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Bonnevie E, Silesky MD, Goldbarg J, Gudmundsen C, Fields M, Smyser J. A multi-site intervention using influencers to communicate about syringe service programmes. HEALTH EDUCATION JOURNAL 2023; 82:779-791. [PMID: 38650842 PMCID: PMC11034740 DOI: 10.1177/00178969231197623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Introduction In the USA, syringe services programmes (SSPs) provide a range of harm reduction services and have numerous benefits for communities. However, stigma, misconceptions about SSPs and changing policies/legislation remain a challenge to effective implementation. This study reviews the implementation of two digital interventions, Appalachian Influence and Shared Influence, which used social media influencers and digital volunteers to communicate positive information about harm reduction and SSPs. Methods The intervention was designed to deliver accurate and supportive messaging in locally relevant and meaningful ways. Messaging was informed by interviews with subject matter experts and community organisations, and was integrated into prompts used by local influencers (paid individuals with more than 1,000 followers) and digital volunteers (unpaid individuals with no following requirement, who joined the project independently). Results In the first 6 months of implementation, Appalachian Influence and Shared Influence engaged a total of 9,014 individuals, 236 of whom were paid influencers and 8,778 of whom were digital volunteers. Paid influencer posts achieved a total of 868,943 impressions, 42,432 engagements and 1,567 comments. Comments on paid influencer posts were overwhelmingly positive, with 87.4% positive and 0.8% negative. Interviews showed the importance of understanding local realities, leading with compassion and emphasising the 'human' aspects of dependency and addiction in messaging. Conclusion This study shows the potential to implement an influencer-led social media intervention to reach people with authentic and compassionate messaging about harm reduction and SSPs. Future research should examine intervention effectiveness and how this approach can be applied to other stigmatised topics.
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Affiliation(s)
| | | | | | | | | | - Joe Smyser
- The Public Good Projects, New York, NY, USA
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Hamilton LK, Wheeler-Martin K, Davis CS, Martins SS, Samples H, Cerdá M. A modified Delphi process to identify experts' perceptions of the most beneficial and harmful laws to reduce opioid-related harm. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103809. [PMID: 35908313 DOI: 10.1016/j.drugpo.2022.103809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND States have enacted multiple types of laws, with a variety of constituent provisions, in response to the opioid epidemic, often simultaneously. This temporal proximity and variation in state-to-state operationalization has resulted in significant challenges for empirical research on their effects. Thus, expert consensus can be helpful to classify laws and their provisions by their degree of helpfulness and impact. METHODS We conducted a four-stage modified policy Delphi process to identify the top 10 most helpful and 5 most harmful provisions from eight opioid-related laws. This iterative consultation with six types of opioid experts included a preliminary focus group (n=12), two consecutive surveys (n=56 and n=40, respectively), and a final focus group feedback session (n=5). RESULTS On a scale of very harmful (0) to very helpful (4), overdose Good Samaritan laws received the highest average helpfulness rating (3.62, 95% CI: 3.48-3.75), followed by naloxone access laws (3.37, 95% CI: 3.22-3.51), and pain management clinic laws (3.08, 95% CI: 2.89-3.26). Drug-induced homicide (DIH) laws were rated the most harmful (0.88, 95% CI: 0.66-1.11). Impact ratings aligned similarly, although Medicaid laws received the second highest overall impact rating (3.71, 95% CI: 3.45, 3.97). The two most helpful provisions were naloxone standing orders (3.94, 95% CI: 3.86-4.02) and Medicaid coverage of medications for opioid use disorder (MOUD) (3.89, 95% CI: 3.82). Mandatory minimum DIH laws were the most harmful provision (0.73, 95% CI 0.53-0.93); followed by requiring prior authorization for Medicaid coverage of MOUD (1.00 95% CI: 0.72-1.27). CONCLUSION Overall, experts rated laws and provisions that facilitated harm reduction efforts and access to MOUD as most helpful. Laws and provisions rated as most harmful criminalized substance use and placed restrictions on access to MOUD. These ratings provide a foundation for evaluating the overall overdose policy environment for each state.
