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

sophically supportive of the use of substitution treatment. In Canada and internationally, such
physicians may not be present in all prisons.
Similarly, prisoners may continue to inject illicit drugs, including drugs other than heroin,
even during MMT treatment. This reality has been recognized by the Spanish government
and is cited as one of the reasons for allowing prisoners on methadone programs to also
access needle exchange. 282 Ongoing injection of heroin might occur where prisoners do not
receive a methadone dose sufficient to address withdrawal symptoms, or where prisoners
inject narcotics to self-treat pain associated with chronic illness.
Finally, methadone is only a useful treatment for opiate dependency. It is not a harmreduction
option for those who inject non-opiates such as cocaine. Therefore, MMT does not
address the unsafe injecting practices of these drug users.
To summarize, while MMT is an essential element of a harm-reduction strategy, alone or
even in combination with bleach distribution, it is not a sufficient response to the risk of disease
transmission via injection drug use in prisons. Furthermore, for reasons similar to those
set out in the preceding section on the inadequacy of bleach, the implementation of needle
exchange programs in prisons has achieved other important benefits in the areas of prisoner
health and staff safety that cannot be replicated by MMT alone or in combination with bleach.
Opinions of prison staff
Part of the reluctance of Canadian federal and provincial/territorial governments to introduce
needle exchange programs is attributable to the real and expected objections of staff. In 1999
the Union of Solicitor General Employees, representing correction-
al officers, opposed needle exchange programs in federal institutions.
283 However, the evidence regarding the attitudes of individual
prison staff with respect to needle exchange programs is inconclusive.
For example, when researchers from the Expert Committee on
AIDS and Prisons surveyed CSC staff attitudes toward HIV prevention
initiatives, 15% of correctional officers and 31% of healthcare
staff were in favour of making syringe exchange programs
available to prisoners. 284 The survey was conducted 10 years ago.
Since that time there has been new evidence of significant increases
in HIV and HCV infection rates among prisoners, of the successful and safe implementation
of prison needle exchange programs in other jurisdictions, of the implementation and
subsequent expansion of MMT in federal prisons, and of updated HIV/AIDS education programs.
Attitudes and opinions can change. This change can result from knowledge and information
gained through first-hand or through workplace education programs. Therefore, it is
reasonable to expect that the number of staff supporting the implementation of needle
exchange programs would be higher today.
Canadian elected and prison officials should be aware of the evidence of staff attitudes in
other jurisdictions. A recent review of studies of needle exchange programs in Switzerland,
Germany, and Spain found that staff were generally supportive of the programs, although
survey response rates varied. 285 And as noted in this report, particularly in relation to the situation
in Germany and Moldova, staff attitudes have changed as staff have learned first-hand
about the needle exchange programs and the harm-reduction ethos, and as they have participated
in the implementation and review of needle exchange programs.
It is important to highlight that Canadian jurisdictions have safely and successfully introduced
harm-reduction measures such as condoms and bleach in prisons in recent years
despite the initially controversial nature of such measures. The implementation of these programs
has demonstrated that despite initial concerns in some quarters, harm-reduction mea-
A recent review of studies of
needle exchange programs in
Switzerland, Germany, and
Spain found that staff were
generally supportive of the
programs.
Needle Exchange Programs Should Be Implemented in Prisons in Canada 63