How a Misapplied Needle Exchange May Harm Incarcerated People

    A needle exchange program in seven federal prisons in Canada is at the center of a heated debate between the nation’s correctional officers union and harm reduction advocates. Each side says that its constituents—correctional officers and incarcerated people who use drugs, respectively—are endangered by the program.

    The Union of Canadian Correctional Officers claims, against the available evidence, that officers’ safety is jeopardized by incarcerated people accessing sterile syringes. Harm reductionists argue that instead, the program is currently failing those it’s meant to serve—and even putting them at increased risk. 

    Canada’s Prison Needle Exchange Program (PNEP) launched in June 2018. Nearly three-quarters of the incarcerated people who were accepted into it have since stopped participating, according to numbers obtained by Filter from Correctional Service Canada (CSC).

    The exact reasons for the departure of 49 program participants, out of an initially-accepted total of 63, are unclear. CSC told Filter that they “left the program for various reasons, such as statutory release, transfers and withdrawals.”

    But Canadian harm reductionists suggest that low participation numbers—with only 14 current participants—could be caused in part by corrections officers’ hostility towards it, as well as the program’s shortcomings.


    Correctional Officers’ “Evident Hostility”

    It’s hard to know how incarcerated people feel about the Prison Needle Exchange Program, as Sandra Ka Hon Chu, director of research and advocacy at the Canadian HIV/AIDS Legal Network Legal Network, explained to Filter

    Almost everyone she’s in touch with is not “willing to go on the record.” That could be due to the “hostile” environment she says correctional officers are sowing. “I have heard from people familiar with their conditions that some prisoners are facing harassment, and that correctional officers are wearing these badges of a needle with a red line through it, which is intimidating in itself, even though they are not saying something.”

    The union’s spokesperson did not respond to Filter‘s request for comment.

    The “very evident […] hostility of the union of corrections officers,” as Chu described it, is stark outside the walls. In June, for example, “hundreds” of blue-clad off-duty correctional workers paraded around a massive model syringe outside the Canadian Parliament building as part of a union action. They were protesting what union President Jeff Wilkins described as a program that puts the “health and safety of correctional officers at risk.”

    Members of The Union of Canadian Correctional Officers in June; Photograph by the Union

    But Wilkins’ claim is disputed by harm reduction advocates, like the Canadian HIV/AIDS Legal Network, who say that the union’s position contradicts the evidence⁠—and ignores the possibility that the PNEP’s faulty policies may be endangering incarcerated people who use drugs. 

    For one, union representatives have publicly mischaracterized the implementation of PNEPs. Wilkins claimed that PNEPs are “encouraging and turning a blind eye to drug use.” Yet a CSC spokesperson told Filter that “an inmate caught with illicit drugs outside of the [overdose prevention sites or PNEP] may face disciplinary measures and/or criminal charges.” 

    The union also claims that prisoners’ possession of needles in their cells is a safety threat to officers. The Legal Network maintains that there has not been a single reported instance of an assault with a needle from a prison syringe exchange around the world. The United Nations established in 2014 that such programs “are not associated with increased attacks on prison staff or other prisoners”—and that this intervention “minimizes the risks derived from the clandestine syringe use.” 


    The Prison Needle Exchange’s “Serious Deficiencies”

    Beyond the inaccuracies of hostile union arguments, the Legal Network says that incarcerated people who use drugs are put at further risk of interpersonal and legal harms because PNEP policies do not keep “with public health principles or professionally accepted standards for such programs,” as Legal Network Executive Director Richard Elliot wrote in a November 2018 letter addressed to CSC and others, and reviewed by Filter

    One of the “serious deficiencies” Elliot described is the requirement for a warden to individually approve each prospective participant’s enrollment. This, he wrote, “is contrary to international rules” that establish clinical independence.

    There’s no security involvement in the application process” in any other program around the world, explained Chu. “It’s a healthcare service. We would argue that there’s no need for security involvement in the decision to participate.” 

    “The security application process is a major deterrent when you know you’ll be outed.”

    Before receiving final approval from the warden to begin receiving PNEP kits—which include a syringe, sterile water, cottons, vitamin C and a sterile mixing cup—an incarcerated person must also be approved by the facility’s Health Services and Operations department, which conducts a risk assessment. 

    Chu and Elliot believe this process compromises the principle of patient confidentiality. Beyond making a “disclosure [to correctional officers] that is not justified,” as Elliot’s letter expressed, the application process is ignorant to the reality of how drug use is perceived.

