There has been much public debate regarding the efficacy and safety of introducing a needle and syringe program (NSP) in the AMC. It is in everyone’s interest that the research evidence informs this debate. I challenge the basis of many claims made by the Community and Public Sector Union deputy national president Mr Alistair Waters (Needle exchange at AMC a fatally flawed proposal, September 17, Canberra Times
), and I will seek to address one.
Mr Waters’ claim: [prison-based NSP are] “poor public policy that fails to address the causes of the transmission of blood-borne viruses and could heighten the risk of either prisoners or staff getting infected”.
Is this correct? Let us consider the evidence.
Do NSP increase the spread of blood-borne viruses (BBV)? No.
NSP provide sterile injecting equipment to people who inject drugs. Their purpose is to prevent the transmission of BBV, such as HIV and hepatitis C. BBV are spread when the blood of an infected person enters the blood stream of another person (for example, when infected injecting equipment is re-used by another person). People re-use syringes when they do not have access to new syringes. NSP can remove the need for people to re-use injecting equipment and make the public safer by reducing the spread of disease.
Are NSP effective? Yes.
NSP in the community are very effective at preventing the spread of BBV. It is estimated that NSP have prevented 1,482 hepatitis C infections in the ACT between 2000 and 2009. Across Australia, that figure is 96,667 cases of hepatitis C and 32,050 cases of HIV. In fact, the introduction of NSP in Australia has been heralded as a major reason that the rates of HIV infection have remained so low.
Are prison-based NSP effective? Yes. Prison NSP have been introduced in 12 countries and have been extensively evaluated. The overwhelming weight of this evidence shows that they are safe and, when used, effective at reducing the spread of BBV. In fact, prison NSP are the single most effective means of preventing the spread of hepatitis C in prison populations.
For example, an evaluation of a NSP in a Spanish prison showed that, after ten years of operation, the prevalence of hepatitis C in the prison population had dropped from 40% to 26.1% and the prevalence of HIV infection had dropped from 21% to 8.5%1
This coincided with the perception among staff that there had been no increase in drug use or injecting in the prison.
Won’t the needles be used as weapons? There has not been a single reported case of syringes being used as weapons in a prison anywhere in the world where a NSP has been introduced. To that extent, prison NSP can be considered to contribute substantially to institutional safety.2
Needles exist in the AMC now, and we are not aware of a report of a syringe being used as a weapon.
Won’t prisoners be less likely to get treatment and stop using drugs, if they can get needles in prison? No.
Evidence from international prisons where NSP have been introduced indicates that prison NSP actually improve the uptake of appropriate treatment among prisoners who inject drugs in prison.3,4,5,6,7
Why should I care if a prisoner gets hepatitis C or HIV? You don’t have to – but almost all prisoners eventually return to the community. In the ACT, as with all other Australian jurisdictions, most prisoners return to the community within 6 – 12 months of entering prison. This means that the problem of BBV becomes a public health issue for the community. According to the Australian National Council on Drugs, “[t]he failure to reduce the risk of hepatitis C and other blood borne viral infection transmission in prisons severely undermines the work being conducted in the community with injecting drug users."8
Once in the community, BBV can have devastating effects upon community members. Take for example the comments from leading Australian HIV experts Professor Penny and Dr Wodak:
“The risk of HIV in injecting drug users is not limited to themselves but to their sexual partners and, tragically to their children. In New York City, which has a population about the same size as New South Wales but rampant HIV among IDUs [injecting drug users], more than 17,000 pediatric cases of AIDS have been reported, compared to 42 in New South Wales.
These pediatric cases in New York City were in almost all cases the direct result of one or other parent being an IDU. There is a serious risk to Australian children of HIV infection acquired from their parents should an uncontrolled epidemic erupt among IDUs, if present programs are curtailed”9
The verdict: NSP are evidence based public policy that reduce blood-borne virus transmission and reduce risks to prisoners, staff and the broader community. Mr Waters’ claim is wrong.
By Carrie Fowlie, the Executive Officer of the Alcohol Tobacco and Other Drug Association ACT
Other information about the NSP at the AMC is available at www.atoda.org.au
1. Ferrer-Castro, V., Crespo-leiro, M.R., & Garcia-Marcos, L.S. et al., (2012). Evaluation of needle exchange program at Pereiro de Aguiar prison (Ourense, Spain): ten years of experience. Rev Esp Sanid Penit. 14(1): 3-11. Available online at: http://www.ncbi.nlm.nih.gov/pubmed/22437903
2. Ryan J, Voon D, Kirwan A, Levy M, Sutton. (2010) Prisons, needles and OHS. Journal of Health Safety and Environment. 2010; 26(1): pp. 63-72.
3. Dolan K, Rutter S, Wodak, A.D. (2003) Prison-based syringe exchange programmes: a review of international research and development, Addiction, vol. 98, no. 2, pp. 153-8.
4. Lines R, Jürgens R, Betteridge G, Stöver H, Laticevschi D, Nelles, J (2004) Prison needle exchange: lessons from a comprehensive review of international evidence and experience, Canadian HIV/AIDS Legal Network, Montréal, Québec.
5. Niveau, G (2005) Prevention of infectious disease transmission in correctional settings: A review, Public Health.
6. Stöver H, Nelles J (2003) Ten years of experience with needle and syringe exchange programmes in European prisons, International Journal of Drug Policy, vol. 14, no. 5-6, pp. 437-44.
7. Rutter S, Dolan K, Wodak A, Heilpern H (2001) Prison-based syringe exchange programs: a review of international research and program development, NDARC technical report no. 112, National Drug & Alcohol Research Centre, Sydney, NSW.
8. Australian National Council on Drugs 2002, Needle and syringe programs: position paper, ANCD, Canberra, p. 3.