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OTTAWA — Despite pandemic slowdowns, Correctional Service Canada is still planning to expand the needle exchange programs currently offered at nine federal prisons, government officials say.

At a presentation given to the International AIDS Conference in Montreal on Friday, Henry de Souza, the agency's director general of clinical services and public health, said "a number of institutions" have been identified for an expansion, and the program will continue to be implemented across the country.

Inmates have been able to request sterile equipment for drug use at two Canadian prisons since 2018, and another seven were added in 2019. Some advocates have expressed fears the program, which is designed to reduce needle sharing and the spread of infectious disease, could be cancelled after numbers showed a low uptake.

Only 53 inmates were actively using the programs in mid-June, officials told the AIDS conference Friday night, out of 277 who had been approved to participate over the last four years.

These programs are in addition to the country's only prison-based "overdose prevention service," which began operating in 2019 at the men's medium-security Drumheller Institution in Alberta. It is essentially a supervised injection site, offering sterile equipment and consumption under observation.

Since the site opened, there have been 55 participants, 1,591 visits and zero overdoses at the site, officials told the conference.The correctional service says it also offers mental health counselling, access to naloxone to counter opioid overdose effects and preventive treatments, such as pre-exposure prophylaxis — medicine taken to prevent getting HIV. 

All of these efforts have led to a decrease in infections, said Marie-Pierre Gendron, an epidemiologist at Correctional Service Canada. She said HIV infection among inmates nationally is down from 2.02 per cent of the prison population in 2007 to 0.93 per cent in 2020; and hepatitis C is down from 21 per cent in 2010 to 3.2 per cent in 2021.

Lynne Leonard, a University of Ottawa associate professor who was contracted by the agency to evaluate the programs, said during a Tuesday morning panel that both programs have had "significant beneficial outcomes" for inmates, and she saw "eventual successful institutional adoption" despite initial pushback from staff.

Preliminary results from her study found that the program seemed to lead to a significant decrease in HIV infections at the institutions that put it into place. Overdoses at Drumheller were down more than 50 per cent overall since its supervised consumption site opened. 

"I'm encouraged by the way they're describing the program as something they're proud of," said Sandra Ka Hon Chu, co-executive director of the HIV Legal Network.

But a major "red flag" that could be leading to lower participation is the fact that security personnel are involved in the process, she said. That's not the case in other countries' prison needle exchange programs, some of which are fully anonymous or even offer syringes in automated dispensing machines.

"It's really a critical flaw in the program," she said.

Asked about the low uptake, the correctional service said in a statement Tuesday that it has reviewed evaluation reports that indicate participation rates "may be the result of considerations such as stigma, fear, lack of understanding of harm reduction initiatives, and the nature of addiction." 

Inmates are subject to a threat assessment by security and approval by a warden before being able to access programs, as officials described the process. Almost a quarter of requests to participate in the program have been rejected, according to statistics presented at the conference. 

Shawn Huish, the warden at Mission Institution in British Columbia, said it was a challenge to shift the mindset of correctional workers accustomed to searching for drugs, confiscating them and trying to stop inmates from taking them — while at the same time reassuring inmates that participating in the program would not affect their release.

There was a lot of "fake news" to battle, Huish said, including a billboard erected outside the prison that painted the program in a negative light.

"Our biggest focus was talking, educating, breaking down the fear. Having a needle acknowledged in jail can be scary for folks," he said. "You're afraid you're going to get needle sticks. So we looked at the records. In two-and-a-half years, we've had one staff member get pricked, and it was while searching, and it was a thumb tack."

Leah Cook, the regional manager of public health for the Prairies, oversaw the implementation of the supervised injection site at Drumhellerand said it is "the only known service of its kind in a correctional setting on the world stage, for which I am incredibly proud." 

Cook said a "safe zone" was created so that participants in the program could carry their own drug supply to the observation room without the fear of being searched — and it's been nicknamed the "yellow brick road." 

Leonard's research found that staff members at Drumheller preferred it to the needle exchange program and thought it was safer and more successful.

The statement from the correctional service says it is committed to "further implementation" of both types of programs as part of its mission to "better support patients with problematic substance use needs." 

Warkworth Institution and Bowden Institution have been identified for an expansion of the needle exchange program, the statement says, while Collins Bay Institution and Springhill Institution are being considered for an expansion of the overdose prevention service.

This report by The Canadian Press was first published Aug. 2, 2022.

Marie-Danielle Smith, The Canadian Press