Designer drugs have been linked to the deaths of at least 58 prisoners in England and Wales, it has emerged.
Revealing the statistics, Prisons and Probation Ombudsman Nigel Newcomen warned that new psychoactive substances (NPS) have become a "game changer" in the deterioration of safety in jails.
NPS have been identified as a major factor in an upsurge of violence and self-harm behind bars in England and Wales.
Mr Newcomen said: "I am clear that NPS have been a game-changer in terms of reducing safety in prison, with troubling links to our rising numbers of suicides, as well as to other types of death, including deaths from drug toxicity, apparent natural causes and even homicides."
He added: "It is important to note that the link between NPS and the deaths were not necessarily causal, but nor can they be discounted."
Of the 58 deaths which occurred between June 2013 and January 2016, 39 were self-inflicted.
Some involved psychotic episodes potentially resulting from the drugs, while in other cases NPS use or associated drug debts appeared to exacerbate vulnerability, triggering suicide and self-harm.
Two of the deaths involved prisoners being killed by a punch from another inmate.
Mr Newcomen said the availability and affordability of synthetic drugs has made them "attractive to organised and semi-organised crime."
How do He said: "These features compound the difficulty of reducing supply and demand for NPS in prisons.
"They also often make it difficult to draw definitive conclusions in my investigations about their health impact and links to fatalities."
Frances Crook, chief executive of the Howard League for Penal Reform, said the death toll "shames the nation and underlines the urgent need for reform."
The figures emerged days after an announcement that mandatory testing for NPS will be introduced in jails across England and Wales.
Prisons Minister Sam Gyimah said that the government is "under no illusions as to how dangerous these drugs are".
He added: "They cause untold mental and physical damage to prisoners, fuel violence against staff and ruin lives.
"That's why from next week, we are rolling out mandatory testing of synthetic drugs across the prison estate to give governors more power to combat this threat."
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