Matt Bonn and Martha Paynter oppose the routine strip-searching of people incarcerated in Nova Scotia prisons who have been administered methadone.
At the Central Nova Scotia Correctional Facility in Burnside, men who are prescribed methadone to treat opioid use disorder are routinely strip-searched every day after receiving their dose. For these men, the majority of whom likely experienced childhood sexual and physical abuse, strip-searching is re-traumatizing and non-rehabilitative. As advocates for people who use substances and who experience criminalization, we cannot accept that a harm reduction program in provincial corrections is causing harm.
Matt describes what a strip-search involves: “They get you to remove all of your clothes, put your hands through your hair, shake your body, lift up your external genitals, turn around, bend down and cough. In some cases, men in the cells that are across from each other see the search. It becomes so normal in the jail, but back in the community you realize how wrong it is. It’s a violation of human rights. While incarcerated you get really close to your fellow inmates, especially if you’re on methadone. You realize that a lot of these individuals have been sexually abused in their past. Yet every day they are stripped down bare-naked to receive a dose of medication that they are dependent on.”
The province’s policy aims to prevent people who are prescribed methadone from passing along their dose to someone else. In 2014, Clayton Cromwell, a 23-year-old man without a methadone prescription, died at the Burnside jail of a methadone overdose. Referencing the high rates of sexual and physical abuse among incarcerated women, advocates succeeded in lobbying for the province to exempt women from the methadone strip-search policy. People incarcerated on the men’s unit continue to be routinely strip-searched to receive their medication.
Methadone works by reducing the symptoms of withdrawal and craving to reduce injection drug use and unsafe opioid use. It prevents overdose and transmission of blood-borne infectious illness including Hepatitis C, a common illness among prisoners. Harm reduction is an evidence-based public health approach to reduce adverse experiences associated with drug use while recognizing abstinence is not a realistic or necessarily effective solution.
Most incarcerated people have histories of substance use disorder, related to experiences of trauma. Despite this, methadone treatment is highly inaccessible to prisoners. In Nova Scotia and in many jurisdictions, new prescriptions are not generally initiated when a person is admitted to a carceral institution. For those with an existing prescription from a community prescriber, within the corrections facility a “ceiling” dose is applied. People who have experienced incarceration report it is limited to 120mg/day.
In both Burnside and Pictou, two of the province’s jails for men, there is a lack of continuity of care. Receiving methadone in jail is socially stigmatizing but necessary to feel “comfortable in your own skin.” Clinically, an adequate dose is required for effectiveness.
Strip-searching is not an acceptable risk people experiencing incarceration should have to accept as a condition of treatment. Routine strip-searching is different from searches that are based on suspicions by corrections officers. Strip-searching as a requirement for access to a necessary medication is not harm reduction; it is harm. And it is not necessary.
Federal prisons do not routinely strip-search methadone patients because the Corrections and Conditional Release Act, federal legislation governing the treatment of prisoners, only allows routine strip-searching in circumstances where “the inmate has been in a place where there was a likelihood of access to contraband that is capable of being hidden on or in the body”. Staff-administered medication is not “contraband.”
Health care providers promise to abide by professional codes of ethics that insist on respect for patient autonomy, dignity, and consent. The United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules), lay out principles for the treatment of prisoners worldwide. It states that health care providers cannot participate in the cruel treatment or torture of prisoners. Institutional policy that requires patients be strip-searched after receiving treatment jeopardizes adherence to the Nelson Mandela Rules and professional standards of practice.
In prisons, security may be privileged over health. But security is about safety – public safety. Prisoners are members of the public too. If we can only keep people safe by harming dignity, we are not doing care right.
There are other ways to solve the issue of potentially diverted medication. Improving access to methadone is a first step; no one should face barriers to accessing harm reduction options. We must consider and develop alternatives to incarceration for people who require health services and support for substance use disorders and trauma recovery.
Matt Bonn is a first voice consultant and the lead peer with Peers Assisting & Lending Support (PALS), a harm reduction prison outreach program for current or former substance users involved with the Central Nova Scotia Correctional Facility. PALS’ mission is to reduce risks to health when people are released, by providing safe supplies, condoms, and naloxone.
Martha Paynter is a registered nurse working in abortion and postpartum care, a PhD Candidate at Dalhousie School of Nursing, and the founder of Women’s Wellness Within, and organization working for reproductive justice and prison abolition. @marthpaynter.