Prison Needle Exchange

This paper analyses current trends in prison drug use, the prevalence of HIV/AIDS and HCV in prisoner populations and other information relevant to assessing the need for prison-based needle exchange programs in Canada. The first part presents background information on (1) the role of injection drug use (IDU) in the HIV and HCV epidemics, (2) prevalence of substance users and levels of substance use in Canadian prisons, (3) levels and patterns of injection drug use and needle sharing in Canadian prisons, (4) the prevalence of HIV and hepatitis C infections among Canadian prisoners, (5) evidence of cases of disease transfer from sharing needles in prisons, and (6) existing harm reduction policies and programs in provincial and federal correctional systems in Canada. The next section reviews international experience with prison-based needle exchange programs, emphasizing evaluations of their effects on behaviour and their effectiveness in reducing harms among prisoners who use drugs by injection. The third part provides a review of the legal/constitutional and moral/ethical rationales for providing sterile needles to prisoners and a brief summary of the previous calls for piloting prison-based needle exchange programs in Canada. The last part discusses several possible courses of action available to the Canadian government as it considers its options on prison-based needle exchange programs.

This volume addresses the interface of two major national problems: the epidemic of HIV-AIDS and the widespread use of illegal injection drugs. Should communities have the option of giving drug users sterile needles or bleach for cleaning needs in order to reduce the spread of HIV? Does needle distribution worsen the drug problem, as opponents of such programs argue? Do they reduce the spread of other serious diseases, such as hepatitis? Do they result in more used needles being carelessly discarded in the community? The panel takes a critical look at the available data on needle exchange and bleach distribution programs, reaches conclusions about their efficacy, and offers concrete recommendations for public policy to reduce the spread of HIV/AIDS. The book includes current knowledge about the epidemiologies of HIV/AIDS and injection drug use; characteristics of needle exchange and bleach distribution programs and views on those programs from diverse community groups; and a discussion of laws designed to control possession of needles, their impact on needle sharing among injection drug users, and their implications for needle exchange programs.

This edited volume provides the first ever comprehensive, international and multi-disciplinary review of the evidence regarding substance use and harms in people who cycle through prisons and jails. Grounded in solid evidence and a human rights framework, the text provides a roadmap for evidence-based reform

Based on the experience of many countries in the WHO European Region and the advice of experts, this guide outlines some of the steps prison systems should take to reduce the public health risks from compulsory detention in often unhealthy situations, to care for prisoners in need and to promote the health of prisoners and prison staff. This requires that everyone working in prisons understand how imprisonment affects health, what prisoners' health needs are, and how evidence-based health services can be provided for everyone needing treatment, care and prevention in prison. Other essential elements are being aware of and accepting internationally recommended standards for prison health; providing professional care with the same adherence to professional ethics as in other health services; and, while seeing individual needs as the central feature of the care provided, promoting a whole-prison approach to care and promoting the health and well-being of people in custody.