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Bluthenthal RN, Humphrey JL, Strack CN, Wenger LD, LaKosky P, Patel SV, Kral AH, Lambdin B. Racialized environments and syringe services program implementation: County-level factors. Drug Alcohol Depend 2024; 263:112430. [PMID: 39216198 PMCID: PMC11409812 DOI: 10.1016/j.drugalcdep.2024.112430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 08/10/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Racialized health inequities in substance use-related harms might emerge from differential access to syringe service programs (SSPs). To explore this, we examined the association between county-level racialized environments, other factors, and (1) SSP presence, and (2) per capita syringe and (3) naloxone distribution. METHODS 2021 US National Survey of SSP data (n=295/412;72 % response rate) was used to identify SSP presence and the sum of syringes and naloxone doses distributed in 2020 by county. Study measures included racial residential segregation (RRS; i.e., divergence and dissimilarity indexes for Black:Non-Hispanic White & Hispanic:Non-Hispanic White) and covariates (i.e., demographic proportions, urban/suburban/rural classifications, 2020 US presidential Republican vote share, and overdose mortality from 2019). We used logit Generalized Estimating Equations to determine factors associated with county-level SSP presence, and zero inflated negative binomial regression models to determine factors associated with per capita syringe and naloxone distribution. RESULTS SSPs were reported in 9 % (283/3106) of US counties. SSP presence was associated with higher divergence and dissimilarity indexes, urban and suburban counties, higher opioid overdose mortality, and lower 2020 Republican presidential vote share. Per capita syringes distributed was associated with lower RRS (divergence and Hispanic:White dissimilarity), lower racially minoritized population proportions and rural counties, while per capita naloxone distribution was associated with lower Hispanic and "other" population proportions, and rural counties. CONCLUSIONS Racialized environments are associated with SSP presence but not the scope of those programs. Preventing HIV and HCV outbreaks, and overdose deaths requires addressing community level factors that influence SSP implementation and accessibility.
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Affiliation(s)
- Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | | | | | | | - Paul LaKosky
- North American Syringe Exchange Network, Tacoma, WA, USA
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Barsky BA. Law Enforcement Interventionism as Determinant of Decision-Making Among Resuscitated Opioid Users. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:40-42. [PMID: 38635424 DOI: 10.1080/15265161.2024.2327282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
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Kimmel SD, Xuan Z, Yan S, Lambert AM, Formica SW, Green TC, Carroll JJ, Bagley SM, Rosenbloom D, Beletsky L, Walley AY. Characteristics of post-overdose outreach programs and municipal-level opioid overdose in Massachusetts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104164. [PMID: 37713939 DOI: 10.1016/j.drugpo.2023.104164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Post-overdose outreach programs have proliferated in response to opioid overdose. Implementing these programs is associated with reductions in overdose rates, but the role of specific program characteristics in overdose trends has not been evaluated. METHODS Among 58 Massachusetts municipalities with post-overdose outreach programs, we examined associations between five domains of post-overdose outreach program characteristics (outreach contact rate, naloxone distribution, coercive practices, harm reduction activities, and social service provision or referral) and rates of fatal opioid overdoses and opioid-related emergency medical system responses (i.e., ambulance activations) per calendar quarter from 2013 to 2019 using segmented regression analyses with adjustment for municipal covariates and fixed effects. For both outcomes, each domain was modeled: a) individually, b) with other characteristics, and c) with other characteristics and municipal-level fixed effects. RESULTS There were no significant associations (p < 0.05) between outreach contact rate, naloxone distribution, coercive practices, or harm reduction activities with municipal fatal overdose trends. Municipalities with programs providing or referring to more social services experienced 21% fewer fatal overdoses compared to programs providing or referring to more social services (Rate Ratio (RR) 0.79, 95% Confidence Interval (CI) 0.66-0.93, p = 0.01). Compared to municipalities in quarters when programs had no outreach contacts, municipalities with some, but less than the median outreach contacts, experienced 14% lower opioid-related emergency responses (RR 0.86, 95% CI 0.78-0.96, p = 0.01). Associations between naloxone distribution, coercive practices, harm reduction practices, or social services and opioid-related emergency responses were not consistently significant across modeling approaches. CONCLUSION Municipalities with post-overdose outreach programs providing or referring to more social services had lower fatal opioid overdose rates. Municipalities in quarters when programs outreached to overdose survivors had fewer opioid-related emergency responses, but only among programs with below the median number of outreach contacts. Social service linkage should be core to post-overdose programs. Evaluations should assess program characteristics to optimize program design.
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Affiliation(s)
- Simeon D Kimmel
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States; Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States.
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown Building - 4th Floor, Boston, MA 02118, United States
| | - Shapei Yan
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States
| | - Audrey M Lambert
- AHOPE, Department of Recovery Services, Boston Public Health Commission, 774 Albany St, Boston, MA 02118, United States
| | - Scott W Formica
- Social Science Research and Evaluation, Inc, 84 Mill Street, Lincoln, MA 01773, United States
| | - Traci C Green
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 024537, United States; Department of Medicine, Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, United States; COBRE on Opioids and Overdose at Rhode Island Hospital, 1125 North Main St., Providence, RI 02904, United States
| | - Jennifer J Carroll
- Department of Medicine, Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, United States; Department of Sociology and Anthropology, North Carolina State University, Raleigh, NC, United States
| | - Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, 801 Albany St, Boston, MA 02118, United States
| | - David Rosenbloom
- Department of Health, Law, Policy and Management, Boston University School of Public Health, 348W, 715 Albany Street, Boston, MA 02118, United States
| | - Leo Beletsky
- Northeastern University School of Law, Bouvé College of Health Sciences, and The Action Lab, 416 Huntington Ave, Boston, MA 02115, United States; Division of Global Public Health and Infectious Diseases, University of California, San Diego School of Medicine, 9500 Gillman Drive, La Jolla, CA 92093, United States
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Crosstown Building - 2nd Floor, Boston, MA 02118, United States
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Chayama KL, Ng C, Fleming T, Small W, Sue KL, McNeil R. Housing-based syringe services programs to improve access to safer injecting equipment for people who inject drugs in Vancouver, Canada: a spatially oriented qualitative study. Harm Reduct J 2023; 20:126. [PMID: 37679789 PMCID: PMC10483728 DOI: 10.1186/s12954-023-00862-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Housing environments shape injection drug-related risks and harms and thus represent a critical implementation setting for syringe services programs (SSPs). As critical harm reduction measures, SSPs provide safe injecting equipment to people who inject drugs (PWID). Vancouver, Canada, has well-established syringe distribution programs through which PWID have low-threshold access to unlimited syringes and related injecting equipment, including through non-profit operated supportive housing and single-room occupancy hotels. This study examines the role of housing-based SSPs in distributing injecting equipment to PWID in Vancouver. METHODS Between January and March 2020, semi-structured, in-depth interviews were conducted in Vancouver with 26 PWID. Interviews were audio-recorded, transcribed, and coded. Salient themes were identified using inductive and deductive approaches. RESULTS Many participants accessed SSPs in housing facilities and expressed preference for these programs over those offered at other locations and through other health and social services. Three major themes emerged to explain this preference. First, most participants injected in the buildings where they resided, and housing-based SSPs made injecting equipment available when and where it was most needed. Second, many participants preferred to avoid carrying syringes outside of the places where they inject due to fears that syringe possession may lead to criminal charges or confiscation of syringes and/or illicit drugs by police. Third, for some participants, anti-drug user stigma and concerns over unwillingly disclosing their drug use hindered access to SSPs outside of housing settings. Programs operated within housing facilities often offered greater client anonymity along with more supportive and less stigmatizing environments, particularly in the presence of peer staff. CONCLUSION The current study advances understanding of access to injecting equipment in a setting with city-wide syringe distribution programs. Our findings underscore the benefits of housing-based SSPs and encourage the expansion of such services to maximize access to harm reduction supports for PWID.
