Needle Exchange in Prison

8/3/2019 Needle Exchange in Prison

1/4

Needle Exchange in PrisonCarol Polych, MSc Nursing; PhD Adult Education

For the Canadian Harm Reduction Networkhttp://www.canadianharmreduction.com/

Illegal drug use in Canada continues in spite of the incarceration of legions of illicit drug users, dealers,growers, and manufacturers, held captive in a senseless draconian war against drugs. About 93% of themoney spent each year on Canadas Anti-Drug Strategy goes to enforcement that is supposed to reduce thesupply of illegal drugs, despite documentation that drug seizures have no effect on street availability, price tothe user, or overdose (Wood, et al., 2003). As the warhas ground along, the price of cocaine, for example,has fallen dramatically even as purity has increased; In 1981, one gram of cocaine cost US$600, but 25years later in 2006, the same gram only cost the end user Cdn$70 for 99%-pure cocaine (UN Office ofDrugs and Crime, 2009, p. 261). Prohibition just isnt working -- again. Not in the community and not inprison either.

In Canada, 17% of male prisoners and 14% of female inmates admit to injecting drugs while inside, 60% ofthe time with a used syringe ([Correctional Service of Canada] CSC, 2010, p. 12). Anecdotal evidence,however, places the benchmark closer to of those who are incarcerated injecting illegal drugs whilebehind bars. Voluntary urinalysis for drugs showed that 11.3% of inmates tested positive for drugs, with the

same percentage refusing to be tested (CSC, 2008). In British Columbia, incarceration has been shown toincrease the risk of catching Human Immunodeficiency Virus (HIV) infection by 2.5 times (Werb et al., 2008).And death from overdose has been documented at a rate 20 times more often among those behind bars inprovincial custody and 50 times more often among inmates of federal penal institutions than among peopleliving in the community (Fruehwald & Frottier, 2002).

Line Beauschesne (2002) professor of Criminology at the University of Ottawa, advised the Senate SpecialCommittee on the Non-Medical Use of Drugs that Canada has the second highest rate of drug-userimprisonment in the world, after only the land ofstars and bars (Hedges, 2006, p. 18). Roughly 150,000Canadians yearly are under the supervision of the criminal justice system (Prison Justice, 2007) with almost40,000 people locked up in 2009 (Statistics Canada, 2009). As of 2002, Canadian drug laws hadcriminalized an astonishing 1.5 million Canadians for simply using marijuana (John Howard Society, 2002),with 56,870 more charged last year alone with possession (Statistics Canada, 2011). In Ontario, police laiddrug charges in 22,500 incidents in 2003, which resulted in a conviction rate of about 30% for possessionand about 40% for trafficking (Canadian Centre on Substance Abuse, 2006). The Correctional Service of

Canada (2007) found that roughly 80% of inmates arrived for incarceration with a serious substance abuseproblem, half of those imprisoned had committed their crime while under the influence, and 90% of offendershad been previously convicted. (It almost makes you think that something isnt working.) But the FederalConservative government under Stephen Harper is expanding prison capacity by a further 5,775 beds(Pich, 2010), even while the crime rate has dropped like a stone to its lowest level in 38 years (StatisticsCanada, 2011). Who is the government planning to incarcerate next?

Despite tacit recognition of illegal drug use in prison, the crying need for appropriate intervention is met onlyby deliberate ignorance and calculated neglect in Canada. In 2007, Stockwell Day, Canadas Public SafetyMinister in the early years of the Conservative Federal regime, exercised the power of his office to shutdown programs for safer tattooing, established in 6 prisons, claiming that he didnt want to waste taxpayersmoney. In that same year, 68% of inmates admitted to getting a tattoo behind bars and 60% had receiveda piercing (CSC, 2010, p. 22). The Chief Public Health Officer of Canada, Dr. David Butler-Jones, wasconcerned then about the staggering potential consequences of the programs closure. He said that thesafer tattooing program would have recovered the full annual implementation cost of $100,000 cost perprison by preventing only 4 new Hepatitis infections yearly, but it was not given enough time to demonstrateits worth (cited in Kondro, 2007a).

