’ is a slang term for the effects of withdrawal from a drug 36 Leonard said that spice was in all prisons and said ‘the main thing in prison now is spice. It used to be heroin and things like that or cannabis, but these last two years spice is running the jails’ Speaking of the harm that spice caused in prisons he said: If spice was to stop in the prisons, you’d see a lot less people behind the door for debt, a lot less people going to Seg I suppose, a lot less violence you know what I mean. I think spice is causing a lot of problems in prison these days Talking of the cost of spice, John said that £20 would buy you 4 joints in prison, which he considered to be between 5 and 10 times the outside purchase price. He described spice as very addictive and explained how people would go to differing lengths to obtain it as a result: There’s people that haven’t got a lot of money and so they have to pay for it through canteen, there’s people that can pay for it through bank accounts or there’s people that have to steal to pay it, there’s people that have no money. Loads of people on it, but you just have to go different ways of about getting it d’you know what I’m saying? He also described occasions where those who had no means to pay were offered spice for free if they were able to smoke it all at once through a ‘bong’ or ‘pipe’ - doing so would be highly likely to produce adverse effects known as a ‘rice attack’ for the amusement of those supplying the drug. 37 4.6 Awareness of risks Although they had limited awareness of what spice actually was and how it was manufactured, the participants had a fairly good understanding of some of the risks associated with its use. Benny considered spice to be very dangerous saying: I mean it’s just as risky as sharing a needle really, coz it can be a bad batch. No one actually knows what’s going into this. You just see round the wings, so many random people who have been smoking it still coming up with seizures. I know there is a couple of cases where people have lost their mind over the stuff. It’s a risky drug and where it’s legal, and it’s so much cheaper than cannabis. Benny knew little about how spice was made. He was aware that it was a herbal substance sprayed with a chemical, but had heard that it included fish tranquilizer resulting in a nickname of ‘fish food’ (interestingly while spice is often sold under the pretext of being a pot pourri, some other psychoactive substances are sold under the pretext of being fish food) Benny explained that seizures relating to spice use were so common that the term ‘rice attack’ was used amongst prisoners to describe them (rice is another street name for spice). He also explained that smoking spice in a pipe rather than a cigarette increased the risk of a ‘rice attack’ as the amount required to ensure ignition was more than a safe quantity. As a result, the preference was to smoke spice in a cigarette, but prisoners would risk the use of pipes when tobacco was scarce on the wing. 38 Stewart also did not know how spice was manufactured. He had heard it was used to tranquilize fish so that they are comfortable when transported by air. He felt more information was needed about it, as while he now understood the risks inherent in spice use, he did not when he first tried it. Leonard thought that spice was a very dangerous and claimed that he knew someone in another prison who had died from a heart attack after using it. He was particularly concerned for those with mental health problems: People like me with mental health problems and other mental health people, if they are smoking spice it is not a good thing. They could do something, seriously and by the time staff realize what’s going on, it’s game over John also had no knowledge of how spice was manufactured or what it contained, but agreed that it was an unsafe drug. He described it as “Not safe at all, simply for the fact that as soon as you smoke it you don’t know how you’re going to react… it’s definitely more dangerous than cannabis because of how addictive it is and the chemicals that are obviously in it and what it does to you mentally. Yeah I think it is a dangerous drug, a very dangerous drug.” 4.7 The impact of being in custody Exploring the significance of being in custody on drug use choices, Benny stated that he would probably not have chosen to use spice had he not been in prison and that if he returned to drug use in the community he would probably use cannabis or cocaine. However, he did explain that his time on license might be difficult: 39 I mean I’ve got this issue now that I’m going to approved premises where I am going to get drug tested and alcohol tested every day on entry. So I can’t do anything illegal but spice isn’t illegal, they can’t stop me from smoking spice if I wanted to go out and smoke spice, legally I can, they can not stop me because it’s not illegal. I was speaking to someone in the exercise yard explaining that I was going to this approved premises. Not even knowing whether I took drugs or not his first thing was ‘oh there’s a spice man, there’s a shop and next door to him the guy in there sells all the spice there’, so you can get it straight away. So it’s