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Are we ready to introduce a Needle and Syringe Exchange Program in Prisons?

Rebecca Vassarotti 31 July 2019 23
Is it time to discuss the introduction of NSPs in prisons? File photo.

Is it time to discuss the introduction of NSPs in prisons? File photo.

Many people might not know this but hepatitis C is a major public health issue.

It is much more prevalent than better-known blood-borne viruses (BBVs) such as HIV, and can have devastating effects on people’s health. Untreated it can lead to cirrhosis, liver damage, liver cancer and liver failure. It’s one of the reasons that the United Nations recognises the issue on World Hepatitis Day each year.

The good news is, there is now a cure for hepatitis C. Since the inclusion of highly effective treatments on the Pharmaceutical Benefits Scheme, treatment and a cure is now within reach of most Australians.

Australia has been a leader in responding to hepatitis C with policymakers, researchers, health professionals and the community coming together for a national response. Late last year, the fifth National Hepatitis C strategy was released, which mapped out a plan to enable Australia to meet the global target of eliminating the disease by 2030.

This Strategy recognises that there are groups in the community that are disproportionally impacted and need tailored responses.

Detainees in Australian prisons are some of these vulnerable community members given that generally there are much higher rates of hepatitis C in prison populations than in the general population. However, access to effective treatments and the sustained commitment of health and justice staff have resulted in a significant reduction in the rate of hepatitis C here in the ACT.

Nevertheless, a fully comprehensive public health response has been hampered by custodial dilemmas.

While needle and syringe exchange programs (NSPs) are widely available across the community and are a major contributor to Australia’s low transmission rates for a range of BBVs, the introduction of this program within our local prison has been rejected by custodial officers several times, most recently in 2016.

This has meant that while hepatitis treatment has been available and effective, re-infection post-treatment within prison environments could become an issue.

Re-infection creates additional impacts on health and additional risk to others. This is one of the reasons we need to move this issue out of the ‘too hard basket’ and once again re-examine how we might reconcile the strong evidence around the effectiveness of this approach with concerns of people working in custodial settings.

There are legitimate concerns for those who work within custodial settings about how this might work and how to manage the risks. There is a need to work out the practical considerations of how a NSP might work in a prison environment.

It is, however, hard to understand how a regulated system can be more dangerous than the current system that is operating, where we know that injecting equipment is circulating within the prison, equipment is being reused, re-infection is occurring, and both employees and detainees are currently at risk.

We now have a strong collective commitment from Governments, health professionals and others across Australia about the need to do something about this issue (as articulated in the National Strategy).

There is also growing evidence about how these types of programs might work, with more countries introducing NSPs in custodial settings, including Spain and Switzerland. Canada is also moving to introduce NSPs in prisons to reduce transmission of a range of BBVs.

Our treatment options for people in our local prison is working well and we need to ensure we don’t undermine these great efforts. It is also the case that despite its inability to implement the policy, the ACT Government has a long-standing commitment to establish an NSP in the prison.

Drug policy reform is often complex and challenging. When we engage with this issue, I believe we need to overcome our own assumptions, recognise new evidence and perspectives and work to find common ground to ensure that the needs of all key stakeholders are met in seeking to achieve better public health outcomes for the whole community. Canberra has a history of leading the nation in a whole range of social justice and health policy areas – what are some of the areas of reform that you believe have been good for our community?

If you want to find out more about the experiences of people with hepatitis C leaving custodial settings, AIVL has recently released a report documenting these experiences.

Rebecca works with a number of organisations working on issues related to hepatitis.


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23 Responses to Are we ready to introduce a Needle and Syringe Exchange Program in Prisons?
Carol Mead Carol Mead 6:39 pm 04 Aug 19

There is already a needle and syringe program in prison ..... it is illegals and dangerous. It is time we reconsidered a safer option.... if prisoners are going to use, they should be able to do it safely.

carpediem 12:09 pm 02 Aug 19

Drugs in prisons is a worldwide problem. I recently read that there are NO drug-free prisons anywhere in the world. Where there is demand, supply will follow. So lets accept that this is a bigger issue that just Canberra or Australia, and get on with the best harm-minimisation solutions we can find. HIV-free needles are a good start in my opinion, and if we can keep our kids alive by simple pill testing then lets do that too.

    rationalobserver 5:38 pm 13 Aug 19

    No, you keep your kids alive by teaching them to be responsible citizens, and by avoiding the sorts of risky behaviour that will see them end up in prison, or dead.

John Moulis 11:09 am 02 Aug 19

It’s a good article, and it would theoretically work if all the variables existing on the outside fall into play, but in the prison environment it would be a disaster.

When I was on the roids I attended the NSP, got my new syringes, gave my postcode then disposed of the old ones in the bin outside. It was all very formal, straightforward and anonymous.

In the prison environment you have rivalries, ill-feeling among inmates and an adversarial hierarchy within the inmates and staff. Could the prisoners be relied upon to return their syringes after they’ve used them? What guarantees are there to ensure a siege or situation doesn’t develop with a custodial officer held hostage?

The idea of a NSP program in the prison has been floated before but has fallen over when these arguments have been put forward. Until a fail-safe solution can be found, it would not be able to operate on a day-to-day basis.

