Time to rethink our approach to drugs in prisons: Barriers to in-prison substance use treatment and harm reduction programs

This is the third in a three-part series highlighting the critical need to consider policy and program reform in Canadian federal prisons. You can read the first post here, and the second post here.

In this series, I’ve cast doubt on the effectiveness of in-prison drug enforcement and raised a number of issues related to access to medication in Correctional Service of Canada (CSC) institutions. Under the current federal government’s tough-on-crime agenda, the prison population is expanding and a majority of these prisoners report substance use problems. Given this, it’s important to ask: are prisoners receiving substance use interventions that improve their health and well-being, and assist with community re-entry?

For people hoping to reduce or eliminate their use of alcohol and other drugs, substance use treatment can have a positive impact. Over the years, CSC has developed various programs that target prisoners’ substance use (e.g., moderate and high intensity programs) and has reported successes with those programs in terms of both institutional and post-release outcomes. CSC’s National Correctional Programs Referral Guidelines state that correctional planning should allow for prisoner participation in substance use programming “as soon as possible”. However, many prisoners, including those with severe substance use needs, end up on long waitlists.

There are numerous barriers to timely and effective delivery of in-prison substance use treatment – prisons are, by design, difficult environments for rehabilitative programming. People are not sent there voluntarily. And the fact that security imperatives take precedence correspondingly shapes operational procedures (e.g., lockdowns) and correctional and program staff attitudes.

Security infrastructure gets considerably more money than programming, and funding for the latter is more likely to face cuts. For example, Canada’s correctional services ombudsman has noted that investment in CSC’s methadone maintenance treatment – an effective substitution therapy for opiate dependence – was set to be reduced in 2014/15. As prison populations grow and funding becomes scarcer, the resulting overcrowding (e.g., “double bunking,” lack of rooms for programs) and resource issues (e.g., not enough trained staff to meet program demand) will affect access to and quality of programs.

Another problematic issue is the prioritisation of candidates for substance use treatment programs. Former correctional staff explain that sentence length and release eligibility dates are often used as filters to determine who gets programming first. Those serving shorter sentences (e.g. four years or less) often get swiftly pushed through their sentence plan. Conversely, those serving longer sentences, regardless of their personal history, are de-prioritised or not even considered for programs until many years down the line. This situation creates a lot of inconsistency. And any prisoner applying for parole who has not been able to complete their designated programming is likely to be deemed ineligible or unsupported.

Lack of timely access to substance use treatment is another reason why some people continue to use drugs while incarcerated. The zero-tolerance policies in place in federal prisons make it difficult to establish harm reduction education and services. Elsewhere I have written in detail about the political and operational barriers, including evidence suppression, that prevent certain in-prison harm reduction programs like safer tattooing and needle distribution initiatives in Canada. In some other countries, these types of programs are operational. Here in Canada, multi-stakeholder efforts are underway to build support for implementation of prison-based needle and syringe programs to help improve the health services available to prisoners.

It’s essential to remember that most people who serve time in federal prisons eventually return to the community. For people who use drugs, the initial period after release is a critical window – they may return to enabling social networks or reinstate drug use that exposes them to increased risk of overdose. During this transition period, continuity of care, such as linking former prisoners to community-based substance use treatment and harm reduction services, is yet another area that requires significant improvements. This makes it that much more important that people who use drugs receive access to quality treatment programs and services that help them learn to stay safer while they are in custody. If we don’t address these issues, we are doing too little, too late.

Tara Marie Watson

About Tara Marie Watson

Tara Marie Watson received her PhD from the Centre for Criminology and Sociolegal Studies, University of Toronto. She has longstanding interests in drug policy and correctional populations, and research experience related to public health programming for people who use drugs.

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