everywhere, it’s taken over everywhere, it’s not just in prisons now. Stewart said that he thought that he would probably have tried spice if he had not been in custody as he was inquisitive, but also said ‘But I don’t think I would have got on it like I did in here. I probably wouldn’t have liked it and that would have been enough to suppress it’ When asked if he would use it outside of prison, Leonard said ”No way, not a chance, because if I done that outside and it made my head go the way it did in prison, there’s no body there staff wise to do something like in prison to support you and to stop what is going to happen. Outside I wouldn’t have that support, so it could be a dangerous thing” John also stated that he definitely would not use spice outside, stating his experiences in with it in prison would dissuade him. He stated that he was glad he had tried it in prison rather than the community where he could just buy it in a shop (making it harder to avoid addiction). 40 5 – QUANTITATIVE RESULTS This chapter details the results of the quantitative survey phase of the research. 101 survey responses were collected. 5.1 Section 1 – General Information Section 1 of the survey asked for general demographic information about age, ethnicity and offence type. Respondents ranged in age from 18 to 59 years, with a mean age of 32. The ethnic breakdown of the respondents was 72% White, 6% Asian or Asian British, 12% Black, Black Caribbean, Black African or Black British, 4% other ethnicity and 6% with mixed or multiple ethnicity. 30% were convicted of violent offences, 21% robbery offences, 26% drug offences, 5% motoring offences, 9% acquisitive offences and 16% for other offences. 5.2 Section 2 – Drug Use Section 2 of the survey asked questions about the respondent’s drug use history, focussing on the use of Class A drugs, Cannabis and Spice. Respondents were asked whether they had ever taken any of these types of drugs, whether they had taken any of them in prison, if they taken any of them in their current prison and whether they currently used any of them. In addition, they were asked if they were aware of the presence of spice in the research prison, how easy it was for prisoners to buy spice in the research prison and how expensive it was in comparison to cannabis. With regards to Class A drugs, 34% reported that they used at some point, 19% reported they had used in prison, 9% reported they had used in the research prison and none reported 41 being a current user. With regards to cannabis, 65% reported that they used at some point, 35% reported they had used in prison, 22% reported they had used in the research prison and 7% reported being a current user. With regards to spice, 43% reported that they used at some point, 39% reported they had used in prison, 32% reported they had used in the research prison and 22% reported being a current user. 94% of respondents reported being aware of the presence of spice in the research prison. 44% reported it was ‘very easy’ and 20% ‘fairly easy’ to buy spice in the research prison as opposed to 2% reporting it was ‘fairly hard’ and 2% ‘very hard’. 33% reported not knowing. Limiting analysis of this question to the 32 respondents who had actually reported using spice in the research prison found 66% reporting it was ‘very easy’ and 22% ‘fairly easy’ as opposed to 3% reporting it was ‘fairly hard’ and 3% ‘very hard’. 6% reported not knowing. Exploring the cost of spice compared to cannabis found 16% reporting spice was ‘much cheaper’ and 8% ‘a bit cheaper’ than cannabis. 26% reported they cost about the same, 2% reported spice as ‘a bit more expensive’ and 3% ‘much more expensive’ than cannabis. Disregarding the 46% that reported ‘not knowing’ revealed that 29% reported spice as ‘much cheaper’, 15% ‘a bit cheaper’, 47% ‘about the same’, 4% ‘a bit more expensive’ and 5% ‘much more expensive’ than cannabis. Limiting analysis to those who had reported using spice in prison and who did not report ‘not knowing’ revealed that 25% reported spice as ‘much cheaper’, 9% ‘a bit cheaper’, 50% ‘about the same’, 6% ‘a bit more expensive’ and 9% ‘much more expensive’ than cannabis. 5.3 Section 3 – Using Spice in Prisons Section 3 of the survey presented respondents with a number of potential reasons for spice 42 use and asked them to indicate how important the reason was in their decision to use spice in prison. Each reason was presented with a 5 point Likert scale with ‘Strongly Agree’ ‘Agree’ ‘Neither Agree or Disagree’, ‘Disagree’ and ‘Strongly Disagree’ as the available options. A further question asked respondents if they thought they would have used spice if they had not been in prison. The permitted responses were ‘Yes I would have used it outside’, ‘ No, I would have used another drug’, ‘No, I would not have used anything’ and ‘I don’t know’. The questions in this section were only asked of those who had indicated that they had used spice in prison (39 respondents). The following table shows the extent to which respondents that had used spice in prison agreed with the listed statements (invalid or incomplete answers excluded). Table 1 – Participants reasons for spice use (n=39) Reason for spice use Strongly Agree % I used spice because I was curious 15.4 I used spice because the effects are 10.3 pleasant. I used spice because the effects are 7.5 better than other drugs. I used spice because it is relaxing. 