Needle and Syringe Program in the Alexander Maconochie Centre

There has been significant developments regarding establishing Australia’s first a needle and syringe program (NSP) in the Alexander Maconochie Centre (AMC) – the ACT’s adult prison, including the recent consultation on the Public Health Association of Australia’s report (the Moore Report) on potential implementation.

The sector is now awaiting a response from the ACT Government regarding next steps in implementation.

For further information contact:

Carrie Fowlie
Executive Officer, ATODA
Email: carrie@atoda.org.au
Phone: (02) 6255 4070

+The Moore Report

Balancing access and safety: meeting the challenge of blood borne viruses in prison.
Report for the ACT Government into implementation of a needle and syringe program at the Alexander Maconochie Centre. Public Health Association of Australia, July 2011

The Public Health Association of Australia (PHAA) was engaged by the ACT Government in May 2011 to investigate and report on models for the implementation of an NSP in the AMC. The project also entailed an assessment of barriers to implementation and broad consultations with key stakeholders. The emphasis of the project has been on seeking to develop a model that ensures optimal health and safety outcomes for everyone impacted upon by a custodial sentence. This includes not only the person being detained in custody but all prison staff and the broader community. This report outlines outcomes and recommendations from the project and proposes a way to meet this challenge.

 

The report can be accessed from: http://www.phaa.net.au/documents/email/NeedleandSyringeProgramReportAMC.pdf

+Health Directorate Consultations - closed 8 September 2011

The Health Directorate sought stakeholder views on the report and its recommendations ahead of finalising its response.  A six week consultation period ran from Thursday 28 July 2011 – Thursday 8 September 2011.  For further information, including the Chief Minister’s media release and the PHAA report visit: http://www.health.act.gov.au/consumer-information/community-consultation/moore-report-implementation-of-a-needle-and-syringe-program

+ATODA NSP in AMC Submission (8 September 2011)

ATODA engaged with a range of stakeholders, including hosting a consultative forum, to develop its submission. Read the ATODA submission here.

+Background and Rationale for a Prison Based NSP

Over 80% of all newly acquired hepatitis C infections in Australia and the vast majority in most Western countries are associated with injecting (illicit) drug use. Sharing injecting equipment is the primary manner in which blood-borne viruses (e.g. HIV/AIDS, hepatitis C and B) are spread in this population. NSPs are one of the major components of Australia’s approach to reducing the spread of blood-borne viral infections among injecting drug users.

Each case of hepatitis C infection, a blood-borne virus, costs the Australian community and health services between $798 and $18,835 per year. NSPs in the ACT have been cost-effective at preventing the spread of blood-borne viruses, including hepatitis C. However, the substantial savings from NSPs in the community are being eroded by transmission of hepatitis C among a confined and identifiable population (i.e. prisoners).

The 2007 Australian prison entrants blood-borne virus survey found that 35% of 740 consecutive prison entrants were HCV antibody positive, compared with 0.2% in the general Australian population.

Prisoners have high rates of hepatitis C upon entry into prison. For most, this has resulted from unsafe injecting practices. Injecting drug use occurs in Australian prisons and continued injecting behaviours and the sharing of injecting equipment causes the transmission of hepatitis C among prisoners who continue to inject in prison. NSPs reduce the rate of transmission of hepatitis C and other blood-borne viruses in this population.

Prison staff safety is essential. The risk of punishment for possessing injecting equipment means that prisoners attempt to hide used syringes, which places staff at risk of needle-stick injuries and contracting blood-borne viruses. The prohibition of injecting equipment also means that prisoners who do inject are at a greatly elevated risk of negative health outcomes. Syringes are often used many times, increasing the likelihood of blood-borne virus transmission among prisoners, and making a substantial contribution to the spread of blood-borne viruses throughout the community. The very fact that substantial numbers of prisoners continue to inject in prison demonstrates that appropriate treatment and support is not reaching many prisoners who need it most.

This population should be targeted for interventions which reduce the risk of blood-borne virus infection. Prisoners who may contract hepatitis C in prison are generally released into the community within a relatively short period of time; such prisoners become a substantial contributor to the spread of hepatitis C in the ACT community.

The overwhelming evidence indicates that incorporating NSPs into prisons is safe and effective in reducing the risk of blood-borne virus transmission among prisoners, staff and the community.

+Evidence of Effectiveness and Safety

The arguments for introducing a NSP into the AMC are many and widely accepted by international and domestic bodies, health professionals, and the ACT Government. The overwhelming evidence indicates that incorporating NSPs into prisons is safe and effective in reducing the risk of blood-borne virus transmission among prisoners, staff and the community.

