THE LACK OF NEEDLES AND THE DAMAGE DONE

If Needle Exchange Works In Canadian Cities Big And Small, Then Why
Do We Refuse To Implement The Practice In Our Prisons?

Providing clean needles to intravenous drug users is a broadly
accepted and successful public health measure: When you reduce
needle-sharing, you prevent transmission of blood-borne illnesses
like hepatitis C and HIV-AIDS.

Needle-exchange programs also provide an entry point for drug
addiction treatment programs and have been shown to reduce drug
overdoses (which require costly police, ambulance intervention and
hospital care).

If needle exchange works in Canadian cities big and small, then why
do we refuse to implement the practice in our prisons?

At this point, some (maybe even many) readers will say: "Hold on,
this is crazy talk. You can't give needles to criminals - especially
not in jail."

But before you dismiss the notion of prison-based needle exchange out
of hand, set your prejudices aside for a moment and dispassionately
consider the evidence.

According to a report published earlier this month by the Canadian
HIV-AIDS Legal Network, there are more than 60 prisons worldwide with
needle-exchange programs - in Europe, Asia and the Middle East.

Evaluations of these programs have consistently shown that common
fears are unfounded. In addition to the benefits seen in the
community, prison needle exchange does not lead to an increase in
drug use, and the programs have not resulted in syringes being used
as weapons against staff or other prisoners, nor has there been an
increase in accidental needle-stick injuries. (These are the
conclusions of the Public Health Agency of Canada, not some radical
fringe group.)

In any given year, about 300,000 Canadians will use injection drugs.
Many have addictions and suffer from serious mental-health problems;
there is also a fair bit of self-medication in victims of sexual abuse.

A significant number of IV drug users will spend time in prison,
usually for petty crimes related to their illness - addiction or
another brain disease.

(About 30 per cent of women and 14 per cent of men in jail are there
on drug-related charges. We should ask ourselves if they should be in
prison in the first place, rather than in treatment in the community,
but that is a topic for another day.)

Despite what people may think, illegal drugs - including ones that
are injected like heroin - get into prison and they are used fairly commonly.

A survey by Correctional Services Canada (CSC) shows that 38 per cent
of prisoners have used illicit drugs while in custody, including 11
per cent who used injection drugs.

In fact, research has shown that IV drug-use patterns are similar
whether a person is in prison or not.

CSC acknowledges this reality to a certain extent: Prisoners can get
bleach to clean needles, though bleaching is not a very effective
method of killing viruses.

Similarly, prisoners have access to condoms though, at least
theoretically, there is no sex, consensual or otherwise, taking place
in prison.

So why do we keep playing these games? Why not provide prisoners with
clean needles?

After all, prison is also a place where there are disproportionately
large numbers of people with infectious diseases.

Rates of hepatitis C and HIV-AIDS are 10 to 20 times higher in the
prison population than in the general population.

Simple measures like needle exchange can prevent a lot of harm. The
lack of availability of clean needles only exacerbates the risk of infection.

Again, this is made clear by surveillance data, which show that,
among newly-admitted prisoners, the hepatitis C infection rate is 9
per cent in males and 31 per cent in females; the prevalence rate in
the prison population is 27 per cent for males and 36 per cent for females.

The numbers are equally disturbing for HIV-AIDS. Upon admission,
infection rates are 0.8 per cent for men and 1.9 per cent for women;
in the general prison population it is 1.5 per cent in men and 4.5
per cent in women.

While these figures are not directly comparable, they tell us
something important: A lot of prisoners are getting infected while in
prison, and likely through needle-sharing. Incarceration essentially
doubles your risk of contracting a deadly infectious disease.

There are, of course those who will tug on their law-and-order
britches and say: "Who cares if a few junkies get a deadly disease in prison?"

Beyond the ethical dimension - the loss of liberty that incarceration
entails does not mean prisoners lose their other rights as citizens,
including access to health care - there are practical reasons for us
to want to reduce infections in prison.

First and foremost, 90 per cent of prisoners return to society. Does
it make sense, morally or financially, to send them back to society
sicker than when they were first incarcerated?

It costs about $22,000 a year to treat hepatitis C; for HIV-AIDS,
it's about $29,000 annually. (Keeping someone in prison, by
comparison, costs about $90,000 annually.)

We are living in strange political times: The crime rate is falling
yet the number of people being imprisoned is soaring, and promises to
grow more as the federal government pursues its "tough on crime" agenda.

While the rhetoric about "safer streets" is superficially appealing,
we need to ask ourselves how we can truly build a safer and healthier
society: Certainly not by incarcerating large numbers of people with
addictions in conditions that facilitate the spread of disease.

Clean needles cost a few pennies. An open mind is priceless.