“It Goes on Everywhere”: Injection Drug Use in Canadian Federal Prisons

ABSTRACT

Background: International and Canadian research on in-prison injection drug use has documented the frequency of its occurrence as well as some of the resulting consequences such as increased prevalence of HIV and hepatitis C virus. Access to prison-based harm reduction programing is thus important. Objectives: The aim of this study was to learn from former prisoner experiences and insights on in-prison injection drug use in order to advance and improve access to harm reduction options, in particular prison-based needle and syringe programs (PNSPs). Methods: The qualitative and community-based study was conducted in 2014/2015 and included former prisoners from Ontario, Canada (N = 30) who had recent experience of incarceration in a federal prison and knowledge of injection drug use. Data analysis followed the deductive approach, drawing on the expertise of the academic and community-based research team members. Results: Interview and focus group participants disclosed that drugs are readily available in Canadian federal prisons and that equipment used to inject is accessed in a variety of ways, sometimes gained through illicit means and sometimes made by prisoners themselves. Equipment sharing is a frequent occurrence, and disposal of such supplies is rare. Conclusions/Importance: While not yet available in Canada, PNSPs have led to positive outcomes in international contexts, including reductions in needle sharing and transmission of HIV and hepatitis C. Support for PNSPs among numerous Canadian organizations and associations, along with a recent change in government, could suggest a renewed opportunity for PNSP implementation.

KEYWORDS:

• Injection drug use
• prisons
• former prisoners
• Canada
• harm reduction
• community-based research
• interviews
• focus groups

Acknowledgments

The author would like to acknowledge the entire research team for their invaluable contributions to study development, data collection, and data analysis: Stéphanie Claivaz-Loranger, Seth Clarke, Annika Ollner, Tara Marie Watson, Krysta Williams, and our research assistants. Specific appreciation goes to Ann De Shalit for her work on the project and help with this article. The study was made possible through the support of PASAN and the Canadian HIV/AIDS Legal Network. Thanks also to the community organizations and agencies that hosted focus group sessions, and the many others that helped with recruitment, as well as to the Ontario HIV Treatment Network for generously funding the research.

Declaration of interest

The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.

Funding

This work was supported by the Ontario HIV Treatment Network [Grant number RIR-C G928].