New research suggests that every dollar spent in Prison Needle Exchange Programs (PNEPs) in Canadian federal prisons will save $2 in infection treatment costs, making the case for further investment in these programs. The research is published in CMAJ (Canadian Medical Association Journal).

“Needle exchange programs are evidence-based strategies that prevent transmission of blood-borne viruses, reduce injection-related infections, improve access to medical care, and facilitate entry into substance dependence programs for people who inject drugs,” writes Dr. Farah Houdroge, Disease Elimination Program, Burnet Institute, Melbourne, Australia, with coauthors.

The World Health Organization has set a target of reducing hepatitis C infections to fewer than two per 100 people who inject drugs per year as part of an elimination strategy for hepatitis C. In 2024, Canada unveiled its 2024–2030 Sexually Transmitted and Blood-Borne Infection Action Plan that emphasized support for harm reduction programs and expanding the PNEP.

Researchers from Canada and Australia sought to assess the return on investment for Canada’s PNEP, and the potential impact of scaling it up, as part of efforts to eliminate blood-borne infections in prisons. Using a modelling study, they found that expanding the program to 50 per cent of people in all federal prisons who inject drugs from 2025 to 2030 would prevent 15 per cent of new hepatitis C cases and eight per cent of injection-related infections compared with the status quo.

“This study adds to the growing body of evidence supporting PNEPs as effective harm reduction strategies that are also cost saving. Given that they show both health and economic benefits, PNEPs should be a priority not just in Canada, but globally,” the authors conclude.

In a related commentary, authors argue that more comprehensive interventions to make substance use in correctional institutions safer, and specifically reduce related risks of acute death, are needed. “Prison-based programs aimed at mitigating the health harms of substance use by correctional inmate populations should be carefully evaluated as part of their implementation, as has been done in the related research with specific respect to needle exchange programs. Without systematic expansion of and increased access to such programs, prisoners in Canada will remain at unnecessarily high risk of ill health and death from the adverse consequences of substance use,” the authors conclude.

“Cost–benefit analysis of Canada’s Prison Needle Exchange Program for the prevention of hepatitis C and injection-related infections” and “The burden of drug overdose deaths among correctional populations: implications for interventions” were published December 16, 2024.