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Affiliation(s)
- Koharu Loulou Chayama
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 6371 Crescent Road, Vancouver, Canada
| | - Cara Ng
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
| | - Taylor Fleming
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 6371 Crescent Road, Vancouver, Canada
| | - Will Small
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, Canada
| | - Kimberly L Sue
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 06520, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, USA
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada.
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 06520, USA.
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, USA.
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"They don't go by the law around here": law enforcement interactions after the legalization of syringe services programs in North Carolina. Harm Reduct J 2022; 19:106. [PMID: 36163255 PMCID: PMC9513969 DOI: 10.1186/s12954-022-00690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2016, the US state of North Carolina (NC) legalized syringe services programs (SSPs), providing limited immunity from misdemeanor syringe possession when law enforcement is presented documentation that syringes were obtained from an SSP. This study explores the law enforcement interactions experienced by SSP participants since the enactment of this law. METHODS This study used a convergent, mixed-methods design consisting of structured surveys and semi-structured interviews with SSP participants in seven NC counties. Survey and interview data were collected simultaneously between January and November 2019. This survey was designed to capture demographics, characteristics of drug use, SSP services used, and past-year negative experiences with law enforcement (officer did not recognize SSP card, did not believe SSP card belonged to participant, confiscated SSP card, confiscated syringes, or arrested participant for possessing syringes). Semi-structured interviews explored lived experiences with and perspectives on the same topics covered in the survey. RESULTS A total of 414 SSP participants completed the survey (45% male, 54% female, 1% transgender or non-binary; 65% White, 22% Black, 5% American Indian/Alaskan Native, 8% some other racial identity). 212 participants (51.2%) reported at least one past-year negative experience with law enforcement. Chi-square testing suggests that Black respondents were more likely to report having experienced law enforcement doubt their SSP card belonged to them. Interview data indicate that law enforcement practices vary greatly across counties, and that negative and/or coercive interactions reduce expectations among SSP participants that they will be afforded the protections granted by NC law. CONCLUSION Despite laws which protect SSP participants from charges, negative law enforcement responses to syringe possession are still widely reported. Evidence-based policy interventions to reduce fatal overdose are undermined by these experiences. Our findings suggest NC residents, and officers who enforce these laws, may benefit from clarification as to what is required of the documents which identify participants of registered SSPs where they may legally obtain syringes. Likewise, more thorough trainings on NC's syringe law for law enforcement officers may be merited. Further research is needed to assess geographic differences in SSP participants' law enforcement interactions across race and gender.
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Weisenthal K, Kimmel SD, Kehoe J, Larochelle MR, Walley AY, Taylor JL. Effect of police action on low-barrier substance use disorder service utilization. Harm Reduct J 2022; 19:86. [PMID: 35906660 PMCID: PMC9338497 DOI: 10.1186/s12954-022-00668-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Police action can increase risky substance use patterns by people who use drugs (PWUD), but it is not known how increased police presence affects utilization of low-barrier substance use disorder bridge clinics. Increased police presence may increase or decrease treatment-seeking behavior. We examined the association between Operation Clean Sweep (OCS), a 2-week police action in Boston, MA, and visit volume in BMC's low-barrier buprenorphine bridge clinic. METHODS In this retrospective cohort, we used segmented regression to investigate whether the increased police presence during OCS was associated with changes in bridge clinic visits. We used General Internal Medicine (GIM) clinic visit volume as a negative control. We examined visits during the 6 weeks prior, 2 weeks during, and 4 weeks after OCS (June 18-September 11, 2019). RESULTS Bridge clinic visits were 2.8 per provider session before, 2.0 during, and 3.0 after OCS. The mean number of GIM clinic visits per provider session before OCS was 7.0, 6.8 during, and 7.0 after OCS. In adjusted segmented regression models for bridge clinic visits per provider session, there was a nonsignificant level increase (0.643 P = 0.171) and significant decrease in slope (0.100, P = 0.045) during OCS. After OCS completed, there was a significant level increase (1.442, P = 0.003) and slope increase in visits per provider session (0.141, P = 0.007). There was no significant change in GIM clinic volume during the study period. CONCLUSIONS The increased policing during OCS was associated with a significant decrease in bridge clinic visits. Following the completion of OCS, there was a significant increase in clinic visits, suggesting pent-up demand for medications for opioid use disorder, a life-saving treatment.
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Affiliation(s)
- Karrin Weisenthal
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
| | - Simeon D Kimmel
- Division of Infectious Disease, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Jessica Kehoe
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Marc R Larochelle
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, 801 Massachusetts Avenue, 2nd Floor, #2109, Boston, MA, 02118, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, 801 Massachusetts Avenue, 2nd Floor, #2109, Boston, MA, 02118, USA
| | - Jessica L Taylor
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.
- Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, 801 Massachusetts Avenue, 2nd Floor, #2109, Boston, MA, 02118, USA.
