drug policy – Page 5 – Matters of Substance

“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

One could argue that the best way to reduce and prevent harms from substance use is for everyone to stop using psychoactive substances. Similarly, one could argue that the best way to eliminate traffic fatalities and injuries is for everyone to stop driving. Rather, we adopt harm reduction strategies like seat belts, encourage people to obey road signs and not to drink and drive. When I ride my bike, I wear a helmet as that has been shown to prevent injuries. Shouldn’t everyone have access to evidence based strategies that reduce harms related to licit and illicit substance use? The Supreme Court of Canada definitely thinks so. In 2011 they granted Insite, North America’s first and only supervised injection site, an immediate exemption from federal drug laws, upholding BC Supreme Court decision that supervised injection is a health care service.

Harm reduction is a respectful nonjudgmental approach to reducing harms of drug and alcohol use that meets people “where they are at,” in relation to substance use without the expectation of eliminating or reducing use. The goal is to reduce harm, both for the individual using a substance and for those influenced by other people’s use. Harm reduction philosophy and principles stem from a pragmatic understanding that substance use is a feature of human existence – it is a part of our world and we can work to minimize its harmful effects rather than simply ignore or condemn them (see www.ihra.net). Participation and social inclusion of people who use substances in harm reduction responses are important principles of harm reduction. Within an overall philosophy of harm reduction, there is a wide range of evidence based harm reductions strategies that reduce the harms of alcohol, tobacco and illicit drugs such as heroin, cocaine and crack.

Much of the focus in harm reduction has been on reducing the harms of illicit drug use such as blood borne diseases, overdoses, public disorder and crime. For example, strategies like the provision of clean injection supplies or safer crack use kits, supervised injection, naloxone, methadone maintenance, and heroin prescription programs have been shown to reduce these harms especially among disadvantaged populations . Street based harm reduction services often emphasize the importance of a trusting relationship with clients to reduce stigma and to increase referrals and access to other health, housing and social services.

We sometimes hear the argument that restricting or prohibiting the establishment of harm reduction services will reduce harm to the community and is therefore harm reduction. But this is often based on fear or misinformation rather than evidence. Harm reduction services reduce harms by their presence not their absence. Illicit drug use is often feared and highly stigmatized with incarceration as a response; treating substance use as a criminal rather than health issue. This is why many are calling for drug policy reform and the decriminalization of currently illegal drugs..

Providing information and education about safer use of drugs and alcohol is also part of a harm reduction approach (e.g. safe use of prescription drugs, safer drinking guidelines or safer injection techniques). Harm reduction strategies are part of public health, substance use and treatment services complementing withdrawal and abstinence based approaches. So why are some harm reduction strategies seen as more controversial than others even though there is a strong evidence base? Societal understanding of harm reduction is expanding and more work is being done on alcohol harm reduction and harm reduction approaches tailored to youth and women. Get ready for future blogs that address these and other issues.

Author: Bernie Pauly RN, Ph.D, Associate Professor, School of Nursing, Scientist, Centre for Addictions Research of BC, bpauly@uvic.ca

Tag: drug policy

What is harm reduction?