[MUSIC] So we know that one in five people in prison around the world are there for drug-related charges. And I think to me this suggests the scope of the problem of how we respond to drug use in societies around the world. We have in law a principle of proportionality, that is the sentence should be proportionate to the offence under criminal law. And yet when we look at the number of people in prison for drug-related offences, and we know that the large majority of those people are there for non-violent drug offences. Then we have on a massive scale, a question of disproportionality in the application of our criminal law when it comes to drugs. And we also then have to be concerned about the implications of putting so many people in prisons, especially so many people who are there, in part, because of their own problematic drug use. We know that putting people in prison for a health condition is not likely to lead to particularly good results. And in fact, the evidence we have suggests that it doesn't. We know that very substantial numbers of people in prisons for drug offenses are there with a current or a past experience of problematic use. In some cases, their involvement in criminal activity is simply to support their own use of substances, even when we're talking about people in prison for trafficking offenses for example, not just possession charges. And so we're taking a population that we know is already at risk of experiencing poor health in various ways, including with infectious diseases such as HIV and hepatitis C and other bloodborne infections acquired through the use of non-sterile injecting equipment. And we're putting people in places where their health then deteriorates further. In many cases, because the policies of correctional systems in fact deliberately compound that problem by denying people access to the health services that they need. We know over and over again that people in prison of course experience often very poor conditions of detention generally. But if you're someone who is experiencing withdrawal from drugs for example and you're denied access to evidence-based treatment for your problematic substance use, for opioid use disorder, for example. Then we have just done a further harm to your health. And in fact, in most prisons of the world people who have problematic opioid use are denied access to evidence-based treatment such as opioid substitution therapy. At last count, only 52 countries of the world provided access to opioid substitution therapy in prisons for people with opioid use disorder in some form. And in many cases, that's not necessarily going to be a program, even where it does exist, that is taken to scale and that everyone has access to it. In my own country, for example Canada, there are numerous prison systems where it is very difficult to get access to opioid substitution therapy, even though this is a well established evidence-based medical intervention outside prison and much of the country. We also have some prisons and we are not unique in this by any means. Where even if you may be allowed to continue your treatment with opioid substitution therapy, if you are receiving that treatment before being imprisoned, you are not allowed to actually start that treatment while imprisoned. Which seems a very poor public health approach to a known problem, a documented problem in our present system. We have even fewer prisons in the world that actually provide access to sterile injection equipment. And yet we know that virtually every prison in the world at some point people who are incarcerated there will have access to controlled substances in some way. Drugs make their way into our prisons, despite all of the efforts by prison authorities using technology, and sniffer dogs, and scanners, and searchers and so on. We know that drugs make their way into prisons. Prison systems themselves admit this in many cases. What is much harder to get in prison is the means to actually use those substances safely with as little risk as possible. And so we also know documented in prison after prison around the world that when people have access to drugs in prison but they don't have access sterile injection equipment, people share injection equipment and people share injection equipment that they make themselves out of whatever they can get access to in prison. And we know of course that we have documented cases of outbreaks in prison of infectious diseases including HIV and hepatitis C. None of this should come as a surprise to us. The people who use drugs that are being disproportionately incarcerated in our prisons are disproportionately a population at risk of acquiring HIV and hepatitis C outside of prisons. To then concentrate that population in one place and further deny them the means of preventing onward transmission results in the very predictable consequence of further transmission. This is a public health disaster in the making. We also know in prison after prison around the world, the getting access to basic health care services is often very difficul. And for prisoners who may be living with HIV or other serious illness, this problem can be even more significant. In many cases, prisoners just simply don't get access to antiretroviral treatment for their HIV. We can't ignore these things happening in our prisons, because the health of prisoners is actually ultimately public health. We also know from the data that the large majority of people who go to prison, at some point will come out of prison. So what happens to their health while in prison, of course, necessarily has an effect on the health of the broader community. If people go into prison, they're being sentenced to lose their liberty as a penalty for what they have done. It is in no way at all justified to deny people access to health services and in fact, to put them at greater risk of acquiring serious infections while in prison. There is simply no justification in the philosophy of criminal law that would consider that a just sanction. And yet that is precisely what we do in the case of people who use drugs and incarceration as our principal response to them. When people leave prison, of course, they not only leave with whatever health conditions they may have acquired in prison, such as infections with HIV or hepatitis C. We also know from the data that people with problematic substance use are at greater risk of returning to drug use, especially if they've not had any access to effective drug dependence treatment in prison. And they are therefore in the period after release from prison at greater risk of experiencing an overdose, including potentially a fatal overdose. And yet in many places not only here we're not providing access to effective drug dependence treatment for people while they are incarcerated even though we know they're at risk of overdose when leaving. There isn't good transition planning, pre-release planning, to connect people to services. And to make sure that people have access to the information, and to the interventions that they might need if they do return to using opioids for example. Such as having easy access to naloxone, the emergency antidote that can reverse an overdose and prevent it from actually killing someone. So there are many points at which the experience of imprisonment as a response to drug use actually is making people's health much worse. The notion that by putting people in prison we are somehow going to do them good, that we are going to act to their benefit is actually not borne out unfortunately, in the evidence from prison system after prison system around the world. In most cases, what happens is the prosecution and imprisonment of people who use drugs actually makes the situation worse. In some cases, it leads to death. This is not a proportional response to drug use. And it's time for our policy makers and our prison authorities to drastically rethink why it is that we're using imprisonment as society's predominant response to drug use, rather than actually scaling up health services that are evidence based, and will do much more good to protect both individual health and the health of the public more broadly. [MUSIC]