    James_Ryan 8:38 am 07 Aug 19

    “In the prison environment you have rivalries, ill-feeling among inmates and an adversarial hierarchy within the inmates and staff. Could the prisoners be relied upon to return their syringes after they’ve used them? What guarantees are there to ensure a siege or situation doesn’t develop with a custodial officer held hostage?”

    Prison NSP has not fallen over because of a rational argument in which the issues you raise overwhelm the evidence in support of implementation.

    This is important … the issues you raise are potentials already. Detainees at the AMC can easily access needles and syringes now. They have them. If detainees were pre-disposed to use needles and syringes to riot, murder, injure and take hostage … they’d have done that already.

Susanne Gardiner Susanne Gardiner 6:47 am 02 Aug 19

We don't have one yet?

Blen_Carmichael 7:19 pm 01 Aug 19

“When we engage with this issue, I believe we need to overcome our own assumptions, recognise new evidence and perspectives and work to find common ground to ensure that the needs of all key stakeholders are met in seeking to achieve better public health outcomes for the whole community.”

I can picture custodial officers rolling their eyes as they read this.

Chris Cross Chris Cross 2:43 pm 01 Aug 19

What a load of rubbish. Pill testing to support illegal drug taking at concerts, clean needles to support illegal drug taking in prisons... What's next? Free condoms to rapists because it'll protect both the rapist the victim from diseases and stop the spread of them? Come on... get real. Taxpayers should NOT be supporting criminals who WILLINGLY break the law for their own selfish interests! If they are spreading disease to loved ones or anyone else that's on their conscience not mine. It's contraband! It SHOULDN'T BE THERE! Spend the money on invasive searches, more staff, more cameras, and thick brick walls (not country club fencing so smugglers can easily see who's on the other side). Don't make it easier/nicer to for them to load up on drugs to help them get through their sentences. Make it harder. Much harder.

Jill Moran Jill Moran 10:00 am 01 Aug 19

Yes! Absolutely. We have a responsibility to reduce transmission of HIV and Hepatitis in our prisons.

Julie Arnold Julie Arnold 9:42 am 01 Aug 19

No. Try harder to keep drugs out and require hep C inmates to take the new meds to cure the condition. Not simple but better than arming prisoners and encouraging drug taking.

James_Ryan 8:42 am 01 Aug 19

Thoughtful article, Rebecca. Thank you.

Prison NSP is an important gap in the suite of BBV prevention strategies nationally. There is a very strong evidence base of safety and effectiveness supporting its implementation, and absolutely no evidence supporting any delay or refusal to implement.

Nathan Lofthouse Nathan Lofthouse 8:18 am 01 Aug 19

How about anyone who wants to introduce something to the custodial environment grab a set of keys and work there for 12 months before pushing an agenda in ignorance.

    Peter Marshall Peter Marshall 8:53 am 01 Aug 19

    Many of the proponents have, Nathan. Look for analogy at retired police commissioners. They all seem to have different views about drug laws after retirement when they can speak freely.

    Don Li Don Li 11:07 am 01 Aug 19

    Oh yes look at the analogy from people who are high up and away from the front line.

    Nathan Lofthouse Nathan Lofthouse 5:20 pm 01 Aug 19

    Yeah Peter many have, but a lot more vocal ones have not, and it seems the loudest advocates have often been the ones with the least experience in the field.

Capital Retro 8:06 am 01 Aug 19

When judges used to give hard labour as part of sentencing there were no drug problems.

Prisons have now become havens for drug addicts because of the certainties there are there.

rationalobserver 7:44 am 01 Aug 19

Its a prison. Its meant to be a punishment for doing wrong. That drugs and such are available in such a controlled environment is simply unacceptable. Stop that and you stop the problem, not the symptoms.

Justin Sevi Justin Sevi 7:40 am 01 Aug 19

But we were going to have a drug free, world's best practice, human rights loving prison.. slight downgrade to ambitions these days..

Ozi Cavusoglu-Rucinski Ozi Cavusoglu-Rucinski 7:24 am 01 Aug 19

Yes let’s arm prisoners with a weapon because the guards that work there don’t have enough to worry about. Good plan 👌🏻

    Martin Butterfield Martin Butterfield 9:23 am 01 Aug 19

    I think they already have the needles Its just that they are dirty.

    Ozi Cavusoglu-Rucinski Ozi Cavusoglu-Rucinski 9:28 am 01 Aug 19

    The thing is that they’re in prison for a reason. In some cases because they destroyed someone else’s life. They don’t deserve clean needles.

    In my opinion. Not saying what I’m saying is right or wrong.

    Ozi Cavusoglu-Rucinski Ozi Cavusoglu-Rucinski 10:36 am 02 Aug 19

    Most of them are in jail because they willingly harmed someone else. Drugs are illegal. The government should be putting their resources into ensuring the drugs aren’t getting into the jails instead of giving prisoners a ‘safe way’ to take them.

    I genuinely don’t see how this minimises harm to everyone else. The issue is that they are sneaking drugs and needles and whatever else in. So common sense says that you take that ability away. There’s your harm minimisation.

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