An injection of knowledge

The Canadian corrections system needs to smarten up about harm reduction in prisons

Harm reduction policies have been in place in the community for some time, and evidence-based practice has consistently shown the effectiveness of harm reduction. Yet prison harm reduction is behind the times. True, prisons present a very different situation than community settings due to the various necessary security considerations, but the status quo in prisons is most likely fueled by political ideology. Regardless of the why, health issues that stem from sharing needles in prisons are extreme, and something must be done.

Traditionally, enforcement is the primary tool in prisons, aiming to prevent drugs and needles from getting in. While enforcement may be lowering how many drugs get in, it isn’t stopping them completely. A recent infectious disease survey showed that drug use in prisons is much lower than in the community; however, it tends to be much riskier in terms of HIV and hepatitis C transmission. The fact that inmates found with drugs or needles are punished is also a large driver of unsafe injection practices. For example, cases have been reported where 30 inmates were sharing a single needle, simply because it was the only one available.

Cases have been reported where 30 inmates were sharing a single needle, simply because it was the only one available.

Needles are designed for one time use, as the metal point of the needle is very fine. With each use, the point of the needle gets bent and begins to hook inwards. When this hooked tip is pulled out of the vein it causes tearing and vastly increases the chance of infection. Because of this, and the fact that so many people are sharing the same needle, studies have repeatedly shown that the transmission rates of blood-borne illness— particularly HIV and hepatitis C—are much higher in prisons than in the community. HIV transmission is also an issue with tattooing in prison, again because the overuse of needles without proper sterilization leads to transmission of HIV and hepatitis C. Tattoing isn’t allowed in prisons, so inmates do it secretly and don’t have access to proper sterilization equipment.

Needle exchange programs have been an important part of community harm reduction for many years in Vancouver and around the world. Their success in reducing problems with unsafe injection practices, increasing access to treatment services, and reducing transmission of infections, is well documented. Unfortunately, there are currently no needle exchange programs in any Canadian prisons. Canada is well behind other nations in this respect. Needle exchange programs exist in prisons worldwide including Switzerland, Spain, and Germany; the benefits of these programs have been shown to outweigh the risks over time.

Corrections officers reportedly fear that syringes could be used as weapons if they were freely available. That’s a potentially valid concern, but consider this: we already know that needles are making their way into prisons, thus the chance of being stabbed already exists. And why not set up a medically supervised injection site like Vancouver’s Insite, currently the only safer injection site in North America? This would allow staff to keep track of every needle, and take proper security precautions to ensure the safety of both corrections officers and the inmates. As for the illicit substances that inmates would bring to such a facility, Correctional Services of Canada has to face reality: simply making drugs contraband will never stop their entry entirely.

Prisons aren’t closed systems—a large proportion of inmates go in and out regularly for minor crimes. In other words, the health problems of inmates are also the health problems of the community. We can’t afford to ignore this issue any longer. The average lifetime treatment costs of an HIV-positive person in BC is at least $250,000, which makes the reduction of new infections in prison not only a moral duty, but also a financial necessity.