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Simmons J, Elliott L, Bennett AS, Beletsky L, Rajan S, Anders B, Dastparvardeh N. Evaluation of an Experimental Web-based Educational Module on Opioid-related Occupational Safety Among Police Officers: Protocol for a Randomized Pragmatic Trial to Minimize Barriers to Overdose Response. JMIR Res Protoc 2022; 11:e33451. [PMID: 35212639 PMCID: PMC8917434 DOI: 10.2196/33451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/15/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As drug-related morbidity and mortality continue to surge, police officers are on the front lines of the North American overdose (OD) crisis. Drug law enforcement shapes health risks among people who use drugs (PWUD), while also impacting the occupational health and wellness of officers. Effective interventions to align law enforcement practices with public health and occupational safety goals remain underresearched. OBJECTIVE The Opioids and Police Safety Study (OPS) aims to shift police practices relating to PWUD. It adapts and evaluates the relative effectiveness of a curriculum that bundles content on public health promotion with occupational risk reduction (ORR) to supplement a web-based OD response and naloxone training platform (GetNaloxoneNow.org, or GNN). This novel approach has the potential to improve public health and occupational safety practices, including using naloxone to reverse ODs, referring PWUD to treatment and other supportive services, and avoiding syringe confiscation. METHODS This longitudinal study uses a randomized pragmatic trial design. A sample of 300 active-duty police officers from select counties in Pennsylvania, Vermont, and New Hampshire with high OD fatality rates will be randomized (n=150 each) to either the experimental arm (GNN + OPS) or the control arm (GNN + COVID-19 ORR). A pre- and posttraining survey will be administered to all 300 officers, after which they will be administered quarterly surveys for 12 months. A subsample of police officers will also be qualitatively followed in a simultaneous embedded mixed-methods approach. Research ethics approval was obtained from the New York University Institutional Review Board. RESULTS Results will provide an understanding of the experiences, knowledge, and perceptions of this sample of law enforcement personnel. Generalized linear models will be used to analyze differences in key behavioral outcomes between the participants in each of the 2 study arms and across multiple time points (anticipated minimum effect size to be detected, d=0.50). Findings will be disseminated widely, and the training products will be available nationally once the study is completed. CONCLUSIONS The OPS is the first study to longitudinally assess the impact of a web-based opioid-related ORR intervention for law enforcement in the U.S. Our randomized pragmatic clinical trial aims to remove barriers to life-saving police engagement with PWUD/people who inject drugs by focusing both on the safety of law enforcement and evidence-based and best practices for working with persons at risk of an opioid OD. Our simultaneous embedded mixed-methods approach will provide empirical evaluation of the diffusion of the naloxone-based response among law enforcement. TRIAL REGISTRATION ClinicalTrail.gov NCT05008523; https://clinicaltrials.gov/show/NCT05008523. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33451.
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Affiliation(s)
- Janie Simmons
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Luther Elliott
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Alex S Bennett
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Leo Beletsky
- School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Sonali Rajan
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, United States
| | | | - Nicole Dastparvardeh
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
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Hayes BT, Favaro J, Coello D, Behrends CN, Jakubowski A, Fox AD. Participants of a mail delivery syringe services program are underserved by other safe sources for sterile injection supplies. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103474. [PMID: 34619446 PMCID: PMC8755579 DOI: 10.1016/j.drugpo.2021.103474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/02/2021] [Accepted: 09/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND In the United States, accessing sterile injection supplies remains challenging for many people who inject drugs (PWID). Although women are less likely to inject drugs than men, women who do inject are disproportionately affected by IDU-related complications. Needle Exchange Technology (NEXT), the first formal online accessed mail delivery syringe services program (SSP) in the US, may overcome access barriers. We evaluated whether NEXT was reaching women participants and people without access to other safe sources of sterile injection supplies. METHODS This cross-sectional study examined NEXT participants who enrolled in the mail-delivery SSP from February 2018 through March 2021. All NEXT participants completed an online questionnaire during enrollment, which included sociodemographic and clinical characteristics and injection-related risk factors (including prior sources of sterile injection supplies). Multivariable logistic regression (MVR) was used to examine associations between gender and prior use of safe sources of injection supplies (i.e., SSPs or pharmacies). RESULTS 1,032 participants received injection supplies. Median age was 34 and participants were mostly cis-gendered women (55%) and white (93%). 34% reported infection with HCV; women were more likely to report HCV infection than men (38% vs 28%; p < 0.01). 68% of participants acquired injection supplies from less safe sources. Few participants exclusively used safe sources for injection supplies (26%). In adjusted MVR analysis, women participants had significantly lower odds than men of having exclusively used safe sources for injection supplies (adjusted OR 0.71, 95% CI 0.52, 0.98). CONCLUSION Our findings suggest that NEXT services are utilized by women and people without prior access to sterile injection supplies. Women participants were less likely than men to have exclusively used safe sources for sterile injection supplies. Future research should explore women's preference for mail-delivery over in-person SSPs and determine whether online accessed mail delivery services can reach other underserved populations of PWID.
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Affiliation(s)
- Benjamin T Hayes
- Division of General Internal Medicine, Montefiore Medical
Center, Bronx, NY, USA,Corresponding author at: Montefiore Medical
Center, 3300 Kossuth Ave., Bronx, NY, 10467 United States. Tel.: +1
718-920-7102; fax: +1 718-561-5165.
| | | | | | | | - Andrea Jakubowski
- Division of General Internal Medicine, Montefiore Medical
Center, Bronx, NY, USA
| | - Aaron D. Fox
- Division of General Internal Medicine, Montefiore Medical
Center, Bronx, NY, USA
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Carroll JJ, Ostrach B, Wilson L, Dunlap JL, Getty R, Bennett J. Drug induced homicide laws may worsen opioid related harms: An example from rural North Carolina. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103406. [PMID: 34392113 DOI: 10.1016/j.drugpo.2021.103406] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 12/26/2022]
Abstract
Drug-induced homicide (DIH) laws typically allow for the prosecution of drug distribution resulting in an overdose fatality as equivalent to homicide or manslaughter. Despite vigorous debate about the appropriateness of DIH laws as a response to overdose, the public health impacts of this increasingly common prosecutorial strategy remain unknown. In this policy analysis, we take up the question of how DIH prosecutions impact local persons and communities through the lens of a high-profile DIH conviction that took place in Haywood County, a rural county located in the Appalachian region of western North Carolina. Describing insights gained from two unrelated but overlapping studies carried out in Haywood County, we identify several plausible mechanisms through which DIH laws may negatively impact public health. Among these are disruptions to the local drug market and deterrence from calling 911 when witnessing an overdose. With the number of DIH prosecutions growing rapidly, more research on the public health impacts of DIH laws is urgently needed.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology & Anthropology, North Carolina State University, 10 Current Drive, Suite 344, Raleigh, NC 27695-8107, United States; Department of Medicine, Brown University, 222 Richmond St, Providence, RI 02903, United States.
