Post #277
950 words; 4 minutes to read
The needle exchange programs in Canadian prisons has serious weaknesses and fails to meet best practice standards, according to a recent study by an international group of researchers.
The need is evident
About 40% of those held in Canada’s prisons have a ‘moderate to severe’ drug addiction issue, according to a federal government report. ‘the latest available information from CSC indicates that among the 26.8% of people in federal prison who disclosed using drugs within the past six months while incarcerated, 47.1% reported injecting with a previously used needle and 52.9% said they passed their needle to someone else after injecting’. These patterns create serious problems, including deaths from overdoses and the spread of serious disease.
Most prison systems have problems with illicit drug use, leading to the development of needle exchange programs in many countries as long ago as the early 1990s. ‘Decades of research from these jurisdictions have established their benefits, including dramatically declining rates of syringe sharing; substantially lowered rates of HIV and HCV transmission; increased institutional safety and improved needle disposal; the stabilization or decrease of rates of drug use’.
CSC reluctant to create a program
Despite this record of success, Canada only adopted needle exchange programs in prisons in 2019, and then mainly as a result of legal challenges. The system instead favoured ‘Drug interdiction practices… ubiquitous forms of bio- and other surveillance methods such as urinalysis, strip-searches, cell searches, drug detection dogs, and ION scanners… Such efforts have been found both to increase health-related risks of drug use and to increase demand for drugs.’ The prison officers union has consistently opposed the creation and extension of needle-exchange programs.
That may be a main reason why, the study shows, the program is still not effectively implemented, with very limited participation and many procedures that are not consistent with international best practice. ‘ As of November 2023, across the eleven prisons with a PNEP, in which 3855 people were incarcerated, there were only fifty-one approved participants.’ This though more than 450 people had expressed an interest.
The very slow rollout of the program has been criticized by Canada’s correctional investigator.
Problems with the program
While the study points out that there ‘is not a singular authoritative source globally for what constitute “professionally accepted standards,” …. The most often referenced standard is the UNODC handbook for prison syringe distribution programs. The handbook outlines core principles including that such programs must be equitable, non-stigmatizing, and confidential, and that sterile drug use equipment should be un-rationed.’
‘The syringe distribution model developed by CSC in 2018 departs significantly both from internationally accepted professional standards and from the principle of equivalence of care, as described above.
The barriers are many
It is hard for prisoners to get access to the program because of ‘CSC’s unique security- oriented model. These assumptions are consistent with, and embedded in, penal logics found elsewhere in correctional practice that orient toward securitization as a means of organizing and coordinating the practices of correctional officers.
CSC and the union have argued that making needles available in prisons is dangerous. But ‘the innate dangerousness of needles is not borne out in the Canadian and international literature…, especially considering there is already a widespread existence of needles in circulation in carceral environments.’
In the CSC model, guards and other security personnel play a central role, unlike programs elsewhere. ‘In fact, we are unaware of any prison syringe program internationally in which security staff play a role as central as they do in CSC’s PNEP… By contrast, international evidence typically supports models that integrate modalities operated by community health workers or peer workers.’
Security takes priority over health
As a result, ‘security preoccupations and perceptions of risk are prioritized over health concerns or addressing the needs of those incarcerated. In the case of CSC, their PNEP model is directly molded by prison administration through the involvement of the prison security leadership… the Warden/Deputy Warden/AWO assesses entitlement to a healthcare program through the lens of institutional security. The PNEP is further shaped by correctional officers who are responsible for ensuring adherence to program, including storage of needle kits.’
In this model far fewer people are admitted into the program than might otherwise be the case based on need and interst. As well, ‘21% of PNEP participants were removed involuntarily from the program as a result of failing to adhere to program requirements.’ These requirements include a prohibition on sharing needles, a prohibition on participating if one’s cellmate is not in the program, and the requirement that the needle kit be made visible at any times to guards doing the rounds of ranges.
Participants face additional risks
The security-focused approach of CSC also ‘places PNEP participants in a contradictory and insecure position, where accessing essential healthcare exposes them to sanction.’ Often participation in the program is made known to other prisoners in various ways, meaning that participants are subject to various forms of pressure and discrimination from other prisoners as well as from staff.
Another result of the security-focus is CSC’s decision to limit points of access to solely hand-to-hand and one-for-one exchange with healthcare personnel employed by CSC. This is not consistent with existing best practice standards that rely on independent health care workers or community workers.
In essence, instead of seeing participation in needle-exchange as a part of required heath care for prisoners, the program has been seen as an unwanted threat to security that should operate with maximum surveillance even if that undermines its reach and effectiveness.
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