Prison Needle Exchange: Lessons from a Comprehensive Review ...

in drug consumption, and there were no new cases of HIV, HBV, or HCV infection in the
prison population. In addition, there were no reports of syringes being used as weapons
against staff or other prisoners. The prison also experienced a significant decrease in overdoses
and in abscesses. 135 In terms of drug consumption in prison, there were two interesting
results. First, the evaluation showed that the longer prisoners who had injected heroin and
cocaine before imprisonment stayed in prison, the higher the likelihood they would consume
drugs in prison. Second, the evaluation showed that the longer the harm-reduction project
had been in existence at the time the prisoner entered the institution, the less likely it was that
prisoners who had taken heroin and cocaine before imprisonment would use
drugs in prison. 136
The Realta project was also subjected to an evaluation similar in structure
to that done in Hindelbank. 137 The Realta project distributed 1389 syringes in
its first 19 months of operation, using dispensing machines. The findings of
the evaluation supported those in Hindelbank. Syringe sharing fell drastically,
and was evident in only a few cases. There was no evidence of new HIV,
HBV, or HCV infections in the institution, and there were no instances of
syringes being used improperly (although there was one report of a prisoner
receiving a needle-stick injury from a discarded syringe).
Surveys of staff attitudes at both institutions found that there was a high
level of acceptance of the programs.
The original program at Oberschöngrün has not been evaluated scientifically.
However, the physician in charge made a number of observations after
the project’s first three years. Among these were the disappearance of syringe
sharing and abscesses, no increases in deaths or overdoses among people
who inject drugs, and no instances of syringes being used as weapons. 138
While urinalysis is practised in the three prisons visited in the course of
preparation of this report (Oberschöngrün, Hindelbank, Saxerriet), none of
these institutions penalized people for traces of THC in their urine. In some
cases the prisons tested for THC but did not penalize for it, while in others
they chose not to test for THC at all. This practice was followed because the
prisons agreed that penalizing people for smoking marijuana or hashish,
which is detectable in urine for much longer than are injection drugs, would
result in many prisoners switching from cannabis use to injection drug use. The prison
authorities wanted to avoid this outcome, due to the significantly increased health risks associated
with injecting drugs.
It is also significant that prisoners in institutions with a needle exchange program are permitted
to access both methadone maintenance therapy and the needle exchange program.
Current situation
Prison needle exchanges continue to operate without incident in the seven prisons identified
above. Some of these have adapted their programs based upon experience gained over several
years. Hindelbank, for example, will now provide prisoners participating in the program with up
to five additional “points” (needles) to attach to the main body of the
syringe. This is to accommodate people who inject drugs and who may
have trouble injecting due to difficulty finding veins. In such cases, the
user may need to make several attempts to inject. With additional
“points,” the prisoner need not reuse a needle that gets duller with each
attempted injection. This practice has not resulted in any security prob-
Any syringe found outside
its plastic safety box
is considered illegal.
Hindelbank Prison,
Switzerland.
(photo: Peter Dimakos)
All syringes must be stored
in the plastic safety boxes
provided by the health unit.
Review of International Evidence 23