Supervised injection sites are highly controversial. Learn about why a Canadian prison is starting such a program behind bars.
In a June 2019 article, Washington D.C. news and opinion website Daily Caller reported on a harm reduction policy to be implemented in a Canadian prison.
A prison in the Canadian province of Alberta, the article reports, is set to begin a supervised drug injection site, also referred to as a safe injection site, by the end of June 2019. The prison, near Drumheller, Alberta, already has a needle exchange program in operation for inmates.
What are Supervised Injection Sites?
Supervised injection sites are part of an overall “harm reduction” strategy that has been adopted in Canada and is gaining traction in the United States. The philosophy behind harm reduction is that there will always be people who use drugs and it is better to accept that fact and work to lower the risk of overdose death, infection and other complications of injection drug use.
According to the government of Alberta, which is implementing the Drumheller prison program, supervised injection sites provide three important services:
- Harm reduction by providing supervision of the injection and sterile needles and other implementations
- An opportunity for addiction treatment professionals to interact and offer help to people who struggle with drug misuse
- An opportunity to administer naloxone and medical care in the event of an overdose
Supervised injection sites also provide immunity for individuals who struggle with drug misuse, preventing arrest and parole violations for drug possession and use.
Canada’s Experience with Supervised Injection Sites
Canada has been at the forefront of safe injection sites, with the first such sanctioned facility opening in Vancouver in 2003. Since then, safe injection sites – both legal and illegal – have increasingly opened across the country.
Research in Canada has confirmed that safe injection sites reduce:
- Overdose deaths
- Ambulance calls for overdose
- HIV infection
However, the concept of safe injection sites has been controversial from its very beginnings in Canada. Challenges have been made to the policy all the way up to the Supreme Court of Canada. The stigma of drug use, a lack of public understanding of addiction (the “why don’t they just stop” mentality), political conservatism and funding issues have made the implementation of safe injection sites difficult.
In addition, many communities that have safe injection facilities have seen a sharp increase in local crime rates – especially violence, drug dealing, theft and prostitution – and an increased number of homeless persons, leading to sharp resistance from these communities.
Safe Injection Sites and Prisons
Supervised injection sites have never been implemented or studied in prisons in Canada. Given that the rate of addiction and the complications of drug use are much higher in prison populations, trying safe injection sites in prisons seems to be the next logical step in a country that is increasingly embracing the harm reduction strategy.
It’s perhaps not surprising that incarcerated people are at high risk of addiction. Compared to the general population, people who are incarcerated:
- Have a higher rate of mental health disorders
- Are more likely to come from a background with many socioeconomic risk factors for addiction
- Live a difficult lifestyle behind bars, which promotes dysfunctional coping mechanisms, such as drug use
- Are part of a social system in which drug dealing and use are considered beneficial
Prisons are a high-risk environment for using drugs or relapsing into drug use. The prison environment also carries a higher risk of complications from drug use, especially for injection drug use. People in prison are more likely to share needles, which results in higher rates of HIV, Hepatitis C, and other blood-borne infections.
As a result, prisons are a particularly rich target for harm-reduction strategies, such as supervised injection sites and needle-exchange programs. In addition, they are a natural target for maximum cost-to-benefit return on substance use treatment programs.
Supervised injection sites in prisons are going to take some getting used to before it becomes a widely accepted practice by the general public and the appropriate stakeholders. It requires a mindset of acceptance that drug use is (and probably always will be) a significant problem in prisons. At present, many people who oppose the policy have perceptions and ideas related to drug use and misuse such as:
- They shouldn’t be doing drugs in prisons anyway; why should we help them do something illegal?
- Why should my tax dollars be used to help criminals use drugs?
- Why don’t they just stop drugs from getting into prisons?
It is expected that these types of opinions and perceptions will have to shift before the policy becomes overwhelmingly popular.
How Does This Affect Society Moving Forward?
Meanwhile, while society struggles with stigma and uninformed impressions about addictions, it will be very interesting to see how things develop in the Alberta prison as it launches the supervised injection site.
Some key questions to be answered by the Drumheller prison supervised injection site experience include:
- Will the site lead inmates to become healthier as they prepare to go out into society at the end of their prison terms?
- Will fewer people come out of prison addicted to drugs?
- Will prison health care costs drop as a result of this preventive care?
Answering these questions will help inform policymakers about the success of drug injection sites and assist in the effort of reducing harm related to addiction.
de Andrade, Dominique; Ritchie, Jessica; Rowlands, Michael; et al. “Substance use and recidivism outcomes for prison-based drug and alcohol interventions.” Epidemiologic Reviews, May 3, 2018. Accessed June 21, 2019.
Government of Alberta. “Supervised consumption services.” 2019. Accessed June 21, 2019.
Hawk, Mary; Coulter, Robert; Egan, James; et al. “Harm reduction principles for healthcare settings.” Harm Reduction Journal, October 24, 2017. Accessed June 21, 2019.
Kerr, Thomas; Mitra, Sanjana; Kennedy, Mart; et al. “Supervised injection facilities in Canada: Past, present, and future.” Harm Reduction Journal, May 18, 2017. Accessed June 21, 2019.
Klaufmann, Bill. “Opposition erupts over proposed opioid safe consumption service in East Village.” Calgary Herald, August 11, 2019. Accessed June 21, 2019.
Kolind, Torsten; Duke, Karen. “Drugs in prisons: Exploring use, control, treatment and policy.” Drugs: Education, Prevention and Policy, May 23, 2016. Accessed June 21, 2019.
Krayden, David. “Canadian federal prison poised to introduce heroin injection site for inmates.” Daily Caller, June 9, 2019. Accessed June 21, 2019.
Ng, Jennifer; Sutherland, Christy; Kolber, Michael. “Does evidence support supervised injection sites?” Canadian Family Physician, November 2017. Accessed June 21, 209.
Zlotorzynska, Maria; Wood, Evan; Montaner, Julio; et al. “Supervised injection sites: prejudice should not trump evidence of benefit.” Canadian Medical Association Journal, October 15, 2013. Accessed June 21, 2019.
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