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

• do not increase drug consumption or injecting
• reduce risk behaviour and disease (including HIV and HCV) transmission
• have other positive outcomes for the health of prisoners
• have been effective in a wide range of prisons in six countries
• have successfully employed different methods of needle distribution to meet the needs
of staff and prisoners in a range of prisons
Not only are needle exchanges a proven effective public health measure for reducing the
harms associated with injection drug use, including HIV and HCV transmission; federal and
provincial/territorial governments in Canada have a legal obligation to respect, protect, and
fulfill prisoners’ right to health. This right is recognized in interna-
tional law, and includes the right to preventive health-care measures.
In the context of the HIV/AIDS epidemic, needle exchange programs
have been proved an effective preventive health measure for
those at risk of HIV infection. Given the persistence of illicit drug
use in prison, and the evidence of needle sharing among prisoners
who inject drugs, prison needle exchange programs are crucial to
the right to health for prisoners who inject drugs.
In addition, there are sound reasons to believe that prison needle exchange programs are
cost-effective and would even result in cost savings for Canadian governments.
Canadian governments should make important public health decisions based on the evidence
and their legal obligations, not on public opinion or political expediency. Nor should
elected or prison officials make a decision about prison needle exchange programs by ignoring
the evidence and their legal obligations, as has been the case for too long in Canada.
Leadership from elected officials and prison authorities is required. Leadership is also
required from individual prison staff, both correctional staff and health service staff, and
from outside physicians who work in prisons. Governments in Canada, and in particular
CSC, have been among the leaders in introducing harm-reduction measures in prisons.
Individual prison systems in Canada have already introduced condom and bleach distribution
and MMT, and provide HIV education to prisoners and staff – although work needs to
be done to ensure that prisoners throughout Canada have reliable access to such measures.
Despite the debate and resistance that surrounded the introduction and implementation of
harm-reduction measures, they are now widely accepted as part of the prisons systems’
responsibility to prisoners and have not compromised institutional security and good order
in Canadian prisons. The existence of these measures and the experience of their implementation,
along with international experience of and evidence from prison needle exchange programs,
represent the building blocks for the introduction of needle exchanges in Canadian
prisons.
Recommendation
Canadian prisons should
implement needle exchange
programs without delay.
Both federal and provincial/territorial correctional services in Canada should immediately
take steps to implement multi-site pilot needle exchange programs.
Needle Exchange Programs Should Be Implemented in Prisons in Canada 65