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Affiliation(s)
- Leah K Hamilton
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, United States; New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States.
| | - Katherine Wheeler-Martin
- New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States
| | - Corey S Davis
- New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States; Network for Public Health Law, 7101 York Avenue South, #270, Edina, MN 55435, United States
| | - Silvia S Martins
- Columbia University, Mailman School of Public Health, Department of Epidemiology, Epidemiology, 722 West 168th St. New York, NY 10032, United States
| | - Hillary Samples
- Rutgers Institute for Health, Health Care Policy and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, United States; Rutgers School of Public Health, Department of Health Behavior, 683 Hoes Lane West, Piscataway, NJ 08854, United States
| | - Magdalena Cerdá
- New York University, Grossman School of Medicine, Center for Opioid Epidemiology and Policy, 180 Madison Ave, 4th Floor, New York City, NY, 10016, United States
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Del Pozo B, Sightes E, Goulka J, Ray B, Wood CA, Siddiqui S, Beletsky LA. Police discretion in encounters with people who use drugs: operationalizing the theory of planned behavior. Harm Reduct J 2021; 18:132. [PMID: 34915910 PMCID: PMC8675297 DOI: 10.1186/s12954-021-00583-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Policing shapes the health risks of people who use drugs (PWUD), but little is understood about interventions that can align officer practices with PWUD health. This study deploys the Theory of Planned Behavior (TPB) to understand what influences police intentions to make discretionary referrals to treatment and harm reduction resources rather than arrest on less serious charges.
Methods On-line surveys integrating TPB constructs and adapting an instrument measuring police intentions to make mental health treatment referrals were completed by police employees in Indiana, Massachusetts, and Missouri. They also included items about stigma towards PWUD and attitudes and beliefs about opioid addiction, treatment, and recovery. Findings Across the sites, 259 respondents perceived control over their decision to arrest for misdemeanors (69%) and confiscate items such as syringes (56%). Beliefs about others’ approval of referrals to treatment, its ability to reduce future arrests, and to increase trust in police were associated with stated practices of nonarrest for drug and possession and making referrals (p ≤ .001), and nonarrest for syringe possession (p ≤ .05). Stigma a towards PWUD was negatively associated with stated practices of nonarrest (p ≤ .05). Respondents identified supervisors as having the most influence over use of discretion, seriousness of the offense as the most influential value, and attitude of the suspect as the most important situational factor. The 17 Likert scale items analyzed had a Cronbach’s alpha of 0.81. Conclusion The TPB offers untapped potential to better understand and modify police practices. In designing interventions to improve the health outcomes of police encounters with PWUD, further research should validate instruments that measure the relationship between these variables and discretionary intentions, and that measure role-relevant police stigma towards PWUD.
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Affiliation(s)
- Brandon Del Pozo
- The Miriam Hospital/Warren Alpert Medical School of Brown University, 164 Summit Avenue, Providence, RI, 02906, USA.
| | - Emily Sightes
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, USA
| | - Jeremiah Goulka
- Health in Justice Action Lab, Northeastern University, Boston, USA
| | - Brad Ray
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri St Louis, St. Louis, USA
| | - Saad Siddiqui
- Missouri Institute of Mental Health, University of Missouri St Louis, St. Louis, USA
| | - Leo A Beletsky
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, USA
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Murphy J, Russell B. Police Officers' addiction frameworks and policy attitudes. Addict Behav 2021; 122:107007. [PMID: 34146796 DOI: 10.1016/j.addbeh.2021.107007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/08/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023]
Abstract
Police officers have frequent encounters with people who use drugs, either by making an arrest for a drug-related offense or responding to a drug overdose call. Yet, little is known about how police officers view drug addiction - as a disease, a moral failure, or something else - and how their frameworks for conceptualizing addiction impact their attitudes toward drug policies, including the use of naloxone. This research examined police officers' adherence to a moralistic addiction framework in relation to their support for treatment-oriented drug policies. Officers (N = 618) were surveyed about their beliefs on drug policy and the extent to which drug addiction was a product of one's morals or related to social or biological reasons. Results found that approximately 22% of the variance in drug policy attitudes could be explained by addiction frameworks and control variables. Officers who embraced a biological perspective of addiction were more supportive of policies that expanded treatment, including access to naloxone, and less punitive sanctions. Those with stronger moralistic views were less supportive of expanding treatment initiatives and endorsed expanding punitive sanctions. Officer age and education was positively related with expanding treatment and naloxone use while exposure to overdoses was negatively related to policy support. These results demonstrate that officers' frameworks about drug addiction play an important role in drug policy attitudes and, by extension, how they might interact with people who use drugs.
