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

punished by prison staff for accessing the program, and that the program provided a useful
tool to reach prisoners with health-promotion messages and to refer them to other health programs.
They also suggested that some flexibility was necessary in the program, in that a strict
one-for-one exchange policy was not always practical. This issue was debated in the monitoring
committee. The non-governmental organization staff argued in favour of flexibility
regarding this policy. Their principle concern was that they did not want to deny a sterile needle
to prisoners who injected drugs and who did not have a needle to exchange, since this
would place the prisoner in a situation where he would be forced to share needles. The prison
guards, however, were concerned with security issues. In the end, an 80% return rate was
agreed as an acceptable standard (the program’s return rate was 82%).
Evaluations of the other pilot projects were also positive. In discussing the experience of
nine prison needle exchanges, a 2001 report prepared by the National Plan on Drugs noted
that “[t]hese experiences have shown that these programmes can be reproduced in a penitentiary
environment without resulting in any distortion or direct problems.” 195 The 2002 document,
Needle Exchange in Prison: Framework Program, provided the following conclusions
concerning the evaluations of Spanish prison syringe exchange programs: 196
• Implementation of a NEP, as in the community outside prisons, is feasible and adaptable
to the conditions of execution of the prison sentence.
• NEPs in prison, as in the community outside prisons, produce behavioural changes
that lead to a reduction in the risks associated with injection drug use.
• NEPs in prison facilitate referral of users to drug addiction treatment programs.
• Implementation of a NEP does not generally cause an increase in drug use or, specifically,
an increase in parenteral heroin or cocaine use.
• A NEP in prison should operate with a certain degree of flexibility and be tailored to
the individual circumstances of each prisoner, but without for-
getting the conditions for implementation established in each
program.
• It is feasible for a NEP and other drug addiction prevention or
intervention programs to coexist.
It is always preferable to find
a way to provide prisoners
who injects drugs with a
sterile needle than force
them into a position
where they will share.
The Spanish experience of prison syringe exchange has also found
that levels of intravenous drug use have remained unchanged, there
have been no accidental needle-stick injuries, there has been no
increase in conflict among prisoners or between prisoners and staff,
there have been no instances of syringes being used as weapons, and
staff support for the programs has grown with the experience of implementation. 197
Now that prison needle exchange has been expanded nationally, guidelines for ongoing
evaluation have been developed as part of the Framework Program. A computer software
package called SANIT is used in each prison to record the number of users of the program,
number of syringes supplied and returned, enrolments/withdrawals from the program, and
reasons for withdrawals. Health status is also included. To maintain the confidentiality of the
program users, a randomly generated number or pseudonym is used to identify each participant.
In addition to quantitative data, the evaluation also includes qualitative feedback from
prisoners and staff. Standard anonymous questionnaires for collecting this data are included
within the Framework Program document. It is suggested that evaluations be done on at least an
annual basis, if not more regularly (ie, three-, six-, and 12-month intervals). As a result, ongoing
evaluation and assessment of the programs will be available annually on a national basis.
Review of International Evidence 35