Michaud Liam, Stöver Heino, van der Meulen Emily, De Shalit Ann, Chu Sandra Ka Hon, Thomas Rhiannon, Pont Jörg
York University, Toronto, Canada.
Dahdaleh Institute for Global Health Research, Toronto, Canada.
Health Justice. 2025 Jul 3;13(1):41. doi: 10.1186/s40352-025-00332-w.
In 2018, in response to a lawsuit and years of civil society advocacy for prison-based syringe distribution due to elevated rates of injection drug use, HIV, and hepatitis C virus among incarcerated people, the Correctional Service of Canada (CSC) developed a Prison Needle Exchange Program (PNEP). Implementation of the PNEP has been slow and has faced significant critiques and challenges. As of early 2025, the PNEP is only available at eleven of forty-three federal prisons in Canada. Employing realist review methodology, an iterative process for synthesizing evidence concerning complex policy interventions, this article investigates CSC's approach to, and implementation of, the PNEP. By recognizing broader social and institutional contexts, and through the integration of environmental considerations, realist reviews consider policy outcomes and implications in addition to efficacy. In our study, we draw upon 114 distinct documentary sources, comprised of scholarly articles, news media, program evaluations, and correctional policies, as well as 257 pages of federal government disclosures acquired through Access-to-Information requests. Together, these allow us to identify factors that have either facilitated or impeded the PNEP's ongoing rollout and uptake among people in prison.
Our results find that perceived risks regarding the circulation of needles and the use of a "Threat Risk Assessment" to determine eligibility function as major impediments to program efficacy. Findings also reveal incarcerated people seeking to enroll in the PNEP are frequently denied access and that the active involvement of correctional officers in enforcing compliance to program requirements acts to the detriment of participation. Results indicate the absence of meaningful confidentiality protections along with elevated rates of program discontinuation. Over roughly seven years of its existence, the PNEP has had extremely low uptake, particularly among women.
We propose a significant revisioning of CSC's PNEP to bring it into alignment with the best practices of similar prison-based harm reduction initiatives internationally, and according to professionally accepted standards of syringe distribution. The Canadian experience provides a cautionary tale to other jurisdictions considering implementing a carceral syringe program.
2018年，由于监狱中注射吸毒、艾滋病毒和丙型肝炎病毒感染率上升，针对一项诉讼以及民间社会多年来对监狱内注射器分发的倡导，加拿大惩教署（CSC）制定了监狱针头交换计划（PNEP）。PNEP的实施进展缓慢，并面临重大批评和挑战。截至2025年初，PNEP仅在加拿大43所联邦监狱中的11所提供。本文采用现实主义审查方法，这是一种综合有关复杂政策干预措施证据的迭代过程，研究了CSC对PNEP的方法和实施情况。通过认识更广泛的社会和机构背景，并通过纳入环境考虑因素，现实主义审查除了考虑效力外，还考虑政策结果和影响。在我们的研究中，我们借鉴了114个不同的文献来源，包括学术文章、新闻媒体、项目评估和惩教政策，以及通过信息获取请求获得的257页联邦政府披露信息。这些资料共同使我们能够确定促进或阻碍PNEP在监狱人群中持续推广和采用的因素。
我们的研究结果发现，对针头流通的感知风险以及使用“威胁风险评估”来确定资格是项目效力的主要障碍。研究结果还显示，寻求加入PNEP的在押人员经常被拒绝准入，并且惩教人员积极参与执行项目要求不利于参与。结果表明缺乏有意义的保密保护措施，以及项目中断率较高。在其存在的大约七年时间里，PNEP的采用率极低，尤其是在女性中。
我们提议对CSC的PNEP进行重大修订，使其与国际上类似的基于监狱的减少伤害举措的最佳做法保持一致，并符合专业认可的注射器分发标准。加拿大的经验为其他考虑实施监狱注射器计划的司法管辖区提供了一个警示故事。
