The harm reduction tool box contains many useful programs: needle exchanges and safer crack kits, safe injection sites and outreach vans are very important tools that a community can use to support people who use drugs and manage illicit drug use. Methadone maintenance therapy (MMT) is an important component of a community’s harm reduction services. For people addicted to opiates, MMT can be a life saver and a game changer. MMT offers people a way out of the illicit drug life. It is not a panacea and it doesn’t work for everyone, but for some it has been transformative. Many communities in Canada offer MMT including Whitehorse.
Given that MMT can be both a life saver and a way of reducing the number of people involved in illicit drugs and the resultant crime that often comes with it, one would think that every community where there is illicit opiate drug use would be clamoring for a methadone program – like a prison community environment for instance. A prison environment is not only a “good” place to offer MMT it is the most perfect place to offer MMT. Here you have a disproportionately high number of people who use illicit drugs, and you have illicit drug use in the jail that administrators sorely wish wasn’t true, and you have a relatively controlled environment with LOTS of supervision. Offering MMT in a prison setting makes good sense. Here’s why: in a controlled prison environment a person entering it could be offered MMT and in doing so could reduce his/her likelihood of injecting illicit smuggled drugs. It could prevent sharing of such illicitly smuggled drugs and therefore reduce HIV and HCV transmissions. It could stabilize the person’s addiction and he/she would get lots of supervision transitioning from illicit opiates to methadone. Conceivably by the time s/he is released their opiate addiction could be well managed by MMT. Back in community this person is not seeking illicit drugs and can conceivably side step the illicit drug scene and future involvement in the justice system altogether. So both the jail and the inmate win.
Imagine then my dismay when in 2012 the Whitehorse Correctional Centre discontinued offering MMT to its inmate population. A host of reasons for discontinuing the program were offered: it was a risk issue; inmates on methadone also had other drugs in their system; the medical staff at the jail weren’t sufficiently trained; it could be used as currency in the jail; MMT wasn’t a legitimate medical treatment. Letters to the Minister from the Canadian Drug Policy Coalition, the Legal Network and my agency did nothing to sway the department. Evidence that showed every other jail and penitentiary in Canada offered MMT still did nothing to change the department’s mind. People entering the Whitehorse Correctional Centre who were on MMT were abruptly withdrawn and suffered both greatly and unnecessarily.
It took a human rights complaint from a former inmate against the department to create change. Facing a human rights complaint that they would most likely lose, the department in the summer of 2015 modified their policy and allowed people entering into the correctional facility already on MMT to continue their course of treatment. In policy anyway this meant no more abrupt withdrawals. It was and is a win.
But before we could even get the celebration party invitations mailed another barrier; the centre is still abruptly withdrawing new inmates from their methadone if they have a “dirty” urine test including THC. Furthermore the centre will not start anyone with an opiate addiction on MMT. The only people getting MMT at Whitehorse Correctional Centre are people who are currently on MMT when they enter the prison and have no other drugs including marijuana in their system.
So the fight continues in Whitehorse for a better and more humane approach and it saddens me to think that the only way to have that fight is likely through more human rights complaints. It also saddens me that the department is so short sighted it cannot see how instrumental they could be in really changing lives. Putting people with addictions on a treatment program that can be their ticket out of the justice system once and for all rather than getting hung up on clean urine tests and other excuses is the shortest of the short sighted. Starting people onto MMT while incarcerated could position the department as truly understanding that their mandate is not to fill jail cells but rather to put themselves out of business. The end result – people coming back into their home community healthy and out of the system. Now that would be a game changer.