We know over and over again that people
in prison of course experience often very poor conditions of detention generally.
But if you're someone who is experiencing withdrawal from drugs for example and
you're denied access to evidence-based treatment for
your problematic substance use, for opioid use disorder, for example.
Then we have just done a further harm to your health.
And in fact, in most prisons of the world people who have
problematic opioid use are denied access to evidence-based
treatment such as opioid substitution therapy.
At last count, only 52 countries of the world provided access to opioid
substitution therapy in prisons for people with opioid use disorder in some form.
And in many cases, that's not necessarily going to be a program,
even where it does exist, that is taken to scale and that everyone has access to it.
In my own country, for example Canada, there are numerous prison
systems where it is very difficult to get access to opioid substitution therapy,
even though this is a well established evidence-based medical intervention
outside prison and much of the country.
We also have some prisons and we are not unique in this by any means.
Where even if you may be allowed to continue your treatment with opioid
substitution therapy, if you are receiving that treatment before being imprisoned,
you are not allowed to actually start that treatment while imprisoned.
Which seems a very poor public health approach to a known problem,
a documented problem in our present system.
We have even fewer prisons in the world that actually provide access to sterile
injection equipment.
And yet we know that virtually every prison in the world at some
point people who are incarcerated there
will have access to controlled substances in some way.
Drugs make their way into our prisons,
despite all of the efforts by prison authorities using technology, and
sniffer dogs, and scanners, and searchers and so on.
We know that drugs make their way into prisons.
Prison systems themselves admit this in many cases.
What is much harder to get in prison is the means to actually use those
substances safely with as little risk as possible.
And so we also know documented in prison after prison around the world that when
people have access to drugs in prison but they don't have access sterile injection
equipment, people share injection equipment and people share injection
equipment that they make themselves out of whatever they can get access to in prison.
And we know of course that we have documented cases of outbreaks in prison of
infectious diseases including HIV and hepatitis C.
None of this should come as a surprise to us.
The people who use drugs that are being disproportionately incarcerated in our
prisons are disproportionately a population at risk of acquiring HIV and
hepatitis C outside of prisons.
To then concentrate that population in one place and
further deny them the means of preventing onward transmission
results in the very predictable consequence of further transmission.
This is a public health disaster in the making.