Prison needle programs could save double what they cost – our new modelling shows how

Needle and syringe programs are a proven public health intervention that provide free, sterile injecting equipment to people who use drugs. By reducing needle sharing, these programs help prevent the spread of blood-borne viruses such as hepatitis C and HIV and minimise life-threatening bacterial infections.

Australia leads the world in community-based needle and syringe programs. But they are not used in Australian prisons – which are hotspots for injection-related infections.

This is a breach of human rights and United Nations resolutions, which make clear health-care standards for people in prison must be equivalent to those in the community.

In addition to meeting human rights standards, our new modelling – the first of its kind in Australia – shows there would be significant economic benefits to implementing prison-based programs.

Needle and syringe programs in the community

Australia is a world leader in needle and syringe programs in the community. There are 4,218 sites across the country (as of 2021). Each year they distribute more than 50 million needles and syringes.

Among people who inject drugs, that’s about 508 needles and syringes per person each year — the highest rate globally, and more than double the World Health Organization’s benchmark for high needle and syringe program coverage (200 per person per year).

For reference, the country with the second-highest coverage was Finland (with 450 needles and syringes per person who injects drugs per year) followed by the Netherlands (367).

Prisons are infection hotspots

A law enforcement emphasis in responding to drug use – rather than public health focus – has resulted in grossly disproportionate rates of incarceration among people who use drugs.

In Australia, between 29% and 52% of people in prisons report injecting drugs at some point in their lives, and around 40% of people who were injecting drugs in the community before prison continue to inject inside.

Without access to sterile injecting equipment, needle sharing and unsafe injecting practices are common. As a result, people who inject drugs in prison are at higher risk of transmitting blood-borne viruses such as hepatitis C than those in the community.

In 2023, 42% of all hepatitis C treatments in the country were delivered in prisons. These treatments are government-funded, highly effective and curative (meaning total recovery).

But the prevention strategies used in the community – which stop infections happening again – are not used in prison. Re-infection in prisons occurs at more than twice the rate of initial infection.

Why the gap in prisons?

Australian peak bodies, as well as major research and community health organisations, have long supported the introduction of prison-based programs.

However, legal and political opposition, concerns around safety and security, and funding constraints have all contributed to the lack of progress.

As of 2023, prison needle and syringe programs operated in eleven countries worldwide. The outcomes are positive for both health (reduction in needle sharing, drug use and hepatitis C and HIV transmission) and prison safety.

A 2024 study of Canada’s existing needle and syringe program, operating in nine prisons, found it will save the health-care system $C0.85 million in treatment costs between 2018 and 2030 by preventing hepatitis C and other injection-related infections. In contrast, the program cost just $C0.45 million to run. Canada has since expanded the program to eleven prisons nationwide.

Here’s what we found

To bring an economic perspective to this debate in Australia, our new study estimated the costs and benefits of introducing needle and syringe programs in all Australian prisons, aiming to reach 50% of people who inject drugs in prison between 2025 and 2030.

We drew on a similar program in Luxembourg which follows international best practice. This needle and syringe program is delivered through prison health services. Sterile injecting equipment is provided face-to-face by health staff. Used equipment is exchanged one-for-one (meaning a sterile needle-syringe can be exchanged for a used one), in a confidential and safe manner.

Then, we identified the specific components and resources needed to implement the program, such as sterile injecting equipment and annual training sessions for prison health staff. We researched their associated costs to calculate the total cost of scaling-up nationally.

Finally, we modelled the number of hepatitis C and other injection-related infections the program would prevent. These infections can have serious health consequences and are costly to treat. The money saved here helped us calculate the cost savings (that is, the benefits) of the program.

Implementing prison-based programs nationally would cost approximately $A12.2 million between 2025 and 2030. But this investment could prevent 894 hepatitis C infections and 522 injection-related bacterial and fungal infections.

We estimated these infections would cost the health-care system $31.7 million to treat – more than double the cost of preventing them with a prison needle and syringe program.

In other words: for every dollar invested in prison-based programs, more than two dollars would be saved in health-care costs.

Where to from here?

People have strong views about injecting drug use and prison-based needle and syringe programs. But countries where needle and syringe programs have been successfully implemented in prisons have several things in common.

First, there is widespread understanding among everyone involved in using, administrating or overseeing the program of its benefits. Eliminating blood-borne viruses can reduce health risks for people in prison and improve the safety of staff.

Second, successful implementation is inclusive. It ensures a range of people have meaningful input in how the program is designed and delivered, including incarcerated people, health-care professionals and policymakers, prison officers and government bodies.

Third, drug use in prison is treated as a public health issue, not a political football. The failed War on Drugs has only compounded the issue, leading to the over-incarceration of people who use drugs and the creation of lucrative prison drug markets.

If Australia is to eliminate hepatitis C by 2030 – as the national hepatitis C strategy outlines – it will be essential to combine prison-based treatment with prevention strategies, including needle and syringe programs.

We now know they are likely to save money too.