Submitted by Anne Rucchetto
On the heels of the federal election and a landslide victory for the Liberal Party, attention is quickly shifting to the implications of this election and its possibilities for galvanizing systemic changes that will improve the lives of Canadians. Issues with direct impacts on health and well being that have come into popular discussion—during debates and subsequently through media outlets—include elder care, Pharmacare, child care, euthanasia, and environmental regulations. For health promoters and medical professionals, the attention that these challenges are garnering signals a promising shift in public thought. Exposure of health and quality-of-life issues is a vital step towards discussion, critique, and, in time, positive change. With that considered, it is necessary to acknowledge the converse of exposure: neglect and erasure. This leads to the question of where the health of Canadian prisoners will fit in with our collective agenda, under a new government that has the power to challenge what many health and human rights organizations have deemed the “retrogressive” negative impacts of prisoner health under the Conservative party’s decade-long tenure. 
Stephen Harper’s strategies for dealing with drug-use have been to decrease drug use through the implementation of laws that make distribution, production, and consumption of drugs as difficult and undesirable as possible. Under the 2007 National Anti-Drug Strategy, drug users have experienced increased criminalization and rates of imprisonment. Bill C-10, the Safe Streets and Communities Act (2012) has established mandatory minimum sentences for certain drug-related offenses.  Furthermore, the principle of harm reduction, which had been supported in previous national strategies—“reflecting a consensus among service-providers, researchers and affected populations”—has been eliminated by the Conservative government.  A review conducted in 2009 by De Beck et. al showed that law enforcement received an overwhelming 70 percent of drug strategy funding, with prevention and treatment trailing far behind with 14 percent and 17 percent, respectively. 
It is vital to note that this type of punitive approach to drug policy has been widely recognized as severely detrimental to the health of populations, globally, by organizations such as The United Nations, The World Health Organization, and the Global Commission on Drug Policy.  This is due to the systemic effects such policies have on vulnerable populations, who consistently bear the worst burden of negative health outcomes. Bill C-10 has ushered in a “dramatic explosion” in the prison population and exists in opposition to the repeatedly expressed concern of “Canadian health officials, jurists, criminologists, and other drug policy and human rights experts.”  This sharp increase in prisoners has disproportionately affected the most marginalized groups in Canada, including Aboriginal and Indigenous peoples, people living with mental illness, and those who suffer from addiction. 
A 2014 report by the Correctional Investigator of Canada observed, “80 percent of federally sentenced male offenders have a substance abuse problem” and the trend of overrepresentation of disadvantaged groups in prisons has “accelerated” since 2005. Over this period, the Aboriginal prisoner population has grown by 47.4 percent, the Black prisoner population by 75 percent, while the number of federally sentenced woman has increased by 66 percent, with Aboriginal women specifically increasing by 112 percent. 
As the focus has been put on law enforcement, rather than public health, treatment and rehabilitation for drug users have been underfunded. This ignores the extensive body of research that demonstrates that although punitive approaches to drug offences do not effectively reduce crime or drug use, they do enforce human and societal costs that also undermine public health. This is especially true within prisons, where the lack of prison needle and syringe programs (PNSP) exacerbates and perpetuates cycles of abject health conditions.
In Canada, over 200 needle and syringe programs (NSP) serve Canadian communities.  Numerous evaluations demonstrate that they reduce the risk of HIV and Hepatitis C while increasing access to care and voluntary admission to rehabilitation facilities. Yet, not one of these programs exists in prisons. This means that while drug use continues among prisoners, there is no safe or clean way to administer drugs.  As a result, prisoners are using anything they can find to inject drugs, which leads to increased needle sharing. This can be attributed to the rates of HIV and HCV that are 15 and 39 times, respectively, the prevalence in the rest of the Canadian population.  The denial of access to sterile equipment is a prohibition that is unique to prisoners, who are oftentimes imprisoned as a result of using drugs. Thus, while prisoners are moralized for their addictions, they are also being exposed to life-threatening illnesses that could be easily prevented.
