Pubdate: Mon, 01 Oct 2012
Source: Globe and Mail (Canada)
Copyright: 2012 The Globe and Mail Company
Author: Andre Picard


Four AIDS groups and a former inmate have filed a lawsuit in Federal
Court seeking a supervisory injunction - a court order that would
force Ottawa to establish needle exchange programs in Canadian prisons.

The claimants argue, essentially, that prisoners should have the same
access to health care as non-prisoners, and denying them clean needles
violates their rights under the Charter of Rights and Freedoms.

It's an imaginative use of the courts but has little chance of
success. Criminal conviction and incarceration have some consequences,
including temporary loss of some privileges of citizenship, if not
fundamental rights. The courts have been clear that access to all
health and social services is not an absolute right; the provision of
services has to be balanced against other societal interests, in
prison as elsewhere.

That being said, the Correctional Service of Canada would be
well-advised to establish needle-exchange programs - and quickly - not
because it's a legal obligation but because it's a sensible
public-health measure, and makes good economic sense.

The common reaction to the suggestion of prison needle exchanges is 
sputtering outrage. The two principal arguments go something like this: 
"Drugs are illegal and prisons are drug-free so why would we give 
junkies needles?" And: "You're going to give dangerous criminals a 
weapon - are you nuts?"

Public Security Minister Vic Toews articulated that position in
responding to the lawsuit, saying: "Our government has a
zero-tolerance policy for drugs in our institutions."

The law-and-order argument is, on the surface, compelling.

But here's the reality: There is no such thing as a drug-free prison;
never has been, never will be. According to CSC's own figures, one in
every nine prisoners injects drugs regularly - this despite all rules,
the searches and the guards.

Drugs are easy to smuggle, but hiding a six-pack of needles in an
orifice is a little more tricky. So injection drug users do two
things: They fashion needles out of any material they can find, and
they share. To access those needles they use the common prison
currency: sex.

All these practices entail serious health risks. Dull needles cause
wounds and infections. Sharing homemade, unsterilized needles spreads
infections with incredible efficiency, and transactional sex is almost
as efficient.

Lack of access to clean needles is one of the principal reasons that
infection rates for HIV and hepatitis C are 10 to 30 times higher in
the prison population than in the general population.

Prisoners are not prisoners forever - 90 per cent return to the
community, too often with deadly baggage like HIV/AIDS and hepatitis

Prisoners already have access to condoms - even though having sex with
other inmates is against the rules - and, in some prisons, inmates are
provided with bleach to disinfect needles.

These harm-reduction measures are entirely appropriate, but they are
insufficient. We should provide needles too.

A dozen countries worldwide, as diverse as Iran and Switzerland,
already do so. Where these programs exist, needles aren't used as
weapons, not any more than forks and bed sheets.

The greatest risk posed by needles in prison is when they are hidden
and staff and other prisoners suffer accidental needle sticks.

Drugs are a public-health issue much more than a justice issue. Good
public health practice demands needle exchanges in communities, and
this is doubly true in communities where injection drug users are
commonplace - prisons.

We can blithely pursue our macho, tough-on-crime approach and
prisoners will continue to inject with makeshift, disease-ridden kits,
at great cost, both human and financial.

Or we can take a pragmatic, health-first approach and provide needles
to reduce, as much as possible, the harm done to prison staff, to
prisoners and to members of the general public.

The right choice seems obvious. And we should not ignore it just
because the idea of distributing needles in prison leaves us a little
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