Chelsea Cox comments on the introduction of two clean needle exchange pilot programs in Canadian prisons.
Federal prisons in Canada made headlines a few weeks ago when two pilot programs were announced that will provide access to clean needles for those serving time in two Canadian federal prisons. Clean needle programs are a harm reduction measure that operates by providing drug users with clean hypodermic needles to minimize the harms associated with intravenous drug use. Similar clean needle exchange programs are available to the general public in Canada, but these pilot programs mark the first of their kind within Canadian prisons.
Needle exchange programs have existed in prisons outside of Canada for decades, the first of which was implemented in Switzerland in the 1990’s. Human rights activists, medical professionals, harm reduction scholars, and first voice drug users have long advocated for similar programs in Canada.
The reasoning behind a clean needle exchange is simple – drug use will happen inside prison walls. “Just say no” and abstinence are not reality. Drugs will find their way inside prison walls regardless of rules and policies. A reality-based approach to drug use in prisons should focus on minimizing harms.
This goal is simple and the need is great. HIV rates are 200 times higher in prison populations than the general public. Hepatitis C rates are 260 times higher, and conservative estimates find 20% of inmates have used drugs while inside.
The effects of needle exchange programs are simple. They lower transmission rates of communicable diseases and provide equitable access to services that individuals have access to outside of prison. While lower rates of HIV and Hepatitis C would be tangible examples of positive effects, an elusive outcome is the establishment of trust and respect that is generated by meeting individual drug users where they are at and prioritizing safe drug practices rather than abstinence.
However, dealing with the opinions of stakeholders as to the need and desirability of these programs is not as simple.
The union representing correctional officers in Canada has stated that the pilot needle exchange program that will be introduced in two federal sites in Canada goes against their mandate. The union claims to be “a little baffled as to why the government would introduce an operational nightmare for correctional officers to try to institute.”
It makes sense that the safety of their own members and operational feasibility are primary and fundamental motivators in decision-making for correctional staff. But, correctional staff and other critics of needle exchange programs often rest their arguments on speculations that access to clean needles will increase drug use, that prisoners will take the needles and weaponize them against staff and each other, and that it will be an “operational nightmare.” These arguments, while logical, have been proven time and time again as baseless by decades of research.
Understanding the roots of drug use and dependency can help to unwind the superficial stigmatization that often naturally arises when talking about illicit drug use. Drug dependency and addiction are not a recreational choice; it is an all-encompassing health issue. This health issue does not evaporate when someone with a drug dependency enters prison walls.
If we are unwilling as a society to take an upstream stance on drug dependency as an illness, then harm reduction measures such as clean needle exchange programs are necessary. Drugs will continue to be used and abused in society regardless of their legal status. Mechanisms to minimize the risks and harms of drug use should be prioritized by all institutions regardless of whether those within the institution are serving time.
Drug dependency is blind to circumstance and context, and the provision of necessary programs like clean needle exchanges should be as well. Access to these programs is available outside of prison walls and has proven to be efficacious and to save lives and money. Therefore, their introduction inside of prison walls makes sense – especially given the archetype of those serving time. At least 7 out of 10 inmates serving time have a substance abuse issue entering the system. With higher rates of concentrated drug users than the general public, the lack of access to harm reduction programs such as clean needles exchanges could constitute a human rights violation, and might result in further entrenched stereotyping and stigmatization.
While these two pilot programs represent a small step in the right direction for Canadian drug and correctional policy, capacity and scalability of similar programs are urgently needed. Drug use will continue to happen. With the current opioid epidemic highlighting the dangers and pervasiveness of drug harms in Canadian society, harm reduction measures such as clean needle exchanges should be prioritized.
Chelsea Cox is a combined J.D. and Master of Health Administration candidate at Schulich School of Law at Dalhousie University and an Alumna of Yale’s Sherwin B. Nuland Summer Institute in Bioethics.