This backward step was followed by another. Also in 2007, Day, an active fundamentalist-Christian(Hedges, 2006) and extreme right-winger (Hoover, 2000), cancelled consideration of implementing needleexchange behind bars (Kondro, 2007b). This foolhardy action flew in the face of evidence from the PublicHealth Agency of Canada that needle exchange behind bars clearly decreases infection rates while causingno new security problems (Elliot, 2007). His alleged concern for taxpayers money just doesnt add up,considering that the lifetime cost of treatment for one Canadian who contracts HIV in Corrections (orelsewhere) is estimated to be over $250,000 (Werb et al., 2008). Werb et al. further point out that genetic
http://www.canadianharmreduction.com/http://www.canadianharmreduction.com/


2/4

typing of HIV now enables identification of the exact source of infection, evidence that may open the door tofinancial compensation for preventable infection, similar to that provided for some Canadians who tragicallyacquired Hepatitis C Virus (HCV) through government laxity about the safety of blood harvested in bloodbanks.

Government closure of the safer tattooing program and stonewalling of needle exchange took place in 2007,even while the prevalence of HCV among the 13,250 prisoners held by the federal system was documented

at 31% (CSC, 2010, p. 32), a stark contrast to the less than 1% Hepatitis C infection rate found amongCanadians living in the community in 2004. About half of all inmates were tested for HCV upon admission toprison (CSC, 2010, p. 29); of the men who tested negative upon arrival, 4.4% later reported that theycontracted HCV over the next 2.9 years that they were imprisoned (CSC, 2010, p. 35). Between 2007, thetime that prison needle exchange was blocked and safer tattooing programs were closed, and 2010, the rateof known HIV infection among male prisoners tripled from 1.5% (CSC, 2007) to 4.5% (CSC, 2010, p. 31)and the rate among women was 7.9%.

The CSC study, carried out in 2007, was based on voluntary self-report, that is, on information already 4years old, which likely seriously underestimated the amount of HIV present in prisons. Even so, this ratecompares at about 15 times higher than the 0.3% rate of HIV infection among people living in the communityat that time. This figure is supported by data from Vancouver, which shows that, in 2007, among peoplewho identify injection drug use as the means by which they contracted HIV, 20% reported that they caughtthe virus while they were in prison (Kerr, 2007). About 30% of people who test HIV positive are also knownto have HCV infection (Cowan-Dewar, Kendall, & Palepu, 2011): double trouble. And who knows what the

figures are now, 4 more years into the epidemics?

Incarceration has been found to notreduce injection drug use whatsoever (Public Health Agency of Canada,2010, p. 12). The Cedar Projectfound that 41% of young Aboriginal people struggling with drug dependencyhad already spent time in Corrections. Upon being asked in 2007, 17% of men and 14% of women admittedto injection drug use while in federal prison (CSC, 2010, p. 39) and, of those who injected their drug, 55% ofmen and 41% of women reported that they had shared needles. In 2003, male injection drug users inprovincial prison in Quebec were shown to have an HIV prevalence of 7.2% while, among those who did notinject, it was 0.5%. Hepatitis C prevalence among men who injected was 53.3% and 2.6% among thosewho did not. Among women in prison who injected, HIV was shown to run at 20.6% and HCV at 63.6%,while among women who did not inject, the prevalence of HIV was 0% and HCV was 3.5% (Public HealthAgency of Canada, 2010).

Bleach to clean used needles is supposed to be provided by Correctional staff upon request, and 57% ofmen said that they did ask for it, however 37% also reported access problems. Sixty nine percent of

inmates did clean their needle with bleach; so did most (60 to 68%) of the 70% of inmates who received atattoo or piercing while incarcerated (CSC, 2010, p. 22). Prisoners clearly are making use of what harmreduction measures are open to them, despite the breaches of confidentiality experienced, for example,when they have to ask Correctional staff for bleach.