Prison NSPs are cost-effective, safe, and endorsed by international and domestic bodies. They have been introduced in 12 countries, where they have been the subject of extensive evaluation. The results demonstrate that prison NSPs can:

  • Reduce rates of needle stick injuries among corrections staff and reduce the likelihood of contracting a blood-borne virus among those who do sustain a needle-stick injury;
  • Reduce the rate of blood-borne viral transmission among prisoners who inject drugs in prisons; and,
  • Improve the uptake of appropriate treatment among people who inject drugs in prisons.

The ACT Minister for Health has stated:

“From a health point of view, it is a no-brainer; you have a Needle and Syringe Program in the jail as soon as you can.”

Prison staff’s attitudes to NSPs in prisons have been generally positive once they have been implemented. In a 2004 review of NSPs in European countries, the World Health Organization found that not a single case of syringes being used as weapons by inmates had been reported. In Australia, there has been only one reported case, in 1990, in which a prison officer was assaulted with a syringe. However this occurred when there were no NSP facilities available in the prison.

Evaluations of Needle and Syringe Programs in overseas prisons have shown that they do not increase drug consumption or injecting and they effectively reduce needle sharing. Additionally, there have been no documented cases of adverse events from NSPs in prisons anywhere in the world, making NSPs in prisons a safe health intervention.

+Research and Evidence Summaries

ACT Human Rights Commission (2007) Human Rights Audit on the Operation of Correctional Facilities under Corrections Legislation. Canberra.

ACT Legislative Assembly (18 May 2010) Select Committee on Estimates 2010 – 2011, Canberra. Available online at: http://www.hansard.act.gov.au/hansard/2009/comms/estimates16.pdf

Anex (2010) With conviction: the case for controlled needle and syringe programs in Australian prisons. Available online at: http://www.anex.org.au/downloads/HMPC%20Paper%20on%20NSP%20in%20Prison%20-%20October%202010.pdf

Australian Institute of Health & Welfare (2010) The health of Australia’s prisoners 2009, AIHW cat. no. PHE 123, Australian Institute of Health & Welfare, Canberra.

Australian National Council on Drugs (2002) Needle and syringe programs. ANCD Position Paper. ANCD, Canberra. Available online at: http://www.ancd.org.au/images/PDF/Positionpapers/pp_needle_syringe.pdf

Awofeso N. (2009) Updating the hepatitis C infection risk reduction hierarchy in prison settings. Australasian Journal of Correctional Staff Development. Volume 4, No 1-4

Butler T, Milner L (2003) The 2001 New South Wales Inmate Health Survey, Corrections Health Service, Sydney.

Butler T, Milner L. (2003) The 2001 New South Wales Inmate Health Survey. Sydney. Cited in Mogg D, Levy, M (2007) Moving beyond non-engagement on regulated needle-syringe exchange programs in Australian prisons. Harm Reduction Journal. 2009; 6: p. 7.

Butler T, Papanastisiou C. (2008) National prison entrants’ blood borne virus and risk behaviour survey report 2004 & 2007. NDRI, Curtin University and NCHECR, University of New South Wales.

Department of Health & Ageing (2010) Third National Hepatitis C Strategy: 2010-2013, Australian Government Department of Health & Ageing, Canberra.

Dolan K, Rutter S, Wodak, A.D. (2003) Prison-based syringe exchange programmes: a review of international research and development, Addiction, vol. 98, no. 2, pp. 153-8.

Dolan K, Larney S, Jacka B, Rawlinson W. (2009) Presence of hepatitis C virus in syringes confiscated in prisons in Australia. Journal of Gastroenterology and Hepatology 24(10); pp. 1655-1657.

Dolan K, Teutsch S, Scheuer N, Levy M, Rawlinson W, Kaldor J, Lloyd A, Haber P. (2010) Incidence and risk for acute hepatitis C infection during imprisonment in Australia. European Journal of Epidemiology 25(2): pp. 143-148.

Hall W, Lucke, J (2010) Legally coerced treatment for drug using offenders: ethical and policy issues, Crime and Justice Bulletin no. 144, NSW Bureau of Crime Statistics and Research, Sydney.

