Inside prisons, however, it’s a different story. A lot of people use drugs in prisons across North America, but most don’t have access to harm reduction supplies, drug-positive supports or safer drug use information. Drugs are more expensive, and the penalties for getting caught holding or using are harsh. There are also high rates of hepatitis C, HIV and other infections from sharing injection equipment. 

Correctional Service Canada (CSC), the body responsible for prisons where people serve sentences of two years or more, is supposed to protect the health of people who are incarcerated. Yet prior to 2018 it was not willing to implement prison-based syringe programs, despite international evidence of the benefits. 

In 2012, in response to this neglect, a group of plaintiffs—the HIV Legal Network, PASAN (a prisoner justice organization), CATIE (Canada’s source for HIV and hepatitis C information), CAAN (formerly, the Canadian Aboriginal AIDS Network and now Communities, Alliances & Networks), and Steve Simons, a person who was incarcerated in a federal prison—launched a constitutional challenge against CSC, calling for access to sterile injection equipment in federal prisons. 

In 2018, the federal government finally announced it would roll out a Prison Needle Exchange Program. Currently, nine of Canada’s 43 federal prisons host PNEP facilities.

As the case was making its way through the courts, research was also being undertaken by the HIV Legal Network, PASAN and Professor Emily van der Meulen of Toronto Metropolitan University. It focused on what former prisoners, harm reduction workers and prison health care providers thought about introducing a prison syringe program. They summarized their findings in a report called On Point, published in 2016.

In 2018, following years of advocacy, research and the lawsuit, the federal government finally announced it would roll out a Prison Needle Exchange Program (PNEP). 

Currently, nine of Canada’s 43 federal prisons host PNEP facilities, and CSC has plans to expand the program to others. PNEP has not been extended to provincial jails, however. These facilities, which are not operated by CSC, house the majority of incarcerated people in Canada—many of whom are on remand awaiting trial, in places where health care services are even more difficult to access.

A few years after the first PNEP was implemented, researchers from the HIV Legal Network, PASAN and Toronto Metropolitan University got back together. They launched a new study to learn about formerly incarcerated people’s knowledge and experiences of the PNEP in its current form. 

The project has now wrapped up, and in November 2022 the group—I should disclose that I was one of the authors, and supported the project—released a report of its findings named Points of Perspective.

To explore these findings and convey what people should know about PNEP, I spoke with the study’s principal investigators: Emily van der Meulen (EV) of Toronto Metropolitan University and Sandra Ka Hon Chu (SC) of the HIV Legal Network.

Rhiannon Thomas: Why was it important for you to follow up on your previous On Point research? 

EV: Our first study on prison syringe distribution was conducted in 2014-2015, before CSC launched its PNEP. We wanted to learn from the research participants what kinds of syringe distribution program they thought would be the best for federal prisons: a peer-based model, one where either prison health care staff or external community workers distribute sterile equipment, or automatic syringe dispensing machines. 

They told us that they wanted multiple, confidential ways to access supplies, which should include dispensing machines and human contact, preferably with external harm reduction workers. 

However, the model that CSC began rolling out in 2018 has just one kind of distribution [in-person, by prison health care workers], and in many ways is overseen by correctional officers. So we felt that conducting a new study looking at the barriers and limitations of CSC’s needle exchange was important.

“People told us that PNEP participants had their cells tossed more often after they joined the program, and were targeted by guards in other ways.” 

What was a key research takeaway for people who care about drug policy?

SC: A major takeaway from our recent Points of Perspective study is how the lack of confidentiality and the overwhelming focus on “security risks” deter people from using the PNEP. 

To decide if someone is eligible to participate in the program, CSC first conducts a “Threat Risk Assessment” which includes multiple layers of review, including from the prison warden. People in our study described how simply applying to the PNEP means that prison staff, including guards, know about their drug use—even if their application gets rejected. And if they are accepted, even more prison staff will know because of the daily visual inspections of the PNEP equipment. 

People also told us that PNEP participants had their cells tossed more often after they joined the program, and were targeted by guards in other ways as well. 

Were there any comments or issues from study participants that surprised you? 

EV: I didn’t find people’s responses to our questions particularly surprising, because we had already been hearing through word-of-mouth about the problems with how CSC designed the PNEP. But I did find myself getting frustrated at various points. 

The correctional service had a unique opportunity to follow decades of international research on how to set up an effective prison syringe distribution program, including best-practice guidelines developed by an agency of the United Nations. But instead, they implemented a security-based model with virtually no privacy or confidentiality that people are fearful of accessing because of the punitive consequences. 

For me, what was surprising was CSC’s problematic program design—it was understandable that the research participants had a lot of concerns with it.  

“We hope CSC takes a hard look at our recommendations and makes critical changes to the PNEP, treating it like the health program it is, rather than prioritizing security.”

Why should people be paying attention to drug policy and drug use in prisons?

SC: Drug policy in prison is as repressive as it gets: A “zero tolerance” policy means tremendous stigma towards people who use drugs, penalties for drug use, and very few harm reduction services—the harms of which fall most harshly on the disproportionate number of Indigenous, Black and poor people behind bars. 

But people in prison have a right to health and are entitled to health care that is at least equivalent to what we have in the community outside prison. It’s important for us to push for effective health and harm reduction measures, especially given the much higher rates of HIV and hepatitis C and a growing number of drug poisoning deaths among people in prison. 

How would you place the messages of Points of Perspective in the context of drug policy progress in Canada?

EV: Policymakers in Canada have been moving toward framing drug policy through a health lens rather than criminal law one. And while this has its own problems—like pathologizing drug use—prisons continue to see people who use drugs almost exclusively as a security risk. 

What this means is that correctional officers are involved in harm reduction programs like the PNEP. That’s not good. The study participants repeatedly told us that CSC needs to get security out of health care. That sentiment mirrors broader conversations about drug policy, especially decriminalizing drug possession.

What do you hope will follow regarding prison health care and the PNEP from this report?

SC: We hope CSC takes a hard look at our recommendations and makes critical changes to the PNEP, treating it like the health program it is, rather than prioritizing security. 

This should start with removing the “Threat Risk Assessment.” CSC also needs to diversify the ways equipment is distributed by installing syringe dispensing machines and involving peers and external community organizations in the distribution. Prison staff should also be trained to respect people who use drugs and to appreciate the value of harm reduction, so they stop stigmatizing people who use drugs and support programs like the PNEP. And we hope that provincial prison authorities will implement their own syringe distribution programs incorporating the lessons learned from the PNEP, so people in the provincial system have real, meaningful access.

Photograph via US Department of Veterans Affairs

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