Navigating harm reduction and security mandates: Prison leadership perspectives on implementing prison needle...

Area of Science:

• Public Health
• Criminology
• Health Services Research

Background:

• Prison needle exchange programs (PNEPs) are vital for reducing bloodborne virus transmission among people who inject drugs.
• Despite PNEPs' proven benefits, global implementation is limited, with Canada experiencing low uptake and persistent barriers since 2018.
• Limited understanding exists regarding the influence of prison leadership on PNEP delivery, necessitating research into administrative perspectives.

Purpose of the Study:

• To identify organizational, system, and structural/policy-level barriers to PNEP implementation from the perspective of prison administrators.
• To explore how prison leadership influences the successful delivery and sustainability of PNEPs within the Canadian federal correctional system.

Main Methods:

• Semi-structured interviews were conducted with 27 prison leaders (custodial and medical services) across nine Canadian federal prisons with operational PNEPs between January and March 2025.
• Thematic analysis of interview data was performed using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework.

Main Results:

• Implementation challenges stem from structural tensions between harm reduction and "zero tolerance" mandates, compounded by union resistance, policy ambiguity, and federal directives.
• Prison climate, staff turnover, and leadership engagement significantly impacted attitudes toward PNEPs, while healthcare personnel faced trust issues due to their communication role.
• Program fit was perceived differently based on security classification, and streamlined processes with designated leadership roles facilitated uptake; time, education, and experience fostered readiness.

Conclusions:

• Overcoming outer context barriers and clarifying health-corrections responsibilities are essential for PNEP sustainability.
• Active leadership engagement is critical for fostering system-wide adoption and successful implementation of prison needle exchange programs.