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Accessing Medical Care After a Needlestick Injury: First Responders' Perception of HIV Risk and Attitudes Toward Syringe Service Programs. J Community Health 2021; 45:554-560. [PMID: 31691089 DOI: 10.1007/s10900-019-00775-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
First responders have an increased risk of occupational exposure to HIV as the result of a needlestick injury (NSI) because of the chaotic prehospital environment in which they provide care. Approximately 2.3 of every 1000 first responders (0.23%) who are exposed to HIV via a NSI risk seroconversion if left untreated. Participants completed a 28-question online survey examining level of concern about HIV, thoughts about injection drug use, number of accidental NSIs, and medical services received after a needlestick. First, all data were analyzed descriptively. Second, a multiple linear regression model was used to explore the level of concern about HIV as a function of the predictor variables. Nearly half of the respondents worked as paramedics (n = 141, 23.5%) or emergency medical technicians (n = 154, 25.7%), followed by 15.5% (n = 93) and 11.3% (n = 62) who indicated their primary first responder affiliation as "firefighter" or "police," respectively. The majority of the study population identified as male (75%, n = 450); 24.8% identified as female (n = 149). Slightly more first responders reported receiving no medical services after a needlestick (9.8%, n = 59) than received an HIV screening (9.5%, n = 57), and only 3.2% (n = 19) of those who experienced a needlestick reported receiving post-exposure prophylaxis. The results suggest that perceived risk of HIV infection via needlestick ultimately influences follow-up medical screening. Greater concern about HIV is significantly associated with HIV screening and willingness to obtain post-exposure prophylaxis. Future research should examine the impact of continued HIV education and policies outlining medical evaluation and other post-exposures procedures.
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Beletsky L, Abramovitz D, Baker P, Arredondo J, Rangel G, Artamonova I, Marotta P, Mittal ML, Rocha-Jimenéz T, Morales M, Clairgue E, Kang S, Banuelos A, Cepeda J, Patterson TA, Strathdee SA. Reducing police occupational needle stick injury risk following an interactive training: the SHIELD cohort study in Mexico. BMJ Open 2021. [PMCID: PMC8039238 DOI: 10.1136/bmjopen-2020-041629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective At a time of unprecedented attention to the public health impact of policing, it is imperative to understand the role of occupational safety in shaping officer behaviours. We assessed the longitudinal impact of police training in a quasi-experimental hybrid type-1 trial to reduce syringe-related occupational risk, while realigning police practices with public health prevention among people who inject drugs (PWID). Setting Tijuana, Mexico. Participants Of 1806 Tijuana municipal police trainees, 771 reporting previous exposure to syringes were randomly selected for follow-up. All participants completed at least one follow-up visit; attrition at 24 months was 8%. Intervention Between 2015 and 2016, officers received a training intervention (Safety and Health Integration in the Enforcement of Laws on Drugs, SHIELD) bundling occupational needle stick injury (NSI) prevention with health promotion among PWID. Outcome measures Longitudinal analysis with generalised linear mixed models to evaluate training impact on occupational NSI risk via NSI incidence and prevalidated Syringe Threat and Injury Correlates (STIC) score. This composite indicator integrates five self-reported risky syringe-handling practices (eg, syringe confiscation, breaking) and was used as a proxy for NSI risk due to reporting bias and concerns about reliability of NSI incidence reports. Results No change in self-reported NSI incidence was observed, but significant reductions in risk (16.2% decrease in STIC score) occurred at 3 months, with a sustained decrease of 17.8% through 24 months, compared with pretraining (p<0.001). Police assignment (patrol vs administration) moderated the training effect (p=0.01). Younger age, male gender, lower rank and previous NSI were independently and significantly associated with higher NSI risk overtime, although all groups demonstrated significant reductions post-training. Conclusions SHIELD is the first intervention to be associated with significant sustained changes in police practices that pose risk for both occupational and the public’s health. Integrating occupational safety and public health education should inform other interventions to mitigate the community health detriments of policing behaviours. Trial registration number NCT02444403.