| | - Bayla Ostrach
- Medical Anthropology and Family Medicine, Boston University School of Medicine, 1 Boston Medical Center Pl, Boston, MA 02118, United States
| | - Loftin Wilson
- North Carolina Harm Reduction Coalition, 4024 Barrett Drive. Suite 101, Raleigh, NC 27609, United States
| | - Jesse Lee Dunlap
- Down Home North Carolina, 301 N. Haywood St, Waynesville, NC 28786, United States
| | - Reid Getty
- North Carolina Harm Reduction Coalition, 4024 Barrett Drive. Suite 101, Raleigh, NC 27609, United States
| | - Jesse Bennett
- North Carolina Harm Reduction Coalition, 4024 Barrett Drive. Suite 101, Raleigh, NC 27609, United States
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Hayes BT, Favaro J, Davis CS, Gonsalves GS, Beletsky L, Vlahov D, Heimer R, Fox AD. Harm Reduction, By Mail: the Next Step in Promoting the Health of People Who Use Drugs. J Urban Health 2021; 98:532-537. [PMID: 33710493 PMCID: PMC7953942 DOI: 10.1007/s11524-021-00534-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Benjamin T Hayes
- Division of General Internal Medicine, Montefiore Medical Center, 3300 Kossuth Ave., Bronx, NY, 10467, USA.
| | | | - Corey S Davis
- The Network for Public Health Law, Los Angeles, CA, USA
| | | | - Leo Beletsky
- School of Law, Bouve College of Health Sciences, and Health in Justice Action Lab, Northeastern University, Boston, MA, USA.,UCSD School of Medicine, La Jolla, CA, USA
| | - David Vlahov
- Yale School of Public Health, New Haven, CT, USA.,Yale School of Nursing, New Haven, CT, USA
| | | | - Aaron D Fox
- Division of General Internal Medicine, Montefiore Medical Center, 3300 Kossuth Ave., Bronx, NY, 10467, USA
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Ohringer AR, Serota DP, McLean RL, Stockman LJ, Watt JP. Disparities in risk perception and low harm reduction services awareness, access, and utilization among young people with newly reported hepatitis C infections in California, 2018. BMC Public Health 2021; 21:1435. [PMID: 34289822 PMCID: PMC8296725 DOI: 10.1186/s12889-021-11492-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/29/2021] [Indexed: 12/09/2022] Open
Abstract
Background Newly reported hepatitis C virus (HCV) infections in California increased 50% among people 15–29 years of age between 2014 and 2016. National estimates suggest this increase was due to the opioid epidemic and associated increases in injection drug use. However, most of California’s 61 local health jurisdictions (LHJs) do not routinely investigate newly reported HCV infections, so these individuals’ risk factors for infection are not well understood. We sought to describe the demographics, risk behaviors, and utilization of harm reduction services in California’s fastest-rising age group of people with newly reported hepatitis C infections to support targeted HCV prevention and treatment strategies. Methods California Department of Public Health invited LHJs to participate in enhanced surveillance if they met criteria indicating heightened population risk for HCV infection among people ages 15–29. From June–December 2018, eight LHJs contacted newly reported HCV cases by phone using a structured questionnaire. Results Among 472 total HCV cases who met the inclusion criteria, 114 (24%) completed an interview. Twenty-seven percent of respondents (n = 31) had ever been incarcerated, of whom 29% received a tattoo/piercing and 39% injected drugs while incarcerated. Among people who injected drugs (PWID)—36% (n = 41) of all respondents—68% shared injection equipment and many lacked access to harm reduction services: 37% knew of or ever used a needle exchange and 44% ever needed naloxone during an overdose but did not have it. Heroin was the most frequently reported injected drug (n = 30), followed by methamphetamine (n = 18). Pre-diagnosis HCV risk perception varied significantly by PWID status and race/ethnicity: 76% of PWID vs. 8% of non-PWID (p < 0.001), and 44% of non-Hispanic White respondents vs. 22% of people of color (POC) respondents (p = 0.011), reported thinking they were at risk for HCV before diagnosis. Eighty-nine percent of all respondents reported having health insurance, although only two had taken HCV antiviral medications. Conclusions Among young people with HCV, we found limited pre-diagnosis HCV risk perception and access to harm reduction services, with racial/ethnic disparities. Interventions to increase harm reduction services awareness, access, and utilization among young PWID, especially young PWID of color, may be warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11492-3.
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Affiliation(s)
- Alison R Ohringer
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA. .,Office of Viral Hepatitis Prevention, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, 850 Marina Bay Parkway, Building P, 2nd Floor, Richmond, CA, 94804, USA.
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rachel L McLean
- Office of Viral Hepatitis Prevention, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, 850 Marina Bay Parkway, Building P, 2nd Floor, Richmond, CA, 94804, USA.
| | - Lauren J Stockman
- Office of Viral Hepatitis Prevention, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, 850 Marina Bay Parkway, Building P, 2nd Floor, Richmond, CA, 94804, USA
| | - James P Watt
- Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA, USA
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12
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Uzwiak BA, Hudgins A, Pizzicato LN. Legacies of the war on drugs: Next of kin of persons who died of opioid overdose and harm reduction interventions in Philadelphia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103351. [PMID: 34252788 DOI: 10.1016/j.drugpo.2021.103351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Between the years 2017-2019 in Philadelphia, more than 70% of all deaths from opioid overdose occurred in a private residence. To learn more about home-based opioid use and overdose, researchers conducted qualitative interviews with next of kin of overdose victims to learn their perceptions about the decedent's drug use and their opinions about city-led harm reduction efforts, specifically naloxone administration and collaborative efforts to open an overdose prevention site. METHODS In 2019, researchers conducted 35 qualitative interviews with next of kin of persons who died of opioid overdose in Philadelphia in 2017. Data were coded and analyzed using NVivo software. RESULTS Data reveal that while persons who use drugs may benefit from enhanced harm reduction interventions that target their family members and caregivers including naloxone education and public health messaging about overdose prevention, these efforts may be up against other realities that Philadelphia families navigate-in particular structural inequalities exacerbated by decades of "War on Drugs" policies. CONCLUSION Existing health disparities and structural barriers to care increase vulnerability to overdose and highlight the urgency to collaborate with impacted families and communities to design relevant harm reduction interventions. Without efforts to redress the consequences of war on drug policies, however, harm reduction interventions will not reach their full potential.