17.5 I used spice because it makes time go 27.5 more quickly. I used spice because it is safer than 0 other drugs. I used spice because I was addicted to 2.5 it. I used spice because it was cheaper 10 than other drugs. I used spice because it was legal 12.5 outside. I used spice because it is easier to get 12.5 hold of than other drugs. I used spice because it does not smell. 7.7 I used spice because it is not detected 28.2 by MDT testing. Agree % Neither % 59 48.7 7.7 15.4 Disagree Strongly % Disagree % 15.4 2.6 12.8 12.8 30 25 22.5 15 50 47.5 12.5 12.5 10 7.5 10 5 2.6 51.3 23.1 23.1 17.5 17.5 25 37.5 10 40 27.5 12.5 30 22.5 22.5 12.5 40 20 15 12.5 25.6 25.6 20.5 20.5 23.1 12.8 23.1 12.8 Of prisoners who had used spice in prison, 21% stated that they would still have used spice outside. 39% stated that they would have used an alternative drug. 23% stated that they 43 would not have used anything and 18% reported not knowing. 5.4 Section 4 – About Spice This section of the survey asked respondents for their views on spice, with a particular focus on safety. Initially they were asked what the single one most important reason for spice use was (the same reasons as section 3 were presented, but only one answer was permitted. In addition the answers ‘other’ and ‘don’t know’ were added). The questions in this section were asked of all respondents, regardless of whether they had used spice in prison. Respondents were then asked what they thought spice was with the options ‘a natural herbal substance’, ‘a herbal substance sprayed with chemicals’ (the correct answer), ‘something else’ and ‘don’t know’. They were then asked if they thought that being legal outside prison meant that spice was safer than controlled drugs, with ‘yes’, ‘no’ and ‘don’t know’ permitted. They were then asked how safe they thought spice was when compared to both heroin and cannabis, with ‘safer’, ‘same’, ‘more dangerous’ and ‘don’t know’ options. The next question asked respondents how addictive they thought spice was. ‘very’, ‘fairly’, ‘slightly’ and ‘not’ addictive options were allowed as was ‘don’t know’. Finally, respondents were asked if they had heard the term ‘rice attack’ to describe someone fitting or passing out through spice use and whether they had witnessed anyone do so. ‘yes’, ‘no’ and ‘don’t know’ answers were permitted. 59 of all respondents gave a valid reason as the most important reason for prisoners using spice (23 did not know and 19 failed to answer the question correctly). 27 of the 39 who had reported using spice in prison gave a valid reason (5 did not know and 7 failed to answer the question correctly). The results are shown in the following table. 44 Table 2 – Most important reason for spice use (n=59) Most important reason for prisoners using spice Curiosity. Pleasant effects. All respondents % 6.8 Respondents that have used spice in prison % 3.7 8.5 3.7 0 0 15.3 22.2 Makes time pass quicker. 22 37 Safer. 0 0 Cheaper. 0 0 Legal outside. 0 0 10.2 7.4 0 0 Not detected by MDT. 32.3 22.2 Other. 5.1 3.7 Better than other drugs. Relaxing. Easier to get hold of. Does not smell. Respondents’ views on what sort of substance spice is are reflected in the following table. The results are shown for all respondents and separately for those who have reported having used spice before. 45 Table 3 – Participants understanding of the physical nature of spice. What sort of substance do you think spice is? A natural herbal substance All respondents % 1 Respondents that have used spice before % 2.4 A herbal substance sprayed with chemicals Something else 48 71.4 20.4 14.3 Don’t know 30.6 11.9 Respondents were asked if they thought that being legal outside meant spice was safer than controlled drugs. Responses are shown in the following table. Table 4 – Participants views on whether legality is indicative of safety Do you think that being legal outside means that spice is safer than other drugs? Yes All respondents % Respondents that have used spice before % 8.2 4.9 No 63.9 70.7 Don’t know 27.8 24.4 The next two questions asked respondents how safe they thought spice use was in comparison to cannabis use and heroin use. The results are shown in the following tables, again broken down between all respondents and those that have used spice before. 