Prison watchdog calls for more harm-reduction services to prevent drug overdoses and deaths

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Canada’s prison watchdog says Ottawa can’t continue to use the COVID-19 pandemic as an excuse for slow progress on expanding services to reduce inmate drug overdoses and deaths.

Correctional Investigator Ivan Zinger agrees that the pandemic did disrupt the prison system, but he said there is also a reluctance by Correctional Service Canada (CSC) to effectively integrate harm-reduction services such as overdose prevention, prison needle exchange and treatment options. The Office of the Correctional Investigator has, for years, been pushing for harm-reduction measures.

Before the pandemic, the federal government had designated a number of facilities for expansion of both overdose prevention sites, where inmates would be monitored by health care staff after using illicit drugs, and needle exchange, but spokesperson Marie Pier Lécuyer said COVID outbreaks caused delays.

The Collins Bay Institution in Ontario and Springhill Institution in Nova Scotia were supposed to open overdose prevention services (OPS) sites by the end of last year but have yet to do so.

Dr. Zinger said CSC has a statutory obligation to respond to the needs of the incarcerated population to maximize their ability to safely reintegrate and rehabilitate – and quickly. “It’s been going on for so long that, in my view, it’s no longer just a public-health issue or a security issue. It’s a human-rights issue,” he said in an interview.

Over the past decade, 46 inmates across Canada have died from suspected drug overdoses at federal institutions, according to data provided by CSC. Another 728 people have nonfatally overdosed between April, 2011, and March, 2022.

The worst year was 2019-20 when 148 inmates overdosed, the majority of whom were in Ontario (79). For comparison, the median across 10 years was 70, with the high of 148 and low of 34 in 2012-13.

Illicit drugs make their way behind bars through a variety of means, such as by mail, concealed in an inmate’s body, through correctional staff and even by drone drops.

In 2019, Alberta’s Drumheller Institution became the first federal prison in Canada to operate an overdose prevention site because of a high number of drug overdoses. The prevalence of drug use among inmates was estimated to be as high as 70 per cent, according to Dr. Zinger. It remains the only federal or provincial institution in the country to house a service of this kind. No overdose deaths have occurred since its opening and all non-fatal poisonings in the prison have occurred outside of the OPS site.

Inmates at the Drumheller prison must seek approval before using OPS. CSC said 61 people have been approved to use the site, which has had 1,661 visits.

James Bloomfield, Prairies regional president of the Union of Canadian Correctional Officers, said the Drumheller model should be expanded nationwide as overdoses spike. “Drumheller was a prime example of this, where we had guys burning out left, right and centre from responding to overdoses, sometimes six, seven at a time,” he said.

Mr. Bloomfield, once opposed to the Drumheller site, is now an advocate of its expansion to replace the needle-exchange program, which he said is a safety concern for staff and inmates because needles are out of sight in cells and can lead to injury. That program has come under scrutiny for being improperly implemented.

Collins Bay and Springhill, where CSC plans to open OPS sites, had the highest number of reported overdoses in their respective regions since 2018, representing 45 per cent of Ontario’s 171 incidents and 40 per cent of the Atlantic region’s 35 incidents, respectively, CSC data show.

Ms. Lécuyer said COVID-19 outbreaks at both facilities last year affected the government’s ability to conduct consultation about opening overdose prevention services and prevented minor infrastructure modifications at Collins Bay. However, in December, CSC was able to engage Springhill stakeholders, the statement said.

That site is now expected to open early this year and a launch date for Collins Bay will be “determined shortly as the infrastructure changes are ongoing,” she said. Additional sites are to be announced later this fiscal year, which ends on March 31.

She did not provide timelines for needle-exchange expansion. The government indicated last August that at least two more institutions, Warkworth in Ontario and Bowden in Alberta, will offer the program that is currently available at nine federal institutions. There are 326 inmates approved to participate nationwide, but Ms. Lécuyer did not say how many are active.

In June, officials told a conference that less than 20 per cent of approved participants were utilizing the needle-exchange program. It launched in 2018 – 14 years after former correctional investigator Howard Sapers recommended its introduction – to help prevent the sharing of needles among inmates and spread of infectious diseases.

Dr. Zinger said he has had concerns dating back four years, including restrictive criteria for eligibility, but they have yet to be addressed. There has also been scrutiny of Drumheller’s supervised drug-use site for having limited resources, peer assistance and hours of operation.

Ms. Lécuyer said CSC is updating guidelines for both programs and is working on a new psychosocial treatment option and peer support.

Opioid agonist therapy, where medications such as methadone and suboxone are prescribed to treat substance-use disorder, is also offered in prisons. The treatment has been expanded after CSC settled a complaint filed by Prisoners’ Legal Services that waiting times were too long. As of last September, more than 25 per cent of the incarcerated population was accessing this program, including 201 people on the waiting list.

But Dr. Zinger noted in his annual report, released last June, that the service’s zero-tolerance drug strategy is subverting harm-reduction measures. “Maintaining a zero-tolerance approach to drugs that relies on ever more intrusive detection, disciplinary and repressive measures – strip searches, body-cavity scanning, cell searches, charges, urinalysis testing – is a costly game of diminishing returns,” he wrote.

“If a person is so desperate, indebted or addicted enough to the point of concealing drugs in body cavities with potentially life-threatening consequences, then surely this level of desperation should point us to consider other less intrusive, evidence-based and compassionate approaches of addressing the harms of illicit drug use behind bars.”

CSC Commissioner Anne Kelly responded last November to Dr. Zinger’s report, saying the service is revising the drug policy to align with the Canadian Drugs and Substance Strategy, released in 2019, reflective of evidence-based approaches to respond to substance-use disorder.

With a report from The Canadian Press