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Affiliation(s)
| | | | - Lia N Pizzicato
- Division of Substance Use and Harm Reduction, Philadelphia Department of Public Health, United States
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Dayton L, Tobin K, Falade-Nwulia O, Davey-Rothwell M, Al-Tayyib A, Saleem H, Latkin C. Racial Disparities in Overdose Prevention among People Who Inject Drugs. J Urban Health 2020; 97:823-830. [PMID: 32514829 PMCID: PMC7704879 DOI: 10.1007/s11524-020-00439-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lauren Dayton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street M227, 2nd Floor, Baltimore, MD, 21205, USA.
| | - Karin Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street M227, 2nd Floor, Baltimore, MD, 21205, USA
| | - Oluwaseun Falade-Nwulia
- Department of Medicine - Infectious Disease, Johns Hopkins University School of Medicine, 725 N. Wolfe Street, Suite 215, Baltimore, MD, 21205, USA
| | - Melissa Davey-Rothwell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street M227, 2nd Floor, Baltimore, MD, 21205, USA
| | - Alia Al-Tayyib
- Denver Public Health, Denver Health and Hospital Authority, 601 Broadway, Denver, CO, 80203, USA
| | - Haneefa Saleem
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5033, Baltimore, MD, 21205, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street M227, 2nd Floor, Baltimore, MD, 21205, USA
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Fernández-Viña MH, Prood NE, Herpolsheimer A, Waimberg J, Burris S. State Laws Governing Syringe Services Programs and Participant Syringe Possession, 2014-2019. Public Health Rep 2020; 135:128S-137S. [PMID: 32735195 DOI: 10.1177/0033354920921817] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Law is an important factor in the diffusion of syringe services programs (SSPs). This study measures the current status of, and 5-year change in, state laws governing SSP operations and possession of syringes by participants. METHODS Legal researchers developed a cross-sectional data set measuring key features of state laws and regulations governing the possession and distribution of syringes across the 50 US states and the District of Columbia in effect on August 1, 2019. We compared these data with previously collected data on laws as of August 1, 2014. RESULTS Thirty-nine states (including the District of Columbia) had laws in effect on August 1, 2019, that removed legal impediments to, explicitly authorized, and/or regulated SSPs. Thirty-three states had 1 or more laws consistent with legal possession of syringes by SSP participants under at least some circumstances. Changes from 2014 to 2019 included an increase of 14 states explicitly authorizing SSPs by law and an increase of 12 states with at least 1 provision reducing legal barriers to SSPs. Since 2014, the number of states explicitly authorizing SSPs nearly doubled, and the new states included many rural, southern, or midwestern states that had been identified as having poor access to SSPs, as well as states at high risk for HIV and hepatitis C virus outbreaks. Substantial legal barriers to SSP operation and participant syringe possession remained in >20% of US states. CONCLUSION Legal barriers to effective operation of SSPs have declined but continue to hinder the prevention and reduction of drug-related harm.
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Affiliation(s)
- Marcelo H Fernández-Viña
- 6558 Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
| | - Nadya E Prood
- 6558 Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
| | - Adam Herpolsheimer
- 6558 Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
| | - Joshua Waimberg
- 6558 Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
| | - Scott Burris
- 6558 Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, PA, USA
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15
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“…I can use any syringe I find”: contextual determinants of HIV risk in public injecting settings in Nigeria. DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-05-2020-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to explore the contextual determinants of HIV risk among people who inject drugs (PWID) in public settings in Nigeria.
Design/methodology/approach
In-depth, individual interviews were conducted with 29 street-based PWID recruited through snowball sampling in Uyo, Nigeria. Interviews were tape-recorded, transcribed, coded and analysed hematically.
Findings
Homelessness and withdrawal pains encouraged consumption of drugs in public spaces (e.g. bunks, public parks). Conversely, the benefits of participation in street drug-use scenes, including reciprocity norms that guarantee free drugs during withdrawal and protection during overdose, fostered a preference for public injecting. Although participants recognized the need to inject with sterile syringes, scarcity of syringes compelled them to improvise with old syringes or share syringes, increasing risk for HIV transmission. HIV risk was exacerbated by unlawful and discriminatory policing practices, which deterred possession of syringes and encouraged risky behaviours such as rushing injection and sharing of equipment.
Practical implications
Contextual factors are key determinants of HIV risk for street-based PWID. Implementation of needle and syringe programmes as well as reforming legal frameworks and policing practices to support harm reduction are needed responses.
Originality/value
This is one of very few qualitative studies that explore risk factors for HIV transmission among PWID in West Africa. The focus on scarcity of sterile syringes and HIV risk is unique and has important policy implications.
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West BS, Becerra Ramirez M, Bristow CC, Abramovitz DA, Vera A, Staines H, Gudelia Rangel M, Patterson TL, Strathdee SA. Correlates of trichomoniasis among female sex workers who inject drugs in two Mexico-US border cities. Int J STD AIDS 2020; 31:866-875. [PMID: 32623979 DOI: 10.1177/0956462420929463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper evaluates correlates of trichomoniasis among female sex workers who inject drugs (FSWIDs) in two Mexico-US border cities. HIV-negative FSWIDs aged 18 years or older were enrolled in a study between 2008 and 2010 in Tijuana and Ciudad Juarez (Cd.), Mexico. All participants underwent a baseline interviewer-administered survey and did a rapid test for trichomoniasis. Using regression to estimate prevalence ratios, we examined sociodemographics, sex work characteristics, sexual health and behavior, substance use, and police and violence exposures as potential correlates of trichomoniasis. Of 584 women (284 in Tijuana, 300 in Cd. Juarez), prevalence of trichomoniasis was 33.6%. Factors associated with trichomoniasis in multivariable analysis were having money stolen by police in the past six months (adjusted prevalence ratio [aPR] =1.448, 95% confidence interval [CI] = 1.152-1.821), recent methamphetamine use (aPR = 1.432, CI = 1.055-1.944), lifetime syphilis infection (aPR = 1.360, CI = 1.061-1.743), ever use of a home remedy to treat vaginal symptoms (aPR = 1.301, CI = 1.027-1.649), and number of regular clients in the past month (aPR = 1.006 per client, CI = 1.004-1.009), while controlling for age and city of interview. Alongside the need for trichomoniasis surveillance and treatment programs, findings indicate that both structural and behavioral factors serve as primary correlates of trichomoniasis among FSWIDs in these cities.
