The success of Canada’s first drug overdose prevention site behind bars at Alberta’s Drumheller Institution has sparked an expansion of the program to at least two additional federal prisons, which are anticipated to begin the service by the end of the year.
Prison guards at Drumheller were initially opposed to the overdose prevention site, or OPS. But James Bloomfield, Prairies regional president of the Union of Canadian Correctional Officers, said the program is now viewed as an “absolute positive” and members are pushing for it to replace prison needle exchange programs, or PNEPs, across the country as increasingly toxic drugs made their way inside.
Springhill Institution in Nova Scotia and Collins Bay Institution in Ontario are among a list of institutions marked to house an OPS, Correctional Service Canada confirmed to The Globe and Mail. The Atlantic prison was poised to operate a site in 2020 but its implementation was sidelined by the COVID-19 pandemic.
“We put [OPS] on the plate to take away from putting needles in the cells of prisoners and having them exchange them because that was an obvious failure, and it still is today a 100-per-cent failure that Corrections Canada refuses to acknowledge,” Mr. Bloomfield said.
While Mr. Bloomfield welcomes the expansion of OPS to other prisons, he said it does little to curb concerns by officers running “inferior” needle exchange programs and should be rolled out faster to other institutions in the Prairies.
The medium-security Drumheller Institution, chosen because a high number of prisoners were overdosing, was the first federal prison in Canada to house an OPS where incarcerated individuals can inject drugs under the supervision of a medical professional. The service was introduced in June, 2019, and remains the only site to operate in Canada – and around the world.
Nine federal institutions across Canada offer the needle exchange program, which was introduced in June, 2018. It gives inmates access to sterile, unused needles and equipment in an effort to reduce needle sharing and reduce transmission of blood-borne infections.
Corrections Canada said an external evaluation of the Drumheller program would determine if the service should be expanded, but a report has yet to be made public. The Globe obtained a 66-slide PowerPoint presentation from the union that shows an evaluation of the overdose prevention site, in addition to an interim study of the PNEP, which was completed by University of Ottawa researcher Lynne Leonard in 2020.
An evaluation of the OPS was based on confidential interviews with staff and inmates three months after it was implemented. Summarized in the slides, the study showed health care workers and correctional officers who, at first, expressed largely negative views of the program and addictions changed their perspectives. Inmates indicated the site made them feel safer and better supported.
Dr. Leonard noted the announcement of the incoming OPS was originally “seen as antithetical to and a complete reversal of” staff’s established roles to prohibit drug use and entry in the institution.
“I’ve changed my attitude. I’m not so against it. ... This is the future of how it is going to be, so don’t fight it. … More of a win for everyone in the end,” said one unnamed staff member who was interviewed. Another said, “Our Institution should be proud and is proud of what we have done.” An inmate said they no longer have to trust “someone else’s needle is clean” and another said they would have died by overdose without access to an in-prison OPS.
Kyle Lawlor, a spokesperson with the Correctional Service of Canada, said the COVID-19 pandemic has delayed a final report. Mr. Lawlor confirmed Springhill and Collins Bay are “among the institutions” that are being considered and “work is under way to further explore and confirm the next targeted sites, including consulting labour partners as well as taking into consideration public-health advice.”
In an interview with The Globe, Dr. Leonard said evaluation interviews related to the PNEP have resumed and a final report is in the works. She expects to further evaluate OPS in federal institutions when the government moves forward with additional sites. She requested Corrections Canada provide her interim reports to The Globe but they were not received.
Some people interviewed for the 2020 study contrasted OPS to PNEP, though Dr. Leonard was not tasked with comparing the programs. People interviewed said the OPS is more beneficial because it decreased stigmatization of people using drugs, increased officer and prisoner safety, and more appropriately transferred responsibility to health providers, not guards. Concerns about needle stick injuries with PNEP outweighed the actual prevalence of incidents, Dr. Leonard concluded, but were frequently mentioned.
“Not all treatment options work for every individual, and offering multiple treatment options means that we are providing individuals under our care the best chance to succeed in their journey of recovery,” Mr. Lawlor said in response to the union’s comments.
Among Dr. Leonard’s recommendations was “urgent consideration” to extend hours of the Drumheller OPS that operates between 7 a.m. and 7 p.m. local time, on weekdays. The study showed 30 inmates used the service 798 times between July, 2019, and February, 2020. No overdose deaths were recorded but one participant suffered a non-fatal overdose outside of operating hours.
Site hours remain unchanged, Mr. Lawlor said, to align with staffing resources and operational requirements such as inmate counts and meals, but could expand as additional funding becomes available. A total of 49 patients were approved to use the Drumheller service. “I want it in my back pocket. If I need it, it’s there for me,” one inmate said.
In Dr. Leonard’s interim evaluation of PNEP, she concluded there had been significant challenges to its implementation. As of March, 2020, only four prisons of nine had active participants and three institutions recorded no interest in the program. Inconsistent rollout of the program, limited access to lifesaving naloxone and stigma were listed among the reasons for the program’s poor performance.
Staff interviewed for the study also indicated that the rollout of the OPS was poorly communicated and that Corrections Canada should better educate and train staff on its purpose and implementation should they broaden the program to other institutions to promote early acceptance.
“If you don’t understand the problem, then you are not going to embrace the response,” Dr. Leonard said in referring to both programs. “It needs to be understood what substance use disorder is, and addiction needs to be really well understood.”
Additionally, it was suggested that Ottawa provide safe snorting equipment to inmates, expand peer-assisted drug injection, and boost access to opioid agonist therapy, counselling services and safer tattooing services, the PowerPoint shows. Mr. Lawlor said progress is being made to reduce wait times for opioid agonist treatment and the provision of snorting equipment.
At the time of the report, while COVID-19 was raging through Canada, drug toxicity deaths were rapidly increasing and, to this day, continue to mount. The government of Canada was not immediately able to provide data on fatal and non-fatal drug overdoses behind bars between 2018 to now.
The government of Alberta declined to comment on the outcomes of the Drumheller OPS and whether it would consider a similar service at provincial jails.
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