What can be done to reduce hepatitis C in Australian prisons?
Hepatitis Australia and over 20 other public health bodies have issued a Consensus Statement which calls on Australian governments to reduce the spread of hepatitis C in prisons. The Statement explains ‘Hepatitis C, which is both preventable and treatable, is endemic among Australian prisoners…As the health status of prisoners moves with them between prison and their home and community, addressing, or neglecting, their health care needs, has a substantial impact for better or worse on the health of the general community’. It calls on Australian governments to ‘provide sufficient funding to allow comprehensive interventions for the prevention, treatment and harm reduction and aftercare of hepatitis C to be expanded to meet the personal and public health needs of prisoners and all who work in custodial settings, their families and the community’.
Hepatitis Australia et al. 2011, Consensus statement: addressing hepatitis C in Australian custodial settings, Hepatitis Australia, Canberra, http://www.hepatitisaustralia.com/__data/assets/pdf_file/0008/2123/Prisons-consensus-statement.pdf.

Lines R, Jürgens R, Betteridge G, Stöver H, Laticevschi D, Nelles, J (2004) Prison needle exchange: lessons from a comprehensive review of international evidence and experience, Canadian HIV/AIDS Legal Network, Montréal, Québec.

Lines R, Jürgens R, Betteridge G, Stöver H (2005) Taking action to reduce injecting drug-related harms in prisons: the evidence of effectiveness of prison needle exchange in six countries, International Journal of Prisoner Health, vol. 1, no. 1, pp. 49-64.

Loxley W, Carruthers S, Bevan J. (1995) In the same vein: First report of the Australian study of HIV and injecting drug use. Perth: Curtin University of Technology.

McDonald, D. (2005) The Proposed Needle and Syringe Program at the Alexander Maconochie Centre, Canberra’s New Prison – An information paper on the evidence underlying the proposal. Canberra.

Mogg D, Levy M (2007) Moving beyond non-engagement on regulated needle-syringe exchange programs in Australian prisons. Harm Reduction Journal. 2009; 6: p. 7.

National Centre in HIV Epidemiology and Clinical Research (2009) Return on investment 2: evaluating the cost-effectiveness of needle and syringe programs in Australia, National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney.

National Indigenous Drug and Alcohol Committee (2009) Bridges and Barriers: Addressing Indigenous Incarceration and Health. Canberra: Australian National Council on Drugs.

Niveau, G (2005) Prevention of infectious disease transmission in correctional settings: A review, Public Health.

Poroch N (2007) You do the crime, you do the time: Best practice model of holistic health services delivery for Aboriginal and Torres Strait Islander inmates in the ACT prison. Winnunga Nimmityjah Aboriginal Health Service, Narrabundah, ACT.

Rutter S, Dolan K, Wodak A, Heilpern, H (2001) Prison-based syringe exchange programs: a review of international research and program development, NDARC technical report no. 112, National Drug & Alcohol Research Centre, Sydney, NSW.

Ryan J, Voon D, Kirwan A, Levy M, Sutton. (2010) Prisons, needles and OHS. Journal of Health Safety and Environment. 2010;26(1): pp. 63-72.

Stöver H, Nelles J (2003) Ten years of experience with needle and syringe exchange programmes in European prisons, International Journal of Drug Policy, vol. 14, no. 5-6, pp. 437-44.

United Nations Office on Drugs and Crime (2008) HIV and AIDS in places of detention: a toolkit for policymakers, programme managers, prison officers and health care providers in prison settings, United Nations Office on Drugs and Crime, Vienna.

Van Beek, I (2004) In the Eye of the Needle: Diary of a Medically Supervised Injecting Centre.

Watchirs, H (5 September 2009) Human Rights for Prisoners – the ACT Experience, ACT Human Rights & Discrimination Commissioner. NSW State Library, Sydney. Available online at: http://www.hrc.act.gov.au/content.php/content.view/id/194.

World Health Organization, United Nations Office on Drugs and Crime & Joint United Nations Programme on HIV/AIDS (2007) Interventions to address HIV in prisons: needle and syringe programmes and decontamination strategies, World Health Organization, Geneva.

+ATODA Budget Submission 2011/12

ATODA’s submission to the ACT Budget 2011/12 consultation included a proposal for an NSP in the AMC.  Click here to read the excerpt.

+Recent Media

Needle exchange: ACT Government pushes on with plan for jail program (ABC News; 24 Sept 2014)

CPSU position on NSP in ACT prison unjustifiable (Canberra Times; 18 Sept 2014)

Needle exchange at AMC a fatality flawed proposal (Canberra Times; 17 Sept 2014)

Prison needle exchange debate should go to independent arbitrator, Chief Minister Katy Gallagher says (ABC News; 17 Sept 2014)

Officers dig in as hepatitis cases rise (Canberra Times; 4 June 2013)

ANCD Prison issues update (Australian National Council on Drugs; October 2012)

Needle swap vital (Canberra Times, Letters; 26 March 2012)

Needle points (Canberra Times, Letters; 22 March 2012)

