Managing acute bromazolam intoxication in a custodial setting: a prison health case study

PURPOSE: Synthetic benzodiazepines pose significant health risks, especially within prison settings where substance use, multi-morbidity and constrained healthcare environments intersect. As the illicit drug market continues to evolve, prisons face increasing challenges in responding to changing patterns of use. This paper aims to present a case study of a bromazolam-related drug incident in a Scottish prison to identify operational learnings that can support future approaches to meeting the health needs of those within prison settings. DESIGN/METHODOLOGY/APPROACH: The authors conducted a descriptive observational case study as part of a public health response and wider service evaluation to a drug-related outbreak. Approval for the analysis and inclusion of routinely collected clinical and incident data was granted by the Caldicott Guardian. Information was extracted using a standardised data collection template. The authors incorporated qualitative insights from stakeholder reflections to understand operational challenges and perceived drivers of the outbreak. FINDINGS: Thirty prison residents were affected, four requiring hospitalisation and three of these requiring intensive care admission. While the clinical response was timely and prevented any fatalities, the incident exposed vulnerabilities in operational preparedness, communication pathways and incident coordination. PRACTICAL IMPLICATIONS: This case highlights the need for strengthened preparedness for illicit substance outbreaks, particularly benzodiazepines, in prisons. This includes development and awareness of clear major incident protocols, workforce resilience planning and integrated harm-reduction approaches. ORIGINALITY/VALUE: This paper provides practice-based insight into the management of an emerging synthetic benzodiazepine incident within a prison setting, offering practice-based learning that may support preparedness and multi-agency responses to similar incidents in prison settings.