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Affiliation(s)
- Leo Beletsky
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- School of Law, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Daniela Abramovitz
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Pieter Baker
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Jaime Arredondo
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- Programa de Politica de Drogas, Centro de Investigacion y Docencia Economicas, Mexico, Mexico
| | - Gudelia Rangel
- Mexico Section, U.S.-Mexico Border Health Commission, Tijuana, Mexico
| | - Irina Artamonova
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Phillip Marotta
- School of Medicine, Department of Psychiatry, Yale University, New Haven, Connecticut, USA
| | - Maria Luisa Mittal
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- School of Medicine, Universidad Xochicalco - Campus Tijuana, Tijuana, Mexico
| | - Teresita Rocha-Jimenéz
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
| | - Mario Morales
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- School of Government and Public Policy, University of Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Erika Clairgue
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Sunyou Kang
- School of Law, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Arnulfo Banuelos
- Department of Planning and Special Projects, Secretaria de Seguridad Publica Municipal, Tijuana, Mexico
| | - Javier Cepeda
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas A Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Steffanie A Strathdee
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
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Scheibe A, Sibeko G, Shelly S, Rossouw T, Zishiri V, Venter WD. Southern African HIV Clinicians Society guidelines for harm reduction. South Afr J HIV Med 2020; 21:1161. [PMID: 33391833 PMCID: PMC7756663 DOI: 10.4102/sajhivmed.v21i1.1161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 01/06/2023] Open
Affiliation(s)
- Andrew Scheibe
- TB HIV Care, Cape Town, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Shaun Shelly
- TB HIV Care, Cape Town, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Theresa Rossouw
- Department of Immunology, University of Pretoria, Pretoria, South Africa
| | - Vincent Zishiri
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Willem D.F. Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Beletsky L, Abramovitz D, Arredondo J, Baker P, Artamonova I, Marotta P, Mittal ML, Rocha-Jimenez T, Cepeda JA, Morales M, Clairgue E, Patterson TA, Strathdee SA. Addressing Police Occupational Safety During an Opioid Crisis: The Syringe Threat and Injury Correlates (STIC) Score. J Occup Environ Med 2020; 62:46-51. [PMID: 31658223 PMCID: PMC6933083 DOI: 10.1097/jom.0000000000001754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To develop and validate syringe threat and injury correlates (STIC) score to measure police vulnerability to needlestick injury (NSI). METHODS Tijuana police officers (N = 1788) received NSI training (2015 to 2016). STIC score incorporates five self-reported behaviors: syringe confiscation, transportation, breaking, discarding, and arrest for syringe possession. Multivariable logistic regression was used to evaluate the association between STIC score and recent NSI. RESULTS Twenty-three (1.5%) officers reported NSI; higher among women than men (3.8% vs 1.2%; P = 0.007). STIC variables had high internal consistency, a distribution of 4.0, a mode of 1.0, a mean (sd) of 2.0 (0.8), and a median (interquartile range [IQR]) of 2.0 (1.2 to 2.6). STIC was associated with recent NSI; odds of NSI being 2.4 times higher for each point increase (P-value <0.0001). CONCLUSIONS STIC score is a novel tool for assessing NSI risk and prevention program success among police.
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Affiliation(s)
- Leo Beletsky
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
- School of Law & Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave., Massachusetts 02115, United States
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Jaime Arredondo
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, California. 92182, United States
| | - Irina Artamonova
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Phil Marotta
- School of Social Work, Columbia University, 1255 Amsterdam Ave., New York, NY, 10027, United States
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
- School of Medicine, Universidad Xochicalco, 4850 Calle Rampa Yumalinda, Chapultepec Alamar, Tijuana, Baja California, 22110, Mexico
| | - Teresita Rocha-Jimenez
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, California. 92182, United States
| | - Javier A. Cepeda
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Mario Morales
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Erika Clairgue
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Thomas A. Patterson
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
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Khorasheh T, Naraine R, Watson TM, Wright A, Kallio N, Strike C. A scoping review of harm reduction training for police officers. Drug Alcohol Rev 2019; 38:131-150. [PMID: 30785229 DOI: 10.1111/dar.12904] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/20/2018] [Accepted: 01/01/2019] [Indexed: 01/18/2023]
Abstract
ISSUES Preventable overdose deaths, especially due to opioids, have increasingly been reported worldwide. Expansion of life-saving harm reduction services is underway with increasing public support in some jurisdictions. However, such services often fall short of reaching people who use drugs (PWUD), in part, due to law enforcement practices that are aligned with punitive drug laws and incongruent with harm reduction principles. One suggested strategy to facilitate police understanding and uptake of practices that are more congruent with harm reduction is to provide police with relevant training. APPROACH This scoping review synthesises English-language peer-reviewed and grey literature on harm reduction training programs for police. KEY FINDINGS We reviewed 31 sources and found that most trainings covered topics related to harm reduction objectives, overdose recognition and response, occupational safety and policing practices. Information was often presented via single-session, 1-hour long, slide-assisted presentations that were integrated into in-service trainings. Inconsistent throughout the literature was the career stage or position/rank of training audience (e.g. cadets, senior officers, street-level officers), when and how much training should be provided, and the occupational background of the training facilitator. IMPLICATIONS The available literature contains significant gaps pertaining to descriptions of training development, design and content specific to facilitating positive police-PWUD interactions, and formal evaluations. These gaps limit our understanding of what well-designed trainings may look like, if and how training alters policing practices, and to what extent training completion may lead to improved outcomes. CONCLUSION Greater research and formal evaluations of harm reduction training for police is recommended.
