Hi, I'm Brent Stafford, and welcome to another edition of Rug watch on GFN TV. In 2003, the World Health Organization developed the Who Framework Convention on Tobacco Control, which declares all people must be protected from of exposure to environmental tobacco smoke. Its impact was monumental as institutions the world over moved quickly to ban combustible tobacco products. But for some institutions, banning tobacco products is a serious challenge. And the risk could not be greater than when a prison system decides to go smoke free. Joining us today to talk about the smoke free policy implemented by the Scottish Prison Service and the challenges and opportunities for tobacco harm reduction in prison is Michael Stony, governor of HMP Barlini, scotland's largest male prison. Nick, thanks for coming on the show.
Thank you for having me.
Now, I don't want to bury the lead, so let me ask you off the top, is it true that prisoners in Scotland have access to free ecigarettes?
No, it's not true. In the transition, the changeover between smoking tobacco and moving towards vape, we did offer free equipment and vape pods for a period to aid that transition, but now we're in business as usual mode.
And that's the prisoners can vape, but they have to pay?
Still, that's amazing. So before we get into the details, tell us about HMP Barlini, its history and the community it serves.
It's Glasgow's prison. It's very highly connected, both passionately and psychologically strangely to the city. It's pretty iconic and referenced in all kind of areas of drama, books and everything. So it's part of Scottish culture. It's 140 year old prison that holds somewhere between 1214 to 1500 people on average from all sentence ranges, from romance for life sentence prisoners, all adult mail.
Now, what's the philosophy behind the time there? As I understand it, it's really focused on the community.
Yeah, we're looking to try and as much as possible transition people back into the community. We look to build resources and people we're looking to help. We probably base it on a solute genetic model of trying to create good health from people. And by that we mean, in the broadest sense, all the stresses that life is thrown upon as a lot of our guys who have been involved in adverse sheltered events, a lot of abuse, a lot of trauma, almost a drug use is often self medication. So what we're trying to do is establish connections with them in the community, with their own family or other sports, but also while they're in prison, in custody with us is to allow them the opportunity to build resources. Within themselves to cope with what we would consider as normal life stressors, paying the bills, coping their tenancy, trying to seek employment, eventually try to stabilize themselves, move away from kind of self medicating with illicit substances or other harmful substances such as alcohol and trying to just move into what we would consider, I suppose, a productive citizen.
May you've played a central role in developing health centered programs within the SPS. Tell us about that.
We have a range of programs that specifically focus on harm reduction through smoke cessation programs, replacement, nicotine patches, et cetera. A lot of different types of drug recovery programs, both therapeutic and clinical. So in terms of clinical supports, we've got our normal oprah replacement treatment programs such as methadone. We've also got different drugs we use in terms of Astronaut or Pivotal, which is a monthly injection, which is recent for us, it's quite costly in terms of a treatment option. However, it is a great impact operationally due to the fact that rather than curing for methadone every day an individual has one injection a month of Pivotal. And that's allowed them to kind of they probably have a greater deal of clarity about the lights rather. And they don't have the stigma attached to being in a methadone, being seen as a drug user or a junkie as they would call it over here. And that's probably helped them start to connect with proper recovery. So they attend peer led initiatives with a lot of recovery cafes running as we call them, very much peer led initiatives and they've been very successful and they also push each other, they're facilitated by a local charity, but we give them potentially free rein in the prison to adapt and adopt their program as they see fit. So they start providing lots of through care supports, lots of employment opportunities. So try to kind of watch through synergy lots of things at the moment.
Let me ask you, when did the prison system go smoke free?
It was November, St. Andrews Day. So the 30 November 2018.
So it's actually been quite recent yeah.
In the last four years. When you take when we subtract the COVID years, which everybody feels are relatively lost years, it does still feel relatively.
Recent yet so what percentage of prisoners smoked before the implementation?
On all of the studies we conducted, it was always well above 80% would say they smoked tobacco products.
Now, smoking, at least in my mind, I guess just from watching movies, really shows that smoking is ingrained in prison culture, is it not?
