Harm reduction: a public health approach to prison drug use

• DOI: https://doi.org/10.1108/IJPH-06-2021-0053
• Published date: 30 December 2021
• Date: 30 December 2021
• Pages: 458-472
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Linsey Ann Belisle,Elia Del Carmen Solano-Patricio

Harm reduction: a public health approach

to prison drug use

Linsey Ann Belisle and Elia Del Carmen Solano-Patricio

Abstract

Purpose –As prison drug use continuesto be a concern worldwide, harm reduction practicesserve as

an alternative approach to traditional abstinence-only or punishment-oriented methods to address

substance use behindbars. The purpose of this study is to present a summary of researchsurrounding

prison-basedharm reduction programs.

Design/methodology/approach –This narrative review of the international literature summarizes the

harms associatedwith prison drug use followed by an overview of the literature surroundingthree prison-

based harm reduction practices: opioid agonist therapy, syringe exchange programs and naloxone

distribution.

Findings –A collectionof international research has found that thesethree harm reduction programs are

safe and feasible to implement in carceralsettings. Additionally, these services can effectively reduce

some of the harms associatedwith prison drug use (e.g. risky injection practices, needle sharing, fatal

overdoses, etc.).However, these practices are underused in correctionalsettings in comparison to their

use in thecommunity.

Originality/value –Various policy recommendations are made based on the available literature,

including addressing ethical concerns surrounding prison populations’ rights to the same standard of

health care and servicesavailable in the community. By taking a public healthapproach to prison drug

use, harm reduction practices can provide a marginalized, high-risk population of incarcerated

individualswith life-saving services ratherthan punitive, punishment-orientedmeasures.

Keywords Public health, Correctional health care, Harm reduction,

Evidence-based substance-use treatment, Prison drug use, Substitution treatment

Paper type General review

Introduction

Despite numerous attempts to eliminate drug use in prison, 30%–50% of the 10 million

adults incarcerated worldwide have used drugs behind bars (Stone and Sander, 2016;

Walmsley, 2013). One possible explanation for the high prevalence of prison drug useis an

overrepresentation of individuals with substance use disorders in correctional settings;

approximately 5% of the general US adult population meets the criteria for a substance-use

disorder, compared to 58% of adults in US state prisons (Bronson et al.,2017). This

overrepresentation of individuals who engage in drug use in correctional settings is strongly

tied to the criminalization of drug usein most parts of the world.

Another possible explanation is that traditional approaches to curb prison drug use focus

on abstinence or increasing surveillance, control and sanctions (Kolind and Duke, 2016).

These types of strategies fall short of their goal to eliminate drug use in prisons and post-

incarceration (Dolan et al., 2015;Kolind et al.,2016;Woodall, 2011). When considering the

criminal justice response to substance use, Chandler et al. (2009) remind us that

“punishment alone is a futile and ineffective response to drug abuse” (p. 189). This is

illustrated in the failed War on Drugs, which focuses on abstinence andis rooted in punitive

deterrence. This War on Drugs has been a significant contributor to mass incarceration in

Linsey Ann Belisle is based

at the Department of

Criminal Justice and Social

Work, University of

Houston –Downtown,

Houston, Texas, USA.

Elia Del Carmen Solano-

Patricio is based at the

School of Public Policy and

Leadership, University of

Nevada Las Vegas, Las

Vegas, Nevada, USA.

Received 19 June 2021

Revised 24 October 2021

4 December 2021

Accepted 5 December 2021

Authors would like to thank Dr

Terance Miethe and Dr Emily

Salisbury for their mentorship

and ongoing feedback

regarding this manuscript. The

authors received no funding for

this article. Correspondence

concerning this article should

be addressed to Linsey A.

Belisle, University of Houston-

Downtown, Department of

Criminal Justice and Social

Work, One Main St, Houston,

TX, 77002, BelisleL@uhd.edu.

PAGE 458 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jVOL. 18 NO. 4 2022, pp. 458-472, ©Emerald Publishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-06-2021-0053