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Affiliation(s)
- Triti Khorasheh
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Renuka Naraine
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tara Marie Watson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Amy Wright
- The Works, Toronto Public Health, Toronto, Canada
| | - Natalie Kallio
- keepSIX Supervised Consumption Services, South Riverdale Community Health Centre, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Cook AK, Worcman N. Confronting the opioid epidemic: public opinion toward the expansion of treatment services in Virginia. HEALTH & JUSTICE 2019; 7:13. [PMID: 31338621 PMCID: PMC6717979 DOI: 10.1186/s40352-019-0095-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/02/2019] [Indexed: 05/16/2023]
Abstract
BACKGROUND Public opinion polls have consistently shown Americans prefer treatment over arrest policies for opioid users. As the opioid epidemic remains a major health problem in the United States, it is important to determine the type of treatment policies the public would support. Theoretically, government should take into consideration the opinion of its constituents when deciding how to act. As such, the 2018 Virginia Commonwealth Public Policy Poll determined levels of support for the expansion of community-based treatment in one's community. RESULTS Overall, the results showed 80% of Virginians (n = 788) supported the expansion of community-based treatment centers in their neighborhood, 69% supported the use of housing in their community, while less than half supported the provision of clean needles to IV drug users so they do not use dirty needles that could spread infection. Multivariate analyses revealed education, sex, and political party affiliation are significant factors in predicting support for the expansion of services. CONCLUSIONS Given the lack of progress made by the government in reducing the supply and demand of drugs over the course of the war on drugs, it is time to move away from punitive policies to responsible and pragmatic approaches that include the expansion of community-based treatment.
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Affiliation(s)
- Amy Kyle Cook
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, 1001 W. Franklin Street, Richmond, VA, 23284, USA.
| | - Nicola Worcman
- Substance Abuse Prevention, Treatment, and Policy, Virginia Commonwealth University, Richmond, VA, USA
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Davis CS. Bias Against People Who Inject Drugs Undermines Police Training on Needlestick Injury. Am J Public Health 2019; 109:839-840. [DOI: 10.2105/ajph.2019.305096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Corey S. Davis
- The author is with the Network for Public Health Law, Los Angeles, CA, and the Brody School of Medicine, East Carolina University, Greenville, NC
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Syringe Decriminalization Advocacy in Red States: Lessons from the North Carolina Harm Reduction Coalition. Curr HIV/AIDS Rep 2019; 15:276-282. [PMID: 29740734 DOI: 10.1007/s11904-018-0397-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Syringe access programs (SAPs) are cornerstone harm reduction interventions for combatting the national opioid epidemic. The goal of this paper is to describe effective advocacy strategies for enacting syringe decriminalization legislation to foster the expansion of SAPs in high-need areas amidst political opposition. RECENT FINDINGS Decades or research shows that SAPs prevent the transmission of HIV among people who inject drugs (PWID) and are a cost-effective tool for linking PWID to medical care, health education, and social services. In the USA, state laws criminalizing distribution and possession of syringes impede the expansion of SAPs into areas where they are sorely needed. In 2016, North Carolina became the first state to legalize SAPs with a Republican super majority. This paper distills strategies for community organizations seeking to advance syringe decriminalization legislation in politically conservative states with histories of prioritizing punitive sanctions over public health responses to drug use.
