CONCLUSION

Throughout this article, the substantial, positive cost/benefit ratio of expanding existing MMT in Canadian prisons has been illuminated. Even though CSC has implemented a policy to provide MMT to prisoners in federal prisons in Canada, it did so only after being forced by legal challenges (Canadian HIV-AIDS Legal Network 2002). In addition, short-term cost considerations have negatively affected the ability of the program to reach all prisoners who could benefit from it. This article has revealed significant justification for universal expansion of MMT programs at CSC. Not only has MMT been proven cost-effective, but its benefits range from a heroin addicted inmate feeling clear-headed and energetic, to substantial reductions in future criminality, illicit heroin use and HIV, AIDS and Hepatitis C infections among IDU inmates (Centre for Addiction and Mental Health 2001). As Millar (1998) properly stated, these aspects of MMT should absolutely be considered, as “a number of suffering people will be provided with better social circumstances and better health, and a potential source of infection that threatens everyone will be removed” (p. 19).

While methadone is not itself a cure, it nevertheless is “a tool that helps you to repair the damage caused by dependence, and to build a new life” (Centre for Addiction and Mental Health 2001:6). The time has come for not only stakeholders, but the whole of society as well, to acknowledge that:

• drugs are consumed in prisons;
• needles and syringes are used (and shared) in prisons;
• HIV prevention is more important than upholding ‘morality;’
• the provision of sterile injection equipment is not contrary to staff’s mandate, and provides more security for staff and inmates; and
• harm reduction is more cost-effective than total prohibition (Jürgens 2002:50).

While the provision of MMT is a medical decision that is not appropriate for every heroin addict and is usually reserved for those who have tried numerous approaches but have repeatedly failed to stop injecting, it is a decision that should not be curtailed by short term cost considerations.

Notwithstanding each of the important comments noted above, the expansion of existing MMT in Canadian prisons necessarily require community support or a policy to exploit their use will be futile. It is hoped that this article will shed light on the necessity of such a policy, not only for the benefit of heroin-addicted inmates, but also for the benefit of us all.

To conclude, two quotes are provided with the hope of clearly illustrating the substantial benefit of expanding existing MMT in Canadian prisons:

First, and with respect to the costs associated with the development and implementation of such a policy: “What is being suggested is a small investment by government standards. It is not often that a health care intervention has so much potential for direct savings to government” (Millar 1998:19).

Finally, and with respect to the immeasurable benefits provided by MMT, Dr. Marie Nyswander, co-founder of MMT, once stated:

When an addict no longer has to worry compulsively about his source of supply, then he can concentrate on other things. At that point, rehabilitation can become a meaningful word (Centre for Addiction and Mental Health 2001:36, quoted from: A Doctor Among the Addicts by Nat Hentoff, New York: Rand McNally 1968).