Home / Health and Human Rights in Prison: The Need for Prison-Based Needle and Syringe Programs

Health and Human Rights in Prison: The Need for Prison-Based Needle and Syringe Programs

During the prison law seminar I took in law school, professor and prison justice expert Michael Jackson said something I’ll never forget. People are sent to prison as punishment, he told us, not for punishment.

That simple statement stuck with me. Prisons don’t have to be dangerous, cruel, filthy and overcrowded places for them to be extremely punishing experiences. The deprivation of liberty a prison sentence entails is the punishment, and it is punishing enough. Inmates need not be treated with additional harshness, and prisons must not be allowed to deteriorate into violent and dangerous places, in a misguided effort to see that people convicted of crimes receive an appropriate punishment for their actions.

Photo credit: Alexandre Vanier

People do not surrender their human rights when they enter a prison. Yet Canadian prison policy is failing to uphold the human rights of inmates and is making prisons far more punishing places than they need to be. From the ongoing use of solitary confinement, a practice the UN says can amount to torture, to severe overcrowding and deplorable conditions, inadequate treatment and care for the mentally ill, a shocking over-incarceration of Indigenous people and increasingly dangerous conditions, Canada’s so-called “correctional” facilities tend to be anything but. Instead, goals of rehabilitating and preparing offenders for reintegration into communities are sacrificed in the name of cost-saving and administrative efficiency.

But we all pay a price when people emerge from prison sicker, angrier and more marginalized than when they went in. Problems in prisons and prison populations do not stay locked up behind the walls, but inevitably spill out into our communities.


One area where government and prison officials could take relatively simple and eminently sensible steps to address a critical problem in prisons – one with significant implications for public health – is in the area of HIV and hepatitis C infection. Rates of HIV and hepatitis C in federal prisons are vastly higher than in the rest of the population, and transmission of these diseases within prisons is occurring at an alarming rate. A Vancouver study estimated that incarceration more than doubled the risk of HIV infection for people who use injection drugs, and one in five HIV infections among people who inject drugs in Vancouver was acquired in prison.[i]

Sharing needles to inject drugs is a primary cause of the high rates of HIV and hepatitis C infection in Canadian prisons. As a result of criminalization of addiction and addiction-related behaviours and the insufficient resources dedicated to community-based treatment and support, our prisons are rapidly filling with people struggling with substance use problems. In particular, women and Indigenous people suffering from addiction are greatly over-represented in Canadian prisons.

While many people assume that drugs would not be available in such a secure and highly restrictive environment, illegal drugs can and do make their way into prisons. A 2010 survey by Corrections Service Canada found that 34 percent of men and 25 percent of women in federal prisons admitted to using drugs in the past six months, and 17 percent of men and 14 percent of women admitted to injecting drugs. Among the prisoners who reported having injected drugs, 55 percent of men and 41 percent of women used someone else’s needle, and 38 percent of men and 29 percent of women shared a needle with someone who has HIV, hepatitis C, or an unknown infection status.[ii]

Photo credit: Todd Huffman
Photo credit: Todd Huffman


Needle and syringe programs, often known as “needle exchanges”, are a vital harm reduction tool available in hundreds of communities across Canada. They are a cost-effective way of reducing the risk of infection from sharing used injection equipment, facilitate access to care and treatment, and have been supported by all levels of government. Prison-based needle and syringe programs (PNSPs) offer similar benefits in the many countries where they’ve been implemented, including Switzerland, Germany and Spain. They are supported by doctors and medical associations and hundreds of community organizations across the country. Evaluations of PNSPs have consistently demonstrated that they:

  • Reduce needle sharing
  • Reduce drug overdoses
  • Do not lead to increased drug use or injecting
  • Facilitate referrals to drug treatment programs
  • Have not resulted in needles being used as weapons against staff or other prisoners.

However, despite these clear benefits, Canadian prisoners are denied access to sterile injecting equipment. This not only puts the health and lives of prisoners at risk, but also correctional staff who run the risk of being exposed to non-sterile needles, as well as prisoners’ families and the broader public when prisoners are released back into the community with health problems they contracted in prison.

People in prison have the right, protected by law, to essential health care that contributes to their rehabilitation and reintegration, and to a standard of health care that’s equivalent to that available on the outside. Yet despite these legal guarantees, prisoners are not being provided with equal access to harm reduction options, with grave consequences for their health and human rights, as well as public health more broadly.


The BCCLA has taken action to demand sane, humane prison policies many times over the years, including our ongoing challenge, with the John Howard Society of Canada, to prolonged solitary confinement, and our work to ensure that the rule of law continues to run behind the walls of Canada’s prisons and jails.

In the coming months, we’ll be turning our sights to the lack of harm reduction tools for injection drug users in prisons and the violations of the rights to life, security and equality this policy failure entails. The BCCLA will be intervening in a constitutional challenge brought by Steven Simons, a former prisoner who was infected with hepatitis C during his imprisonment, the Canadian HIV/AIDS Legal Network and other community organizations against the Government of Canada over its failure to make sterile injection equipment available to federal prisoners and prevent the spread of HIV and hepatitis C in federal prisons.

We intend to argue that the prohibition on access to sterile injection equipment in prisons violates the principles of fundamental justice enshrined in the Charter: the restriction goes too far in trying to achieve its objective of protecting and promoting the health and safety of prisoners and staff, and its negative effects are grossly disproportionate. We will also argue that because the government has complete control over prisoners’ access to health care of any kind, the Constitution imposes an obligation on government to provide prisoners with necessary health care, including clean needles and syringes, just as they would have access to in the community.

For more information on the lawsuit and an informative range of research on PNSPs, check out the Prison Health Now website. And watch this space for news about the BCCLA’s intervention.

Prisons may be designed for punishment, but they should not be a death sentence.

[i] See Canadian HIV/AIDS Legal Network, “Prison Needle and Syringe Programs: Policy Brief” (15 February 2012).

[ii] Ibid.