Assessing the Need for Prison-Based Needle Exchange Programs in Canada: A Situational Analysis

The purpose of CCSA's National Policy Working Group (NPWG) is to provide a forum or focus for agencies, or individuals with an expertise in substance abuse to participate in a broad discussion and analyze policy issues and topics from a national perspective.The NPWG is not an advocacy group, but provides a "best practice" analysis and positions for consideration by the CCSA Board and the broader addictions community.The NPWG contributes to CCSA's goal of policy formulation by monitoring significant research and policy developments and providing informed comment on issues of national significance. Ce document est également disponible en français sous le titre Évaluer le besoin de programmes d'échange de seringues dans les prisons au Canada : analyse de situation. This document was made possible in part through a financial contribution from Health Canada.The views expressed herein do not necessarily reflect the views of Health Canada. Abstract The overall goal of this background paper is to present a situational analysis of 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. Introduction It has become increasingly evident that simplistic " just say no " and one-sided " get tough " enforcement approaches are not providing adequate responses to either the complex causes or the sizeable …