Yeah, it was always used as a currency, if you like, as well in prisons and it was always a fundamental part of prison life in terms of, I suppose it's coping mechanisms as well. People come to whatever, I'm being a non smoker, I don't really have a connection what it gave you, but people obviously feel there was a cuts they could lean on when they were in prison at stressful times.
Now, previously in the past, of course, smoking, it was in the 1990s that the pressure really started getting put on institutions with regard to smoking. So 2018, that's a long ways away from when the first pressure started. Yeah. So what happened? What were the discussions like within side the system as you were looking at going smoke free, even, say, back in.
The early 2000s, early 2000s, we moved somewhere mid 2000 toward really restricting the places where people could smoke. So staff were banned from smoking and prisoners were only allowed to smoke in the cell or out in exercise yard, out in open air. So there's only two places in the prison they could smoke from mid two thousands on notes. So there was, I suppose, at that time, when there wasn't such focus on replacement therapies or even the technology that's in dates, there weren't many options. I suppose that was probably the best solution for the time.
Yeah, I guess not many people think about it, but prison officers, the staff for the longest time, they smoke too, and they're part of the whole issue.
Yes, I remember as an officer, the offices were very nice places to be on the present landings at times when staff were smoking. So you would get in London for fresh air at times, lots of people.
So let me ask you, what, if any, were the operational difficulties in going smoke free?
I think that this would be a very difficult step for us. That would be something that would cause great angst and you could have some, as we said, operational issues to deal with. People doesn't have unrest. These were all potentials that we had to mitigate risk for. So the process we undertook at the time was about we set the date pretty early, but a year out. We started to build up both our communication strategy and the alternatives, the resources. NHS as a partner organization, the National Health Service, they started to build up their resources as well. Focus on hand reduction, nicotine replacement treatments, lots of awareness sessions, smoke assistance sessions, lots of peer led initiatives as well. In terms of them joining in sessions, I think probably the greatest element was just constant communication to the prisoner population. This is happening, there's a day, here's what we do. And each stage we reached certain milestones. So I think, for example, in February of 2018, we introduced the kind of single use e cigarettes into the canteen for purchase, and that was to give people an opportunity to maybe attempt and try an alternative to tobacco through that time. So it wasn't the multi use vapes, that kind of battery charged versions of, as we see where you put pods in, it was just a single use ones. They weren't overly popular at all. People had to pay for them, they were relatively expensive. You could still purchase tobacco, which was the preferred choice, if you like. And in terms of the nicotine replacement processes from NHS, there was a couple options and some were more palatable than others with patches come, so people dent. We started to ramp up the options, but also ramp up, I suppose, the information we were providing to people so well in advance. They knew it was happening and it gave a long time to get them tuned in to probably this was an event that was going to take place so I felt that kind of communication worked really well for us.
Yeah, in the end you run right up to the wall, I think, of any of these kinds of bands and.
I talk about other elements on the way. So we weren't sure if we were going to introduce these vaping devices and we were concerned about potential implications of them. They weren't tested, could they start setting files? The USB chargers would be problems with them. There was a whole range of issues we had to walk through and assure ourselves and give ourselves comfort that we weren't creating more problems. But in the late August and September of that year, we then offered the Vapes for free to all that were in custody at a time and for those that were going to be in custody throughout that period, new ones coming in to just probably a month or two post towards the new year. So live in November, late November and then to December, January, it was free. And then we moved on a six month subsidization process where we reduced we increased the costs of the Vape itself and increased the cost of the pods over a period in toll release. The target date then was April 2019. To be business as normal, you pay the full price for the vape, you pay the full price for the pods so gave them a kind of time frame that they were seeing that we have to temporarily support them and it wasn't that we were just cutting people off and then moving on. The other element was a fortnight kind of amnesty on. If we found people with tobacco products after the date, we weren't taking them through the judicial process as we would have in the prison, there was no punishment award for it so people was just a kind of amnesty if you find stuff, we take it off you, but there's no further punishment to that. That helped as well, because Scottish people in particular, being chancers, decided they would hang on your things, they would stockpile and they would hide stuff. So it became a game for the first few weeks. But nothing which adversarial is more of trying catches, if you can thing. And invariably that when you look at.