46 Table 5 – Participants views on relative safety of spice use compared to cannabis Compared to using cannabis, how safe do you think using spice is? Spice is safer than cannabis All respondents % Respondents that have used spice before % 1 2.4 The risk is the same 13.3 19 Spice is more dangerous than cannabis Don’t know 55.1 59.5 30.6 19 Table 6 – Participants views on relative safety of spice use compared to heroin Compared to using heroin, All respondents % how safe do you think using spice is? Spice is safer than heroin 16.3 Respondents that have used spice before % The risk is the same 26.5 35.7 Spice is more dangerous than heroin Don’t know 11.2 14.3 45.9 23.8 26.2 The next question asked how addictive respondents thought spice was. Again results are split between all respondents and those that have used spice before. Table 7 – Participants views on the addictiveness of spice How addictive do you think spice is? Very Addictive All respondents % 28.9 Respondents that have used spice before % 33.3 Fairly Addictive 20.6 23.8 Slightly Addictive 9.3 19 Not Addictive 9.3 9.5 Don’t know 32 14.3 47 The qualitative phase of the research identified the term ‘rice attack’ being used as a new slang term to refer to fitting or episodes of unconsciousness resulting from spice use. Respondents were asked they had heard of the term ‘rice attack’ and if they had seen witnessed somebody suffer from one. 88% of all respondents stated that they had heard of the term and 58.2% stated that they had witnessed a ‘rice attack’. Examining the responses of those who had reported using spice in prison found 97% reporting they had heard the term and 76% reporting having witnessed a ‘rice attack’. 5.5 Additional Comments A free text box was included in the survey asking ‘Is there anything else you wish to say about spice use in prison?” The majority of respondents who chose to add a comment held a negative view of spice as these quotes reflect: “Don’t do it. It’s not worth doing, people die from it I heard its poison and not worth messing yourself up or losing your life” “Prison service has no idea how to stop this problem” “I don’t see how people can smoke spice in prison” “I have never taken drugs and don’t agree with them at all. Since I've been in prison I now know how to grow it, cultivate it, cut and sell it. Never seen so much drugs in one place. Constantly hear of prisoners having rice attacks. Disgusting. Need to sort it out (security that are in charge)” 48 “Whoever made the stuff should be put in prison and made to see the effects it has on the people who take it.” “Those who use spice, or other drugs, should be segregated to a specific wing to help tackle the problem. It will make it harder to supply them and they can be monitored.” “My knowledge of spice is that in prisons worldwide it’s an epidemic” “It’s out of control and more studies need to be carried out. People need to know the effects it has on prisoners and people in general, prisoners get very addicted very quickly and into debt” “Its killing people, get rid ASAP” “It’s very dangerous, don’t take it” “It causes untold trouble” “Its an epidemic!” “People don’t know the long term effects they think it kills time and makes you relaxed. You can take it and have a rice attack. It shouldn't be legal as it is dangerous.” “It’s out of control and something needs to done about it” “It is obvious to staff when people are under the influence of spice but nothing is done about it. It should be dealt with more seriously.” 49 “I've witnessed persons suffer psychosis from short term use and hallucination. This drug is dangerous and a serious problem.” “Spice causes a lot of problems in a prison.” “It’s a madness!” “Start testing for it.” “Spice has people in a headlock” “I am appalled at the proliferation of spice in prison and would like to see this, as well as all other substance abuse, eradicated in prison. Achieving this will have a direct correlation with violence reduction in prisons.” Some respondents were positive about spice as reflected in the following quotes: “Put it in the canteen” “It is an ideal prison drug because it can’t be detected, doesn’t smell and passes the time. Downside - it makes you very lazy. I couldn't smoke it outside coz I would get nothing done” “Spice is banging” 50 “Spice is probably a substitute for other drugs to pass the time quicker and make people more relaxed.” “Spice is OK and it chills the prisoners out” “It is a bird killer and passes time by. It helps relieve stress and anxiety and give you good dreams. Spice makes your imagination beyond fantasy levels.” “Spice makes you chill out and forget about life. I use my imagination and get a quick release from smoking spice” 6 - DISCUSSION 51 This chapter presents discussion on the research findings, arranged thematically around the research questions. As each topic is examined, any findings from the qualitative phase of the research are introduced. 6.1 To what extent is spice prevalent in prisons? As explained in the methods chapter, a key limitation of this research is that its scope was limited to one prison. It was, therefore, known from the outset that, in the purest sense, the results could only really measure prevalence of spice at the researched prison. However, as practitioners have been reporting problems with spice in many prisons, the extent of use in the research prison may be an interesting indicator of what the extent of the issue may be elsewhere, even if the findings are not truly generalisable. As reported in the quantitative results, 43% reported that they used spice at some point, 39% reported they had used it in prison, 32% reported they had used it in the research prison and 22% reported being a current user. It is important to note that this is the percentage that have admitted use. Even though the survey was anonymous, it is likely that this figure is lower than the true number of