Content warning: this article discusses drug use and mental health in federal prisons across Canada and here in Kingston, which may be distressing for some readers.
A new service at Collins Bay Institution aims to prevent overdose deaths at a correctional facility that has been plagued by drug smuggling, by providing a safe space for inmates to use substances.
On November 28, 2023, Collins Bay became the third institution in Canada to implement an Overdose Prevention Service (OPS) site, and the first such site in Ontario. Members of the media were invited to tour the site of the new OPS site on Monday, Feb. 5, 2024, along with several Correctional Service Canada (CSC) officials.
According to those officials, Collins Bay was chosen for the OPS program because research showed historically high numbers of overdoses at the institution, many of which were due to opioids.
CSC states that these OPS sites are the only existing prison-based supervised consumption sites known worldwide and, since their establishment, there have been no fatal overdoses at these sites.
OPS aims to prevent fatal and non-fatal overdoses or drug poisonings, while also reducing the sharing of needles, transmission of infectious diseases (including HIV and Hepatitis C), and the occurrence of skin infections, while facilitating referrals to other health-care services and programs.
At the OPS site, everything is available for drug users to consume their substances in a safer and more controlled manner: needles, tourniquets, drug cooking apparatus, even vitamin C to dissolve the drug in order to keep vein damage to a minimum. The substances themselves are self-supplied — which means the inmate would be in possession of a contraband substance that was smuggled into the institution.
The obvious question of whether providing a safe space for illicit drug use conflicts with CSC’s mandate to keep contraband out of the prison system was put to Blake Wilson, the institution’s Assistant Warden of Operations.
“Ultimately, it is one of the many things that we do to help our population,” Wilson answered.
“It is a harm reduction strategy that stops unnecessary deaths.”
He explained that, from an operational perspective, if drug users have a medical emergency in the OPS site, there are emergency medical staff immediately on hand to help them. The entire range or institution does not need to be locked down, with medical staff running to the incident area. Ultimately, the inmate gets the help they need more quickly.
Participants using the OPS will not be disciplined for using the service. However, inmates found to be in possession of or dealing in illicit drugs outside of an OPS can face administrative consequences, disciplinary sanctions, and/or criminal charges.
Led by Collins Bay Institution’s Manager of Health and Rehabilitation, Matthew Secord, the tour of the OPS provided insight into how it works.
Located within the Health Services department of the institution, the OPS site looks like any ordinary doctor’s office, except for the two OPS rooms equipped with heavy cell doors, each fitted with a slot.
As with all medical information, Health Services information about OPS participation will only be shared outside of Health Services with consent or if a life is in danger, as per CSC guidelines on sharing medical information. An inmate simply applies for a medical pass to visit Health Services as they would for any other health appointment.
Once at the OPS site, the inmate sits down with a nurse, who explains the safest methods to use the narcotic.
The nurse ascertains the needs of the patient, and OPS provides sterile needles and syringes, as well as other sterile consumption equipment such as swabs, sterile water and cookers, heat source, and straws. Any equipment that is used is documented and must be returned to the nurse for disposal of medical waste.
“We are still committed to keeping drugs out of our institutions,” Secord emphasized. “We go about that multiple ways: through various technologies that… detect and keep drones out of our airspace and institution, searching visitors,… drug detector dogs… We’re not stopping any of that. We’re still continuing all of that. What [OPS] is is harm reduction.”
Secord explained that the inmate can ask to have their drugs tested with an FTS (fentanyl test strip), a small strip of paper that can detect the presence of fentanyl in various kinds of drugs such as cocaine, methamphetamine, heroin, etc.
The inmate enters a private room and the door is locked, explained Secord. Inside, they may sit at a table, or there is a mat available to lie down. There are numerous information posters explaining safer substance use.
Nurses can explain syringe use and safety to make sure the inmate is using needles in the safest way possible, so as not to cause injury. However, Secord made a point of stating that nurses do not inject the inmate or help in any other way with consumption of the drug. The patient is monitored for the duration of the appointment, usually around 30 minutes.
Asked how many inmates have used the overdose prevention services site since opened on November 28, 2023, Secord gave a blunt and concise response.
“So far, none,” he disclosed.
Roger Martin, Nursing Project Manager at the Correctional Service of Canada, has overseen the opening and implementation of OPS at the two other sites where it is available at federal institutions: Drumheller Institution in Alberta, which began operation of its OPS in June 2019, and Springhill Institution in Nova Scotia, which implemented its OPS in July 2023. He said it is not surprising that so far the Collins Bay OPS has no participants: “With with any new program implemented, there’s going to be a period in which we need to establish trust with the population. We’re working with an incredibly vulnerable and stigmatized population. And when we implement a program such as this, there’s going to be hesitation to using the services we provided.”
At the two institutions with existing OPS sites, as of November 19, 2023, a total of 86 patients have been approved, with participants using the service for a total of 2,137 visits. Martin said that at both of these sites, participation was slow to get started and that it will take a “couple of trailblazers” to try out the OPS at Collins Bay before it catches on and is seen with less skepticism by the prison population.
Currently, staff at Collins Bay Institution are encouraging participation with information pamphlets.
“This population meets with health services quite frequently. We are here with them, and we’re here to support them. So if we know that an individual is actively using, we will provide them the opportunity to explore the Overdose Prevention Service. We’ll show them around; we’ll discuss the program with them. And we’ll be available to them if they have any questions. We’re outreaching within the population as well, meeting with various stakeholders [and] patients and ensuring that evidence-informed information is being shared with the population,” Secord pointed out.
“This is another tool for health care,” he continued, “to effectively provide harm reduction to this stigmatized vulnerable population that we see as significantly impacted by overdoses or the use of illicit substances. It’s a manner in which we can provide holistic care and meet the individuals where they are. They’re not just meeting with registered nurses; they’re not just using these substances. It’s affording us another opportunity to connect with and to provide them effective health teaching, or connect them with other sources such as mental health, clinical health, parole officers, or whoever it might be — but helping them navigate the challenges of addiction behind the institutional walls.”
Secord stressed that, besides the four men sitting with the media, it takes a dedicated team to successfully implement programs such as OPS.
“It would not be successful without the passionate frontline staff: the registered nurses who treat these individuals on a day-to-day basis and see the impact of illicit substance use and overdoses… the officers that are responding to these overdoses after hours… It’s a communal effort for us to see a concern within the population and to address it effectively through evidence-based research and meeting the individuals where they are,” he expressed.
According to Martin, there is more to come. CSC has plans to set up OPS sites at Warkworth Institution in Ontario and Drummond Institution in Quebec in the near future.