Needles in Prison: Where is Public Health Behind Bars?

“Our government has a zero-tolerance policy for drugs in our institutions.”  This comment comes from Canada’s Public Security Minister Vic Toews, responding the 2012 Federal lawsuit filed by four HIV groups and a former Canadian Correction inmate seeking a supervisory injunction – a court order that would force Ottawa to establish Canadian prison-based syringe access programs (PSAPs).

You may be asking yourself: “Drugs are illegal and prisons are drug-free, so why would we give inmates needles to commit a crime?”

The reality is prisons are not drug-free and needle-free; never have been, never will be.

Contrary to the assumption that prisons are a highly restricted, secure environment, virtually no prison in the world has been able to keep drugs completely out. Needles are easily smuggled in or can be made from various items already in prisons (see example here). These needles are shared, often for a fee, between anywhere from 10 to 20 inmates.

Roughly 80 percent of inmates arrive with substance use problems and incarceration has absolutely no effect on reducing injection drug use.  The Correctional Service of Canada itself admitted that 17 percent of male and 14 percent of female inmates reported injecting drugs while in prison – 60 percent of the time with a used syringe.

The danger here is that our prisons have become hot spots for HIV and hepatitis C virus (HCV) transmission. To begin with, HIV and HCV prevalence rates in prisons are at least 10 and 30 times higher than the population as a whole. A Vancouver study estimated 21 percent of all HIV infections among people in Vancouver who inject drugs were acquired in prison.

In the face of our government’s “zero tolerance” policies, Canada has acknowledged that drug use does exist in its institutions. Currently, bleach kits, which inmates can use to sterilize syringes, are available upon request. Advocates for PSAPs see bleach kit programs as a step in the right direction. But these programs have also come under scrutiny. Research shows inmates report limited access to such programs, particularly because they come with increased surveillance and stigmatization from correctional officers.

In addition to principles based on prohibition, the reason the Correctional Service of Canada has not moved forward with PSAPs is because of the concern that inmates may turn syringes on officers and use them as weapons. What is the evidence behind this?

In the 60 PSAPs across 12 countries introduced since 1992, there have been no reports of needles from PSAPs being used as weapons. Rather, evidence shows:

  • Reduced needle sharing
  • Reduced needle pricks
  • Decreased HIV and HCV transmission (also safer for officers if they do get pricked)
  • No increase in drug use or injecting
  • Reduced drug overdoses
  • Increased referrals to drug treatment programs
  • Effectiveness in a wide range of institutions

Despite this compelling evidence, PSAPs remain a tough sell in Canada. One possible reason why prison health has not been prioritized by the public may be due to a misconception that people stay in prison forever. But prisoners (including those who have contracted HIV and HCV) do not stay behind bars forever. Over 95 percent of people are eventually released back into the community. They are our brothers and sisters, mothers and fathers, sons and daughters. They are part of our communities – making prison health a vital component of public health.

Ignoring this fact not only harms public health more broadly, but, by definition, also violates human rights. HIV advocacy groups argue many rights are violated by refusing PSAPs, including the right to the highest attainable standard of health.

If not evidence, what will it take to introduce true public health and human right standards for Canadians behind bars?


Author: Alissa Greer, Research Project Coordinator at Rocky Mountain Poison and Drug Center

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

What contributes to alcohol-related violence and how can we prevent it?

Commonly seen and heard navigating down the corridor of an entertainment district are staggering patrons and their escalating aggression levels. When witnessed, incidents of alcohol-fueled violence may seem insignificant numerically; however, over the course of time the offences amount to substantial trauma and related legal costs. For example, a Canadian inmate study estimated that 28% of violent crimes reported to police are alcohol-associated1. In British Columbia, this translates to 17,888 offences in 2012 and a startling figure of 211,683 police-reported incidents over the ten years previous2. To see a striking visual illustration, visit the Victoria Police crime mapping portal and observe the concentration of assaults around the downtown entertainment district.

Behind these statistics, the alcohol-violence connection is complex and shaped by multiple factors: individual personalities, drinking environments, and social norms each having variable effects on human behaviour and drinking cultures. At the individual level it is hard to deny alcohol’s ability to impair judgement. Arguably this is the euphoric feeling (and the associated loss of fear or “Dutch Courage”) consumers seek.  The same decrease in cognitive function also leads to increased risk of physical violence and victimization when intoxicated patrons interact (i.e., around bars, nightclubs, or liquor outlets). In fact, a research article considering 11, 563 injury cases from 45 different hospitals across 16 different countries found that intoxicated patients had a higher likelihood of violence-related injury than any other catalyst. Many studies have also linked decreases in the price of alcohol, increases in trading hours, and high alcohol outlet densities (on and off premise alcohol retailers per unit area or roadway) to greater rates of homicides, assaults, and domestic violence independent of demographic and socio-economic status3&4. The only positive note is the consistently insignificant effect of restaurant liquor licenses on violence rates inferring that drinking with a meal and a small social group is mostly low risk.

Preventative measures to reduce the burden of alcohol-related violence are not out of reach for British Columbians. In fact, we have already come a long way in accepting evidence- based limits on pressing matters such as driving rights and public intoxication. Should we not consider the expediency of introducing fair pricing of higher alcohol content products, limiting late night sales of alcohol, and restricting alcohol outlet densities since these have been shown to reduce alcohol-related violence5&6? Allowing alcohol prices to keep pace with inflation6, shortening the 9:00am to 4:00am hours of on-premise liquor sales, and creating population based restrictions on liquor establishment densities removing the pressure on municipal governments to assess and approve liquor licenses7 seem reasonable steps toward harm reduction.

Armed with this knowledge, what alcohol availability restrictions are we willing to accept in order to decrease related harms?


Author: Jessica Fitterer