Needles in jail (Canberra Times, Letters; 21 March 2012)

HIV fears for prison guard pricked by used needle (Herald Sun; 20 March 2012)

Jail syringe debate [PDF] (Canberra Times, Letters; 20 March 2012)

Needle exchange program is a health care necessity (Canberra Times, Letters; 16 March 2012)

Jail is no place for needles (Canberra Times; 16 march 2012)

Disagreeing with Stanhope on the needle exchange program ( Canberra Times; 15 March 2012)

Rights exist behind the wire (Canberra Times, 13 March 2012)

Prison Needles Risk is a Furthy (Justice Action, Media Release; 18 January 2012)

Prison needle exchange talks continue (ABC News; 11 January 2012)

Radio Current Affairs Documentary: Needle Exchange (ABC Radio, PM Program; 10 January 2012)

2011

Prison needle exchange scheme will protect us all (Canberra Times; 7 December)

Another AMC inmate contracts Hep C (Canberra Times; 1 December)

Prisons shouldn’t incubate blood borne disease (Anex; 1 December)

Anti-needle stance at odds with law (Canberra Times; 29 November)

Prisoners divided on jail needle program (Canberra Times; 23 November)

Ominous and misguided opinions on needles and prisons (Canberra Times; 20 October)

Sterile needles can stop the spread of disease in prisons – here’s how (The Conversation; 18 October)

Australian prisons in danger of HIV epidemic (ABC; 17 October)

Growing calls for prison needle exchange (ABC Radio; 15 October)

Need for prison needle exchange (ABC TV; 15 October)

Needle Exchange Program in Switzerland a success (ABC; 7 October)

Group offers to run jail needle exchange (ABC; 4 October)

CPSU stands in way of evidence-based public-health move (Canberra Times; 30 September)

Needle row: commissioner quits CPSU (Canberra Times; 29 September)

ACT considers prison needle exchange (PM – ABC Radio, 28 September)

Stanhope lashes CPSU over needle exchange (ABC, 28 September)

Stanhope poised to take on union (Canberra Times, 28 September)

Prison needle debate (Canberra Times, 28 September)

Inmates ‘denied’ hepatitis care: Libs (Canberra Times, 28 September)

No needles, no drugs in prison (City News; 15 September)

Missing points (Canberra Times; 9 September)

The need for prison needles (City News; 8 September)

Nurses oppose needle exchange plans (ABC; 8 September)

Debate over needle program (Chronicle; 6 September)

Needle exchange (Canberra Times; 6 September)

Jail fails to ‘embrace’ human rights ethos (Canberra Times; 3 September)

Needle Problem (Canberra Times; 1 September)

Drugs don’t belong in jail (Canberra Times; 1 September)

Union stymies jail needle bid (Canberra Times; 30 August)

Prison officers stand firm against needle exchange (ABC TV; 29 August)

Drugs in jail (Canberra Times; 15 August)

Needle exchange (Canberra Times; 11 August)

Continuity of care is crucial for ex-prisoners rebuilding lives (Canberra Times; 9 August)

Jail means offenders are out of sight and out of harm’s way (Canberra Times; 5 August)

Get the facts on prison needle-exchange programs (Canberra Times; 4 August)

Govt should not start up irrational needle exchange program (Canberra Times; August)

How do BYO drugs fit with punishment or reform? (Canberra Times; 1 August)

Prison needle exchange ‘makes sense’ (ABC; 29 July)

Prison needle exchange needed: report (ABC TV; 28 July)

Jail report recommends needle exchange plan (ABC; 28 July)

Moore report open for further six week consultation (ACT Government media release; 28 July)

Greens welcome Moore report (ACT Greens media release; 28 July)

Jail report tipped to back needle swap plan (Canberra Times; 27 July)

Australia’s health care in prisons under fire (Canberra Times; 23 July)

ACT won’t plunge into jail needle program (Canberra Times; 29 June)

Government responds to burnet report (ACT Government media release; 28 June)

Group says prisoners back needle exchange (Canberra Times; 23 June)

100% of prisoners reject NSP says prisoner aid veteran (Canberra Liberals media release; 21 June)

Prisoners are against needle plan: submission (Canberra Times; 21 June)

Blunt words on sharps (Canberra Times; 18 June)

Jail needle opposition ‘industrial blackmail’ (Canberra Times; 17 June)

Safety ‘paramount’ in any prison needle exchange (ABC; 14 June)

Jail guard joins push for drug reform (Canberra Times; 14 June)

Prison needle program may reduce virus spread (ABC TV; 1 February)

Last updated 3 November 2014