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Cloud DH, Ibragimov U, Prood N, Young AM, Cooper HLF. Rural risk environments for hepatitis c among young adults in appalachian kentucky. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:47-54. [PMID: 31113713 DOI: 10.1016/j.drugpo.2019.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/25/2019] [Accepted: 05/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rural Kentucky is an epicenter of hepatitis C(HCV), especially among young adults who inject drugs. While the Risk Environment Framework (REF) has been used widely to study and address socio-ecological determinants of infectious disease among people who inject drugs (PWID), it has been almost exclusively applied to urban environments. Applying REF to rural environments can enhance our understanding of the drivers of HCV epidemics in these hard-hit areas, and inform the creation and implementation of harm reduction interventions in this local context. METHODS Participants were recruited between March and August 2017 via community-based outreach methods (e.g., cookouts, flyers) and peer referral. Individuals who met eligibility criteria (aged 18-35, recently used prescription opioids and/or heroin to get high, lived in one of the 5 target counties) participated indepth, semi-structured interviews. The interview guide was informed by the REF, and covered HCV-related risk behaviors and environmental features that shaped vulnerability to engaging in these behaviors. Interviews were transcribed and analyzed using constructivist grounded-theory methods. RESULTS Participants (N=19) described multiple intersecting risk environment features that shaped vulnerability to HCV transmission. Economic decline generated intergenerational poverty, dwindling employment prospects, and diminished social enrichment opportunities that collectively contributed to substance misuse and risky injection practices. Geographic isolation, lack of collective knowledge about HCV transmission risks, scarce harm reduction services, familial poverty, and fear of law enforcement interacted to increase the odds of people injecting in "trap houses" (akin to shooting galleries) or secluded areas, spaces in which they rushed to inject and shared injection equipment. Pervasive stigma was a structural barrier to adopting, expanding, and using harm reduction services. CONCLUSION This exploratory study identified features of rural risk environments that may contribute to significant HCV burdens in Appalachian Kentucky. Findings signal the importance of expanding proven harm reduction strategies and anti-stigma interventions tailored to rural contexts.
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Affiliation(s)
- David H Cloud
- Emory University, Rollins School of Public Health, United States.
| | | | - Nadya Prood
- Emory University, Rollins School of Public Health, United States
| | - April M Young
- University of Kentucky College of Public Health, United States
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Needlestick injuries and other body substance exposures among police officers in a city police department. Am J Infect Control 2019; 47:294-297. [PMID: 30318400 DOI: 10.1016/j.ajic.2018.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND We determined the incidence and circumstances of needlestick injuries and other body substance exposures among police officers in a city police department. METHODS We analyzed data extracted from the city's centralized human resource database on all incidents from January 1, 2011, to December 31, 2016, and characterized their circumstances. We calculated the annual incidence of needlestick injuries per 1,000 officers and per 10,000 reactive calls. We ran a Poisson regression model to determine the trend in the annual incidence over time. RESULTS We found 13 needlestick injuries and 37 additional body substance exposures involving city police officers. Needlestick injuries most commonly occurred during pat-down searches and searches of property or vehicles; 9 source persons tested positive for hepatitis C. The annual incidence of needlestick injuries ranged from 0-5.1 per 1,000 police officers and from 0-2.5 per 10,000 reactive calls for service without a significant trend. Most body substance exposures consisted of spitting, human bites, and other contact with blood. No incidents reportedly led to transmission of bloodborne viruses. CONCLUSIONS Although these appear to be rare events, police officers in this department are at risk for needlestick injuries and other body substance exposures. We recommended engineering, administrative, and personal protective equipment control improvements.
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Morales M, Rafful C, Gaines TL, Cepeda JA, Abramovitz D, Artamonova I, Baker P, Clairgue E, Mittal ML, Rocha-Jimenez T, Arredondo J, Kerr T, Bañuelos A, Strathdee SA, Beletsky L. Factors associated with extrajudicial arrest for syringe possession: results of a department-wide survey of municipal police in Tijuana, Mexico. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:36. [PMID: 30219105 PMCID: PMC6139125 DOI: 10.1186/s12914-018-0175-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/29/2018] [Indexed: 12/04/2022]
Abstract
Background Mexican law permits syringe purchase and possession without prescription. Nonetheless, people who inject drugs (PWID) frequently report arrest for syringe possession. Extrajudicial arrests not only violate human rights, but also significantly increase the risk of blood-borne infection transmission and other health harms among PWID and police personnel. To better understand how police practices contribute to the PWID risk environment, prior research has primarily examined drug user perspectives and experiences. This study focuses on municipal police officers (MPOs) in Tijuana, Mexico to identify factors associated with self-reported arrests for syringe possession. Methods Participants were active police officers aged ≥18 years, who completed a self-administered questionnaire on knowledge, attitudes and behaviors related to occupational safety, drug laws, and harm reduction strategies. Univariable and multivariable logistic regression was used to identify correlates of recent syringe possession arrest. Results Among 1044 MPOs, nearly half (47.9%) reported always/sometimes making arrests for syringe possession (previous 6mo). Factors independently associated with more frequent arrest included being male (Adjusted Odds Ratio [AOR] = 1.62; 95% Confidence Interval [95% CI] =1.04–2.52; working in a district along Tijuana River Canal (where PWID congregate) (AOR = 2.85; 95%CI = 2.16–3.77); having recently experienced a physical altercation with PWID (AOR = 2.83; 95% CI = 2.15–3.74); and having recently referred PWID to social and health services (AOR = 1.97; 95% CI = 1.48–2.61). Conversely, odds were significantly lower among officers reporting knowing that syringe possession is legal (AOR = 0.61; 95% CI = 0.46–0.82). Conclusions Police and related criminal justice stakeholders (e.g., municipal judges, prosecutors) play a key role in shaping PWID risk environment. Findings highlight the urgent need for structural interventions to reduce extra-judicial syringe possession arrests. Police training, increasing gender and other forms of diversity, and policy reforms at various governmental and institutional levels are necessary to reduce police occupational risks, improve knowledge of drug laws, and facilitate harm reduction strategies that promote human rights and community health.
