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

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working place, it is interesting to note that exchange rates within SEPs are high (almost 1:1): the return rate for two prisons in Lower Saxony were 98.9% for the dispensing machine in the women’s prison in Vechta, and 98.3% in the men’s prison in Lingen, Gross-Hesepe.... Therefore the risk of needle stick injuries by syringes not properly disposed of is very low. 234 [emphasis added] The safety of these programs has been noted by officials from the Correctional Service of Canada. In January-February 1999 a delegation from the CSC’s Study Group on Needle Exchange Programs travelled to Switzerland to observe the syringe exchange initiatives in three different prisons. Among the findings of the delegation’s report was a note on the safety of these programs. Inmates involved in the needle exchange program are required to keep their kit in a pre-determined location in their cells. This assists the staff when they enter the cell to conduct cell searches. Because syringes and needles are an approved program, there is no need for the offender to conceal them in their cells. To date, no injury has been inflicted on staff by a needle. 235 Providing prisoners with access to the means necessary to protect them from contracting HIV and HCV is in fact compatible with the interests of workplace safety and of the maintenance of safety and order in the institutions. All the international evidence indicates that there are already needles present within the prisons of many countries. Therefore, any suggestion that the implementation of prison needle exchange will introduce syringes into a “needle-free” environment is demonstrably false. Therefore the question becomes: Which situation is preferable? The status quo – where there are syringes in prisons, the number and location of which are unknown, but these syringes are most likely contaminated with disease – or the situation in institutions with well-managed needle exchange programs, in which the number of syringes in circulation is known, the prisoners who have them are known, and the needles are sterile, or at least used by only one person whose identity is known? From a workplace health and safety perspective, the second scenario is preferable to the first. The Spanish Ministry of the Interior and the Ministry of Health and Consumer Affairs, in their 2002 guidelines on the implementation of prison needle exchange programs, succinctly summarizes the safety benefits of needle exchange: The start-up of a NEP should not increase the risk, but rather, as previously stated, result in greater safety. First of all, illicit syringes, which are usually hidden and unprotected, are replaced by program syringes equipped with a rigid protective case. Secondly, in the event of an accident, it is less likely that the syringe has been used because the inmate can and should exchange it for a new one at the first opportunity after use. Thirdly, in the event that the syringe has been used, it is less likely that it has been shared by various inmates, thus reducing the probability of it being infected and enabling the user to be identified with greater cer- In no case have needles and syringes been used as weapons either against personnel or other inmates. The safety of prison needle exchange programs has been noted by officials from the Correctional Service of Canada. Analysis of the Evidence 45
tainty, which allows preventive actions to be taken if necessary. Finally, in the long term, reduction of parenterally transmitted diseases will make prisons a healthier and less risky environment. 236 No increase in drug consumption or injecting The belief that needle exchange programs promote injection drug use has historically been a barrier to the implementation of this effective harm-reduction measure in both the community and in prison. However, within prisons this argument is complicated by the fact that many prisoners are incarcerated as a result of drugs or of drug-related offences. Consequently, providing bleach or sterile needles to prisoners is seen to be condoning or promoting behaviour that the prison should be seeking to eradicate as part of the individual’s “rehabilitation.” Acknowledging the reality of drug use in prisons is also difficult for prison systems because it may be perceived as an admission of the failure of such systems and their personnel to provide effective drug programming and to maintain institutional control and security. In the case of prison syringe exchange, scientific evaluations have consistently found that the availability of sterile syringes does not result in an increased number of drug injectors, an increase in overall drug use, or an increase in the amount of drugs in the institutions. In a recent review of 11 evaluated prison needle exchange programs in Switzerland, Germany, and Spain, Stöver and Nelles found the following: 237 Reduction of parenterally transmitted diseases will make prisons a healthier and less risky environment. Drug use in Prison Country the institution IDU in the institution Am Hasenberg No increase No increase Germany Basauri No increase No increase Basque Country Hannöversand No increase No increase Germany Hindelbank Decrease No increase Switzerland Lehrter Strasse No increase No increase Germany Lichtenberg No increase No increase Germany Lingen I No increase No increase Germany Realta Decrease No increase Switzerland Saxerriet No data No data Switzerland Vechta No increase No increase Germany Vierlande No increase No increase Germany 46 Prison Needle Exchange: Lessons from a Comprehensive Review of International Evidence and Experience
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Prison Needle Exchange: Lessons fro
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In memory of Andréa Riesch Toepell
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Spain 29 Summary 29 HIV/AIDS, HCV,
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Prison Needle Exchange: 2006 update
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Sample Evaluations of Prison Needle
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initiatives occurring in local comm
Page 16 and 17: ings on the feasibility and efficac
Page 18 and 19: Executive Summary This report exami
Page 20 and 21: • do not endanger staff or prison
Page 22 and 23: Prisoner Health Is a Public Health
Page 24 and 25: Methodology The evidence for this r
Page 26 and 27: HIV and HCV Epidemics in Prison Pre
Page 28 and 29: injection drug practices and unprot
Page 30 and 31: Many prisoners, whether in pretrial
Page 32 and 33: while in holding cells before incar
Page 34 and 35: While harm-reduction policies do no
Page 36 and 37: • Additional Protocol to the Amer
Page 38 and 39: fit from medical treatment under th
Page 40 and 41: Review of International Evidence of
Page 42 and 43: History of the response to HIV/AIDS
Page 44 and 45: in drug consumption, and there were
Page 46 and 47: lence rate of approximately 0.1% in
Page 48 and 49: ic acid, filters, plaster, and sodi
Page 50 and 51: harm-reduction measures and declare
Page 52 and 53: injection drug use, HCV infection r
Page 54 and 55: the jurisdiction of the government
Page 56 and 57: punished by prison staff for access
Page 58 and 59: changed to a peer model, which has
Page 60 and 61: the prisoners who were injecting, a
Page 62 and 63: Kyrgyzstan 218 Summary Kyrgyzstan i
Page 64 and 65: of 20% to 40%. However, these treat
Page 68 and 69: These findings demonstrate that the
Page 70 and 71: grams strongly reduced syringe shar
Page 72 and 73: proven effective in barracks-style
Page 74 and 75: • Prison has opportunity to maint
Page 76 and 77: staff, is also an indication of the
Page 78 and 79: Needle Exchange Programs Should Be
Page 80 and 81: professor of Aboriginal ancestry; a
Page 82 and 83: contained and standards presented i
Page 84 and 85: sophically supportive of the use of
Page 86 and 87: • do not increase drug consumptio
Page 88 and 89: the case in countries, including Ca
Page 90 and 91: 15 Central and Eastern Europe Harm
Page 92 and 93: 67 R Keppler, F Nolte, H Stöver.Tr
Page 94 and 95: 121 Australian National Council on
Page 96 and 97: 180 Delegación del Gobierno para e
Page 98 and 99: 245 Ibid at 14. 246 This analysis i
Page 100 and 101: Bibliography International instrume
Page 102 and 103: Byrne A, K Dolan. Methadone treatme
Page 104 and 105: 2000). Elementos Clave para la Impl
Page 106 and 107: Landry S et al. Étude de prévalen
Page 108 and 109: Shapshak P, RK Fujimura, JB Page, D
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