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Affiliation(s)
- Brooke S West
- Columbia University School of Social Work, New York, NY, USA
| | - Milagros Becerra Ramirez
- Department of Family Medicine, University of California Los Angeles International Medical Graduate Program, Los Angeles, CA, USA
| | - Claire C Bristow
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Daniela A Abramovitz
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Alicia Vera
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Hugo Staines
- Departamento de Ciencias Médicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, México
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Department of Medicine, Division of Global Public Health, University of California San Diego, La Jolla, CA, USA
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Footer KHA, Silberzahn BE, Lim S, Huettner S, Kumar VA, Loeffler D, Peitzmeier SM, Sherman SG. "An ethnographic exploration of factors that drive policing of street-based female sex workers in a U.S. setting - identifying opportunities for intervention". BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:12. [PMID: 32410616 PMCID: PMC7227297 DOI: 10.1186/s12914-020-00232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 04/15/2020] [Indexed: 11/23/2022]
Abstract
Background Building on a broader sociological discourse around policing approaches towards vulnerable populations, increasing public health and human rights evidence points to policing practices as a key health determinant, particularly among street-based sex workers. Despite the importance of policing as a structural health determinant, few studies have sought to understand the factors that underlie and shape harmful policing practices towards sex workers. This study therefore aimed to explore the drivers for policing attitudes and practices towards street-based cisgender female sex workers. Methods Drawing on ethnographic methods, 280 h of observations with police patrol and 10 stakeholder interviews with senior police leadership in Baltimore City, USA were carried out to better understand the drivers for policing strategies towards cisgender female sex workers. Analysis was data- and theory-driven, drawing on the concepts of police culture and complementary criminological and sociological literature that aided exploration of the influence of the ecological and structural environment on policing practices. Results Ecological factors at the structural (e.g., criminalization), organizational (e.g., violent crime control), community and individual level (e.g., stigmatizing attitudes) emerged as key to shaping individual police practices and attitudes towards cisgender female sex workers in this setting. Findings indicate senior police support for increased alignment with public health and human rights goals. However, the study highlights that interventions need to move beyond individual officer training and address the broader structural and organizational setting in which harmful police practices towards sex work operate. Conclusions A more in-depth understanding of the circumstances that drive law enforcement approaches to street-based sex work is critical to the collaborative design of interventions with police in different settings. In considering public health-police partnerships to address the rights and health of sex worker populations in the U.S. and elsewhere, this study supports existing calls for decriminalization of sex work, supported by institutional and policy reforms, neighborhood-level dialogues that shift the cultural landscape around sex work within both the police and larger community, and innovative individual-level police trainings.
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Affiliation(s)
- Katherine H A Footer
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Bradley E Silberzahn
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Sahnah Lim
- New York University School of Medicine, Department of Population Health and Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Steven Huettner
- Johns Hopkins School of Medicine, Department of Pediatrics, 5200 Eastern Ave, Baltimore, MD, 21224, USA
| | - Victor A Kumar
- Johns Hopkins Krieger School of Arts and Sciences, Department of Anthropology, 466 Mergenthaler Hall, 3400 N. Charles Street, Baltimore, MD, 21218, USA
| | - Derek Loeffler
- Baltimore City Police Department, Northwestern District, 5271 Reistertown Road, Baltimore, MD, 21215, USA
| | - Sarah M Peitzmeier
- Johns Hopkins Bloomberg School of Publissc Health, Department of Population, Family, and Reproductive Health, Baltimore, MD, USA
| | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD, 21205, USA
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Footer KHA, Park JN, Rouhani S, Galai N, Silberzahn BE, Huettner S, Allen ST, Sherman SG. The development of the Police Practices Scale: Understanding policing approaches towards street-based female sex workers in a U.S. City. PLoS One 2020; 15:e0227809. [PMID: 31978164 PMCID: PMC6980607 DOI: 10.1371/journal.pone.0227809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 12/30/2019] [Indexed: 11/23/2022] Open
Abstract
Policing is an important structural determinant of HIV and other health risks faced by vulnerable populations, including people who sell sex and use drugs, though the role of routine police encounters is not well understood. Given the influence of policing on the risk environment of these groups, methods of measuring the aggregate impact of routine policing practices are urgently required. We developed and validated a novel, brief scale to measure police patrol practices (Police Practices Scale, PPS) among 250 street-based female sex workers (FSW) in Baltimore, Maryland, an urban setting with high levels of illegal drug activity. PPS items were developed from existing theory and ethnography with police and their encounters with FSW, and measured frequency of recent (past 3 months) police encounters. The 6-item scale was developed using exploratory factor analysis after examining the properties of the original 11 items. Confirmatory factor analysis was used to model the factor structure. A 2-factor model emerged, with law enforcement PPS items and police assistance PPS items loading on separate factors. Linear regression models were used to explore the relative distribution of these police encounters among FSW by modeling association with key socio-demographic and behavioral characteristics of the sample. Higher exposure to policing was observed among FSW who were homeless (β = 0.71, p = 0.037), in daily sex work (β = 1.32, p = 0.026), arrested in the past 12 months (β = 1.44, p<0.001) or injecting drugs in the past 3 months (β = 1.04, p<0.001). The PPS provides an important and novel contribution in measuring aggregate exposure to routine policing, though further validation is required. This scale could be used to evaluate the impact of policing on vulnerable populations’ health outcomes, including HIV risk.
