A call for pragmatism in clean-needle debate

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Four AIDS groups and a former inmate have filed a lawsuit in Federal Court seeking a supervisory injunction – a court order that would force Ottawa to establish needle exchange programs in Canadian prisons.

The claimants argue, essentially, that prisoners should have the same access to health care as non-prisoners, and denying them clean needles violates their rights under the Charter of Rights and Freedoms.

It's an imaginative use of the courts but has little chance of success. Criminal conviction and incarceration have some consequences, including temporary loss of some privileges of citizenship, if not fundamental rights. The courts have been clear that access to all health and social services is not an absolute right; the provision of services has to be balanced against other societal interests, in prison as elsewhere.

That being said, the Correctional Service of Canada would be well-advised to establish needle-exchange programs – and quickly – not because it's a legal obligation but because it's a sensible public-health measure, and makes good economic sense.

The common reaction to the suggestion of prison needle exchanges is sputtering outrage. The two principal arguments go something like this: "Drugs are illegal and prisons are drug-free so why would we give junkies needles?" And: "You're going to give dangerous criminals a weapon – are you nuts?"

Public Security Minister Vic Toews articulated that position in responding to the lawsuit, saying: "Our government has a zero-tolerance policy for drugs in our institutions."

The law-and-order argument is, on the surface, compelling.

But here's the reality: There is no such thing as a drug-free prison; never has been, never will be. According to CSC's own figures, one in every nine prisoners injects drugs regularly – this despite all rules, the searches and the guards.

Drugs are easy to smuggle, but hiding a six-pack of needles in an orifice is a little more tricky. So injection drug users do two things: They fashion needles out of any material they can find, and they share. To access those needles they use the common prison currency: sex.

All these practices entail serious health risks. Dull needles cause wounds and infections. Sharing homemade, unsterilized needles spreads infections with incredible efficiency, and transactional sex is almost as efficient.

Lack of access to clean needles is one of the principal reasons that infection rates for HIV and hepatitis C are 10 to 30 times higher in the prison population than in the general population.

Prisoners are not prisoners forever – 90 per cent return to the community, too often with deadly baggage like HIV/AIDS and hepatitis C.

Prisoners already have access to condoms – even though having sex with other inmates is against the rules – and, in some prisons, inmates are provided with bleach to disinfect needles.

These harm-reduction measures are entirely appropriate, but they are insufficient. We should provide needles too.

A dozen countries worldwide, as diverse as Iran and Switzerland, already do so. Where these programs exist, needles aren't used as weapons, not any more than forks and bed sheets.

The greatest risk posed by needles in prison is when they are hidden and staff and other prisoners suffer accidental needle sticks.

Drugs are a public-health issue much more than a justice issue. Good public health practice demands needle exchanges in communities, and this is doubly true in communities where injection drug users are commonplace – prisons.

We can blithely pursue our macho, tough-on-crime approach and prisoners will continue to inject with makeshift, disease-ridden kits, at great cost, both human and financial.

Or we can take a pragmatic, health-first approach and provide needles to reduce, as much as possible, the harm done to prison staff, to prisoners and to members of the general public.

The right choice seems obvious. And we should not ignore it just because the idea of distributing needles in prison leaves us a little squeamish.