Misled approaches to drug use ignore the reality of its prevalence, concentration, and causes. To concentrate drug control strategies on criminalizing certain communities and in turn depriving prisoners of access to basic necessities that are widely available outside of prison is, at best, a wilfully neglectful approach to public health. Prisoner health is inevitably community health, and the diseases that spread within prisons are the eventual responsibility of the society that prisoners will re-enter. At a time when “cost” is at the forefront of all healthcare debates, the price of treating these illnesses—not to mention the lifelong impacts they have on quality-of-life—are not worth the moralizations upon which punitive measures rely. The Liberal party, has, in the past, expressed a commitment to harm reduction practice, but it is the responsibility of health professionals to bring interest and attention to these issues, for the sake of all Canadians.
1. “Drug policy and human rights: The Canadian context,” Submission to the Office of the UN High Commissioner for Human Rights (Canadian HIV/AIDS Legal Network, May 15, 2015), online: http://www.aidslaw.ca/site/wp-content/uploads/2015/06/OHCHRStmt_drugpoli...
2. “Mandatory Minimum Sentences for Drug Offences: Why Everyone Loses,” Briefing Paper (Canadian HIV/AIDS Legal Network, 2006), online: http://www.aidslaw.ca/site/mandatory-minimum-sentences-for-drug-offences...
3. “Drug policy and human rights: The Canadian context,” Submission to the Office of the UN High Commissioner for Human Rights (Canadian HIV/AIDS Legal Network, May 15, 2015), online: http://www.aidslaw.ca/site/wp-content/uploads/2015/06/OHCHRStmt_drugpoli...
4. K. De Beck et al., “Canada's new federal 'National Anti-Drug Strategy': an informal audit of reported funding allocation,” International Journal of Drug Policy 2003; 20(2):188-191.
5. Global Commission on Drug Policy, Taking control. Pathways to drug policies that work, 2014, p. 12.
6. “Drug policy and human rights: The Canadian context,” Submission to the Office of the UN High Commissioner for Human Rights (Canadian HIV/AIDS Legal Network, May 15, 2015), online: http://www.aidslaw.ca/site/wp-content/uploads/2015/06/OHCHRStmt_drugpoli...
7. “Drug policy and human rights: The Canadian context,” Submission to the Office of the UN High Commissioner for Human Rights (Canadian HIV/AIDS Legal Network, May 15, 2015), online: http://www.aidslaw.ca/site/wp-content/uploads/2015/06/OHCHRStmt_drugpoli...
8. Office of the Correctional Investigator of Canada, Annual Report: 2013-2014, 2014 at p. 2, available at
9. Canadian Drug Policy Coalition, Getting to tomorrow: a report on Canadian drug policy (2013), online: http://drugpolicy.ca/report/CDPC2013_en.pdf
10. Canadian Drug Policy Coalition, Getting to tomorrow: a report on Canadian drug policy (2013), online: http://drugpolicy.ca/report/CDPC2013_en.pdf
11. “Drug policy and human rights: The Canadian context,” Submission to the Office of the UN High Commissioner for Human Rights (Canadian HIV/AIDS Legal Network, May 15, 2015), online: http://www.aidslaw.ca/site/wp-content/uploads/2015/06/OHCHRStmt_drugpoli...
12. CSC, Summary of Emerging Findings from the 2007 National Inmate Infectious Diseases and Risk-Behaviours Survey by Dianne Zakaria et al. (Ottawa: CSC, March 2010).
Drug Policy Brief by the Canadian HIV/AIDs Legal network: http://www.aidslaw.ca/site/drug-policy-and-overdose-prevention-and-respo...
Lawsuit Filed Against Government of Canada for Failing to Protect the Health of Federal Prisoners: http://www.aidslaw.ca/site/lawsuit-filed-against-government-of-canada-fo...
Annual Reports from the Office of the Correctional Investigator: http://www.oci-bec.gc.ca/cnt/rpt/index-eng.aspx
Canada’s Source for HIV and hepatitis C information (CATIE) http://www.catie.ca/
Prisoners with HIV/AIDS Support Action Network (PASAN) http://www.pasan.org/