Needle and syringe programmes (NSPs) in prisons could save large numbers of lives
Prisoners have a far higher incidence of blood-borne disease than do the general public and are also far more likely to be users of injection drugs. These facts are not coincidental. Injected drugs are far from the only pathway for the spread of infection, but remain a major factor. Thus, needle and syringe programs (NSPs) in prisons could save large numbers of lives.
Recently, I co-authored “Health Outcomes for Clients of Needle and Syringe Programs in Prisons", in which we systematically reviewed studies examining the effects of, well, needle and syringe programmes in prisons. Although there is a limited amount of data to mine, several things crystallized for me as the project progressed.
There is a great deal of resistance to the idea of prison NSPs. Much of this is ideological
There is a great deal of resistance to the idea of prison NSPs. Much of this is ideological, the kneejerk reaction against services that are seen as enabling a drug habit exist even outside of prisons, and are magnified and amplified by a sense that prisoners shouldn’t be able to get drugs to inject and that, in general, they are deserving of fewer rights and are due less protection than the outside population.
The last point is, of course, the easiest to set aside. Everyone is deserving of basic human rights, including health care, and the principle of equivalence – of at least equal services in prisons as compared to out of them – should be applied in all countries.
Prisoners do have drugs, and they will inject them—the only question is how safely they will do so
The argument that prisoners shouldn’t have drugs to inject is pedantic. Perhaps they shouldn’t—but if we lived in a perfect world, we wouldn’t need prisons in the first place. Prisoners do have drugs, and they will inject them—the only question is how safely they will do so.
Furthermore, the evidence does not support the idea that needle exchange programmes promote drug use. There appears to be no significant increase in use and fewer overdoses with NSPs than without.
As well as the ideological objections, there are, of course, the financial. Any new program has costs. But, then, consider the cost of treating chronic illness in an ever-growing number of prisoners! Although there is little information on the costs and benefits of NSPs in prisons, the community evidence is clear. NSPs, like other preventative interventions, save as much or more than they cost.
Most importantly, NSPs dramatically impact the rate of transmission of disease
Most importantly, NSPs dramatically impact the rate of transmission of disease. The research is far from comprehensive, but what there is demonstrates remarkable results, as you can see in our paper. A study in the Pereiro de Aguiar prison in Spain found dramatic drops in HIV and HBV prevalence after initiating a needle exchange program, and studies in Germany (and Germany, again but in a different setting) and Switzerland found no new infections of HIV or hepatitis after starting NSPs. A third German study found four new hepatitis C infections, only one of which definitely occurred during the period of incarceration. That’s one infection among hundreds of prisoners across six prisons and four studies.
We urge policymakers in the strongest possible terms to move forward and act on this issue!
Should there be more research? Absolutely. But there is already enough to show that prison needle and syringe programmes will help stop the spread of infection with few, if any, drawbacks. We therefore urge policymakers in the strongest possible terms to move forward and act on this issue! It is the right decision morally, legally, and medically.