Tag Archives: needle exchange

Needle and Syringe Programs and Bleach in Prisons: Reviewing the Evidence

I noticed this interesting synopsis on the Update list yesterday and though it was worth passing on – the debate over NSP has raged non-stop for over twenty years now – is there likely to ever be a ceasefire?

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A substantial amount of scientific evidence has shown that NSPs in the community are the most effective intervention available to prevent HIV transmission associated with injecting drug use. As well, NSPs have been associated with increases in access to care and treatment among people who use such programs, and with substantial cost-savings. The concerns raised about NSPs have been shown to be unfounded. NSPs have not led to increased levels of risk behaviour among people who use the programs or increased drug use by people who inject drugs.

An important and growing body of evidence demonstrating the success of prison-based NSPs also exists. Since the early 1990s, the number of NSPs established in prison settings has steadily grown. There are now in excess of 60 prisonbased NSPs in nine countries. While existing quantitative evaluations of NSPs have some limitations, overall the program evaluations have been highly and consistently favourable. NSPs in prison have been associated with a substantial reduction in needle and syringe sharing, and there have been no recorded cases of HIV infection among prisoners participating in an NSP.

Additional benefits observed include reductions in overdose incidents and deaths, an increase in referral to drug treatment programs, increased awareness of infections transmission and risk behaviours, and a reduction in injection-site abscesses. Significantly, none of the adverse consequences projected by some have been found. In particular, there have been no incidents in which syringes or needles from NSPs were used as weapons against guards or inmates, drug use has been stable or has decreased, and there has been no increase in injecting drug use among prisoners. In general, NSPs have been accepted by prison staff, including staff that was initially opposed to such programs. Bleach programmes should be available in prisons where authorities continue to oppose the introduction of NSPs, and to complement NSPs. However, because of bleach’s limited effectiveness, such programmes can only be regarded as a second-line strategy to NSPs and cannot replace NSPs.47

From a public health perspective, piloting and rapidly expanding NSPs is a priority for responding to the dual epidemics of injecting drug use and HIV infection among prisoners. To date a number of outbreaks of HIV among prisoners in the fSU have been documented.Given the evidence of entrenched epidemics of injecting drug use and HIV infection in prisons in many countries in Eastern Europe and the fSU, it is clear that further inaction on the part of prison officials will result in increased morbidity, including HIV infection, and mortality among people who inject drugs in prison. Moreover, the failure to implement NSPs could result in spread of HIV infection among the prison population as a whole, and could potentially lead to generalized epidemics among people in communities into which prisoners are released. Such further spread of HIV would lead not only to greater suffering for affected individuals and their families, but also would result in substantial, avoidable health care costs”.