Needle and syringe programs needed in prisons
The peak professional body for infectious diseases professionals in Australia and New Zealand, the Australasian Society for Infectious Diseases (ASID) is recommending the introduction of needle and syringe programs in Australian prisons to prevent morbidity and mortality from unsafe injecting practices.
Australia is a signatory to the United Nations Standard Minimum Rules for the Treatment of Prisoners (The Mandela Rules). These state: “Prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary health-care services free of charge without discrimination on the grounds of their legal status.”
ASID notes with concern the considerable and rising burden of infections occurring as a result of injecting drug use in prisons. Injecting drug use is much higher amongst people in custody in comparison to the general community, with around 1 in 7 persons reporting injecting whilst they are in prison, in some instances for the first time. Young people, men and First Nations people are more likely to be affected.
High risk injecting behaviours in the custodial setting include injecting illicit substances, amateur tattooing and body piercing and infection risk is increased due to lack of access to sterile injecting equipment. Injecting equipment is frequently makeshift, stored in non-sterile environments, and re-used on numerous occasions by many individuals. This occurs despite a multitude of strategies in place to reduce the supply of illicit drugs.
Unsafe injecting practices puts prisoners at high risk of contracting blood borne viruses (BBV), most notably hepatitis C, and life threatening invasive bacterial infections. There are current outbreaks of highly antibiotic resistant environmental bacteria amongst people who inject drugs in prisons, leading to serious infections of bones and joints, heart valves and severe, limb-threatening soft tissue infections. Treatment of these infections requires prolonged and costly hospital stays, repeated surgeries and high cost, toxic antimicrobial agents.
High rates of BBV within Australian prisons is stalling progress towards Australia’s BBV elimination targets, reversing gains that have been achieved with community harm reduction approaches and antiviral therapy.
There is a wealth of evidence that injecting-related prison harm reduction programs including needle and syringe programs can reduce the transmission of blood-borne viruses. They can also reduce risk behaviours, reduce death and can even improve prison safety and reduce rates of reoffending. The efficacy and safety of needle and syringe programs in prisons is well-established in the literature, with precedence available in the international experience.
ASID stands with a multitude of professional health organisations to call on Australia’s state and territory governments to implement this evidence informed practice as a matter of high priority to prevent further health impact to the vulnerable prison population.
References:
1. Australian Institute of Health and Welfare (2023) The health of people in Australia's prisons 2022, AIHW, Australian Government, accessed 02 September 2024.
2. McCall-Smith, K., 2016. United Nations standard minimum rules for the treatment of prisoners (Nelson Mandela Rules). International Legal Materials, 55(6), pp.1180-1205.
3. Winter, R.J., Sheehan, Y., Papaluca, T., Macdonald, G.A., Rowland, J., Colman, A., Stoove, M., Lloyd, A.R. and Thompson, A.J., 2023. Consensus recommendations on the management of hepatitis C in Australia's prisons. Medical Journal of Australia, 218(5), pp.231-237.
4. Merone, L., Ashton, S., Harris, A., Edwards, W.S., Preston‐Thomas, A., Gair, R. and Russell, D.B., 2022. A complex increase in hepatitis C virus in a correctional facility: bumps in the road. Australian and New Zealand journal of public health, 46(3), pp.377-381.
5. Hajarizadeh B, Carson JM, Byrne M, Grebely J, Cunningham E, Amin J, Vickerman P, Martin NK, Treloar C, Martinello M, Lloyd AR. Incidence of hepatitis C virus infection in the prison setting: The SToP‐C study. Journal of Viral Hepatitis. 2024 Jan;31(1):21-34.
6. Moazen, B., Dolan, K., Saeedi Moghaddam, S., Lotfizadeh, M., Duke, K., Neuhann, F., Stöver, H., & Jahn, A. (2020). Availability, accessibility, and coverage of needle and syringe programs in prisons in the European Union. Epidemiologic Reviews, 42(1), 19– 26.
7. Dolan K, Rutter S, Wodak AD. Prison-based syringe exchange programmes: a review of international research and development. Addiction. 2003;98(2):153-8.
8. Lazarus JV, Safreed-Harmon K, Hetherington KL, Bromberg DJ, Ocampo D, Graf N, et al. Health Outcomes for Clients of Needle and Syringe Programs in Prisons. Epidemiol Rev. 2018;40(1):96-104.
Media Contact: Alison Sweeney alison@asid.net.au or 0425 221 155.