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

keeping in mind that the primary objective of the program is to prevent shared use of
syringes.” 188 The guidelines advise that “The number of kits to be supplied depends on the
frequency of exchange and the user’s consumption habits: it should be sufficient to cover the
inmate’s needs so that he does not have to reuse the syringe before the next day of
exchange.” 189
Second, prisoners participating in methadone maintenance are not disqualified from
accessing the needle exchange program. There are three reasons cited for this decision. The
first is a recognition that some drug users on methadone will continue to inject either sporadically
or habitually, and that this usually indicates that they are receiving an insufficient
dose of methadone. The second is in recognition that people on methadone may still inject
cocaine. The third is that methadone patients may act as “couriers,” obtaining sterile needles
for other people who inject drugs who do not wish to identify themselves to the prison
health unit. 190
The guidelines also enable prisoners living in drug-free units or involved in abstinencebased
programs to access sterile needles. It is recommended that requests for needles by
these prisoners be “approached from a therapeutic point of view, and appropriate therapeutic
measures taken to help him to overcome the relapse, but access
to sterile injection material should never be denied.” 191
The only instances in which participation in the needle exchange
program is restricted are in the cases of persons with mental health
issues who pose a danger or those classified as particularly violent.
In each of these cases, the guidelines suggest that individuals be
assessed on a case-by-case basis. For example, in the case of violent
prisoners, prison officials are encouraged to “regulate the
means of access by especially dangerous inmates, bearing in mind that it is always preferable
to adopt special security rules with these inmates than to deny access to sterile
syringes.” 192 Involvement in the program can also be denied if an individual uses a needle as
a weapon, or continually violates program rules. 193
Correctional officers
reported very positive
experiences with the needle
exchange pilot project.
Evaluation and lessons learned
To evaluate the original Basauri pilot project, a monitoring committee was established to
review and assess the program as it progressed. 194 Evaluations that involved consulting prisoners
and staff were conducted at zero, three, and six months. A 12-month evaluation was
deemed impossible, as the prison’s high turnover rate meant that
few prisoners remained in the institution from the start of the pilot
until the 12-month point. However, an evaluation with prison and
non-governmental organization staff was done after 22 months.
The prisoners accessing the program experienced no obstruction
from correctional officers, and supported the fact that the program
was run by the external non-governmental organization. It was noted
that this personalized aspect of the program was preferable to an
anonymous dispensing machine. Furthermore, the evaluation found that drug consumption
among the prisoners had not increased and that there was a reduction in high-risk behaviours.
Correctional officers also reported very positive experiences with the pilot. They reported
no problems or conflicts with prisoners as a result of the program, and there were no instances
of syringes being used as weapons. While they considered the program to be positive, they
expressed a preference that it be run by prison staff rather than by an external organization.
The staff of the non-governmental organization reported no instances of prisoners being
Prison needle exchange
programs facilitate referral
of users to drug addiction
treatment programs.
34 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience