Needle Exchange Programs in Prisons

Needle exchanges in prisons has always been a contentious issue throughout the prison services with many opponents using the arguments that needles could be used as weapons, that it would send the wrong message and that it would increase drug use amongst inmates. These arguments have never really been backed up by any concrete evidence in fact if anything the evidence suggests that needle exchanges in prisons is a benefit for prisoners and a benefit for society.

In Australia one in three prisoners have Hepatitis C compared to the general Australian population Hepatatitis C in prison is massive. Only 1% of the Australian population has Hepatitis C yet in prison 30% of male inmates do and 50% of Female inmates do.  This can partly be put down to the fact that there is not an effective harm reduction program in most Australian jails especially when it comes to needle exchanges. As Vikki Roach (An Ex-Prisoner) said at the Australian Drug Conference in her “experience while I was inside my cell it was not uncommon for the one needle to be circulating the whole prison”.

The fact that in Australia roughly 25% of the prison population are injecting drugs is also a concern especially when needles are shared as often as they are due to a scarcity of clean needles. Most prisoners will come out of jail at some point and as many experts in Australia warn if Australia was “to have an epidemic of HIV beginning among people who inject drugs, it is almost certain that it would begin in one of our prisons.” Providing needle exchanges in prisons in Australia and indeed the rest of the world therefore is not just vital to combating blood-borne viruses in jail but also protecting the wider public.

Like many other countries Canada is also reluctant to provide needle exchanges in prisons. The government may spend tens of thousands of dollars providing condoms to inmates to prevent the spread of HIV but any good work done by the provision is condoms is severely negated by the absence of a needle exchange program the need for both condoms and needle exchange programs can’t be emphasised enough. The same goes for Ukraine and Australia with their condom programs. If these countries and others want to limit the spread of HIV and other blood-borne viruses then surely they should focus on one of the most prevalent forms of blood-borne viruses spreading namely unsterile needles.

Britain the very country who has in the past been actively encouraging needle exchange sites worldwide  due to the effectiveness of needle exchange programs in combating blood-borne viruses seems to think that somehow inmates should be exempt from needle exchange programs. Surely this is wrong, denying someone the chance to be part of a program which could potentially prevent them from suffering from lifelong illnesses is wrong regardless of what they did.

The US has a very limited needle exchange program throughout society so when it comes to jail there isn’t really any needle exchange to talk about. In New York the needle exchange programs throughout the city have been very effective in dropping HIV infection rates by up to 75% since the 1990’s. With evidence like this it’s quite shocking that there is not a larger spread nationwide of needle exchange programs it’s also shocking that prisons don’t allow needle exchanges considering the rate of HIV in US prisons is over 5 times higher than the general public and up to 40% of prisoners have Hepatitis C. It is a health problem that needs to be tackled especially since by not tackling the spread of blood-borne viruses in prisons it is jeopardising not just the health of the inmates but the health of society as a whole.

As important as it is to allow needle exchanges it is also important to provide the environment to make inmates feel secure using prison based needle exchanges. In Moldova when the first pilot programs began many inmates decided not to use it.  Only 50 needles were exchanged during the first five months of the needle exchange program and only one third of those known to be injecting drugs accessed the program. The main reason was that the inmates did not have the belief that the program was confidential and anonymous.

This lack of trust meant that the NGO running the program had to come up with another way of distributing the needles, one which would allow inmates to have confidence that they would not get into trouble and it would remain confidential. The solution was a peer based program, where the prison would use volunteer inmates to distribute the needles. Moving to this form of distribution helped increase the number of people accessing the needle exchange program to 70%. Idea’s like this is what is needed funny enough all the excuses that opponents have come up with have been shown to be completely inaccurate when it comes to places like Moldova.

One ridiculous excuse for the absence of needle exchanges in prisons is the fear that syringes could be used as a weapon against guards. Firstly this presumes that there are no needles in prisons when in actual fact there are, just they are shared between prisoners making it much more likely for a guard who gets attacked by one to develop a blood-borne virus. Secondly and more importantly a report by the WHO says that since the first Needle exchange program there have been no reports of a prisoner using syringes as a weapon against staff or prisoners in prisons with active needle exchange programs. This kind of nullifies the perception that somehow the syringes are used as weapons. This was the excuse for Scottish Prison Officers’ Association as to why they so vehemently opposed the proposition of a pilot needle exchange being introduced in jails in a prison in Aberdeen. In fact they were so against the idea that they threatened to revolt if the pilot scheme in Scotland went ahead. 

Another excuse is that by providing needles it somehow encourages drug use again this is completely wrong. There is absolutely no evidence that by providing needle exchanges in prisons that drug use goes up in fact there are many studies which seem to show the opposite. One study Nelles, Dobler-Mikola, Kaufmann found that there was no increase in drug use in fact it was the complete opposite with the study finding that injecting decreased! Other studies have found that drug use neither decreased or increased this again disproves the fact that if you provide a needle exchange in prison that it will automatically increase drug use.

Finally the pinnacle of ridiculous arguments against needle exchanges which is wheeled out every time there is talk of a needle exchange in prison being piloted. That is the excuse that somehow needle exchanges give out conflicting messages. A needle exchange does not automatically send out conflicting messages about being tough on drugs in prison all it does is provide a medium to cut blood-borne viruses in prisons. Like in Moldova where  staff who smuggle in drugs are fired and people found bringing in drugs are prosecuted yet they still manage to mirror that tough approach to drugs with the understanding that preventing needle exchanges and thus increasing blood-borne viruses in the prison is pointless.

If a prison does not provide the needles then inmates will just resort to using the limited needles smuggled in how ever scarce; over and over, inmate to inmate and cell block to cell block. Staff at prisons, the government and the wider public need to realise that just like getting rid of all the drugs on the street is impossible the same is true in prison. There may be more checks for drugs, there may be more check for needles but the fact of the matter is drugs will always make their way into prison some way somehow. It’s time that the governments of the world realise that and move towards harm reduction in prison.  The time has come for that the childish notion that we have to be tough on drugs whatever the consequences to families, the users and society to be thrown into the metaphoric waste bin. Being tough on drugs hasn’t stopped drugs in the past and it’s not going to stop drugs in the future all it’s done is create harm and suffering.

The only controversial aspect of needle exchanges in prisons is not the argument that they could be used as weapons nor that they could give out the wrong message. The only controversial aspect is the fact that governments around the world are still denying inmates a relatively cheap, effective means of controlling blood-borne viruses.