28 June 2023
We recently attended the Harm Reduction International Conference in Melbourne, and here, we share our key takeaways from the session focused on harm reduction in Australian prisons.
Chaired by Alison Ritter from the University of New South Wales (UNSW) and Sione Crawford from Harm Reduction Victoria and attended by over 50 participants, the session took a deeper dive into the implementation of best practice in prison harm reduction strategies in Australia.
Speakers from organisations including Harm Reduction International, Harm Reduction Victoria, Burnet Institute, UNSW and Hepatitis Australia covered the differences between the availability and accessibility of harm reduction interventions in prisons, the barriers to progressing implementation and scale-up, and what needs to be done in order to advance the health and wellbeing of people in prison.
Marcela Jofré- Harm Reduction International (HRI)
Key Takeaways:
- The provision of harm reduction in prisons is a human rights obligation and should be at the centre of every drug policy, framed upon international standards which indicate that every human being has the right to the highest attainable standard of physical and mental health regardless of legal status.
- Although HRI’s Global State of Harm Reduction 2022 shows the first increase in key harm reduction services in the community since 2014, harm reduction interventions in prison remain limited in scope with little expansion since 2020, with Oceania showing no changes since 2020.
- The rate of imprisonment amongst Aboriginal and Torres Strait Islander people is 13.3 times higher than the broader population, indicating they are disproportionately affected by the criminal justice system
- Availability does not equate to accessibility, acceptability and quality of harm reduction services. In some countries harm reduction is available in small number of prisons, in other countries people are not able to commence opioid agonist therapy (OAT) whilst they are in prison, being only available for those who has started OAT before incarceration.
- Other barriers include humiliating and punitive treatment for accessing harm reduction interventions in the prison
- COVID-19 responses have impacted the already limited availability of harm reduction services in prisons
Melanie Walker – The Australian Alcohol and Other Drugs Council (AADC)
Prior to the Harm Reduction International Conference, on March 14 2023, the Harm Reduction in Prisons Working Group released a consensus statement ‘Strengthening injecting-related harm reduction in prisons,’ which outlines an evidence-based approach to reducing the spread of blood borne viruses and other injecting-related harms in prisons.
The Working Group is a national cohort of health practitioners, researchers, sector representatives and advocates (including Hepatitis Australia) and is convened by the Social Policy Research Centre’s Drug Policy Modelling Program at UNSW Sydney.
Melanie Walker, former AIVL CEO and now CEO of The Australian Alcohol and other Drugs Council (AADC), the national peak body for the drug & alcohol sector, presented the key findings from the report.
Key findings:
- People in prison inject illicit drugs, and experience significant harms
- Injecting-related harms in prisons can be prevented
- The consensus statement summarises the evidence about how to present those harms and provides the basis for effective action to eliminate injecting related harms in prisons
- Interventions which are effective in reducing injecting related harms in community settings and are likely to be – or are demonstrated to be – effective in prison settings include Needle and Syringe Programs (NSPs: the regulated provision of sterile injecting equipment), overdose prevention sites, naloxone provision, peer led education and programs, OAT, blood-borne virus screening etc
But why is this important?
- People in prison have a higher rates of harmful outcomes from injecting drug use than the general population
- Access to harm reduction interventions in prisons decreases the risk of injury and disease from injecting drug use
- People in prison have the right to access safe and effective harm reduction and healthcare, equivalent to that which is available in community settings
- Imprisonment provides an opportunity to support marginalised and vulnerable populations with harm reduction interventions
Key takeaway:
- We should be implementing the full suite of harm reduction interventions, and not cherry picking from the list, which limits effectiveness
Mark Stoové, Burnet Institute
Mark Stoové from the Burnet Institute in Melbourne, Victoria, presented on some of the lessons learned from trying to implement a Prison Needle Syringe Program (PNSP) in the Australian Capital Territory.
Political context:
- Australia is one of the global leaders in harm reduction and remains one of six countries with high-coverage NSP and OAT in the community. However, Australia is out of step in the prison setting as well as with its broader drug policy and international human rights obligations.
