We need needle exchange in prisons

Does Trudeau back harm reduction or not, ask Sandra Ka Hon Chu and Richard Elliott

Implementing needle and syringe programs in federal prisons could prevent numerous new HIV and Hepatitis C virus infections each year, saving tens of millions of dollars.

Five years ago, we started a constitutional court case, because it was clear that, despite the evidence, the previous government would never agree to implement these health services in federal prisons.

But the Trudeau government has repeatedly declared its commitment to harm reduction and evidence-based policy, to Charter rights, and to the health and welfare of vulnerable Canadians. Prison-based needle and syringe programs reflect all of these.

So why is this government still dragging its feet?

During the last election, the federal Liberal party agreed in writing that there is “compelling evidence” for such programs.

Indeed, that evidence shows that in Canadian prisons, injection drug use is common, injection equipment is scarce and therefore shared, and HIV and HCV are rampant. Government figures indicate federal prisoners have rates of HIV and HCV many times higher than in the Canadian population as a whole. Meanwhile, rates of HIV and HCV among Indigenous prisoners — and Indigenous women in particular — are higher still.

Just as they do outside of prisons, needle and syringe programs in prisons reduce the harms of drug injection (including HIV and HCV infections and overdose), without leading to increased drug use or jeopardizing the safety of prisoners or prison staff. They increase referrals to drug treatment programs, and further virtually eliminate the risk of accidental needle-stick injuries in the workplace. First introduced in Switzerland 25 years ago, such programs now operate in a growing number of countries.

Factor in the ballooning costs of HIV and HCV treatment, and the fiscal case for sterile needles is also compelling. And finally, remember that the vast majority of prisoners are eventually released. Good prison health is good public health.

The Correctional Service of Canada (CSC) has known all this for years. It also knows that access to sterile injection equipment is a necessary part of the solution. Nearly 20 years ago, CSC’s own study group urged the implementation of needle exchange programs.

Eleven years ago, the Public Health Agency of Canada advised CSC that the evidence supporting such programs was definitive. Two years ago, the Canadian Agency for Drugs and Technologies in Health found the same.

Implementing prison-based needle and syringe programs has been recommended by the Correctional Investigator of Canada, Canadian Human Rights Commission, Canadian Public Health Association, Canadian Nurses Association, Canadian and Ontario Medical Associations, World Health Organization, UNAIDS and UN Office on Drugs and Crime.

The government’s ongoing deadly disregard of the evidence is not only negligent public health practice, it also violates human rights standards.

Prisoners have a right to the same standard of health care as is available in the community.

And denying prison-based needle and syringe programs is discriminatory in its impact, harming women and racial minorities disproportionately.

The Trudeau government has reinstated harm reduction as a key pillar of Canada’s federal drug strategy. The prime minister has instructed the attorney general to resolve outstanding litigation that is not consistent with the government’s values or the Charter. And numerous current and former Liberal cabinet members and MPs support harm reduction, including in prisons.

Despite all this, this government has so far failed to act.

Delaying the implementation of prison-based needle and syringe programs is an enormous waste of public money, not only to defend against our lawsuit but to treat prisoners and members of the broader community with HIV and hepatitis infections that can be prevented.

If this government is serious about public health and human rights, including for some of the most vulnerable people in Canada, it must commit — now — to establishing needle and syringe programs in all federal prisons without delay and with a firm deadline. Because it’s 2017.