Making prison needle exchange programs work in Canada – Part 2

This is the second of four unique perspectives on prison needle and syringe programs. It explains why such programs are essential, what is happening in Canadian and international prisons and how such a program can work. All were part of a Canadian Harm Reduction Network panel discussion in support of prisoners’ rights and justice at Toronto’s Ryerson University.

Women’s experiences of incarceration in Canada

By Ruth Elwood Martin

I have been married to prison health since 1994.

That was the year that a friend told me that the Women’s Provincial Correctional Centre for Women desperately needed a physician to work there once a week, and asked me to consider it.

My immediate reaction was, “no way, that type of work must be for only the type of physician who can’t find work elsewhere, the lowest of the low.”

But I found the possibility intriguing and finally decided that I had nothing to lose by trying it out.

The first day I spent in the prison clinic, I saw more women with disease and poor health than I would ever see in a month of working in family practice in my clinic on the west side of Vancouver. I saw numerous women with Human Immunodeficiency Virus (HIV) and hepatitis C, pregnant women who had not received prenatal care before coming to prison, pre-cancerous lesions of the cervix, bacterial endocarditis and sexually transmitted infections.

As I listened to their medical histories, I also listened to their stories of childhood abuse and trauma, of their substance use, of poverty and homelessness, of attempts to become healthy and to turn their lives around.

I knew from that day forward that prison medicine was something that I could not and would not leave. This was a phenomenal opportunity to address the needs of these women.

Our prison system: a few numbers

Canada has 53 federal penitentiaries, housing 12,815 federally sentenced people. Of these, 97 per cent are men, 3 per cent are women and 18 to 23 per cent are Aboriginal.

Studies in Canada and around the world, published in the worldwide medical literature, report that incarcerating people with substance use disorders does not result in discontinuation of substance use inside prison.

In 1999, for instance, a survey in 10 Quebec penitentiaries was conducted with 317 respondents. During their previous three months incarceration, 16 per cent reported using alcohol, 29 per cent reported using some psychoactive drug, and 17 per cent reported using heroin.

Another study, comprised of open-ended qualitative interviews with women in nine federal facilities in 2000/01, found that 19 per cent of study participants reported that they were currently engaging in Injection drug use.

My findings

I was approached by a nurse at the Burnaby Correctional Centre for Women who was studying women getting Hepatitis C through shared needle use. We agreed that we had to do something, starting with a research study.

We developed a questionnaire, held information sessions and eventually were able to interview 104 women (there was an 83 per cent response rate) at the centre. Of these, 21 per cent reported intravenous drug use while in prison, and of these users:

  • 82 per cent re-used their own needles
  • 82 per cent shared their own used needles
  • 77 per cent shared others’ used needles
  • 90 per cent cleaned the needles with bleach
  • more than 75 per cent had Hepatitis C and several also were HIV-positive

What women in prison said

One of my colleagues interviewed six of these women who had reported intravenous drug use while in prison. Three overall themes emerged from the data. (Excerpts of quotes from study participants are italicized below.)

  1. Heroin held an overwhelming control over their lives, resulting in a cycle of drug use, crime and incarceration, outside and inside prison:“My entire record is drug-related: prostitution, possession, trafficking, thefts under, thefts over, B+E’s….My choice is either to sell dope or sell myself. When I got tired of prostitution, tired of getting beaten up, I’d sell dope. When I got tired of that, when I needed more money, I’d go back to working the streets. I had to do crime all the time to pay for my next fix but I wasn’t even getting high anymore.”“Everybody shares needles in here. There’s just not enough of them. A couple of times I was able to smuggle new needles in here and sell them. I’d come back 3 or 4 months later and they’d have the same ones. They’d use them until they were mangled. Sometimes they would bleach them before they shared them but most of the time they didn’t even do that.”“There was one girl who was sick in bed for three days, withdrawing off the methadone because others were making her give it to them. There’s a lot of pressure on people to regurgitate it for others. Once they’ve done it once that’s it, they’re obligated. Others do it to sell it. People think they can put it in the microwave, heat it up and kill whatever’s in it.”
  2. The resolve to change. For some of the women who could get off drugs (inside prison), their resolve to change was strong. This means that incarceration can be an opportunity:“Coming to jail this time saved my life. I would have OD’d if I hadn’t come in. Now I’m off the drugs and I want to keep it that way. The real battle is being here long enough to totally dry out. Now that I’m off I don’t want to use again. I want to get my life back. I’m tired of spending all my time arranging my next fix.”
  3. Resources are needed to help incarcerated women use their incarceration to their best advantage (e.g. access to gender-sensitive healthcare, harm reduction programs, trauma-informed counselling and discharge planning):“There’s no ongoing drug program here. Occasional NA meetings but nothing regular. There’s nothing to rehabilitate women here and nothing to help them stay off the drugs when they get out. They just send you out. You don’t have any release plans. In the past I’ve just gone right back to Main and Hastings and started using again. It’s the only place I know. A lot of women have no choice but to go back to drugs and crime as soon as they get out.”

Learn more

I moved to a refurbished provincial prison in 2004, and there I met an amazing warden, Brenda Tole,with the leadership abilities to shape the place into a more therapeutic, more hopeful model.

With her support and with the feedback of female prisoners, Arresting Hope: Women taking action in prison health inside out was written. It shows how a warden can implement a prison program and how women can transform their lives, through chapters on arrival, daily life, recreation therapy, babies, participatory health research, community, indigenous learning and stories of transformation, in prison.

Go to the Prison Health Now website to hear Dr. Martin’s full presentation.

Ruth Elwood Martin

Dr. Ruth Elmwood Martin is a clinical professor in the University of British Columbia’s School of Population and Public Health, an associate faculty member in its Department of Family Practice, and member of its lead research faculty for its family medicine residency program and inaugural Director of its Collaborating Centre for Prison Health and Education. She is also the program committee chair of the Prison Health Program Committee, a College of Family Physicians of Canada Prison Health Special Interest or Focused Practice. She worked part-time as a correctional centre physician between 1994 and 2011.