Six ways to make harm reduction work in Canada’s prisons

In Canada today, prisoners who inject drugs need to share needles, many of which have been used numerous times by other prisoners. Without access to sterile injection equipment, rates of HIV and hepatitis C virus are much higher behind bars than in the broader community. Prison-based needle and syringe programs (PNSPs) are an important way to address this public health problem, yet Canadian correctional authorities often claim they won’t work. A recent study demonstrates that PNSPs are indisputably feasible in Canada and should be implemented now.

A new report, On Point: Recommendations for Prison-Based Needle and Syringe Programs in Canada, outlines the findings of a two-year study that involved consultation with a range of diverse stakeholders, including former prisoners themselves. The research was conducted by representatives from the Department of Criminology at Ryerson University, PASAN (a community-based AIDS service organization that provides community development, education, and support to prisoners and ex-prisoners in Ontario), and the Canadian HIV/AIDS Legal Network (one of the world’s leading organizations tackling the legal and human rights issues related to HIV).

Study participants were very supportive of PNSPs and made compelling suggestions on how they could be adopted in federal prisons in Canada. One of the most significant findings was that prisoners wanted multiple access points to get their injection equipment; for example, through an automated syringe dispensing machine as well as through face-to-face interactions with trusted personnel. In practice, this could mean that prisons would install dispensing machines in locations out of view of security to ensure confidentiality, and fellow prisoners or prison in-reach workers who are knowledgeable about drug use and harm reduction can also distribute sterile injection supplies. These PNSP models are currently functioning in international contexts, and have been favourably evaluated.

 Here are six recommendations from the report to support the health of prisoners who inject drugs in Canada:

1. Prisoner access to PNSPs and sterile injection supplies should be easy, confidential, and not subject to disciplinary consequences.
2. Prisoners should have regular access to information, education and support from trained personnel regarding safer drug injection.
3. PNSPs should provide more than one approach to distribution within each institution.
4. PNSP implementation and delivery should include ongoing and meaningful consultation with, and education for, relevant stakeholders to ensure the accessibility and positive health outcomes of the program.
5. Prisoners should have an active role in determining PNSP programming, structure and policy.
6. The justice system, including the Correctional Service of Canada, should move toward addressing drug use as a social and health issue.

For too long, correctional authorities have rejected international evidence in support of PNSPs.  This new study demonstrates how these health services could work in our federal prisons. Access to PNSPs saves lives, and it is also a human right. There is no reason to further delay PNSP implementation.

If you want to join in the struggle to establish PNSPs in Canada, learn more at www.prisonhealthnow.ca

Emily van der Meulen was the Principal Investigator of this study, and is an Associate Professor in the Department of Criminology at Ryerson University. Her research interests include prison health and harm reduction, the criminalization of sexual labour, and gender and surveillance. She is co-editor of an anthology of writing on sex work, entitled ‘Selling Sex: Experience, Research, and Advocacy on Sex Work in Canada’ (UBC Press, 2013), and a collection focusing on gendered experiences of surveillance, entitled ‘Expanding the Gaze: Gender and the Politics of Surveillance‘ (University of Toronto Press, 2016).

Sandra Ka Hon Chu works on HIV-related human rights issues concerning prisons, harm reduction, sex work, women, and immigration at the Canadian HIV/AIDS Legal Network. She has authored numerous publications, including a compendium of affidavits describing prisoners’ experiences with injection drug use behind bars. She has also led the Legal Network’s involvement in lawsuits challenging the Canadian government’s failure to adopt prison-based needle and syringe programs and criminal laws governing sex work.