Background:
Commencing in 2018, Correction Services Canada has implemented Prison Needle Exchange Programs (PNEPs) in selected federal Institutions across Canada. One of the program’s goals is to reduce transmission of HIV and HCV by supplying sterile injecting and clean drug preparation equipment to approved participants. Safer smoking and snorting equipment is not provided.
Methods:
Confidential anonymous interviews held with 160 consenting inmates between June 2018 and January 2025 at 14 Institutions with a PNEP in place to determine acceptability of the program and experienced barriers to participation. All interviews subjected to thematic analysis based on grounded theory.
Results:
Inmate interviews from 2024 identified a barrier to PNEP participation not previously reported, the unavailability of harm reduction supplies for people snorting, not injecting, substances: “I’m not a needler. They’ve [PNEP} not got the stuff I need.”
The shift to snorting , primarily meth, was attributed to the forced decline in fentanyl use: “No fenny here.” Fentanyl was seen as a “heat bag”, its presence or a fentanyl-related overdose regarded as the impetus to drive heat on the units resulting in searches and urine testing. “Its all crystal meth now. Not opiates.” “There’s more snorting here now than injecting.” A “shooter” or pen shaft most commonly reported snorting device: I’m using a pen barrel. Often using someone else’s in the heat of the moment.”
Conclusion:
The makeshift snorting devices currently being used can cause cuts to the nasal area and damage nasal membranes causing further bleeding. HCV can be transmitted if these blood-contaminated devices are shared with others with similar injuries. Currently only providing PNEP services to offenders who inject, is ignoring the HCV-prevention needs of offenders who snort substances. Providing safer snorting devices would not only reduce HCV-related transmission risk but would mitigate the inequity of care provided: “There’s an injustice there.” |