Harm reduction in U.S. prisons: yes we can
M. McLemore, R. Schleifer
Human Rights Watch, Health and Human Rights Division, New York, United States
Issues: Amid overwhelming resistance in US prisons to harm reduction programs such as condom distribution, needle exchange and medication-assisted therapy such as methadone and buprenorphine for opiate addiction, several model programs are thriving.
Description: We have documented the implementation and success of harm reduction programs in U.S. prisons and jails, including methadone maintenance at Rikers Island in New York City, one of the countries' largest urban jails; methadone, buprenorphine and overdose prevention for prisoners in Albuquerque, New Mexico; a pilot program for condoms in a medium-security prison in California; pilot methadone programs in the Rhode Island Department of Corrections; and methadone and buprenorphine programs in the prison system of Puerto Rico. Harm reduction programs have proven to reduce risky behavior such as unprotected sexual activity and injection drug use, thereby lowering the risk of transmission of HIV and Hepatitis C. Prisoner participants give powerful witness to the potential of these programs to change outlooks, behavior, lives. Initially skeptical prison officials admit the absence of security incidents and, particularly in the case of medication-assisted therapy, a marked decrease in drug-seeking behavior and greater adherence to medication regimens for chronic conditions such as HIV and Hepatitis C.
Lessons learned: Numerous models for harm reduction programs in US prisons exist. The voices of prisoners whose lives have been changed and those of initially skeptical prison officials can be highlighted to promote awareness that harm reduction is possible and can promote and enhance prison security.
Next steps: Increase awareness among corrections, public health, government and public that harm reduction programs are thriving in prisons and jails in the US. Examine the numerous models that have been implemented to share best practices for reducing transmission of HIV and Hepatitis C.
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