An argument for access to sterile injecting equipment in jail…

The sweat was pouring from his brow.  His insides felt contorted like they were outside of his body.  He could not stop vomiting.  As death was surely looming in, another inmate offered him a hit from an unsterile needle.  What choice did he have?  To suffer through deathly opioid withdrawal or feel the euphoria of a quick fix.  He took the hit.  Without access to sterile injecting equipment he was forced to use the unsterile needle.  Three months later he was diagnosed with Hepatitis C.

This story depicts a disturbing trend.  Many individuals engage in high risk behaviours while incarcerated including needle sharing which places them at an increased risk of contracting Hepatitis C.  Incarcerated persons who inject drugs have eight times the prevalence of Hepatitis C in comparison to those who do not inject drugs.  In Canada, one in four federally incarcerated persons have Hepatitis C and lack of access to sterile injecting equipment perpetuates this public health issue.

An increased incidence of Hepatitis C in the incarcerated population is found in current literature at a global, national, and provincial level.  An estimated 130-170 million people worldwide live with Hepatitis C.  The prevalence of Hepatitis C in Canadian prisons is between 17-40% or 20-50 times higher than the general population.  In New Brunswick, 32.5 cases of Hepatitis C per 100,000 people were reported in 2017 with injection drug use listed as the most prevalent risk factor.  Substance use disorder is overrepresented in the provincial correctional system, in comparison with the general population, with 60% of incarcerated persons reporting addiction and 48% reporting concurrent disorder (addiction and mental health).  There is not access to sterile injecting equipment within New Brunswick correctional centers further adding to the problem. 

Harm reduction approaches to people who use substances, such as needle exchange programs (NEP), are well documented in the literature as a method to decrease the spread of HCV in the correctional setting.  A NEP would enable incarcerated people to have a safe avenue to use and would decrease the risky behaviours associated with an abstinence-based model that increases the spread of Hepatitis C.  An exploratory study conducted found that hepatitis C knowledge, or lack thereof, is related to risky drug using behaviours- including needle sharing.  Another cross-sectional biobehavioral study exploring the role of impulsivity as a factor in risky transmission behaviour finding reward-related impulsivity was often related to drug use. 

The argument against the implementation of a NEP within corrections is grounded with safety concerns. Worldwide, many NEP have been implemented in the correctional setting without reported security threats.  In over 25 years of needle exchange policies in the prison setting worldwide there has not been a single reported incident of assault with a needle.  CSC (2019) reports that federal prison NEP contribute to workplace safety and are not associated with increased assaults on prison staff or inmates.  This perceived threat has been disproven in the literature time and time again.

Correctional centers and healthcare services are highly interdependent, because nurses cannot deliver high quality healthcare without the cooperation of the correctional system and correctional centers cannot deliver correctional services that meet international standards without good healthcare services.  Together the spread of Hepatitis C, and other blood borne pathogens, can be halted with the implementation of a NEP within provincial corrections.

Written by Holly Richards, a passionate Harm Reduction Advocate

References

Arends, R., Nelwan, E., Soediro, R., Crevel, R., Alisjahbana, B., Pohan, H., Borries, K., Schene, A., Ven, A. & Schellekens, A. (2019). Associations between impulsivity, risk behaviour and HIV, HBV, HCV and Syphilis seroprevalence among female prisoners in Indonesia: A cross sectional study. PLOS ONE, 1-13. DOI:  http://doi.org/10.1371/journal.pone.0207970

Barro, J., Casillas, A., Getaz, L., Rieder, J., Baroudi, M., Francois, A., Broers, B. & Wolff, H. (2014). Retractable syringes in a swiss prison needle and syringe exchange program: Experiences of drug-using inmates and prison staff perceptions. International journal of mental Health and addiction, 12, 648-659. DOI: 10.1007/s11469-014-9498-x

Canadian HIV/AIDS Legal Network. (n.d.). The correctional service of Canada’s prison needle exchange program policy brief. file:///C:/Users/e85ee/Downloads/PNEP_Policy-Brief_Eng.pdf

Canadian HIV/AIDS Legal Network. (2019). Prison-based needle and syringe programs: Myths and Facts. file:///C:/Users/Holly/Downloads/PNEP_Myths-and-Facts_Eng.pdf

Correctional Services Canada (CSC). (n.d.) Prison needle exchange program. https://www.csc-scc.gc.ca/health/002006-2005-en.shtml

Courtemanche, Y., Poulin, C., Serhir, B. & Alary, M. (2018). HIV and Hepatitis C virus infections in Quebec’s provincial Detention Centers: Comparing prevalence and related risky behaviours between 2003 and 2014-2015. Canadian Journal of Public Health, 109, 353-361. DOI: https://doi.org/10.17269/s41997-018-0047-4.

Canadian Nurses Association (CNA). (n.d.). https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/cna-harm-reduction-in-canadas-prisons-a-companion-document.pdf?la=en&hash=DA0F1AA67F868820FF5FD00608AC8E44EBDB816C

Health record of clients. Data obtained October 2019.

Iafrate, A. (2015). Canadian Prison Needle-Exchange Programs: Can the Health Benefits Overcome the Current Legal Barriers. Dalhousie Journal of Legal Studies, 24, 25-54. 

New Brunswick (2017). New Brunswick Communicable Disease 2017 Annual Surveillance Report. https://www2.gnb.ca/content/dam/gnb/Departments/h- s/pdf/en/CDC/HealthProfessionals/Annual_Report_CDC_Branch_2017.pdf

Peteet, B., Staton, M., Miller-Roenigk, B., Carle, A. & Oser, C. (2018). Rural incarcerated women: HIV/HCV knowledge and correlates of risky behavior Health, Education & Behaviour, 45(6), 977-986. DOI: 10.1177/1090198118763879

Public Health Agency of Canada (PHAC) (2018). Hepatitis C in Canada: Infographic. CCDR, 44, 7-8. https://www.canada.ca/content/dam/phac-aspc/documents/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2018-44/issue-7-8-july-5-2018/ccdrv44i0708a07-eng.pdf

Stover, H. & Hariga, F. (2016). Prison-based Needle and Syringe Programmes (PNSP)- Still highly controversial after all these years. Drugs: Education, Prevention & Policy, 23(2), 103-112. DOI: 10.3109/09687637.2016.1148117

Tavoschi, L., O’moore, E. & Hedrich, D. (2019). Challenges and Opportunities for the Management of Infectious Diseases in Europe’s Prisons: Evidence-based Guidance. Lancet Inf Dis, 19, 253-258. http://dx.doi.org/10.1016/S1473-3099(18)30756-4

Wirtz, A., Yeh, P., Flath, N., Beyrer, C. & Dolan, K. (2018). HIV and Viral Hepatitis among imprisoned key populations. Epidemiologic Reviews, 40, 12-26. DOI: 10.1093/epirev/mxy003.

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