Prison needle exchange was begun by physicians in Switzerland 20 years ago in 1992, and now takes placein 60 prisons around the world from Germany and Spain to Kyrgyzstan and Iran (Chu, 2009). UninformedCorrectional staff have expressed many fears about needle exchange that are not supported by research orin practice. They fear that needles may somehow be turned against them as weapons. This has not everhappened in any prison program anywhere around the world. Staff may also fear an increase in needle stickinjuries. Evidence shows however that used needles are consistently placed in safe disposal containers, nothidden everywhere; so workplace safety for Correctional staff is actually improved since needle stick injuriesbecome even more rare. Another common objection is the sense that staff, expected to eliminate drug usein prisons, are condoning or even encouraging drug use by implementing needle exchange. Evidence fromaround the world, though, shows that drug use does not rise with prison needle exchange, rather referralsinto treatment rise (Jurgens, Ball, & Verster, 2009, p. 59), possibly due to more positive, respectful contactwith staff. Further, Corrections already has acknowledged that injection drug use is common in prison, asevidenced by the provision of bleach. Staff may also raise the issue of the cost of needles, but the cost oftreating illness contracted through injection drug use while in prison eclipses the relatively low cost ofproviding sterile needles. Seems like needle exchange just makes practical good sense for everybody,inmates and workers alike.

Set aside for now the incomprehensible response to addiction of imprisonment, particularly in a systemwhere illegal drugs are rife but treatment is almost unattainable. Incarceration takes an already vulnerablepopulation and places their every movement under the authority of the state for the duration of the sentence,


3/4

during which time Corrections assumes the responsibility to provide for the ordinary care and safety of theinmate, all within the purview of security. Together with the acknowledged mandate to protect the publicfrom individuals who might pose a risk, Corrections has also been charged by the courts with theresponsibility to ensure that those under its supervision receive the same level of health care as thatprovided to citizens living in the community. However the current practices of Corrections Canada place itscharges squarely in harms way. Other deadly infections wait their chance to pounce. For example, HIVinfection makes a person more susceptible to Tuberculosis (TB). Sterling et al. (2006), estimated that 12%

of all new TB infections yearly are acquired in prison. It is only a matter of time until the more deadly strainsof multi-drug resistant TB are loosed behind bars, where, in such a closed and crowded environment,transmission is efficiently facilitated. From prison, TB is sure to travel home with correctional officers,visitors, contract workers, and released prisoners. For that matter, so are Hepatitis and HIV.

Needle exchange and safer tattooing provisions make Corrections a safer, saner place for inmates, workers,and the community. Even If Corrections Canadas stated goal is perfect abstinence, Harm Reduction can beunderstood and implemented as simply the first practical step to keep people alive until the goal is reached.

What more can we say?

What will it take?

References

Beauschene. L. (2002). Senate Special Committee on Non-Medical Use of Drugs [Evidence].Accessed September 3, 2007 at http://cmte.parl.gc.ca/cmte/Committee. Pub.aspxz?sourceid=55930

Canadian Centre on Substance Abuse. (2006, May). Ontario enforcement report. CanadianCommunity Epidemiology Network on Drug Use. Accessed May 20, 2007 from http://www.ccsa.ca

Chu, S., (2009, December). Clean switch: The case for prison needle and syringe programs.HIV/AIDS Policy & Law Review, 14(2). 5-17.

Correctional Service Canada. (2007). Executive summary: A roadmap to strengthening publicsafety. CSC Review Panel. Accessed July 27, 2011 at http://www.publicsafety.gc.ca/csc-scc/rprt-eng

Correctional Service of Canada. (2008). Section 1: Overview. Departmental performancereports: 2007-2008. Accessed July 28, 2011 at http://www.tbs-sct.gc.ca/dpr-rmr/2007-2008/inst/pen/pen01

Correctional Service of Canada. (2010, March). Research reports: Summary of emerging findingsfrom the 2007 National Inmate Infectious Diseases andRisk-Behaviours Survey. Accessed July 27, 2011 at http://www.csc-scc.gc.ca/text/rsrch/reports/r211/r211

Cowan-Dewar, J., Kendall, C., & Palepu, A. (2011). Editorial: Prisons and public health. OpenMedicine 2011, 5(3), 132-133.