users. The survey also captured cannabis use in the same form. 35% admitted cannabis use in prison, 22% in the research prison and 7% were current users (interestingly all but one of those admitting current cannabis use also reported being a current spice user). The data indicates that the number of prisoners who have used spice in prison is comparable to those that have used cannabis in prison. However, those admitting spice use at the research prison outnumber those who have used cannabis and there are three times as many admitting current spice use than cannabis use. This pattern would suggest that spice has become more 52 prevalent in recent times, at least at the research prison and that it is now clearly the drug of choice. This is a significant point as previous research and literature on drugs in prison has focussed on heroin and cannabis as the drugs of choice. Crewe (2005, 2012) explores the role that heroin has in shaping social structure in prisons. The emergence of spice as the drug of choice could have significant ramifications with regards to how these social structures work. For example Crewe (2005) explains how control of heroin supply affords considerable influence and power to those concerned with it. One of the interview participants in this research, Benny, suggested that spice supply was more fluid and that lots of prisoners were buying and selling spice rather than there being a couple of people who had access to it. If this is the case, this may mean that the way power flows amongst prisoners may be shifting too. The qualitative research also provided some results that gave some indication of the use of spice in other prisons. One interviewee, Benny said that prisoners were arriving at Rochester from category B prisons in possession of spice and mentioned a friend of his who was in debt over spice in HMP Guys Marsh. He said ‘its spread rapidly, it’s sort of a plague now amongst the prisons’. Another, Stewart, agreed that spice use was now common and had spread through most prisons. Leonard stated that spice was now the “main thing”in prison. He stated that it used to be heroin and things like that or cannabis, but that in the last two years, spice had become the major commodity in jail. Respondents were asked how easy is was to buy spice (an indicator of ease of supply). 88% of those who had used spice in the research prison had reported it was ‘very easy’ or ‘easy’ to buy. Both Benny and Stewart stated that the drug was easily available and abundant in supply. 6.2 Why do prisoners choose to use spice? 53 As explained in the results chapter, those that had used spice in prison were asked to rate the importance of a number of reasons for use, by means of a Likert scale. In addition, all respondents were asked to pick the single most important reason for use. Curiosity, relaxation, better effects and ease of purchasing were all reasons that had similarly positive Likert scores indicating that they had some bearing on prisoner’s choices to use spice. However, two reasons produced more significant Likert results, these were that spice makes time pass quicker and that it is not detected by mandatory drug testing. The question asking for the single most important reason for spice use found relaxation, time passing quicker and lack of detection on drug testing as the most important reasons. Interestingly, amongst those who had used spice in prison, relaxation and lack of detection were the joint second ranking reason given as the single most important (22%), whilst 37% cited the fact that it made time pass quicker. These findings were in congruence with the qualitative results where 3 of the 4 interviewees also reported the phenomena of time passing quickly and all cited lack of detection by drug testing as a principal reason for use. It would seem then that prisoner’s motivation to use spice is being driven by qualities of the substance itself (that it has relaxing and time dilatory effects) and by the lack of a current mechanism to detect the drug as part of the mandatory drug testing (MDT) policy. It is, therefore, possible to conclude that the current drug testing arrangements might be encouraging prisoners to use spice rather than other substances such as cannabis. As there is growing evidence to suggest that spice use may carry higher health risks, this possible undesired consequence of current policy may be of interest to policy makers. It is also worth discussing at this point the question of addiction. The qualitative survey results revealed “I used spice because I was addicted to it” to be the most disagreed with reason for spice use. Only 20% of those who had used spice in prison agreed or strongly agreed with this, while 37.5% strongly disagreed and 25% disagreed. This result would 54 indicate that addiction was the least important reason for prisoners choosing to use spice. There is an interesting contrast with another quantitative finding, which found that 76% of those who had used spice before considered it addictive to some extent and 33% considered it very addictive. All 4 interviewees in the qualitative phase of the research described spice as very addictive and two gave candid accounts of their