Injecting substance use in prisons in the United States: a case for needle exchange programs

Despite efforts to prevent illicit substance use in prisons, inmates in many countries still have access to them, along with associated paraphernalia. In the United States, a large proportion of people in prison are there due to drug-related charges. The secretive nature of illicit substance use in prison and the opposition to implementing harm reduction interventions such as needle exchange programs have put prisoners who engage in such practices at high risk for infectious bloodborne diseases. While states have their reasons for opposing the implementation of needle exchange programs in prisons, evidence shows that keeping illicit substances out of prisons is difficult. Programs allowing needle exchange programs are currently illegal in the United States. The authors propose that states reconsider their stance on needle exchange programs as the implementation of such programs in several penal institutions worldwide have proven to be successful in reducing bloodborne diseases and promoting and preserving the health of prisoners. By prohibiting needle exchange programs in prison states are not only denying prisoners' access to health care but are also violating prisoner's right to health as recommended by international instruments on prisoner rights. This article advocates for the implementation of needle exchange programs in the United States prison system with a focus on states. It does this by drawing attention to the effectiveness of such programs around the world and to the fact that incarceration does not necessarily reduce illicit substance use.