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Affiliation(s)
- Katherine H. A. Footer
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
- * E-mail:
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Bradley E. Silberzahn
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Steven Huettner
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, United States of America
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19
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West BS, Abramovitz DA, Gonzalez-Zuniga P, Rangel G, Werb D, Cepeda J, Beletsky L, Strathdee SA. Drugs, discipline and death: Causes and predictors of mortality among people who inject drugs in Tijuana, 2011-2018. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 75:102601. [PMID: 31775080 PMCID: PMC6957706 DOI: 10.1016/j.drugpo.2019.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/17/2019] [Accepted: 11/10/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND People who inject drugs (PWID) experience multiple risk factors for mortality; yet, we know little about causes of death among PWID in Tijuana, Mexico, an area with high levels of injecting and changes in policy/law enforcement responses to substance use. This study examines rates, causes, and predictors of mortality among Tijuana PWID. METHODS Data come from a community-based cohort of PWID aged ≥18 who injected drugs in the past month. Mortality was confirmed by death certificate over 78 months during 2011-2018. Predictors of mortality were identified using time-updated Cox regression, controlling for age. RESULTS Among 734 participants, there were 130 deaths (54 confirmed, 76 unconfirmed), with an incidence rate of 17.74 deaths per 1000 person-years for confirmed deaths (95% Confidence Interval (CI)=13.01, 22.48) and 39.52 for unconfirmed deaths (CI=32.72, 46.31). Confirmed deaths resulted from homicide/trauma (26%), overdose (26%), septic shock (18%) and HIV-related causes (9%). In multivariable analysis of confirmed deaths, baseline HIV seropositivity (adjusted Hazard Ratio [aHR]=6.77, CI=1.98, 23.17), incident HIV infection (aHR=3.19, CI=1.02, 9.96), and number of times being beaten by police in the past 6 months at baseline (aHR=1.08 per time, CI=1.04, 1.12) were predictive of death; whereas, injection cessation for 6+ months during time at risk (aHR=0.25, CI=0.33, 0.79) was protective. CONCLUSION In addition to overdose and HIV prevention efforts, attention to structural conditions that potentiate mortality is needed, including improved access to medication-assisted treatment to support injection cessation and a shift from police as a source of harm to harm reduction.
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Affiliation(s)
- Brooke S West
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, United States; Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States.
| | - Daniela A Abramovitz
- Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Patricia Gonzalez-Zuniga
- Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States
| | | | - Dan Werb
- Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States; Northeastern University School of Law and Bouvé College of Health Sciences, Boston, MA, United States
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health in the Department of Medicine, University of California San Diego, San Diego, CA, United States
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Collins AB, Boyd J, Mayer S, Fowler A, Kennedy MC, Bluthenthal RN, Kerr T, McNeil R. Policing space in the overdose crisis: A rapid ethnographic study of the impact of law enforcement practices on the effectiveness of overdose prevention sites. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 73:199-207. [PMID: 31542327 PMCID: PMC7147938 DOI: 10.1016/j.drugpo.2019.08.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/14/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
North America is in the midst of an overdose crisis. In some of the hardest hit areas of Canada, local responses have included the implementation of low-threshold drug consumption facilities, termed Overdose Prevention Sites (OPS). In Vancouver, Canada the crisis and response occur in an urban terrain that is simultaneously impacted by a housing crisis in which formerly 'undesirable' areas are rapidly gentrifying, leading to demands to more closely police areas at the epicenter of the overdose crisis. We examined the intersection of street-level policing and gentrification and how these practices re/made space in and around OPS in Vancouver's Downtown Eastside neighborhood. Between December 2016 and October 2017, qualitative interviews were conducted with 72 people who use drugs (PWUD) and over 200 h of ethnographic fieldwork were undertaken at OPS and surrounding areas. Data were analyzed thematically and interpreted by drawing on structural vulnerability and elements of social geography. While OPS were established within existing social-spatial practices of PWUD, gentrification strategies and associated police tactics created barriers to OPS services. Participants highlighted how fear of arrest and police engagement necessitated responding to overdoses alone, rather than engaging emergency services. Routine policing near OPS and the enforcement of area restrictions and warrant searches, often deterred participants from accessing particular sites. Further documented was an increase in the number of police present in the neighborhood the week of, and the week proceeding, the disbursement of income assistance cheques. Our findings demonstrate how some law enforcement practices, driven in part by ongoing gentrification efforts and buttressed by multiple forms of criminalization present in the lives of PWUD, limited access to needed overdose-related services. Moving away from place-based policing practices, including those driven by gentrification, will be necessary so as to not undermine the effectiveness of life-saving public health interventions amid an overdose crisis.
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Affiliation(s)
- Alexandra B Collins
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Al Fowler
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Mary Clare Kennedy
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z9, Canada
| | - Ricky N Bluthenthal
- Department of Preventive Medicine Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, United States
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
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Davis CS, Carr DH, Samuels EA. Paraphernalia Laws, Criminalizing Possession and Distribution of Items Used to Consume Illicit Drugs, and Injection-Related Harm. Am J Public Health 2019; 109:1564-1567. [PMID: 31536408 DOI: 10.2105/ajph.2019.305268] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The United States remains in the grip of an unprecedented epidemic of drug-related harm. Infections of HIV, hepatitis C, and endocarditis related to lack of access to new syringes and subsequent syringe sharing among people who inject drugs have increased alongside a surge in opioid overdose deaths.Overwhelming evidence shows that using a new syringe with every injection prevents injection-related blood-borne disease transmission. Additionally, there is promising research suggesting that the distribution of fentanyl test strips to people who inject drugs changes individuals' injection decisions, which enables safer drug use and reduces the risk of fatal overdose. However, laws prohibiting the possession of syringes and fentanyl test strips persist in nearly every state.The full and immediate repeal of state paraphernalia laws is both warranted and needed to reduce opioid overdose death and related harms. Such repeal would improve the health of people who inject drugs and those with whom they interact, reducing the spread of blood-borne disease and fatal overdose associated with infiltration of illicitly manufactured fentanyl into the illicit drug supply. It would also free up scarce public resources that could be redirected toward evidence-based approaches to reducing drug-related harm.
