Despite the slowdown in the pandemic, the Correctional Service of Canada still plans to expand needle exchange programs currently offered at nine federal prisons, government officials say.
In a presentation Friday at the International AIDS Conference in Montreal, Henry de Souza, the agency’s director general of clinical services and public health, said “several institutions have been identified” for expansion and that the program will continue to be implemented throughout the country.
Inmates have been able to request sterile drug equipment at two Canadian prisons since 2018, and seven more were added in 2019. Some advocates have expressed fears that the program, which is designed to reduce needle exchange and the spread of infectious diseases, could be canceled after numbers showed low participation.
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Only 53 inmates were actively using the programs as of mid-June, officials said at the AIDS conference Friday night, out of 277 who had been approved to participate over the past four years.
These programs are in addition to the country’s only prison “overdose prevention service,” which began operating in 2019 at the medium-security Drumheller Institution for men in Alberta. It is basically a supervised injection site, offering sterile equipment and consumption under observation.
Since the site opened, there have been 55 participants, 1,591 visits and zero overdoses at the site, officials said at the conference. The correctional service says it also offers mental health counseling, access to naloxone to counteract the effects of opioid overdose, and preventative treatments such as pre-exposure prophylaxis, a drug taken to prevent HIV.
All these efforts have led to a decrease in infections, said Marie-Pierre Gendron, an epidemiologist with the Correctional Service of Canada. He said HIV infection among inmates nationally has dropped from 2.02% of the prison population in 2007 to 0.93% in 2020; and hepatitis C has dropped from 21% in 2010 to 3.2% in 2021.
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Lynne Leonard, an associate professor at the University of Ottawa who was hired by the agency to evaluate the programs, said during a Tuesday morning panel that both programs have had “significant beneficial outcomes” for inmates, and see “successful institutional adoption” despite initial staff pushback.
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Preliminary results of their study found that the program appeared to lead to a significant decrease in HIV infections in the institutions that implemented it. Overdoses in Drumheller dropped more than 50% overall since its supervised consumption site opened.
“I’m encouraged by the way they describe the program as something they’re proud of,” said Sandra Ka Hon Chu, co-executive director of the HIV Legal Network.
But a major “red flag” that could lead to lower participation is the fact that security personnel are involved in the process, he said. This is not the case with prison needle exchange programs in other countries, some of which are completely anonymous or even offer syringes in automated dispensing machines.
“It’s really a critical flaw in the program,” he said.
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Asked about the low take-up, the correctional service said in a statement Tuesday that it has reviewed evaluation reports that indicate participation rates “may be the result of considerations such as stigma, fear, lack of understanding of harm reduction initiatives and the nature of addiction.” .”
Inmates are subject to a security threat assessment and a warden’s approval before they can access the programs, as officials describe the process. Almost a quarter of the requests to participate in the program have been rejected, according to the statistics presented at the conference.
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Shawn Huish, the director of the Mission Institution in British Columbia, said it was a challenge to change the mindset of corrections workers used to looking for drugs, confiscating them and trying to prevent inmates from taking them, while reassuring to the inmates who participated. to the program would not affect its release.
There was a lot of “fake news” to contend with, Huish said, including a billboard erected outside the prison that painted the program in a negative light.
“Our main goal was to talk, to educate, to break the fear. Having a recognized needle in prison can be scary for people,” he said. “You’re afraid of getting stuck with a needle. So we looked at the records. In two-and-a-half years, we’ve had a staff member get stung, and it was while he was looking, and it was a tack.”
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Leah Cook, the regional public health manager for the Prairies, oversaw the implementation of the supervised injection site at Drumheller and said it is “the only known service of its kind in a prison setting on the world stage, which I am incredibly proud of.”
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Cook said a “safe zone” was created so program participants could bring their own drug supply into the observation room without fear of being searched _ and has been nicknamed the “yellow brick road.”
Leonard’s research found that Drumheller staff members preferred it to the needle exchange program and thought it was safer and more successful.
The correctional service’s statement said it is committed to “further implementation” of both types of programs as part of its mission to “better support patients with problematic substance use needs.”
Warkworth Institution and Bowden Institution have been identified for an expansion of the needle exchange programme, the statement said, while Collins Bay Institution and Springhill Institution are being considered for expanding the overdose prevention service .
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