own addiction to spice, yet did not cite this as the primary reason for choosing to use spice. It is worth considering the extent to which substance users are unwilling to acknowledge addiction as a reason for their actions. This would offer a possible explanation for the qualitative findings, but even those qualitative interviewees, who were happy to acknowledge the extent of their addiction, did not appear to consider it a reason for their use of spice (albeit it is acknowledged that this observation is drawn from a limited qualitative sample size). Issues around prisoners getting into debt through spice addiction was a theme that was evident in the qualitative results and a number of survey respondents made comments about debt and the problems associated with it. Although the findings appear mixed on the subject of addiction, this research does suggest that, regardless of users perceptions of their own motivation, spice may be highly addictive and it also suggest it results in increased levels of debt and possibly increases in associated violence and criminality. This is congruent with practitioner perceptions of the problems associated with spice and addiction, debt and associated criminality are likely to be a key operational threat in prisons. 6.3 Do prisoners understand the potential risks of spice use? As spice is a relatively new phenomena, both in custody and the community, and given the emerging evidence of health risks associated with its use, this research aimed to measure the extent to which prisoners are aware of the potential harm. As indicated in the qualitative findings, prisoners were fairly well aware that spice was not a natural substance, especially 55 those who had used it. There was also a fairly strong view that spice use is more dangerous than cannabis use and, as has just been mentioned there was a high awareness of its addictiveness. Of particular note, is the concept of “rice attacks” a prison slang term for convulsions, fitting or loss of consciousness resulting from spice use. This concept emerged in the qualitative phase and 76% of users reported having witnessed a “rice attack” in the survey phase. Much of the literature on the health risks of spice use is focussed on potential cardiac risks or the mental health risks such as psychosis. Practitioners are reporting increased instances of prisoners being hospitalised following events that prisoners might call “rice attacks” similar to events reported at HMP Dartmoor in March 2014 by the BBC (BBC, 2014). There is scant evidence regarding these effects of spice use, despite the obvious assumption that such effects are not limited to the custodial environment. This appears to be indicative of just how little is known about the effects of spice and it may be that prisoners are, in some ways, more aware of the risks than anyone. This said, there is still some evidence of misinformation. For example, two of the interviewees in the qualitative phase thought that spice contained fish tranquilizer (this is a belief that the researcher has heard others express as well). 6.4 Does being in prison have a bearing on the decision to use spice? While prison is, in many ways, a microcosm of wider society, it is also a very different environment with unique factors that may impact on the choices made by those incarcerated therein. The apparent prevalence of spice in the research prison was much higher than in the wider community. Although it is difficult to make direct comparisons, 43% of survey respondents reported having used spice at some point and 22% stated they were a current user. This contrasts with a wide scale global survey with 14996 respondents, which found 16.8% reporting ever using spice and 6.5% reporting use in the last 12 months. (Winstock & 56 Barratt, 2013). The survey asked respondents if they would still have used spice if not in custody and only 21% reported that they would, with 39% stating they would have used another drug and 23% stating they would not have used anything. It appears that being in prison increases the likelihood of an individual using spice. We have already explored the issue of drug test detection and the apparent time dilatory effects of spice use. Being in prison does bring the risk of sanction from drug testing and may make drugs that are not detected appealing. In addition, as others have found (Cope, 2003), time dilation is appealing to prisoners. These factors are not normally present in the community so it does appear that the custodial environment may indeed have a bearing on the decision to use spice (making it more likely). 6.5 Is spice use supply or demand driven? This research considers the reasons for spice use from the perspective of users and as such primarily explores the factors that drive demand for the drug in prison. The scope of this work does not include full consideration of whether any proliferation of spice in prisons is supply or demand driven. There are a number of reasons why spice may be an attractive drug to suppliers and traffickers. Trafficking into prisons entails a certain amount of loss as some quantity of the supply will be detected and seized by the authorities. As spice is relatively cheap and easy to acquire it would lessen the impact of this attrition on the suppliers. The trafficking of drugs into prisons is a criminal offence under the Prisons Act 1952 as amended by the Offender Management Act 2007. However, trafficking of legally purchased spice appears not to be included under this legislation, lessening the risk of criminal sanction upon those engaged in its supply. 