Drug Use Stigma and Reprisal: Barriers to Prison Needle Exchange in Canada

• Published date: 01 June 2024
• DOI: http://doi.org/10.1177/00328855241240142
• Author: Ann De Shalit,Emily van der Meulen,Sandra Ka Hon Chu,Rhiannon Thomas
• Date: 01 June 2024

Drug Use Stigma and

Reprisal: Barriers to

Prison Needle Exchange

in Canada

Ann De Shalit

1

, Emily van der Meulen

2

,

Sandra Ka Hon Chu

3

,

and Rhiannon Thomas

4

Abstract

After years of advocacy by a range of civil society groups, supported by

scholarly and empirical research, Canada’s federal prison service imple-

mented a needle exchange program at select carceral institutions in 2018.

Since the program rollout, however, uptake has remained minimal. To

understand why, we conducted the f‌irst independent and national study of

the program, interviewing 30 people who were incarcerated at one of the

prisons with a needle exchange. Our f‌indings show that drug use stigma

and anticipated or actual reprisal from correctional off‌icers, particularly

related to breaches of conf‌identiality for program participants, markedly

impede access and utilization.

Keywords

injection drug use, needle exchange, harm reduction, correctional off‌icers,

former inmates, community-based research

1

Trent University, Peterborough, ON, Canada

2

Toronto Metropolitan University, Toronto, ON, Canada

3

HIV Legal Network, Toronto, ON, Canada

4

COUNTERf‌it, Toronto, ON, Canada

Corresponding Author:

Ann De Shalit, Trent University Department of Gender and Social Justice, LEC S113, 1600 W.

Bank Dr., Peterborough, ON, K9L 0G2, Canada.

Email: anndeshalit@trentu.ca

Article

The Prison Journal

2024, Vol. 104(3) 344–364

© 2024 SAGE Publications

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/00328855241240142

journals.sagepub.com/home/tpj

Introduction

Community-based needle and syringe programs have long been upheld as an

effective harm reduction strategy with the potential to reduce the sharing of

injection equipment, transmission of blood-borne infections such as HIV

and hepatitis C virus (HCV), injection-related injuries, and other harms to

health (see Bruneau et al., 2008; Gibson et al., 2001; Strike et al., 2013,

2021; Tyndall et al., 2002). Decades of international research on prison-based

syringe distribution shows similar benef‌icial health outcomes (Chu & Elliott,

2009; Chu & Peddle, 2010; Dolan et al., 2015; Lines et al., 2005; PHAC,

2006; Stöver & Hariga, 2016; Stöver & Nelles, 2003; Stöver et al., 2021;

van der Meulen et al., 2016, 2017). Such programs are especially necessary

given the frequency of in-prison injection drug use and the high rates of trans-

mission of blood-borne viruses within carceral settings (Andía et al., 2005;

Chu & Elliott, 2009; Chu & Peddle, 2010; Cunningham et al., 2017; van

der Meulen, 2017).

In Canada, years of advocacy by people who have experienced incarcera-

tion as well as HIV, prisoner rights, harm reduction, Indigenous, and public

health organizations in support of prison syringe distribution culminated in

a lawsuit in 2012 that sought to compel the Correctional Service of Canada

(CSC), the federal agency that oversees prison sentences of 2 years or

more, to make sterile injection equipment available. As a result of the court

case, in 2018, CSC f‌inally introduced a Prison Needle Exchange Program

(PNEP) at two of its 43 institutions, with “best practices”learned at these

institutions intended to “inform a full national roll-out”(CSC, 2018, para.

1). Although CSC originally indicated its plan to implement PNEPs in

eleven prisons by 2019, at the time of writing a PNEP has only been estab-

lished in nine (CSC, 2021). CSC also created a complementary Overdose

Prevention Service at one institution in 2019 and at two additional sites in

2023 to address concerns around overdose, equipment sharing, and transmis-

sion of HIV and HCV (CSC, 2019a; Taekema, 2024).

When CSC developed the PNEP in 2018, it suggested that the program

would “strengthen its [CSC’s] ongoing efforts to prevent and manage infec-

tious disease in federal penitentiaries and in the community”(CSC, 2018,

para. 1), with data from that period indicating that approximately 430

federal prisoners were living with HIV and more than 6,500 with HCV

(CSC, 2016a, 2016b). The prevalence of HIV and HCV among people in

prison is indeed one of the primary rationales for needle and syringe programs

in those settings (Chu & Elliott, 2009; Chu & Peddle, 2010; Dolan et al.,

2015; Lines et al., 2005; PHAC, 2006; Stöver & Hariga, 2016; Stöver &

Nelles, 2003; Stöver et al., 2021; van der Meulen, 2017). However, in the

De Shalit et al. 345