    Correctional Service Canada applies the “same principles as [for] any other authorized sharp objects” in the process. A CSC spokesperson told Filter that this is a model “proven to be safe and effective.”  But syringes for illicit drug use carry far more stigma than those needed for a diabetic’s insulin, noted Elliot in the letter. 

    The current application process is “a major impediment” for prisoners’ participation, said Chu. Emphasizing that an application to the PNEP is an admission of illegal drug use, Chu said she’s heard from “colleagues who work in prisons and former prisoners that [the security application process] is a major deterrent when you know you’ll be outed.”

    Harm Reductionists must reckon with the possibility that the mere presence of a syringe program may not keep folks safer. 

    “Outing” prisoners’ drug use isn’t isolated to the application process; it may even occur on a daily basis for participants. A prisoner’s PNEP participation is shared with “others” on a “need-to-know basis,” according to a poster hung on a notice board at Kent Institution and obtained from a currently incarcerated person. 

    What’s more, a participant is subjected to visual inspections twice a day. These checks occur in highly public ways, according to Parnian Baber, a legal advocate for British Columbia-based Prisoners’ Legal Services, who also works with incarcerated people in the province.

    “They would have to show their needles at counts, where people stand outside of their cells and [correctional officers] count them. You would have to hold them up so an officer can see it,” Baber told Filter, who learned of this by prisoners who, themselves, had been instructed in the process by correctional staff. She has not spoken with any prisoners who have experienced this. “That’s extremely problematic. Other prisoners will know you have drugs on you. That puts your safety at risk.”

    Elliot wrote that these targeted inspections are “contrary to accepted PNEP practice, where—in the absence of any evidence of security risks—participating prisoners remain subject only to the same checks as other prisoners.” 

    PNEP – CSC Poster

    Poster from Kent Institution about PNEP; courtesy of Parnian Baber

    A person’s PNEP participation could even be disclosed to outside agencies that have a say in whether an incarcerated person can be released. The poster from Kent Institution states that “participation and compliance information may be shared with the [Parole Board of Canada, or PBC],” though it also states that “PNEP participation alone will not affect an inmate’s application for parole.”

    Ironically, CSC also recognizes in the poster that “participation in the PNEP is health information” and “will not normally be shared with the PBC.” The stated exception is if case managers identify “risk-related behaviors directly linked” to PNEP participation⁠—for example, if a person’s needles are lost or stolen. 


    What’s Next?

    The CSC spokesperson declined to comment on the concerns raised by the Legal Network due to “the ongoing litigation before the Ontario Superior Court of Justice related to the implementation of a prison-based needle exchange program in federal prisons.” 

    Representatives of Public Safety Canada, a law enforcement department to whom Elliot of the Legal Network also addressed his concerns, have refused multiple times to meet with the Legal Network, citing “ongoing litigation.” Elliot wrote in his letter that “this is not a necessary consequence of the litigation, but a regrettable choice being made by the government.” In refusing to collaborate on improving the PNEP, CSC seems to be disregarding the Legal Network’s arguments.

    The breakdown in this relationship has led to some positions that may seem surprising. In June, CSC rolled out a supervised consumption site in a men’s facility; the Legal Network was opposed, while the Union of Canadian Correctional Officers was in favor.

    Chu told Filter that the supervised consumption site requires incarcerated people to expose “their drug use—a highly stigmatized and criminalized activity—to other prisoners and staff,” bringing more of the harmful consequences that she and others believe are similarly caused by the PNEP. The union advocated for the site in the belief that it would prevent participants from having needles in their cells—reducing what the union presents as a threat to officers and other prisoners. 

    This ongoing debate encapsulates some problematic politics of harm reduction. As harm reduction interventions are increasingly assimilated into dominant institutions, people committed to reducing harms must reckon with the possibility that the mere presence of a syringe program or safe consumption space may not keep folks safer. 

    Advocates are faced with the tension of injecting life-saving interventions into inherently harmful spaces, like prisons—and the question of what should be done when “harm reduction” results in unforeseen damage.

    Photograph of needle exchange supplies from a program in Seattle; by Joe Mabel via Wikimedia Commons

    Correction, October 2: Parnian Baber’s comments were clarified to reflect her discussions with prisoners.

    • Show Comments

    You May Also Like

    The Invisible Majority: People Whose Drug Use Is Not Problematic

    For years, Mark* woke up each morning, made breakfast for his two young children, ...

    In 2018, the Temperance Movement Still Grips America

    Our society—even some of its most progressive elements—vilifies alcohol. This stands in opposition to ...