Over the years, the HIV Legal Network has participated in inquests exploring the growing number of drug poisoning deaths in Ontario jails. Following a 2020 inquest at the Elgin-Middlesex Detention Center involving the tragic drug poisoning deaths of two men, the jury made important and unprecedented recommendations to Ontario’s Ministry of the Solicitor General to address such deaths in custody. They urged the Ministry to “pursue cultural change” that includes a “non-punitive, harm reduction approach” while upholding the “principle of equivalency” — entitling people in detention to have access to a standard of healthcare equivalent to what is available outside prison and conforming to professionally accepted standards.
Other key recommendations include a requirement that all people in detention who meet the criteria for opioid agonist therapy (OAT) have access to it without delay, that naloxone is available within 30 seconds in the event of an opioid overdose, and that the Ministry adopt Good Samaritan principles so prisoners who call for help or try to help another person in drug-related medical distress are not investigated or punished for having drugs. Notably, the jury also recommended that the Ministry study other harm reduction strategies including making fentanyl testing kits and sterile consumption equipment available in prison health care units. All of these could save lives.
While these recommendations are not legally binding, they can serve as a helpful guide for prison authorities who must uphold their legal responsibility to people in their custody. But four years later, very little has changed, and people behind bars continue to die entirely preventable deaths.
Incarcerated people cannot consistently continue OAT prescriptions from the community, due to long waitlists and health care provider preferences. Provincial authorities have not instituted a clear naloxone policy, nor is naloxone accessible in people’s cells. Not a single provincial prison in Ontario has made sterile drug consumption equipment available, either in the form of a needle and syringe distribution program or a supervised consumption service. And troublingly, there is no apparent system of accountability to ensure jury recommendations are considered and implemented. This is shameful.
We also know that these gaps in vital healthcare and harm reduction services are not unique to Ontario. Over the past two years, the HIV Legal Network has conducted an analysis of healthcare and harm reductions policies and practices across provincial, territorial, and federal prisons in Canada. The findings are stark: not one jurisdiction is meeting international standards regarding the provision of healthcare in prison. These standards include ensuring that healthcare in prison is provided by healthcare authorities (rather than prison authorities); universally offering testing and treatment for sexually transmitted and blood-borne infections (STBBIs); and making safer sex supplies (like condoms and lube), naloxone, OAT, sterile needles and syringes available and accessible.
While many of these standards have been met in the community, prisons have lagged far behind.
Thankfully, some jurisdictions have started to make important progress. In British Columbia, for instance, healthcare in prison is now administered by provincial healthcare authorities, which has led to broad improvements, and there has been more consistent initiation and continuation of OAT. Across federal prisons, OAT is also more consistently initiated and continued for those who need and want the treatment. Additionally, needle and syringe distribution programs and supervised consumption services have been rolled out at some federal institutions, which has the potential to reduce the risk of HIV and HCV transmission and overdose once flaws in the design of the programs are addressed.
The HIV Legal Network’s findings will be published in a report at the end of 2024, with the hope that jurisdictions across the country will make greater progress towards respecting and protecting the health of people in prison. As one key informant shared, “We are so far behind… We have got a lot of work ahead of us when it comes to harm reduction… I have been in this game a long time with corrections, mental health, addictions, and now justice. I have met some of the most beautiful souls, and every day that they are alive is a miracle. I am going to do anything I can to ensure that you are safe, because you deserve it. You deserve dignity.”
On August 10th, we mark another Prisoners’ Justice Day, and the problem of wholly inadequate prison health persists. It is a matter of Canadian and international law that prisoners do not surrender all rights upon incarceration. On this day, we recommit to continuing our work to uphold prisoners’ rights to health and dignity — rights which are intertwined with our own.