The entire population of smokers, I guess, just in your prison, or if you can say within the system overall, how many of them moved over to nicotine vaping products.
Well, I would say all and I think it's because it maybe was free to start with they all kind of made the switch and attempted they were getting free stuff, so again, Dean Scottish, we like free stuff, so that maybe helped and it gave people because there was no other alternative. So we'd see selling tobacco products probably, I think, round about the 20 November or earlier, so they get one. Can I purchase just the week before? And that was it, it was overlaying and so they had no alternatives. So this gave them the least worst option, I suppose not the best option. And as that lease worst became the norm quite quickly, things went remarkably smoothly.
Are there any repercussions for prisoner or prison staff if they get caught smoking now?
No, there would be, yes, there's an internal adjudication process in prisons where they would lose privileges if they're caught being orders or doing something against prison rules. So that could be a loss of TV for two weeks. It could be a reduction in wages or no wages. It could be anything in terms of access to physical training or maybe so. There are a range of typewriting and a member of staff would be what we describe as a disciplined code that would be under investigation as a code of conduct issue nowadays. But again, introducing tobacco products now, I.
Understand that say, pre e cigarettes even being an option, potential bands of tobacco products in prison could spark a black market. Was that a concern with this? And did having the vaping products alleviate that concern?
Yeah, I think probably because of everybody getting things for free right away, including the vaping pods, what it did was just demand right away. So I think if we didn't have that as an option, we would have struggled in terms of people trying to elicitly introduce tobacco products on the black market and we haven't seen many at all that's now 40 years hence and we've hardly seen any attempts to introduce tobacco products, few and far between. It happens, but it's very rare now.
That sounds like the program is a success, isn't it?
Yeah, I think that aligned to smoking cessation and people probably we don't have any evidence to support claims that they maintain tobacco free existence on release, but we would imagine anecdotally people would probably stick to vapes, but we don't have the figures of it because there was lots of discussion about feeling healthier and feeling better about themselves. And we really pushed on the health promotion aspect as well in prison, introducing walking clubs and other things for people to do. We also think with a study from University Stanley who helped us throughout the whole process in terms of taking air samples. So what they see is they took an air samples around the present on the 28 November and then again on the 3 November over the course of the five days. And they noticed an 80% reduction in the air. Particulates in terms of so it was broadly equivalent to Bennett and Oatmeal in Scotland in terms of the air that was in the present, which is a remarkable change for the health of the staff not having to breathe in smoking tubes.
How did you come to them decide that nicotine vaping products were acceptable?
I think for us, it was the best of the alternative options for people who would make conscious choices. So what we have always believed in Scotland in terms of our approaches, we believed in the responsible individual, that people will make their own choices. So if we can leave a person towards a less handful choice, it's a positive step. So we always felt the evidence we had at the time was this was definitely unequivocally, a less handful choice than tobacco products, not just for the prison population, but more importantly at the time for our staff. So we're having staff leaving in second hand smoke pressure from our prison unions. The staff representation about this is an occupational hazard and the risk assessments and safety and what don't quite cut it. They don't meet a reasonable standard. So in terms of risk mitigation, it was a kind of no brainer for us. I think if we align that to the operational potential or operational issues, this was the one that was far more palatable for everyone than any other option. And you also had a lot of staff who were vapors as well, who would probably talk about positive benefits in their lifestyle that their grandkids don't come into the house and the house is smelling and smoking things and not putting others at risk. So there was lots of staff who were kind of proponents of that as well. So as I say, there's a non smoker. I was probably very objective about the whole process in terms of what was right and what was wrong. But I'm very strong supporter of individuals making their own personal conscious choice of harm. So in Scotland we have a strange way about is where we like to self destruct and harm ourselves and we've got an extreme nature about us culturally, but we don't like to harm others so much, but we're not bad at doing it to ourselves. So it's good when you see people make a more health focused conscious choice. And I'm not advocating that vapes are the best thing in the world, we are just saying they are better, far better than tobacco.
Tell me about the admission process, just briefly, just give us an idea of somebody coming into the prison and I would imagine that the smoking issue is pretty much pretty high up on the list.
