Gatekeeping harm reduction in Canadian Federal Prisons: Perspectives on the threat risk assessment for the prison needle exchange program by prison administrative leadership.

Within Canadian federal prisons, the "Threat Risk Assessment" (TRA) appears to be a structural process obstacle within the prison needle exchange program (PNEP) policy that fails to provide low threshold access to PNEPs due to the prioritization of institutional safety at the cost of public health. Alternative options to the current TRA process clarify actionable levels for policy refinement that preserve safety, improve access and better align with evidence and public health goals.