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

contained and standards presented in these instruments, it can be argued that Canadian prisons
(both federal and provincial/territorial) have a legal obligation to provide prisoners with
access to sterile needles. Further, it can be argued that prisoners who have suffered damage
or harm as a result of the failure on the part of prison authorities to provide access to sterile
needles might have a successful legal cause of action against such authorities. Such an action
could be based on the Charter and the common law (for example, an action in negligence).
Inadequacy of bleach
In Canada, bleach is available as a harm-reduction measure in many prisons. 264 Bleach is an
important harm-reduction option for injection-drug-using prisoners who do not have access
to sterile needles. However, it is not a substitute for sterile needles among people who risk
HIV and HCV infection as a result of injection drug use.
The efficacy of using bleach to eliminate HIV in syringes has been well established, 265 but
bleach is not fully effective in reducing HCV transmission. 266 As well, previous studies indicate
that many injection drug users have trouble remembering how to properly disinfect
syringes using bleach. 267 In numerous studies, half or more of injection drug users do not
know or do not practise the proper method of using bleach for disinfecting needles. 268
Therefore, bleach is not regarded as the gold standard for preventing the transmission of
infectious diseases among injection drug users. Further, and specific to harm-reduction measures
in the prison environment, evidence from Australia indicates that a substantial proportion
of prisoners do not avail themselves of bleach even when it is made available. 269 The
probability of effective decontamination of needles using bleach is further decreased in
prison because cleaning is a time-consuming procedure and some prisoners may be reticent
to engage in any activity that increases the risk that prison staff will be alerted to their illicit
drug use.
While providing bleach to prisoners is a positive measure, problems with program uptake,
as well as the limited effectiveness of bleach in preventing HCV transmission, suggest that
this intervention alone is clearly an inadequate response to drug-related harm in prisons. It
has even been suggested that the reuse of an HIV-contaminated syringe cleaned with bleach
may actually increase the risk of HIV transmission. 270 Many studies promoting the value of
bleach as a harm-reduction measure still conclude that access to sterile syringes is preferable
to disinfecting previously used needles. 271
The experience of the needle exchange programs studied for this report indicates a number
of other health benefits associated with needle exchange for prisoners, benefits that cannot
be realized with bleach. These benefits include a significant reduction in abscesses and
other vein problems that result from reusing dull or damaged needles, and a significant
decrease in fatal and non-fatal overdoses in some institutions.
Needle exchange programs have also improved staff safety by reducing or eliminating the
risk to prison staff of accidental needle-stick injuries from concealed syringes during cell and
personal searches. The provision of bleach does not offer this benefit to prison staff, as needles
are still considered contraband within the institutions and are therefore hidden rather
than stored safely in visible areas.
That bleach is a suboptimal public health measure is true not only in the Canadian context,
but also in all prison systems throughout the world that provide bleach or other disinfectants,
but not access to sterile needles. According to UNAIDS, the provision of fullstrength
bleach to prisoners as a harm-reduction measure has been adopted in prisons in
Europe, Australia, Africa, and Central America. 272 Elected and prison officials in jurisdictions
where prisoners have been provided with bleach in the absence of sterile needle distribution
Needle Exchange Programs Should Be Implemented in Prisons in Canada 61