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

Analysis of the Evidence
Refuting objections
A number of objections have consistently been made against the implementation of needle
exchange programs in prisons. In many countries, including Canada, these objections have
formed the basis of politicians’ and prison system officials’ rejections of needle exchange
programs. The four principal objections to prison needle exchange programs are:
1. The implementation of prison needle exchange would lead to increased violence and
the use of syringes as weapons against prisoners and staff.
2. The implementation of prison needle exchange would lead to an increased consumption
of drugs, and/or an increased use of injection drugs among those who were
previously not injecting.
3. The implementation of prison needle exchange would undermine abstinence-based
messages and programs by condoning drug use.
4. The successful implementation of prison needle exchange programs does not indicate
that other jurisdictions will be able to implement successful programs because
existing programs reflect specific and unique institutional environments.
Increased institutional safety
One of the most important lessons to emerge from international experience is that implementing
prison needle exchange programs does not necessitate a trade-off between health
and security. In fact, as explained by Stöver and Nelles in a 2003 review of the evaluations
conducted of prison needle exchanges:
In no case had needles and syringes been used as weapons either against personnel
or other inmates. This was and is one of the controversial issues facing
prison-based SEPs [syringe exchange programs]. Syringes were not misued and
disposal of syringes did not exhibit any problem. For reasons of safety in the
44 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience