Question Period Note: Prison Needle Exchange Program

CSC is being criticized, including by court actions, for not providing enough support, in relation to the provision of clean needles, to offenders in federal institutions.

• Like much of Canadian society, the Correctional Service of Canada is experiencing the effect of Canada’s opioid crisis. To address this issue, the service has implemented various initiatives to decrease drug use and reduce the spread of infectious diseases.

• One of these programs is the Prison Needle Exchange Program which is currently offered in eight institutions and implementation is ongoing.

• This program helps mitigate the harms caused by illicit drug use, without in any way impeding our efforts to combat drugs in correctional institutions.

• With the introduction of the Program, the Correctional Service of Canada now offers all harm reduction measures recommended by the United Nations.

The main goals of the Prison Needle Exchange Program (PNEP) are to reduce the sharing of needles among people who inject drugs, help prevent fatal and non-fatal overdoses, and to facilitate referral to health care services.

The Program is currently offered at eight institutions. Program implementation is ongoing. The PNEP will give federal inmates access to sterile needles in an effort to limit the transmission of infectious diseases, such as HIV and HCV.

PNEP participants are not exempt from the rules against the possession and consumption of illicit drugs.

PNEP Evidence

The PNEP builds on existing harm reduction initiatives recommended by the United Nations Office on Drugs and Crime. Evidence from other countries indicates that PNEPs can reduce the sharing of needles and the related spread of infectious diseases, without increasing drug use. PNEPs have also been found to facilitate referral to drug dependence treatment programs.

Substance Use Disorder in the Offender Population

Substance use disorder in the offender population is a serious and pervasive problem. Approximately 75% of offenders have some problem with alcohol or drugs at time of admission, with a sizable proportion of this group misusing more than one drug at a time.

Furthermore, like much of Canadian society, CSC is experiencing the effect of Canada’s opioid crisis. To address this issue, CSC has implemented programs to decrease drug use and the spread of infectious diseases, including the PNEP.

Other harm reduction measures and health services to support the health needs of federal offenders throughout incarceration and when reintegrating into the community include:
o screening and testing at reception and ongoing throughout incarceration
o education on admission and throughout incarceration regarding infectious diseases and how to prevent their acquisition and/or transmission
o access to trained peer support workers for advice, information and support
o access to harm reduction material and information (e.g. condoms)
o access to substance abuse programs in CSC and community-based Narcotics Anonymous
o opiate agonist treatment (methadone/suboxone)
o Health promotion/prevention initiatives on risks of tattooing
o Mental health referral/counselling
o Post-exposure prophylaxis
o Pre-exposure prophylaxis
o HIV and HCV treatment
o Prevention, diagnosis & treatment of TB (parallel screening for HIV & TB)
o Accessibility to bleach
o Prison Needle Exchange Program
o Overdose prevention service

Overdose Prevention Service

The PNEP is not CSC’s only program to limit to spread of infectious diseases from needles. For example, in June 2019, CSC implemented the Overdose Prevention Service (OPS) at Drumheller Institution. Drumheller Institution was selected based on the findings from a review of overdose incidents at CSC between fiscal years 2012-2013 and 2016-2017.

The OPS provides an opportunity for participants who use illicit substances to do so in a safe environment. The OPS includes consumption rooms within, and run by, CSC Health Services, where health care staff, including nurses, are available to provide health teaching, counselling and emergency response in the event of a medical crisis.

Staff Safety

A Threat Risk Assessment model similar to the one currently in effect for EpiPens and insulin needles will be sued to determine which offenders can participate. Health and security factors, such as an inmate’s past involvement in security-related incidents are reviewed.

The institutional head or deputy warden will confirm if there are security concerns that would prevent the offender from participating in the program. Staff training and ongoing engagement with bargaining agents and other partners will help ensure safe and successful implementation.

No link has been found between PNEPs and increased attacks on staff or other inmates.

Once enrolled in the PNEP, an inmate can exchange the entire PNEP kit for a new one as needed. Appropriate safeguards will be established in every institution to ensure that PNEP kits are safely stored and accounted for. The kit and its contents will be visually inspected and may be removed if it appears to be altered, have unaccounted contents, or the contents are observed outside of the kit.

PNEP Consultations with Bargaining Agents

CSC has been engaging with all three bargaining agents and partners, on the implementation of the PNEP at the local, regional and national levels. At the institutions where the PNEP has been implemented, the implementation pathway involved engagement with institutional staff including the three bargaining agents, distribution of written information to staff and inmates and information sessions with staff, management, Citizen Advisory Committees, inmate committees, Workplace Health and Safety Committees and others. The same approach will continue as CSC continues its roll out of the PNEP at other institutions across the country.

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