The point of prison needle exchange

“Give needles to inmates” was the Dominion Post’s provocative headline when reporting on our “Alcohol and other drugs in the criminal justice system” policy, and a proposed Australian prison needle exchange has just been sunk after media controversy.

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We answer some questions behind the controversy.Needle exchange programmes (NEPs) started as a public health response to high rates of HIV infection among injecting drug users within the general population.

Within the prison population, however, rates of blood-borne diseases, including HIV, hepatitis C and other viruses, occur at a greater ratio. The reason why is obvious. There is a higher rate of imprisonment among injecting drug users. No country has yet been able to stop prisoners using drugs, especially those with existing addictions.

While New Zealand has well developed methods for reducing the supply of drugs in prisons, 15 percent of prisoners still had positive drug tests in 2006. A recent New Zealand study of community needle exchange clients found 25 percent had been imprisoned in the last year, and 40 percent of that group had continued to inject while in prison. Eighty percent of those who had been in prison tested positive for hepatitis C exposure, compared to 60 percent of those who had never been imprisoned.

Inmates who acquire blood-borne diseases in prison take them back to their families and communities on release.  Prison needle exchanges aim to stop both the spread of communicable diseases among prisoners and the consequent spread to the community.

If it’s a public health measure, why is needle exchange so controversial?
Prison needle exchanges are an admission that drugs can’t be kept out of prisons, which goes against the “zero-tolerance” approach of most prisons systems. Opponents also claim that they encourage inmates to start using drugs and may undermine efforts to get prisoners into treatment.

Which countries have a prison needle exchange, and how does it work?
Switzerland was the first country to start in 1992, followed by Germany in 1994 and Spain in 1997. Eastern European countries such as Moldavia and Armenia have recently introduced them to stem the rising rate of HIV, and Scotland is considering a pilot. Perhaps the most unexpected country to start prison needle exchange is Iran.

In some prisons, medical staff exchange equipment; others have vending machines, where prisoners insert used syringes and new ones are released, along with other safe injection equipment. Generally, prisoners register with a programme and receive secure boxes in which to store their equipment.

Do prison needle exchanges make a difference?
Researchers have monitored prison NEPs over more than a decade. A 2006 international review concluded that prison needle exchanges:

• do not lead to increased drug use
• do not undermine abstinence-based
• drug treatment programmes reduce risk behaviours, prevent disease transmission and otherwise improve the health of prisoners who inject drugs.

The review specifically studied whether greater availability of needles caused more needle-stick injuries and more cases of injecting equipment being used as weapons.

The case of a NSW prison officer dying from HIV/AIDS in 1991, following a deliberate needle stabbing, was raised in Australia as an argument against needle exchange in a new Canberra prison. However, the review found no cases of needles being used as weapons in any prison using needle exchange. Swiss prison wardens said that, since needles were not being hidden from staff, accidents during cell searches had stopped.

What makes prison needle exchange work?
The review identified key elements that make prison-based exchanges effective. Some of these are:

• connecting the needle exchange to comprehensive harm-reduction services, including education on blood-borne viruses, and substitution therapy
• consulting with and educating prison staff about needle exchange services
• making sure exchange services are confidential and easily accessible – for instance, having several access points inside a prison
• evaluating pilot programmes to be sure services are effective and meet prisoners’ needs.