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Affiliation(s)
- Mario Morales
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Claudia Rafful
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Tommi L Gaines
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Irina Artamonova
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Erika Clairgue
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Medicine, Universidad Xochicalco, 4850 Calle Rampa Yumalinda, Chapultepec Alamar, 22110, Tijuana, Baja California, Mexico
| | - Teresita Rocha-Jimenez
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, California, 92182, USA
| | - Jaime Arredondo
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, California, 92182, USA
| | - Thomas Kerr
- Center of Excellence in HIV/AIDS, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Arnulfo Bañuelos
- Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, 2141 Blvd Cuauhtémoc Sur y Río Suchiate, 22015, Tijuana, Mexico
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA. .,Health in Justice Action Lab, School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, 02115, USA.
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Abstract
At a time of resurgence in injection drug use and injection-attributable infections, needle stick injury (NSI) risk and its correlates among police remain understudied. In the context of occupational safety training, a convenience sample of 771 Baltimore city police officers responded to a self-administered survey. Domains included NSI experience, protective behaviors, and attitudes towards syringe exchange programs. Sixty officers (8%) reported lifetime NSI. Officers identifying as Latino or other race were almost three times more likely (aOR 2.58, 95% CI 1.12-5.96) to have experienced NSI compared to whites, after adjusting for potential confounders. Findings highlight disparate burdens of NSIs among officers of color, elevating risk of hepatitis, HIV, and trauma. Training, equipment, and other measures to improve occupational safety are critical to attracting and safeguarding police, especially minority officers.
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Prevalence and correlates of needle-stick injuries among active duty police officers in Tijuana, Mexico. J Int AIDS Soc 2016; 19:20874. [PMID: 27435711 PMCID: PMC4951532 DOI: 10.7448/ias.19.4.20874] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 01/23/2023] Open
Abstract
Introduction Police officers are at an elevated risk for needle-stick injuries (NSI), which pose a serious and costly occupational health risk for HIV and viral hepatitis. However, research on NSIs among police officers is limited, especially in low- and middle-income countries. Despite the legality of syringe possession in Mexico, half of people who inject drugs (PWID) in Tijuana report extrajudicial syringe-related arrests and confiscation by police, which has been associated with needle-sharing and HIV infection. We assessed the prevalence and correlates of NSIs among Tijuana police officers to inform efforts to improve occupational safety and simultaneously reduce HIV risks among police and PWID. Methods Tijuana's Department of Municipal Public Safety (SSPM) is among Mexico's largest. Our binational, multi-sectoral team analyzed de-identified data from SSPM's 2014 anonymous self-administered occupational health survey. The prevalence of NSI and syringe disposal practices was determined. Logistic regression with robust variance estimation via generalized estimating equations identified factors associated with ever having an occupational NSI. Results Approximately one-quarter of the Tijuana police force was given the occupational health survey (N=503). Respondents were predominantly male (86.5%) and ≤35 years old (42.6%). Nearly one in six officers reported ever having a NSI while working at SSPM (15.3%), of whom 14.3% reported a NSI within the past year. Most participants reported encountering needles/syringes while on duty (n=473, 94%); factors independently associated with elevated odds of NSIs included frequently finding syringes that contain drugs (adjusted odds ratio (AOR): 2.98; 95% confidence interval (CI): 1.56–5.67) and breaking used needles (AOR: 2.25; 95% CI: 1.29–3.91), while protective factors included being willing to contact emergency services in case of NSIs (AOR: 0.39; 95% CI: 0.22–0.69), and wearing needle-stick resistant gloves (AOR: 0.43; 95% CI: 0.19–0.91). Conclusions Tijuana police face an elevated and unaddressed occupational NSI burden associated with unsafe syringe-handling practices, exposing them to substantial risk of HIV and other blood-borne infections. These findings spurred the development and tailoring of training to reduce NSI by modifying officer knowledge, attitudes and enforcement practices (e.g. syringe confiscation) – factors that also impact HIV transmission among PWID and other members of the community.
