Table 2.

Impact of NPS on staff working environment.

Issue	Description
Aggression/Violence	« It is difficult to get people to listen, to respond. They may be agitated, unreasonable, aggressive. Their priorities are not around progress and growth » « Affects vary from adverse health effects, to violence related to debt (this includes being assaulted through not being able to pay off debt, being violent to others to pay off debt, or violent as a side effect to use). Self-harm also linked with inability to manage use of NPS. Use of NPS has impacted on men attending work or education, as well as gym sessions and programs. » « We have noticed Increases risk of self-harm and suicide attempts, increases risk of violence towards others. » « …Increased levels of violence, bullying others to use to test drug levels, medical issues, falling over, sliding down walls, no recollection of their behaviors. »
Time constraints	« The impact it has on users renders them unable to keep appointments and/or progress. It can also kill them. The spice use within the wings and the prison regime frequently leads to lock downs due to incidents, so again it’s impossible to keep appointments scheduled and many, many meetings have been cancelled. » «It has impacted my ability to interview offenders for report and assessments. I have had to terminate these appointments and reschedule. NPS also affects the work that we are trying to do to rehabilitate offenders. It negates all the effects and support that is provided. » « We all noticed a failure to attend for interview for sentence planning. They are unable to work and get into debt, under threat … and many of them are coerced to do things. As a result, this is disruptive for the prison regime. » « It breaks up the normal day and the Prisoners who would have a full educational session only receive limited time with the Teacher/Instructor. »
Safety	« NPS lead individuals in a zombie like state requiring further staff intervention with regards to their safety. This in turn destabilizes the regime and causes problems for non-NPS inmates. NPS can also lead to aggressions towards staff and others and it is largely responsible for most of debts and bullying in prison. » « It has made the pressure on support services increase. It has increased the level of debt. It has led to more severe and sometimes fatal health issues. It demotivates prisoners. It has made the prison environment less safe. »
Health	« There is a lack of concentration, a lack of motivation to do anything other than use NPS. » «NPS have an impact on many things. On their engagement, on their physical health, on their mental health. A cycle of events that lead them to continue their use. They can’t function They can’t work » « Prisoners heavily using NPS can ‘fall apart’. They have no interest in personal hygiene, they often sell their food and of course lose weight rapidly» « Working with individuals with extreme NPS addictions is difficult even when they are not under the influence at the time, they are often forgetful and experience extreme mental health issues. NPS makes drug users experience a variety of health problems that also interfere with their engagement, to attend health care appointments or because they are generally unwell. I have encountered individuals who have had strokes due to NPS use and this has damaged their ability to engage with rehabilitation in prison due to a lack of specialized care for these types of long term conditions. » « Some prisoners have had to be transferred to psychiatric inpatient units. Instances whereby some have completed stopped eating due to paranoia that the food is poisoned, others have completely refused all medication, either to help manage their mental state as a result of NPS use or medication to manage their pre-existing health conditions, such as diabetics or epileptics. »