Providing sterile syringes in prison is an efficient way to keep people who use drugs safer and healthier, just as it is in the wider world, new research underlines. But if policymakers don’t find that motivating, there’s also the fact that these programs save far more money than they cost.
Prison syringe provision means government officials acknowledging that drug use is widespread there. As the Marshall Project and many Filter authors have described, drug use is common throughout the federal and state systems in the United States. Drugs arrive in a variety of ways, including through corrections officers. Incarcerated people are far likelier than the general population to have substance use disorders, and increasingly vulnerable to overdose and other harms.
The new study was published in the Canadian Medical Association Journal (CMAJ) on December 16. The researchers studied how implementing syringe service programs (SSP) in Canadian prisons impacted hepatitis C and injection-related infections. They then estimated the effect if more prison programs were rolled out.
By 2019, nine out of 43 federal prisons in Canada had opened SSP, known as Prison Needle Exchange Programs (PNEP). Over a 12-year period from 2018-2030, the researchers projected that PNEP at this level would cost a total of $450,000 CAD, and prevent 37 hepatitis C transmissions and eight injection-related infections.
The researchers found that every dollar invested in PNEP results in savings of about $2. So the more programs are opened, the more money the government will save.
The researchers noted that PNEP covered 10 percent of the prison population who inject drugs as of 2022. But if PNEP were expanded to cover 50 percent of this population at all federal prisons, at a cost of $2.7 million until 2030, they estimated that 224 hepatitis C transmissions and 77 injection-related infections would be averted.
Given the costs of diagnosis and treatment for these conditions, the researchers found that every dollar invested in PNEP results in savings of about $2. So the more programs are opened, the more money the government will save.
Sandra Ka Hon Chu is the co-executive director of the HIV Legal Network, which was one of the parties that sued the Canadian government in 2012, in an attempt to force it to offer SSP in federal prisons. She was not involved in the new study, but shared her thoughts about what it shows us.
“This is something we’ve known in community for a long time,” she told Filter. “Needle and syringe programs save money by offsetting the cost of treatment. They’re not very expensive to implement.”
Harm reduction advocates in Canada pressured the government for years to allow prison SSP. The 2012 lawsuit involved a group of criminal justice and HIV organizations, along with a person incarcerated at a federal facility, suing the government on constitutional grounds. The case was never actually settled in court, but the advocacy worked—in 2018, Correctional Service Canada agreed to implement what became PNEP.
To do this, the federal government had to acknowledge the reality of drug use in prisons. To this end, the lawsuit referenced the government’s own estimates of the prevalence of HIV and hepatitis C in the system.
“We had evidence of a lot of injection drug use happening,” Chu said. “Their own data was a confession that this is happening. Our argument is also that there’s no prison system in the world where there is zero drug use, no matter how you crack down. They conceded it was happening.”
However, the government countered “that they had all this other programming that’s doing its job, and they’re worried about the security threat of increasing the number of needles in the prison system,” Chu continued. “Our response is there’s already a lot of needles in the system and they’re not being regulated. They’re not sterile, and there’s greater risk of transmission if you’re reusing needles and people get pricked.”
The authors of the new study acknowledge some limitations: It only focuses on federal prisons, without factoring in the provincial and jail systems. People who may be released and returned to prison, and changes in hepatitis C transmissions over time, are other factors that might alter the outcomes. But the research quite likely underestimated the benefits of syringe provision, because the authors didn’t measure the effect on HIV transmissions, hepatitis B or overdose.
“It continues to be a high-barrier program, and confidentiality is not necessarily respected. So people are deterred from participating.”
While PNEP represents progress, it’s still limited and many problems remain. Chu helped conduct an earlier study, published in 2022, which outlined some of the successes and challenges of the program.
As she and her coauthors explained, the services are operated by prison officials, who have different priorities from health care workers. Correctional Service Canada rules require that anyone who wants to participate first submit to a “Threat Risk Assessment” which requires multiple reviews, including approval from the warden. Syringes are distributed on a one-to-one basis, meaning only one syringe is given out for each one returned, which is not best practice.
And participating in PNEP with no anonymity can put a target on your back—identifying yourself as a drug user, which can bring stigma and discrimination. Participants reportedly face penalties like increased cell searches.
Given these factors, not enough people who could benefit from PNEP are accessing it, Chu said. “It continues to be a high-barrier program, and confidentiality is not necessarily respected. So people are deterred from participating.”
Another harm reduction approach is being tried on a smaller scale in Canadian prisons: overdose prevention sites. To date, three prisons have opened supervised areas where people can use drugs under the eye of staff, and where they are also provided with sterile equipment. But given the scrutiny and stigma in prisons, these sites currently have few participants—at an Alberta prison, one site stood empty for three weeks after opening, until the first participants came.
“You have a handful of overdose prevention sites in the federal correctional system,” Chu said. “And that has been pushed by the correctional officers [so] the needles would be contained, if people use in a physical site they won’t be able to bring equipment back to their cells. They still have low participation rates.”
Photograph via Madison County, New York
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