Backgrounds and methods
 Unsafe injecting drug use is the main route of hepatitis C virus (HCV) transmission in developed countries.1 Consequently, people who inject drugs (PWID) in the general and prison population represent a priority population for HCV elimination, given the high prevalence and incidence in this group. The current national drugs strategy2 aims to reduce harms arising from substance misuse and to reduce the prevalence of blood-borne viruses among PWID through the expansion of needle exchange. In Ireland, this service is delivered in a number of ways, including fixed-site locations such as clinics or community pharmacies and novel interventions such as Backpacking Outreach programmes. However, in 2020, there is no needle exchange provision in Irish prisons. A recent study examined the views of six senior managers, employed as prison health staff and security management, in order to discover attitudes towards needle exchange provision within Irish prisons, as an element of prisoner health service provision in the context of wider service provision for drug users within the prison system.3

In this research, published in the Journal of Correctional Health Care, data were collected in Dublin, using face-to-face, non-standardised, semi-structured interviews in May 2014. They were thematically analysed using subjective narratives that were recorded and transcribed.

Results

Impact of changing dynamics of prison drug use
A majority of the participants agreed that in Ireland, as in other jurisdictions, drug use occurs in prisons. However, research participants claimed that at present there was minimal injecting drug use and needle sharing in Irish prisons and that needles were generally not found in searches. They also reported that there were no verbal reports or physical evidence of injecting drug use and that no significant incidents of needle sharing are emerging or recorded in the prison medical record system. It was asserted that drug culture in prison had shifted compared with 15 years ago. Research participants argued that the catalyst for this change away from an injecting drug use culture in Irish prisons was the availability and remarkable success of methadone maintenance as a treatment option for opiatedependent prisoners.

Operational and logistic issues and challenges
The expressed opposition to the introduction of needle exchange to the Irish prison system was not, however, solely attributable to new evidence that injecting drug use has declined significantly among the prison population. It was also linked to strong ideological conflict expressed by the participants. In particular, it was suggested that the introduction of needle exchange generally implies condoning prison drug use. Also, participants expressed the view that there was a high level of concern from prison staff members in relation to ‘perceived threat to own safety’ should needle exchange provision be introduced. The risks in question refer to assaults by prisoners on staff involving needles, similar conflict between prisoners, and accidental sharps injury from unsafe disposal of drug paraphernalia. All participants felt that the introduction of needle exchange provision would pose serious logistical and operational challenges. Furthermore, it was contended that prisoners who were likely to avail of needle exchange were those who were generally more ‘chaotic in their lives’. The majority of participants conceded that prisoners, like other citizens, have individual civil rights. However, it was argued that these rights were of necessity curtailed in the prison environment. Thus, it was assumed that if a prisoner was convicted, they were entitled to minimal consideration.

Needle exchange as a policy development
Although participants felt that the evidence supporting needle exchange provision has been quite convincing in prisons in other jurisdictions, it was suggested that injecting drug culture was more prevalent in the prison systems of these other countries and that such a harm reduction scheme was unnecessary in Ireland. In addition, it would be difficult to introduce needle exchange due to role conflict between the professional duties to the care of prisoners while in custody and implied obligations to prison administration. Furthermore, the introduction of needle exchange provision in Irish prisons would entail changes in legislation and institutional prison policy regulations. Participants also expressed doubt that the general public would accept the concept of needle exchange in Irish prisons, as drugs are not meant to be used there in the first place.

Conclusions
The authors noted that research participants were generally opposed to the introduction of prison needle exchange in Ireland, suggesting that injecting drug use within Irish prisons has declined and that making needles freely available to prisoners would make prisons riskier since these needles might be used as weapons against prison staff or other prisoners. However, the study authors also observed that opposition to prison needle exchange provision had a strong symbolic component. This was in the sense that to introduce this form of harm reduction to Irish prisons might be seen as condoning illicit drug use and sending out the ‘wrong message’ in relation to the criminal justice system’s approach to this matter

1 Nelson PK, Mathers BM, Cowie B, Hagan H, Jarlais DD, Horyniak D, et al. (2011) Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet, 378(9791): 571–583. https://www.drugsandalcohol.ie/15845/ 2 Department of Health (2017) Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017–2025. Department of Health, Dublin.  https://www.drugsandalcohol.ie/27603/ 3 Rosalim JP (2020) A senior management perspective on the policy debate of needle and syringe exchange program provision in Irish prisons. J Correct Health Care, 26(1): 27–35.  https://www.drugsandalcohol.ie/31593/