Breaking out: Why do Canadian prisons still not have needle exchange programs?

CrossCurrents

By Daniel Werb

Over the last few decades, Canada has slowly forged a path toward a more socially concerned and health-based drug policy, with proposed prescription heroin trials and cannabis decriminalization serving as markers along the road. But there is one glaring exception: Prison-based needle exchange programs (NEP), which international evidence shows are successful in reducing the spread of blood-borne diseases in prisons, still do not exist in Canada.

With hepatitis C (HCV) rates among inmates around 40 per cent and HIV/AIDS rates more than 10 times that among the general population, according to the Canadian HIV/AIDS Legal Network, the issue of inmates’ access to NEPs extends beyond prison walls: Most inmates eventually return to their communities, so it is in the best interest of their communities to support programs that focus on prevention.

But Correctional Service Canada (CSC), which oversees the thousands of inmates who are serving time in Canadian prisons, has thus far rejected plans for NEPs, arguing that they could pose a danger to prison staff. Connor McCollum, federal hepatitis C program coordinator for the Prisoners’ HIV/AIDS Support Action Network (PASAN) in Toronto, says CSC is only making a bad situation worse. “CSC has been running reports on needle exchange programs for years, but there’s been no movement,” says McCollum. “In part, we think it’s because it’s such a political hot potato: Even though prisoners can vote, no politician thinks about them as a constituency, and it doesn’t make political sense to say you’ve got the backing of prisoners.”

More than anything, McCollum thinks lack of public understanding makes issues out of programs like needle exchanges. “If you give accurate information to the public, you’ll find support, because ultimately, people in prison return to the community,” says McCollum. He adds that for many inmates, prison is their first exposure to injection drugs, and that young people often quickly return to their communities infected with HIV or HCV.The Ontario Medical Association, too, sees needle exchange programs as a public health issue. In a 2004 position paper, it called for needle exchange programs to be set up in federal and provincial prisons within 18 months.

Yet there has been little progress. “The implementation of a NEP in correctional facilities is complex and remains controversial,” says Suzanne LeClerc, a CSC spokesperson. For CSC, any program that is introduced into Canadian prisons must have one crucial requirement: that it poses no danger to correctional workers.But Glenn Betteridge, senior policy analyst for the Canadian HIV/AIDS Legal Network, sees no danger. “What evidence is there that prison needle exchange will not promote public health?,” he asks. Betteridge conducted a study of NEPs in a number of countries and found that prisons that instituted needle exchange programs saw marked improvements in the overall health of inmates. A 2004 Canadian HIV/AIDS Legal Network review of prison NEPs from such countries as Switzerland and Kyrgyzstan reported no new cases of HIV/AIDS or HCV in the first year of implementing a NEP.

While LeClerc acknowledges the success of needle exchange programs internationally, she defers her judgment, stating that NEPs are pending a review that will present a full report this spring. For Betteridge, the CSC’s concern over the safety of prison guards is misplaced; he points to the fact that in six countries with prison NEPs (Spain, Switzerland, Germany, Moldova, Belarus and Kyrgyzstan), there are no reported cases of an inmate using a needle from a needle exchange program as a weapon, either against prison staff or inmates.

For McCollum, the CSC’s attitude toward drug use poses a far greater danger than an errant, sterilized needle. “There is a much greater danger to staff without needle exchange programs,” he says. “When a prisoner’s cell is tossed [searched for contraband or dangerous objects], there is a greater risk of needle stick injury and of that needle being contaminated. But if prisoners are given clean needles, there is no need for them to hide their rigs [injecting gear].” McCollum describes one model that would have clean needles kept in containers embedded in the wall, so that guards could easily see where needles were upon entering an inmate’s cell.

But for all the literature on the subject, Canada is still very much beholden to the punitive model of interdiction trumpeted by the U.S. This means that many drug users – particularly those who inject drugs – end up behind bars and that the CSC, while legally entitled to provide for inmates’ right to health, focuses its effort on enforcing a zero tolerance approach to drug use.

While CSC awaits the results of its report, Betteridge and McCollum fear that the window for implementation has been lost with the election of Stephen Harper’s Conservative government. “They have a real love for the crime and punishment mentality,” says McCollum. “Harper wanted to take away the vote from inmates, which is their constitutional right, so I don’t think we’ll be seeing a lot of movement on NEPs.”Betteridge agrees, though he is careful to point out that in one way or another, the public will pay for the choices the government makes. “Needles cost pennies; treating one case of HIV or HCV costs thousands and thousands of dollars,” he says. “It really boils down to a case of spend some money now on prevention, or spend much more later to treat those infected with HIV or HCV within prisons.”While all reports have shown that needle exchange programs positively affect the health of inmates – and communities – and make prisons safer for everyone, Canada, it seems, is destined to continue waiting for their implementation.

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