Yeah. When they do struggle in the first few days of admission if people have been smoking outside and particularly in the early days of that's when new admissions come in and didn't quite realize that there was no smoking in prisons anymore because despite the stimulant effect of tobacco and cigarettes, they used it as a calming mechanism, it was traditional in prison. If an individual come in who didn't have a lot of funds, if you like, it was a pure soul. There would be a poor box where we would give people some tobacco to get them through the night. First night or two that option was no longer there, so we had to consider the alternative options. So those that come in in the first phase, they'd get votes. Those that come in now, what we do is if they've got some funds, we'll give them the Vape and then take it off their next when they get funds back in. So they're almost getting advanced to use the Vape at the time and if that's what they choose to do on admission. So it kind of calms people down. It settles people because people can run. The prison may not even be, for the first time, still find present pretty dehumanized and don't in place. It's still pretty oppressive. You're getting put behind the cell door, you don't know what's happening to you. You'll feel rebut, lost, you'll know, yourself. And I know whenever we come up against big public sector organizations, we sometimes feel just like a number, the same as a prisoner with community prison. So you kind of don't feel the gate, what they're doing to you at times. So that first phase of community prison is always a risky one for individuals which pretends to get more self harm from people. With that phase, we get more incidents from them in terms of mental health issues and to stabilize them quite as useful.
So based on your observation of the prison population and being objective because you were not and are not a smoker, do you think ecigarettes work in helping hardened smokers quit?
I think so. I've had friends who have done it and they will vape now and again and sometimes they go for a period and pops of zero nicotine vape products for whatever reason, I don't know, I've never necessarily asked, but it's more the psychological aspect of doing something with your hands. They've said that they struggle to give up more than the smoking. So I know people who have benefited from it and it does make the prison a healthier place because we're not all breeder than second hand smoke. So I think for us, prison governors, prison leaders, prison managers and prison staff has been an excellent game changer for us in terms of our health. So you've got to think almost by default that it's a game changer for prisoners health. Even if they're only in six months, it's six months without tobacco. If they're in a couple of years, then it's that whole period of time in prison without tobacco and they still get a lot of access to smoke cessation processes to health improvement initiatives as well.
Sounds like tobacco harm reduction in action. Mick, I know you're familiar with the Global Forum on Nicotine and its annual conference on safer nicotine products and tobacco home reduction. GFN is coming up again this June, from June 21 to the 24th. Let me ask you, why is an event like GFN important?
I think from my experience with I suppose it brings message. And for me, when I read the latest report, the latest publication, the History of Tobacco and Tobacco product. I thought it was a very clear, concise and objective piece that actually and from my perspective allowed individuals who are makia, if they read that piece, they would then be far more informed about the harm and the risks and the implications of vaping as opposed to tobacco products in that history. So I do think it allows for proper messaging to be given and not, I suppose, the propaganda of any government in any jurisdiction of what they choose to take forward as an initiative. So it's a bit of a back to this conscious choice, but for me, and giving people the opportunity to make choices in their life because regardless of what you'll do to people, they'll make their own choice. So I think messaging allows people to make an informed choice and I think GFN does that and it does bring, I suppose, a consensus of opinion together. And you have to recognize there is adversarial views or other views out there that conflict. And again, people can make choices over that. I think for a prison population, they are vulnerable to influence, I would say. So it's very easy for us to influence them to say this is what you should do. But I think people in a modern day, I'm not really tuned into being told what to think or what to do, even in the present population, I think with the use of Google you can transform your knowledge potentially. So it's a different world. We look at it in there.
Let me ask you last question, Nick, and that how does it make you feel to be sending people back into the community after prison as non smokers?
Well, I think it's part of a multiple range of supposed outcomes. We would like to see healthier in terms of physically healthier in terms of mentally better connected back to the community, the ability to make good conscious choices, having your rock sack of resources, a range of tools that you can use and skills that you can use and then hopefully survive or thrive far better than you did before. Before he ended up in prison. So I think it's one of our range of things that are a positive outcome and anything that leads to better health or good health is positive. You.