Comparing and contrasting the above figures clearly reveal that the expansion of MMT in federal prisons in Canada would be highly cost-effective in the long-term. In fact, Zaric, Brandeau and Barnett (2000) suggested that such an expansion would be cost-effective, even if the expanded MMT programs were twice as expensive and half as effective in reducing risky behavior as are existing programs. By way of demonstration, the expansion of MMT availability in Vancouver accompanied by the requisite mental health care and counseling would cost approximately $6 million annually (1,500 IDU’s @ $4,000) to serve 1,500 additional heroin addicts. At the same time, as much as $36 million in savings (1,500 x $30,000 x 80% effectiveness) could be generated annually for health care, criminal justice, and corrections services in British Columbia (Millar 1998). Millar further calculated that, even using a more conservative estimate of $15,000 for direct annual costs for treating one IDU, $12 million annually ($18 million in savings minus $6 million in costs) could be the estimated net savings. In fact, “[t]he actual overall savings would be much greater, of course, because of more employment and productivity and less reliance on social assistance” (p. 19). Certainly, these factors would be of serious consideration following the release of heroin addicted inmates from federal prisons.

Clearly, the extent of potential cost savings in expanding existing MMT programs in federal prisons is enormous, and this evidence supports the adoption of such a policy in Canada. In fact, when CSC (2001) conducted its own study to determine release outcomes of offenders who had participated in its National MMT Program (Phase I), it found positive results relating to the cost/benefit ratio of its program. Not only did researchers conclude that participation in the National MMT Program provided a beneficial effect on post-release outcomes, but its report highlighted that:

An important implication of these findings is that CSC may spend less money on these offenders in the long term. The cost of the institutional MMT program may be offset by the cost savings of offenders successfully remaining in the community for a longer period of time than equivalent offenders not receiving MMT. In addition, health related costs such as treatment for HIV or Hepatitis C infection could be affected by MMT availability in prisons. (pp. 30-31)

Such a finding is highly significant given that two real barriers to expanding MMT programs in federal prisons include the general under-funding of health care and CSC’s ongoing suggestion that drug use is not that prevalent in federal prisons. In fact, such a suggestion necessarily flies in the face of one Canadian study that indicates that 50 times as many federal penitentiary inmates die from drug overdoses as in the general population. In a recent media report in which that study was publicized, researcher Dr. Peter Ford states that there’s no truth to a reported Correctional Service of Canada (CSC) claim that methadone programs are universally available. True or not, CSC is legally obligated to provide health care to inmates comparable to that provided to people living outside prison walls. After all, a prison sentence is not a sentence to disease. Prisoners retain all rights that are not expressly forbidden due to incarceration, and access to medical treatment comparative to that available in the community is one such right; not a privilege. Given that MMT is recognized as the most effective treatment for heroin addiction and is used extensively in the community across Canada for treatment, it should be routinely used within prisons, as well.

Indeed, the expansion of existing MMT programs in federal prisons in Canada is a good, sound strategy in long-term cost-effectiveness. Notwithstanding the necessary funds to adopt such a policy, doing so is arguably the best strategy to contain long-term health care and incarceration costs. As CSC has only recently initiated Phase II of its National MMT Program, it is far behind the best treatment practices curve. While CSC may have subsequently saved money in the short-term, it could witness substantially more cost savings in the long-term by expanding existing MMT programs as outlined above.

Currently, however, federal prisons in Canada are not doing all that they can to prevent the spread of HIV, AIDS and Hepatitis C, and accordingly are failing to meet their legal responsibility to provide health care to inmates comparable to that available to those living outside prison walls. (Jürgens 2002) To this end, Jürgens states that: