Opinion: Fix Canada’s prison needle-exchange program and save lives

Recently, researchers from the HIV Legal Network and Toronto Metropolitan University released the first national independent study of Canada’s “Prison Needle Exchange Program,” showing critical barriers to access and flaws requiring urgent fixes. At a time when policymakers purport to care about the lives of people who use drugs, they must reflect on what is — and isn’t — going well for this first program of its kind in a North American prison.

Back in 2018, after more than two decades of inaction, and in the face of troublingly high rates of HIV and hepatitis C among people in prison fuelled by the re-use of drug injection equipment, the Correctional Service of Canada (CSC) quietly announced the introduction of a program to provide sterile needles to people incarcerated in federal prisons. Similar programs have existed in numerous other countries for years, resulting in highly beneficial health outcomes.

While this historic announcement was welcome, there was frustratingly scant consultation with people in prison or with the community organizations that had long advocated for prison needle distribution. And despite acknowledging the incontrovertible evidence demonstrating the many benefits of providing prisoners with sterile injection supplies, our research shows that the model implemented by CSC does not follow successful operational approaches for needle distribution in prisons anywhere else in the world. Still, CSC committed to scaling up its program across all 43 federal prisons and, importantly, to conducting an evaluation.

But in 2022, CSC’s program still only exists in nine federal prisons. In some of those institutions, no one has ever even applied to enrol. Despite this, CSC has promoted its program globally as a “model” for other countries. According to Canada’s federal prison ombudsperson, CSC’s prison needle exchange program, “based on low participation rates, exists more in name than practice.”

This is not because of a lack of need. In our interviews with people formerly incarcerated in federal prisons across the country, they describe pervasive drug use and routine sharing of needles, syringes and other drug paraphernalia. They also told us about the burdens and barriers inherent to CSC’s program, including the need for multiple institutional approvals without any guarantee of acceptance and the hostility of prison staff toward prisoners who use drugs.

Further, interviewees who wished to access injection equipment voiced clear concerns around confidentiality, surveillance, and privacy, which deterred enrolment. As one person shared: “If they’re using the program, and then they’re subject to additional searches and drug tests, then why would anybody want to participate?”

But it didn’t need to be this way.

Severely restricting access to sterile supplies likely stems from an unfounded fear that providing such equipment to prisoners would lead to needle attacks against correctional officers. But the reality is that there has never been a single reported incident of assault with needles from prison distribution programs anywhere in the world. Occupational safety is improved — not reduced — where these programs exist, because staff are far less vulnerable to accidental needle-stick incidents and less likely to come into contact with a syringe that has been shared by many people.

CSC may also fear the proliferation of needles and syringes behind bars. But as our interviews confirmed, this is already the case. In the absence of a functional program, needles and syringes continue to be re-used, posing far greater risks of harm and infection. Resistance from correctional officers is to be expected, but education and training are key. And empirical evidence demonstrates the effectiveness of other programs in other jurisdictions that do not rely on unnecessary surveillance.

As people shared with us, there’s a need to “make it more confidential.” That could be achieved by disseminating secure kits to all people in prison upon request and without a burdensome application process; ensuring that program participation is not recorded in personal files; and diversifying the ways equipment is distributed. Prison authorities, correctional officers and health care staff should also be required to participate in training about the program benefits and the impacts of drug-use stigma.

All told, there are concrete changes CSC can and must adopt to ensure its Prison Needle Exchange Program is working as intended. Maintaining the status quo benefits no one, and lives are at stake.

Sandra Ka Hon Chu is co-executive director, HIV Legal Network; and Emily van der Meulen is a professor in the Department of Criminology, Toronto Metropolitan University.