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AUSTRALIAN DRUG LAW REFORM FOUNDATION
CHAPTER 5 - THE NEED FOR HARM MINIMISATION IN PRISONS
Canadian prison policy
5.1 A recent report into HIV/AIDS in prisons in Canada reached some alarming conclusions, which have considerable public health implications. There are no methadone programs in prisons in Canada. Following research which had been carried out in Switzerland and Australia, prison guards in the province of British Colombia have recently declared their support for prison syringe exchange. Canada, like the United States, has created a revolving door in its prison system with large numbers of now unemployable people permanently tainted by their incarceration.
5.2 Drug testing in prisons has resulted in prisoners switching from marijuana to heroin because THC, a marker for marijuana use, has a much longer half life than do the metabolites of heroin or cocaine. Accordingly, prisoners turn to injectable drugs to avoid detection of marijuana as any drug use could affect their parole. Smoking marijuana is also easier to detect while injecting is not as easy to detect. Many people inject heroin for the first time while in prison. The prevalence of HIV in Canada prisons varies from one per cent to 50%. As in the United States, many inmates in Canada were sent to prison for simple possession and/or use charges. After entering prison, some start injecting as a way of becoming intoxicated without as much risk of being caught through drug testing as if they smoked marijuana. The Report indicated that each needles get used about 50 to 70 times in prisons. There is a concern that prisons are incubators for serious health problems.
Harm minimisation needs in New South Wales prisons, Australia
5.3 Ms Kate Dolan and Mr Tony Butler conducted a study of the prevalence and incidence of Hepatitis B and C in Australian prisons. Preliminary evidence from the study indicates that 37% of prisoners were Hepatitis C positive and 31% Hepatitis B positive.
5.4 The main route of transmission for HIV/AIDS, Hepatitis B and C is through injecting. One out of every four prisoners in Australia injects and almost always share syringes. The other common risk behaviour for blood borne virus transmission in prison which is often overlooked is tattooing. One in six inmates are tattooed in prison and sharing of tattooing needles is universal. By comparison, one in ten male inmates engage in sex in prison and condoms are soon to be supplied.
5.5 A study has found a network of HIV transmission in an Australian prison, involving at least seven inmates. Needle exchange and an extension of methadone maintenance are needed in prisons to stem this flow of viral transmission. In New South Wales, there are 6,000 prisoners at any one time with only 10% on methadone maintenance. Up to 50% of prisoners would qualify for this treatment if sufficient places were made available. That is, 3,000 places instead of the existing 600.
Harm minimisation in all prisons
5.6 Prisons are not a solution to drug problems. The revolving door statistics are remarkable. Even though compulsory treatment for drug users in the community has its problems, it is a much better alternative to prison.
5.7 Needles are obtained in prisons through a variety of ingenious ways. Following an incident involving the stabbing of a prison officer with a syringe in NSW a few years ago, prison officers clamped down on syringes and found 400. According to research conducted with prisoners, this represented only a fraction of all the needles which existed at the time. It can be assumed that there is one syringe for approximately every 10 to 20 inmates who inject drugs. The spread in prisons of blood borne viruses (such as HIV and Hepatitis B and C) has been considerably underestimated.
5.8 A prison sentence ought to mean deprivation of liberty only. Punishment should not endanger the health of prisoners in relation to other citizens. The same health environment that exists in the broader community should also prevail in prisons. It is now clear from epidemiological studies that the potential for spread of Hepatitis C and HIV is much higher in prisons. Authorities should act on this information quickly as the health of prisoners cannot be separated from the health of the broader community.
5.9 Prison reform is never easy to achieve. Arguments against harm minimisation in prisons are largely irrational and mixed up with concerns about prison reform. Prison warders have argued that inmate needle exchange is too dangerous. But injection equipment already exists in prisons in large quantities. Knives and forks can also be used as weapons and be considered dangerous. Machines have been devised in Switzerland where inmates have to place a needle and syringe in a slot to get out a sterile set. Such machines in a strategic location in a prison would not increase the total numbers of needles and syringes in a prison - just ensure that where injection equipment is used, that it is clean.
5.10 The Inquiry came to the following conclusions:
1. Prison conditions reduce the frequency of injecting compared with the general community but each injecting episode is much more risky in terms of transmission of blood borne viral infections such as HIV.
2. As an unintended negative consequence of drug testing in prisons, some prisoners turn to less easily detectable, but injectable, drugs, such as heroin.
3. Few prisons have methadone programs and those which exist do not have enough places for all the inmates who require treatment. Evaluation of pilot prison needle exchange programs is warranted as needle sharing is very common. HIV and Hepatitis C transmission in prison is far more common than generally acknowledged.
4. Realistic prison reform is needed to protect the health of prisoners,
prison officers and the general community.
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