For every dollar invested in Canada’s prison needle-exchange programs, an estimated $2 is saved in hepatitis C and injection-related infection treatment costs, according to a new study in the Canadian Medical Association Journal.
Researchers say their study, published Monday, is the first of its kind globally to examine the economic impact of programs where inmates are provided with sterile, unused needles and equipment kits in an effort to reduce needle sharing and the transmission of blood-borne infections. The federal government introduced the prison needle-exchange programs in nine of 43 federal institutions in 2018 and has since expanded to three other locations.
However, only 10 per cent of the prison population who inject drugs utilized the program at the initial nine institutions in 2022. The study found that even at this level of coverage, the correctional system is saving money. The authors concluded that the return on investment and proven health benefits of the service “strongly support” expansion of the program.
Nadine Kronfli, one of the study’s authors and an infectious disease clinician and scientist at the McGill University Health Centre, said Canada is one of only nine countries that have implemented prison needle-exchange programs (PNEPs). But, despite Canada being ahead of the pack, she stressed that the country will fall behind if it doesn’t strengthen its programs.
“We should take it upon ourselves to be leaders in this sphere, rather than stagnate,” she said. “The lack of improvement, to me, is indicative of a program that exists by name alone, not for the desire of it to perform at its best.”
Dr. Kronfli was recently awarded a $1.1-million grant from Canadian Institutes of Health Research to enhance uptake of needle programs in the initial nine prisons. The goal, she said, is to increase enrolment and the quality of these programs to improve the health of prisoners and in turn the public by lowering the potential for spread once inmates are released.
The federal government has faced a chorus of criticism in recent years – from Correctional Investigator Ivan Zinger, the Union of Canadian Correctional Officers, prisoner advocates and academics – for its slow implementation of harm-reduction measures in correctional institutions. Mr. Zinger has said that there is a reluctance by Correctional Services Canada to effectively integrate measures, such as PNEPs and overdose prevention services, to reduce drug-related harms.
Study co-author Nick Scott, who is head of modelling and biostatistics at the Burnet Institute in Australia, said it can cost between $14,000 and $20,000 for hepatitis C treatment and injection-related infection management in prisons. The needle-exchange programs can help prevent the need for these expensive treatments.
Dr. Scott said the savings could be even higher than their $2 estimate. The study did not include the costs associated with inmates who have hepatitis C and develop more severe diseases or those who are released in the community and have the potential to transmit blood-borne infections. He hopes the study not only catalyzes change in Canada but internationally.
The most recent data provided to The Globe and Mail show that there were 326 inmates in November, 2022, approved nationwide to participate in needle-exchange programs. Just a fraction of those inmates were actually using the program. Dr. Kronfli said that remains an issue at all locations for a number of reasons, including the absence of sponsorship by senior leadership, inconsistent rollout of the program and strict eligibility requirements for inmates.
Prisoners must be approved by an institution’s head or deputy warden to utilize the program, which is determined by a threat risk assessment that considers the inmate’s past behaviour, mental state and potential security threats. Dr. Kronfli said more than quarter of applicants are denied at this stage. Participants can be terminated from the program if they do not comply with its rules.
Dr. Kronfli said she is worried politics will get in the way of the programs’ longevity.
Raquel Dancho, the Conservative critic for public safety, said in a statement that her party opposes the program. Inmates should be placed into drug-treatment programs rather than being provided with needles, she said, adding it endangers the lives of correctional officers and other inmates. “Inmates should not have access to illegal drugs in prison, period,” she said.