Needle and syringe programs in prisons: Does it really matter?

A significant proportion of people who inject drugs in prisons (PWIDP) lack access to the necessary treatment, care, and support for their drug use disorder, resulting in a persistent pattern of drug injection within correctional facilities (Dolan et al., 2015). The exorbitant cost of a new syringe in prison (Treloar et al., 2016) often compels PWIDP to resort to sharing needles, even despite their awareness of the associated risks of infection transmission. However, the act of sharing drug paraphernalia is not solely attributable to a lack of access; it is a complex phenomenon influenced by a combination of individual and structural factors, social environment, and prevailing policies (Allen et al., 2023).

Needle and syringe programs (NSPs) are widely recognized as effective interventions for reducing needle sharing and preventing the transmission of infectious diseases among PWIDP (Lazarus et al., 2018; Moazen et al., 2019). While drug injection remains a significant healthcare challenge in prison settings, prison policymakers often exhibit reluctance in adopting NSPs within their facilities, as evidenced by the limited number of countries that have implemented such programs (Kamarulzaman et al., 2016). For instance, in the European Union, only four countries currently offer NSPs in their prisons, with notably low program coverage in these nations (Moazen et al., 2020).

Reluctance to implementing NSPs in prison settings can be attributed to a variety of factors, with security concerns emerging as the most commonly cited reason (Mogg & Levy, 2009). There are apprehensions regarding the potential misuse of syringes as weapons against both fellow incarcerated individuals and staff members. Tragically, this concern materialized in 1990 in Australia when a 21-year-old prison guard named Geoffrey Pearce was fatally stabbed by a prisoner wielding a syringe contaminated with human immunodeficiency virus (HIV), eventually succumbing to acquired immunodeficiency syndrome (AIDS). Beyond security issues, opponents of NSPs in prison settings argue that providing incarcerated people with syringes may inadvertently encourage drug injection. However, there is a lack of substantial scientific evidence to support this claim.

The concerns raised by prison policy makers are entirely understandable. To address these apprehensions and determine the program's feasibility for permanent implementation, conducting a pilot phase is a prudent solution. A pilot program would effectively highlight any shortcomings, offering both policymakers and healthcare providers an opportunity to identify and rectify any existing issues. To enhance the program's acceptability and effectiveness, it is strongly recommended that both people who live and work in prisons actively participate in designing and implementing the pilot program. This collaborative approach ensures a more holistic and well-informed perspective.

The handbook, titled “Starting and Managing Needle and Syringe Programs in Prisons and Other Closed Settings,” developed by The United Nations Office on Drugs and Crime (UNODC), (UN Office on Drugs and Crime, 2014) serves as a guide outlining the key principles for establishing effective prison-based NSPs to ensure the sustainability of these programs. Nevertheless, should insurmountable challenges arise, leading to the discontinuation of the program, efforts should then be redirected toward bolstering other harm reduction interventions, with a particular focus on treatment, care, and support for incarcerated individuals living with drug use disorders.

The authors declare no conflict of interest.