So what happened in the Australian Capital Territory (ACT)?
- ACT legislated the Human Rights Act in 2004, which included an interpretation of human rights
- The first prison in the ACT, the Alexander Maconochie Centre, was established in 2008 which was compliant with the 2004 Human Rights Act. It was determined that it would provide in prison services equal to those available in the community.
- It was decided than an evaluation of drug policies and services in the AMC would be undertaken 18 months after commissioning.
- The Burnet Institute led the evaluation and report which was tabled in parliament in 2011. A key recommendation was the establishment of a PNSP at the AMC. In 2012 it was announced that an NSP would be established
- However, the public and political discourse which followed, largely led by the labour force union, stonewalled the process. In the enterprise bargaining agreement- 97% voted against the establishment of the NSP.
What lessons were learned?
- Continued advocacy efforts remain crucial
- It is essential to engage the labour force and bring them into the conversation
- Look to other countries for best practice examples
- Political will is key
No prison system in the world is drug-free.…. Political recognition that drugs in prison are an inevitable product of criminalising drug use and incarcerating drug users is a precondition to a mature conversation about how to reduce drug harms in prison.
Carrie Fowlie, Hepatitis Australia
- Hepatitis C testing and treatment in the prison setting is an important ingredient but it is not enough
- The implementation of PNSP is contained in existing Australian policy enshrined in the national hepatitis C strategy endorsed by all Australian ministers
- There are opportunities to strengthen the national drug strategy, as it doesn’t contain commitments. The national HCV, HBV, HIV strategies and the Aboriginal and Torres Strait Islander BBV and STI strategies are all coming up for public consultation. We should all seek to strengthen the wording contained therein.
Sara Stilianos, Justice Reform Initiative
Sara, a member of the community with a lived experience of harms associated with drug use and time in prison, shared her personal story and perspectives from her time in prison.
The lack of support for withdrawal offered by prisons was evident, as was the lack of access to harm reduction options and absence of sterile injecting equipment. The problem lies within the prison policies themselves, policies which are designed for punishment leading to sanctions. There are no existing pharmacotherapy replacement options for drugs such as methamphetamines.
In addition, there is no easily accessible counselling or support, and there is a lack of access to training which might support harm reduction.
Key takeaway:
- Prisons must stop relying on punitive deterrent policies when implementing and designing policies
Michael Lukic, Windana Drug and Alcohol Recovery
The final speaker of the session, a community member with experience of time in prison, also shared their reflections on the state of harm reduction in prisons. Prisons can be viewed, by default, as the biggest rehabilitation facilities, with negative consequence. In his time in prison, Michael was not asked when he entered prison about the extent or nature of his drug use, nor was he offered support with withdrawal or provided with syringes. As a result, further negative health effects followed, creating more of a desire to use drugs upon his release from prison.
The punitive policies in the prison were evident also in this presentation, indicating that there is often a sentiment of pride on the part of prison officers when someone is caught using drugs and punitive measures such as restricted visits often implemented. Prisoners who access bleach are often watched by prison staff. The need for greater education on harm reduction was also emphasised, for people in prison and prison officers.
Key discussion points from group Q&A
What are some of the strategies to consider implementing to advocate for NSPs in Australian prisons? What are the first steps?
- Signal support for NSP in prisons – this issue is silenced and many NGOs and advocacy organisations do not have a strong clear statement of support publicly visible (for example on websites)
- It is important to map the prison system across Australia in the first instance, to actually map what is going on
- One option to consider is litigation. This would involve the opportunity to litigate for reinfection of HCV as a result of imprisonment. This would be a complex class action suit
- Engage with the unions. Bring federal correctional officers from Canada to Australia (as Canada has PNSP in federal prisons). Important to consider that there may be more opportunities in private prisons than in the public
- Educate bureaucrats on the importance of implementing harm reduction interventions in prisons
- Identify champions in policy who are willing to risk public opinion at a national and state level
To learn more about hepatitis C in prisons globally, join INHSU’s Special Interest Group INHSU Prisons. Further information found at https://www.inhsu.org/the-network/inhsu-prisons/