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Police, Law Enforcement and HIV. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.4.21260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Strathdee SA, Arredondo J, Rocha T, Abramovitz D, Rolon ML, Patiño Mandujano E, Rangel MG, Olivarria HO, Gaines T, Patterson TL, Beletsky L. A police education programme to integrate occupational safety and HIV prevention: protocol for a modified stepped-wedge study design with parallel prospective cohorts to assess behavioural outcomes. BMJ Open 2015; 5:e008958. [PMID: 26260350 PMCID: PMC4538275 DOI: 10.1136/bmjopen-2015-008958] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/25/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Policing practices are key drivers of HIV among people who inject drugs (PWID). This paper describes the protocol for the first study to prospectively examine the impact of a police education programme (PEP) to align law enforcement and HIV prevention. PEPs incorporating HIV prevention (including harm reduction programmes like syringe exchange) have been successfully piloted in several countries but were limited to brief pre-post assessments; the impact of PEPs on policing behaviours and occupational safety is unknown. OBJECTIVES Proyecto ESCUDO (SHIELD) aims to evaluate the efficacy of the PEP on uptake of occupational safety procedures, as assessed through the incidence of needle stick injuries (NSIs) (primary outcome) and changes in knowledge of transmission, prevention and treatment of HIV and viral hepatitis; attitudes towards PWID, adverse behaviours that interfere with HIV prevention and protective behaviours (secondary outcomes). METHODS/ANALYSIS ESCUDO is a hybrid type I design that simultaneously tests an intervention and an implementation strategy. Using a modified stepped-wedge design involving all active duty street-level police officers in Tijuana (N = ∼ 1200), we will administer one 3 h PEP course to groups of 20-50 officers until the entire force is trained. NSI incidence and geocoded arrest data will be assessed from department-wide de-identified data. Of the consenting police officers, a subcohort (N=500) will be randomly sampled from each class to undergo pre-PEP and post-PEP surveys with a semiannual follow-up for 2 years to assess self-reported NSIs, attitudes and behaviour changes. The impact on PWIDs will be externally validated through a parallel cohort of Tijuana PWIDs. ETHICS/DISSEMINATION Research ethics approval was obtained from the USA and Mexico. Findings will be disseminated through open access to protocol materials through the Law Enforcement and HIV Network. TRIAL REGISTRATION NUMBER NCT02444403.
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Affiliation(s)
- Steffanie A Strathdee
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jaime Arredondo
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Teresita Rocha
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Daniela Abramovitz
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Maria Luisa Rolon
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Xochicalco University, Tijuana, Baja California, Mexico
| | | | - Maria Gudelia Rangel
- U.S.-Mexico Border Health Commission, Mexico Section, Tijuana, Baja California, Mexico
| | | | - Tommi Gaines
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Thomas L Patterson
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Leo Beletsky
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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Davis CS, Walley AY, Bridger CM. Lessons learned from the expansion of naloxone access in Massachusetts and North Carolina. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43 Suppl 1:19-22. [PMID: 25846157 DOI: 10.1111/jlme.12208] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
States are rapidly modifying law and policy to increase access to the opioid antidote naloxone, and the provision of naloxone rescue kits (NRK) for use in the event of overdose is becoming increasingly common. As of late 2014 the majority of states had passed laws increasing naloxone access, and nearly as many have modified emergency responder scope of practice protocols to permit Emergency Medical Technicians (EMTs) and law enforcement officers to administer the medication. While the text of these laws is generally similar, their implementation varies among states.This article outlines experiences and lessons learned from two diverse states, Massachusetts and North Carolina. In Massachusetts naloxone access initiatives were well underway before formal legislative action occurred, while in North Carolina the passage of a naloxone access law served as a catalyst for the creation of new programs and facilitated the scale-up of existing ones. In both states legislative action was necessary to permit the prescription and dispensing of naloxone to the friends and family members of people who use opioids, a key legal change.
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Affiliation(s)
- Corey S Davis
- Deputy Director of the Southeastern Region of the Network for Public Health Law and a Staff Attorney for the National Health Law Program
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