57 The research did give some consideration to the question of supply. 52.5% of survey respondents agreed or strongly agreed that ease of acquiring spice was a reason for using it and 7.4% of spice users considered it the most important reason. This provides some evidence that supply is, at least to some extent, driving the use of spice. This is an important point as any efforts that focus on reducing demand for the drug may need to be combined with supply reduction efforts to be effective. 7 - CONCLUSIONS 58 This research aimed to examine the following questions: To what extent is spice prevalent in prisons?’ ‘Why do prisoners choose to use spice?’ ‘Do prisoners understand the potential risks of spice use?’ ‘Does being in prison have a bearing on the decision to use spice? While not truly generalizable, the findings showed that spice was prevalent in the research prison to the extent that it could probably be considered the most used illicit drug amongst the researched population. The fact that Mandatory Drug Testing does not currently detect it was a primary factor driving demand for the drug, but of comparable importance was the drugs effect of making time appear to dilate. Although users were reluctant to cite it as a reason for use, there was evidence that spice is highly addictive and this too was likely to be driving demand. Addiction is a particular concern in the custodial setting as it can lead to debt and associated violence and criminality. Prisoners did appear to be relatively well informed as to the risks of spice use, yet still chose to use it despite the risks. The extent to which this results from a conscious calculation of the risks and perceived benefits of use or the effect of addiction was beyond the scope of this research. The research provided evidence that being in custody does increase the likelihood of spice use. Respondents indicated that they would be less likely to use the drug outside of prison. 59 This is understandable, as the most significant reasons identified for spice use were not as applicable in the community. The use of spice in prisons is a growing concern and, while this is becoming widely recognised, efforts to formulate a coherent strategy are still in their infancy. An effective strategy is likely to require a focus on efforts to reduce demand, perhaps including drug testing for spice and work to increase awareness. There may also be potential for spice abuse to be more fully prioritized by substance misuse services. Efforts to reduce supply will also be paramount and there may be potential for legislative changes to have some impact here. 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(2013), ‘Synthetic cannabis: A comparison of patterns of use and effect profile with natural cannabis in a large global sample’, Drug and Alcohol Dependence, v131, pp106-111 Zuardi, A., Crippa, J., Hallak, J., Moreira, F. & Guimarães, F. (2006) ‘Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug’, Brazilian Journal of Medical and Biological Research v39, pp 421-429 ‘SPICE’ SURVEY INFORMATION The information below tells you about this survey. 63 Who is carrying out the survey? I am the Head of Residence at HMP Rochester, but I am also currently studying for a Masters degree at the University of Cambridge and it is in this capacity, as a student, that I am carrying out this survey. What is this study about? As part of my studies I am looking into why some prisoners are choosing to use ‘spice’ in custody. I have carried out a small number of interviews to get people’s views on spice use, but would like to get the views and opinions of a larger number of people. This is why I am asking for your help in completing this survey. What will participation involve? Participation will involve filling in this survey. This should take around ten minutes. Do I have to take part in the survey? Your participation is completely voluntary. If you do not want to take part, you do not have to, and this will not count against you in any way. Are there any benefits in taking part? I cannot pay you for taking part in the study, but you may feel that it is helpful to contribute to our understanding of prison life and your contribution will help advance knowledge and may help others. Will what I say be kept confidential? The survey does not ask for your name or other information that could identify you, it is therefore completely anonymous and your confidentiality assured. Will my contribution remain anonymous? Yes, there is no way for you to be identified. You do not have to write your name anywhere on this survey. How do I take part in the study? To take part, you just need to complete the survey that follows. What will happen to the results of the study? Your survey may contribute to my thesis, which I will write about the issues