Elliot, R. (2007). Deadly disregard: Government refusal to implement evidence-based measuresto prevent HIV and Hepatitis C Virus infections in prisons. Canadian Medical Association Journal, 177(3),262-264. doi:10.1503/cmaj.070854

Fruehwald, S., & Frottier, P. (2002). Death behind bars. Canadian Medical Association Journal,

167(10), 1127-1129.

Hedges, C. (2006). American fascists: The Christian right and the war on America. New York:Free Press (Simon & Schuster).

Hoover, D. R. (2000). A religious right arrives in Canada. Religion in the News, 3(2). AccessedAugust 20, 2007 at http://trincoll.edu/depts/csrp/RINVol3No2/canada_religious_right

John Howard Society. (2002, August). Canadian cannabis policy: Factsheet 1. Kingston, Ontario:John Howard Society of Canada.


4/4

Jurgens, R., Ball, A., & Verster, A. (2009, January). Interventions to reduce HIV transmissionrelated to injecting drug use in prison. The Lancet, 9. Accessed August 9, 2011 atwww.thelancet.com/infection

Kerr, T. (2007). Canadas renewed drug strategy lacks accountability: Review[Media release].Vancouver, Canada: British Columbia Centre for Excellence in HIV/AIDS.

Pich, J. (2010, February 18). New adult penal institutions in Canada [Blog]. Accessed February

27, 2010 at http://www.tpcp-canada.blogspot.com

Prison Justice. (2007). Behind bars in Canada [Fact Sheet]. Accessed December 12, 2010 athttp://www.prisonjustice.ca

Public Health Agency of Canada. (2010, July). Chapter 10: HIV/AIDS among people who injectdrugs in Canada. HIV/AIDS Epi Updates. Accessed August 10, 2011 at http://www.phac-aspc.gc.ca/aids-sida/publication/epi/2010/10

Kondro, W. (2007a, January 30). Prison tattoo program wasnt given enough time. CanadianMedical Association Journal, 176(3), 307.

Kondro, W. (2007b, January 30). Conservative government scuttles needle exchange. CanadianMedical Association Journal, 176(3), 308

Statistics Canada. (2009, December 8). Adult and youth correctional services: Key indicators.The Daily. Accessed July 28, 2011 at http://www. statcan.gc.ca/daily-quotidien/091208/dq091208a

Statistics Canada. (2011, July 21). Police-reported crime statistics. The Daily. Accessed July 28,2011 at http://www.statcan.gc.ca/daily-quotidien/110721/dq110721b

Sterling, T. R., Bethel, J., Goldberg, S., Weinfurter, P., Lourdes, Y., Horsburgh, R., and theTuberculosis Epidemiologic Studies Consortium. The scope and impact of treatment of latent Tuberculosisinfection in the United States and Canada. American Journal of Respiratory and Critical Care Medicine,173, 927-931.

UN Office of Drugs and Crime. (2009). World Drug Report: 2008. Accessed June 20, 2009 athttp://www.unodc.org/documents/wdr/WDR

Werb, D., Kerr, T., Small, W., Li, K., Montaner, J., & Wood, E. (2008). HIV risks associated with

incarceration among injection drug users: Implications for prison-based public health strategies. Journal ofPublic Health, 30(2), 126-132. doi:10.1093/pubmed/fdn021

Wood, E., Tyndall, M. W., Spittal, P. M., Li, K., Anis, A. H., Hogg, R. S., et al. (2003). Impact ofsupply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: Investigationof a massive heroin seizure. Canadian Medical Association Journal, 168(2), 65-166.

Documents

Needle Exchange in Prison