Substance testing in Approved Premises

 

The PPO’s Learning Lessons Bulletin, Approved Premises – Substance Misuse published in November 2017, highlighted the risks posed by psychoactive substances (PS) in Approved Premises (APs). The PPO has previously recommended that APs develop mechanisms to test for PS use, and since the bulletin’s publication, the Approved Premises (Substance Testing) Bill has been brought forward and is currently in the final stages of reading. The Bill aims to provide a clear legislative regime for substance testing in APs, including for PS.

Historically, APs have not tested for PS, although the AP Manual states that if residents have a history of substance misuse, or if staff suspect them of misusing drugs, they should be tested for drugs and alcohol. The upcoming Bill and anticipated testing framework illustrate the importance of the recommendations made by the PPO. This article provides two further case studies, since the bulletin’s publication, that reinforce why the upcoming Bill is needed and important.

Mr A was released on licence from prison to live at an AP. He had a history of substance misuse and before his release from prison, he had started to take PS again.  Five days after his arrival, his roommate reported that Mr A was using crack cocaine and PS. Probation staff reacted appropriately by searching Mr A’s room and by testing him for drugs, which showed no evidence that he had used illicit substances. However, they did not test him for PS use. Mr A’s room mate stated that there was a drugs culture at the AP, with residents taking drugs in their room or in the garden. Reports over the next 10 days indicated that Mr A was regularly using PS. One of the residential support supervisors smelt what she thought was PS on the night that Mr A died but did not challenge him about it.

Before he died, Mr A went to the kitchen and asked an officer for food and milk. Although the officer thought Mr A might have taken an illicit substance, due to his appearance and gestures, he took no further action and sent him to his room. In the morning, his roommate found him dead on the floor, with the bed throw over his head. He had died from cocaine and PS toxicity. The PPO recommended that the National Probation Service should ensure that staff monitor residents appropriately when they suspect that they have used illicit substances and that they seek medical assistance, when needed. The PPO also recommended that the AP team should review its strategy to reduce the supply and demand for PS in Approved Premises, including developing mechanisms to test for PS use, which have since been developed.

Mr B was released from prison on licence to live at an AP. He had a history of drug and alcohol abuse, most notably ‘monkey dust’, a PS that distorts reality and results in the user not being able to recollect their actions while under the influence. As part of a drug reduction programme, Mr B received a regular prescription of subutex, a heroin substitute and engaged with One Recovery, an independent agency which managed his drug treatment. During his time at the AP, Mr B provided positive test results on different occasions for cocaine, cannabis, and benzodiazepines as well as disclosing use of ‘mamba’ (a type of PS). After Mr B had completed his heroin substitute programme, he tried to take his own life, which he stated was due to him having problems in obtaining subutex. AP staff put in place a Care Action Plan. In the following two months, Mr B told staff that he had used PS. He was also given a formal warning after testing positive for benzodiazepine and cannabis.

Over the following weeks, staff raised no further concerns as he gave no indication that he was under the influence of illicit substances (although he was not tested for PS) or that he had suicidal thoughts. On the day of his death, Mr B and three other residents went to an area frequently used by drug users and drank alcohol. He was later found dead, suspended from a tree with a ligature around his neck.  Although no post-mortem toxicology tests were completed, the PPO considered it possible, if not likely, that drugs played a significant role in his decision to take his own life. In the period before his death, there was little to indicate that Mr B was at a heightened or imminent risk to himself. The PPO recommended that the National Probation Service should review its strategy to reduce PS in APs and develop mechanisms to test for PS use.

In conclusion, the two case studies highlight two individual instances of why testing for PS use in APs is important and emphasise the potential direct effect testing can have on residents. The upcoming Bill is important in not only providing a legislative framework for testing in APs, which will directly affect PS use, but also combatting any potential drugs cultures in APs, which may continue to exist if such frameworks are not put into place.