Removing needles from correctional settings

Until correctional administrators can guarantee a totally drug-free environment, they need to manage the risk of infections caused by inmate access to needles


Most correctional officials are aware of the United States Supreme Court decision (Estelle v Gamble) which ruled prisoners have a constitutional right to healthcare and prohibits "deliberate indifference to serious medical need."

Today's correctional healthcare providers understand the offender's right to health services comparable to those available to the general public.

Correctional healthcare workers face the following challenges according to the Center for Disease Control and Prevention (CDC):

• Jails and prisons can be unpredictable work settings
• Security issues are often a higher concern than infection control
• Inmates may have a higher rate of bloodborne diseases

Until correctional administrators can guarantee a totally drug-free environment, they need to manage the risk of infections caused by inmate access to needles.

Infections prevented in prison will reduce healthcare costs and provide a better environment for inmates and staff. More than 20 percent of state offenders and 50 percent of federal offenders are in for drug offenses; many would use a needle if available.

The unfortunate death of correctional officer Gary Pearce, who was stabbed with a needle infected with an HIV blood-filled syringe, stresses the danger of needle access in correctional settings.

Pearce opened a security gate for inmate Graham Farlow at Long Bay Jail in Australia, was assaulted with a contaminated needle, and eventually died from an AIDS-related illness.

Sixty prisons worldwide have needle-exchange programs because inmate access to drugs and needles is prevalent. Earlier this year, prison officers in Canada threatened to walk off the job because of a proposal to introduce an exchange program which could place staff at risk.

American correctional administrators continue to enhance drug and needle interdiction programs, and seek safer solutions other than condoning inmate access to needles.

Exposure to blood and other body fluids occurs across a wide variety of occupations, but correctional staff are at even greater risk each and every day. Prison workers come to work with additional concerns relating to life-altering events such as accidental needlestick injuries and potential assaults with unaccountable needle contraband.

The fluid nature of incarcerated populations ensures a higher percentage of vaccinations is needed in correctional facilities and upon reentry into the community. More than 22,000 inmates in federal and state prisons have HIV (almost four times the general population). Hepatitis B virus (HBV) and hepatitis C virus (HCV) is much higher among inmates than in the community.

The World Health Organization (WHO) estimates the prevalence of TB is up to 100 times higher in prison than in the community. Sixteen billion needle injections are provided worldwide every year. Currently there are 24 vaccine preventable diseases in the world.

Similar to the general public, correctional healthcare staff will always need to inject medications. A CDC study concludes on average 50 percent or more needlesticks and sharps exposures go unreported. Every year 600,000 to $1 million needlestick injuries occur in the United States.

American hospital staff report that one case of "serious" infection by bloodborne pathogens can add up to $1 million in testing, time from work, and disability payments (even routine treatment ranges from $500 to $3000). The litigious nature of many offenders raises additional concerns for needles in correctional institutions.

Let's face the facts. Illicit drugs enter correctional facilities regardless of security measures. State-of-the-art electronic drug detection equipment, staff, inmate and visitor searches, drug sniffing K-9 units, and urinalysis use reduces but does not eliminate drug introduction. Incarceration of drug users contributes to higher rates of diseases in prisons.

Prisoners who inject drugs will most likely share needles. Some inmates claim the same needle would be used up to 200 times and by 100 people. When the syringe's needle gets dull, it is sharpened. If it breaks, prisoners continue to use it, often leading to infected abscesses. Needle sharing among prisoners is making prisons potential incubators of bloodborne infections, including HIV and hepatitis — a solution is needed.

The Needlestick Safety & Prevention Act was created in 2000, and requires employers to provide safer medical devices to address needlestick injuries. Subsequent revisions of the Occupational Safety & Health Administration (OSHA) bloodborne pathogens standard require employees to evaluate safer medical devices to eliminate or minimize exposure to blood or other potentially infectious materials.

The U.S. Food and Drug Administration (FDA) recently cleared a needle-free injection system which has been used worldwide, and has been piloted in local, state, and federal correctional facilities. This new technology delivers vaccines and other liquid medications through the skin without a needle. A custom-wound spring in the injector provides a unique force that drives the liquid through a tiny hole in the end of the needle-free syringe – creating a "fluid needle" that is able to penetrate the skin. Needle-free injections are a natural fit for the corrections system.

Needle-free institutions improve the overall well being of inmates and provide safer environments for staff. Although inmates will continue to hide drugs in shampoo bottles, food, diapers, and virtually every part of the human anatomy, removing needles from correctional institutions will provide another level of protection.

PharmaJet is working to remove needles from our nation's criminal justice system. Correctional healthcare and prison staff have a right to work in a safe environment. Most offenders will be released to the community, so too are their infections and illnesses — creating a broader public health risk. Inmates are members of our community, so if we don't protect their health, we will fail to protect the health of our community. As the number of inmates released to the community increases, so will the public health concerns for the public.

Issues relating to needlestick injuries, reuse, and disposal will be addressed by use of needle-free technology.

• Avoiding needlestick injuries: Correctional healthcare professionals are spared the occupational risk of being infected by blood borne pathogens through needle stick injuries. Officers are exposed to accidental needlestick injuries during cell and body searches. Nearly two-thirds (64 percent) of nurses report being accidentally stuck by a needle while working, and an incredible 74 percent report being stuck by a contaminated needle. There is an estimated 22 million needle-stick injuries world-wide per year.

• Reducing needle-reuse: The World Health Organization (WHO) estimates 50 percent of needle-syringe injections are unsafe, and that over 23 million people contract hepatitis, HIV, and other diseases each year because of this practice. Estimates up to 40 to 70 percent of needles are re-used in some countries.

• Reducing sharps disposal: Disposal of sharps medical waste requires costly disposal services.

Evaluating the cost-effectiveness of needle-free technology should include needlestick injuries, needle-reuse, and sharps disposals. More importantly, staff safety and reducing potential weapons inside of secured settings needs be factored in the equation.

There are health and moral justifications for needle-free correctional institutions. Key stakeholders, including prison security and healthcare staff, government officials, and policy-makers, need to be informed of the risk of needle use in prisons. A national strategy for removing needles from correctional environments should be part of institutional re-entry plans and the standard of care for offenders. A needle-free program is a win-win, frontline component for the next generation of correctional healthcare.

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