How to cut drug deaths in prison: End drug testing

Today's report on legal high deaths in prison makes for harrowing reading. The Prisons and Probation Ombudsman found the drugs led to the deaths of at least 19 people in prison between April 2012 and September 2014.

Prisoners who took synthetic cannabinoids like Spice and Black Mamba often started behaving erratically and violently. One became physically sick, behaved strangely, and then died of a heart attack later the same day. Others started to self-harm. Prisoners under the influence of the drug were often incoherent and unable to stand up properly. Some needed emergency treatment for heart problems, high blood pressure, psychosis or seizures. The price of the drug means many prisoners fell into debt, with all the bullying and intimidation that entails behind bars.

The ombudsman then lists the measures prisons can take to tackle legal high use, like information sharing and monitoring. It does not mention the one thing which would do more than any other to prevent these deaths: scrap drug testing.

As with so much else in drug policy, like trade routes or provision, this comes back to the balloon metaphor. If you squeeze one part of the balloon, it expands elsewhere. That's because you can manipulate any variable in drug policy except the demand. This is how it works in prison too.

The main drugs used in prison were always cannabis and heroin, both of which were smoked (there's too much paraphernalia involved in injecting heroin for it to be viable in prison). These drugs are particularly popular because they kill boredom.

When drug tests were introduced in 1996, the first effect was to reduce cannabis use and increase heroin use. Why? Cannabis stays in the blood stream for about 28 days. Heroin only for two. But then legal highs came along which couldn't be tested for at all.

Truth is, most of these aren't legal highs at all – hundreds of compounds used in the drugs are now banned. But they are much, much more dangerous than relatively harmless cannabis. After all, ambulances started coming to collect prisoners so often they were dubbed 'Mambulances'. And quite beyond the damage to the person taking the drug, they have made life much harder for wardens. Cannabis created relatively docile prisoners. Synthetic cannabis often triggers violence and psychosis.

As ever with drug policy, authoritarian prescriptions from on high have no contact with the reality of the situation on the ground. They have the effect of taking an imperfect but tolerable situation and making it worse. The best thing prisons could do to cut drug deaths is scrap drug tests. This would remove the incentive for prisoners to migrate from cannabis to heroin and legal highs. If drug tests must continue they should involve searches, not physical testing.

But that level of rational, pragmatic problem-solving is nowhere to be found when it comes to drug policy – in prison or out.