Prison Harm Reduction

What is prison harm reduction?

Prison harm reduction includes efforts that provide support services, education, advocacy, and safer drug use, sex, and tattooing supplies for prisoners and ex-prisoners. Harm reduction plays a critical role in supporting prisoners’ human rights, health, and dignity, and reducing the spread of communicable diseases such as Hepatitis C and HIV.

Why is prison harm reduction important?

The living conditions and climate of federal and provincial prisons has been deteriorating over the past decade, with increases in the prison population, severe overcrowding, poor nutrition, limited healthcare services, misuse of solitary confinement and isolation, a lack of meaningful activities, and an increase in prison violence and inhumane “use of force” by correctional officers (Meulen et al., 2016). Rather than working to rehabilitate incarcerated people and prepare them for re-entry in society, prisons violate human rights and exasperate social issues by perpetuating violence; disconnecting people from social support systems, family, and meaningful work; and creating dangerous, boring, and isolated conditions that increase depression, PTSD, substance use, Hep C, HIV, and other physical and mental health challenges.

A significant number of prisoners have a history of substance use and substance use challenges. Despite the fact that a large percentage of people who are incarcerated use injection and non-injection drugs in prison, and rates of HIV and Hep C are much higher among incarcerated populations than among the general public - there are no successful needle exchange programs in Canada due to surveillance and opposition from correctional officers.

What supplies are needed in prisons?

Harm reduction supplies that prisoners need confidential access to include:

• Education about safer substance use, sex, health, disease management, and tattooing

• Safer substance use supplies including sterile injection, smoking, and snorting equipment

• Safer sex supplies including external and insertion condoms, dental dams, and lube

• Safer tattooing equipment including sterile needles and bleach

• Opioid and other drug substitution therapies

Canadian Prison Population

Federal vs Provincial

In Canada, prison administration is divided between federal and provincial/territorial governments. Prison harm reduction policies and procedures, as well as health and wellness programs, vary considerably between federal and provincial institutions and from region to region (Chu, 2019).

• Correctional Service Canada (CSC) is responsible for the federal system and adults serving sentences of 2+ years

• Provincial/Territorial (P/T) correctional services are response for adults serving sentences less than 2 years and those on remand

• Each year, CSC supervises an average of 23,000 adults in federal custody and community programs

• There are 117, 645 adults either in custody or community programs on a given day in 11 reporting provinces/territories 

Gender, Race, & Indigeneity

The Canadian prison population is disproportionately comprised of people who have less formal education, come from low income backgrounds, have mental health and substance use challenges, have experienced sexual and physical abuse, and who are racialized and dealing with the consequences of racism and colonization (Meulen et al., 2016).

• Men account for 86% of custody admissions in provincial/territorial corrections and 92% of custody and community admissions with CSC (federal)

• Black people account for 8.6% of federal prisoners, but only 3% of the overall population

• Indigenous people account for 28% of admissions to provincial/territorial corrections and 27% to federal corrections, but account for only 4.1% of the adult population (Chu, 2019)

Drug Use & Overdoses

SUBSTANCE USE in Prison (Chu, 2019):

• 30% of women and 14% of men in the federal system are incarcerated on drug-related charges

• 80% of men entering federal prisons have a substance use issue. Nearly ⅔ of men were using substances when they committed the offence that resulted in federal time

• 33% of men and 27% of women reported non-injection drug use during the last 6 months in prison

• 14% of women and 17% of men admit to injecting drugs within the last 6 months while in prison; about half of whom shared their injection supplies 

• The most frequently used drugs in prison are cannabis, cocaine, and opiates

Overdoses After Release

In B.C., based on figures from 2016 and 2017, about ⅔ of those die of drug overdose have spent time in jail at some point in their lives or were under correctional supervision outside prison. Of the 1,233 fatalities in that category, 18% or 333, occurred within 30 days of release; 25% or 470, died within one year.

Prison-based Needle and Syringe Programs (PNSPs) 

Due to the scarcity of sterile needles and syringes, people who inject drugs are more likely to share injecting equipment, which significantly increases the risk of transmitting HIV/HCV (Chu. 2019).

• The estimated HIV prevalence among federal prisoners ~1.3%

• The estimated HCV (Hep C) prevalence among federal prisoners ~8%

PNSPs have been functioning successfully for nearly 3 decades elsewhere. Evaluations demonstrate their effectiveness at reducing (Chu. 2019):

• Needle sharing

• Overdoses

• Abscesses

• Needle stick incidences by guards during cell searches

• HIV and HCV transmission

Harm reduction education, resources and supplies are desperately needed in Canadian prisons to support the human rights of prisoners, keep vulnerable populations safe, and contribute to community health - because incarcerated people are almost always released back into the community. Prisoner health is community health, and in the absence of prison abolition, we need prison reform and commitment to the health and wellbeing of incarcerated people.

References

Chu, S. (2019). Harm reduction as social justice: Prisons. Canadian HIV/AIDS Legal Network. [PowerPoint]

Meulen, V., Claivaz-Loranger, S., Clarke, S., Ollner, A., Watson, T. (2016). On point: Recommendations for prison-based needle and syringe programs in Canada. Retrieved from https://www.scribd.com/document/363137458/onpoint-recommendations-pnsps-in-canada-2016?secret_password=QFLJL812oHTQHzzPyfSG#download&from_embed