Rebuttal to the Correctional Service of Canada's Response

Writing on behalf of the Correctional Service Canada (CSC), Jonathan Smith and Henry de Souza suggest that CSC provides a variety of services to manage and prevent blood-borne and sexually transmitted infections. What they neglect to explain, however, is why the federal prison service has yet to implement prison needle and syringe programs (PNSPs) - contrary to over two decades of widely accepted evidence that these programs are effective and safe. PNSPs are listed among the United Nations Office on Drugs and Crime's (UNODC 2013) 15 interventions, to which Smith and de Souza refer, as an essential program, not an optional one. Thus, despite its claims, CSC is not "consistent" with the UNODC recommendations.

Guidelines from the World Health Organization (WHO 2016: 24) issued in 2014 and again in 2016 reinforce this requirement in no uncertain terms:

it is important that countries where injecting drug use occurs prioritize immediate implementation of needle and syringe programmes and opioid substitution therapy (NSPs and OST). Implementation of these essential harm reduction services should facilitate and enhance access to HIV-specific services, such as HIV testing and counselling and antiretroviral therapy, and improve adherence to treatment.

(original emphasis)

The WHO (2016: 32) adds that

it is important to provide people in prisons and other closed settings with prevention measures, such as condoms and clean injecting equipment, and not just with information avoiding risks. People in prisons and other closed settings should have easy, confidential access to NSPs.

In Canada, PNSPs have been called for by the Canadian Medical Association, the Ontario Medical Association, the Canadian Nurses Association, the Canadian Public Health Association, the Canadian Human Rights Commission, and the Office of the Correctional Investigator, in addition to nearly 250 other organizations (see Canadian HIV/AIDS Legal Network 2016). Even CSC's (1999: 2) own Study Group concluded that PNSPs "enhance the occupational health and safety for CSC staff … [and] improve the mental and physical health" of prisoners.

Beyond reducing HIV and hepatitis C virus (HCV) transmission, the evidence demonstrates that PNSPs result in a range of beneficial health outcomes, including reducing overdoses, abscesses, and other injection-related infections; increasing referrals to drug treatment programs; and - importantly - virtually eliminating accidental needle-stick incidents among correctional officers from hidden syringes. But, just as significantly, prisoner access to sterile injection equipment is a human right. As Smith and de Souza acknowledge, CSC and community services must work in tandem to ensure "continuity of health care" to assist prisoners in reducing the acquisition or transmission of infection. This necessarily includes needle and syringe programs, which have been available in the community for over 30 years. Denying this essential health measure to prisoners violates CSC's obligations under the Canadian Charter of Rights and Freedoms, the Corrections and Conditional Release Act, and the UN Standard Minimum Rules for the Treatment of Prisoners. There is no ambiguity to the indispensable nature of PNSPs; it is time for action and implementation.