Thank you.
I would like to start by thanking the committee for inviting me here to speak with you today.
PASAN is a community-based organization that provides support and prevention education services to prisoners around infectious diseases, with a focus on HIV/AIDS and hepatitis C.
My comments today will be focused around drug use and drug dependency in prison and its connection to prisoners' pain management needs and issues.
The federal prison population is comprised of a diverse spectrum of people, and within it there are disproportionate numbers of people of low income, racialized communities, people with disabilities. And obviously, as you well know, it is hugely over-represented by indigenous people, many of whom are suffering from trauma and have been survivors of the residential school program. Prison also has many people with diagnosed and undiagnosed mental health issues, substance abuse habits, and dependencies. Obviously, there are many people in prison with drug-related convictions, going from possession to possession for the purposes of trafficking, but also many people are in prison with convictions for fraud or theft, which are related to their drug use habits.
I want to start by clearly saying that there is a level of trauma and all kinds of issues that prisoners are dealing with as they come in. Also, there's the fact that they're in prison and isolated from their family and from their communities. Obviously, they're in an environment where there's some hostility, and trust and support is quite hard to access for prisoners. These things all play a role in terms of a prisoner's ability to maintain a level of good health.
Just a few notes about how this has been studied over a period of time....
A report was commissioned by CSC. It was a health care needs assessment of federal inmates in Canada that found that inmates were thirty times more likely to inject drugs than people outside, two to ten times more likely to have an alcohol or substance use or abuse disorder, more than twenty times more likely to have been infected with HCV, ten times more likely to be infected with HIV, more than twice as likely to have any mental health disorder, and four times more likely to die of suicide than people on the outside.
These figures point to the fact that prison is not a place where it's easy to maintain a level of health. Also, the correctional investigator's report from 2009-2010 stated that hepatitis C rates have increased by 50% between 2000 and 2008, and also stated that it is a fact that HIV and HCV are acquired, transmitted, and spread in prisons.
I want to talk a little bit about pain management issues in prison generally. Prisoners, like people in the community, are going to have different pain management issues in their lives. This can be based on physical pain, emotional and psychological pain, and distress. As I said earlier, many prisoners are survivors of trauma and abuse in their past. One of the difficulties in terms of drug use in prison and pain management in prison is that a lot of prisoners, as I said earlier, will come into prison already with drug use habits that they need to deal with. The process that the prison service goes through with people is one in which the first response to a drug use situation is often a punitive response rather than a therapeutic response. The policies in prison are ones that obviously try to reduce drug use and try, first and foremost, from a security perspective, to control that situation.
Also, on both sides, prisoners and staff, there is a degree a suspicion, which is a part of the culture of the prison environment. Trust levels are low on both sides.
Often, prisoners who are presenting with pain management needs of all types are at risk of being labelled as having drug-seeking behaviour and are at risk of having a higher level of scrutiny from the guards and the correctional system because they are considered to be a potential risk.
Again, the fact that prisoners know this means that oftentimes there is a greater likelihood that the prisoners are going to become involved in more risky practices—if they are using drugs, they will use them more quickly—and the lack of effective harm reduction materials and services means that prisoners are in a situation in which they are at much greater risk of contracting and spreading infectious diseases.
There is also the allegation that prisoners with the label of potentially being drug-seeking might divert drugs to other prisoners. Again this brings greater scrutiny on prisoners. There are many consequences for suspicion of drug use or diversion, and also the potential that somebody might have a positive urine analysis test. These consequences include potential loss of institutional work, movement within an institution or transfer out of an institution, possibly a period of time in segregation, loss of visits and so more isolation from family, and also potential institutional charges.
The existence of this as a part of the drug strategy again makes it less likely that prisoners are going to come forward looking for support treatment around drug-use types of issues and around self-medication types of issues.
One of the things that is key around this is that in spite of addiction being as a disability, as I said, the first response often tends to be punitive rather than therapeutic. Programming that is available in prison for prisoners around drug use and treatment-type issues tends to be limited. There tend to be fairly long waiting lists to get into the programs that exist.
But when I say “limited”, it is also often the case that people need a certain level of support in order to make changes in their lives. Often the treatment options available are of a certain type and do not recognize that people are struggling to meet their pain management needs at the same time as looking to make changes in their lives, hopefully, so that they have a better chance of staying out when they do eventually get out.
Security considerations often trump the health needs of prisoners around these kinds of issues. I would argue that there's no effective one-size-fits-all strategy around drug treatment for people generally. In the community there are usually greater options for people when they are looking at treatment and rehabilitation with regard to drugs. I think this is important, because we always want to look at the principle of equivalency, in terms of whether what is available to prisoners is as close to possible to being equivalent to that which is available in the community.
In terms of the broad things that are available in the community, from harm reduction services to support services to treatment services, there isn't the same access, and very importantly in terms of people being able to make different choices, it is important that a large proportion of the different options available to prisoners around drug use be provided, hopefully, by community organizations that are going into prisons to provide those services. That gives people different options, options that do not necessarily expose them to a system in which there are obvious concerns about the potential punitive repercussions people are going to face.
I just want to give a very quick example—