I am studying. The findings may also be discussed in other academic publications written by me, and in discussions or presentations with members of the Prison Service or the National Offender Management Service (NOMS), and other university researchers. The study has been approved by the National Offender Management Service (NOMS) Research Committee. Thank you for your time in reading this information. Your contribution to this research would be valuable and very much appreciated. Kind Regards Sam Baker, MSt Student, Institute of Criminology, University of Cambridge. Section 1 - General Information This information helps to identify trends, but cannot be used to identify you personally - this survey is anonymous. How old are you? _________Years What is your ethnicity? White Caribbean / British Other Ethnic Group Asian / Asian British Black African / Mixed / Multiple Ethnicity What offence type(s) are you currently serving a sentence for? (Tick all that apply) Sexual Offences Acquisitive Offences (eg theft) Other Offences Violent Offences Drug Offences 64 Robbery Motoring Offences Section 2 - Use of Drugs This section asks about your experience with drugs Have you ever used any of the following drugs? Class A Drugs (eg Heroin, Crack) cannabinoids) None of these Cannabis Spice (synthetic Have you ever used any of the following drugs in prison? Class A Drugs (eg Heroin, Crack) cannabinoids) None of these Cannabis Spice (synthetic Have you ever used any of the following drugs since arriving in this prison? Class A Drugs (eg Heroin, Crack) cannabinoids) None of these Cannabis Spice (synthetic Do you currently use any of the following drugs? Class A Drugs (eg Heroin, Crack) cannabinoids) None of these Cannabis Spice (synthetic Are you aware of there Spice being in this prison? Yes | No How easy is it for prisoners to buy Spice in this prison? Very Easy | Fairly Easy | Fairly Hard | Very Hard| Don’t Know Compared to cannabis, how much does Spice cost in prison? Spice is much cheaper same Spice is a bit more expensive Spice is a bit cheaper They cost about the Spice is much more expensive I don’t know Section 3 – Using Spice in Prisons If you have used spice in prison, please fill in this section (if you have not used spice in prison, please skip to the next page) How much do you agree with these statements? I used spice because I was curious Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree 65 I used spice because the effects are pleasant Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree I used spice because the effects are better than other drugs Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree I used spice because it is relaxing Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree I used spice because it makes time go more quickly Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree I used spice because it is safer than other drugs Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree I used spice because I was addicted to it Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree I used spice because it is cheaper than other drugs Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree I used spice because it is legal outside Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree I used spice because it is easier to get hold of than other drugs Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree I used spice because it does not smell Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree I used spice because it is not detected by MDT testing Strongly Agree | Agree | Neither Agree or Disagree | Disagree| Strongly Disagree Do you think that you would have used spice if you were not in prison? Yes I would have used it outside No, I would have used another drug No, I would not have used anything I don’t know Section 4 – About Spice Of these, what is the single most important reason for prisoners using Spice? (Tick One) Curiosity drugs Pleasant Effects 66 Better than other Relaxing Makes time pass quicker Cheaper Legal Outside Does not smell Not detected by MDT Other (Please Specify)______________________________ Safer Easier to get hold of Don’t Know What sort of substance do you think spice is? A natural herbal substance Don’t know A herbal substance sprayed with chemicals Something else Do you think that being legal outside means that Spice is safer than controlled drugs? Yes | No | Don’t Know Compared to using cannabis how safe do you think using spice is? Spice is safer than cannabis | The risk is the same | Spice is more dangerous than cannabis| Don’t Know Compared to using heroin how safe do you think using spice is? Spice is safer than heroin | The risk is the same | Spice is more dangerous than heroin| Don’t Know How addictive do you think spice is? Very addictive | Fairly addictive | Slightly addictive| Not addictive| Don’t Know Have you ever heard of the term ‘Rice Attack’ to describe someone fitting or passing out on spice? Yes | No | Don’t Know Have you ever seen someone suffer from a ‘Rice Attack’? Yes | No | Don’t Know Additional Information Thank you for your time. Is there anything else you wish to say about spice use in prison?. 67
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