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Affiliation(s)
- Corey S Davis
- Corey S. Davis and Derek H. Carr are with the Network for Public Health Law, Los Angeles, CA. Corey S. Davis is also with the Brody School of Medicine, East Carolina University, Greenville, NC. Elizabeth A. Samuels is with the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Derek H Carr
- Corey S. Davis and Derek H. Carr are with the Network for Public Health Law, Los Angeles, CA. Corey S. Davis is also with the Brody School of Medicine, East Carolina University, Greenville, NC. Elizabeth A. Samuels is with the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - Elizabeth A Samuels
- Corey S. Davis and Derek H. Carr are with the Network for Public Health Law, Los Angeles, CA. Corey S. Davis is also with the Brody School of Medicine, East Carolina University, Greenville, NC. Elizabeth A. Samuels is with the Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI
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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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Davis SM, Kristjansson AL, Davidov D, Zullig K, Baus A, Fisher M. Barriers to using new needles encountered by rural Appalachian people who inject drugs: implications for needle exchange. Harm Reduct J 2019; 16:23. [PMID: 30940136 PMCID: PMC6444507 DOI: 10.1186/s12954-019-0295-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/20/2019] [Indexed: 01/28/2023] Open
Abstract
Background Using a new needle for every injection can reduce the spread of infectious disease among people who inject drugs (PWID). No previous study has examined new needle use barriers among PWIDs residing in the rural Appalachian part of the United States, an area currently in the midst of a heroin epidemic. Objective Therefore, our primary aim was to explore self-reported barriers to using a new needle by PWID attending a needle exchange program (NEP). Methods We conducted a cross-sectional survey of PWID attending two NEPs in rural West Virginia located in the heart of Central Appalachia. A convenience sample of PWID (n = 100) completed the Barriers to Using New Needles Questionnaire. Results The median number of barriers reported was 5 (range 0–19). Fear of arrest by police (72% of PWID “agreed” or “strongly agreed”) and difficulty with purchasing needles from a pharmacy (64% “agreed” or “strongly agreed”) were the most frequently cited barriers. Conclusions/Importance Congruent with previous findings from urban locations, in rural West Virginia, the ability of PWID to use a new needle obtained from a needle exchange for every injection may be compromised by fear of arrest. In addition, pharmacy sales of new needles to PWID may be blunted by an absence of explicit laws mandating nonprescription sales. Future studies should explore interventions that align the public health goals of NEPs with the occupational safety of law enforcement and health outreach goals of pharmacists. Electronic supplementary material The online version of this article (10.1186/s12954-019-0295-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen M Davis
- Department of Health Policy, Management, and Leadership, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA. .,Department of Emergency Medicine, West Virginia University, PO Box 9149, Morgantown, WV, 26506, USA.
| | - Alfgeir L Kristjansson
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Danielle Davidov
- Department of Emergency Medicine, West Virginia University, PO Box 9149, Morgantown, WV, 26506, USA.,Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Keith Zullig
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Adam Baus
- Department of Social and Behavioral Sciences, West Virginia University, PO Box 9190, Morgantown, WV, 26506, USA
| | - Melanie Fisher
- Department of Medicine, Section of Infectious Diseases, West Virginia University, PO Box 9163, Morgantown, WV, 26506, USA
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Tempalski B, Cooper HLF, Kelley ME, Linton SL, Wolfe ME, Chen YT, Ross Z, Des Jarlais DC, Friedman SR, Williams LD, Semaan S, DiNenno E, Wejnert C, Broz D, Paz-Bailey G. Identifying Which Place Characteristics are Associated with the Odds of Recent HIV Testing in a Large Sample of People Who Inject Drugs in 19 US Metropolitan Areas. AIDS Behav 2019; 23:318-335. [PMID: 29971735 PMCID: PMC6318077 DOI: 10.1007/s10461-018-2217-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This exploratory analysis investigates relationships of place characteristics to HIV testing among people who inject drugs (PWID). We used CDC's 2012 National HIV Behavioral Surveillance (NHBS) data among PWID from 19 US metropolitan statistical areas (MSAs); we restricted the analytic sample to PWID self-reporting being HIV negative (N = 7477). Administrative data were analyzed to describe the 1. Sociodemographic Composition; 2. Economic disadvantage; 3. Healthcare Service/Law enforcement; and 4. HIV burden of the ZIP codes, counties, and MSAs where PWID lived. Multilevel models tested associations of place characteristics with HIV testing. Fifty-eight percent of PWID reported past-year testing. MSA-level per capita correctional expenditures were positively associated with recent HIV testing among black PWID, but not white PWID. Higher MSA-level household income and imbalanced sex ratios (more women than men) in the MSA were associated with higher odds of testing. HIV screening for PWID is suboptimal (58%) and needs improvement. Identifying place characteristics associated with testing among PWID can strengthen service allocation and interventions in areas of need to increase access to HIV testing.
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Affiliation(s)
- Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA.
| | - Hannah L F Cooper
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Mary E Kelley
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Sabriya L Linton
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Mary E Wolfe
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Yen-Tyng Chen
- Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Zev Ross
- ZevRoss SpatialAnalysis, 120 N Aurora St, Suite 3A, Ithaca, NY, 14850, USA
| | - Don C Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, 39 Broadway, Suite 530, New York, NY, 10006, USA
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Leslie D Williams
- Institute for Infectious Disease Research, National Development and Research Institutes (NDRI), Inc., 71 West 23rd Street, 4th Fl, New York, NY, 10010, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Elizabeth DiNenno
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Cyprian Wejnert
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Dita Broz
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
| | - Gabriela Paz-Bailey
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-46, Atlanta, GA, 30333, USA
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Park JN, Linton SL, Sherman SG, German D. Police violence among people who inject drugs in Baltimore, Maryland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 64:54-61. [PMID: 30579221 DOI: 10.1016/j.drugpo.2018.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 09/15/2018] [Accepted: 12/04/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Police violence is a deleterious public health and criminal justice issue that disproportionately affects people who inject drugs (PWID). Studies documenting the prevalence and correlates of physical police violence in this population are rare. The aim of this study was to examine the correlates of past year physical police violence among an urban sample of PWID. METHODS PWID participating in the 2015 wave of the National HIV Behavioral Surveillance (NHBS) system in Baltimore City, Maryland, completed a socio-behavioral survey. Multivariable logistic regression was used to detect the socio-demographic, place-based, law-enforcement and health behavior correlates of exposure to police violence as well as knowledge of violence directed towards other PWID. RESULTS Enrolled PWID (N = 570) were mostly male (72%), non-Hispanic Black (77%) and daily heroin injectors (86%). Seven percent had experienced past year physical police violence (Respondent-Driven Sampling [RDS] weighted estimate: 4%), and a quarter (24%) knew someone who had experienced physical police violence in the past year (RDS-weighted estimate: 17%). Male gender, homelessness, arrest, drug paraphernalia confiscation, and receptive syringe sharing were independently associated with police violence. Knowing someone who had experienced police violence was independently correlated with selling drugs, arrest, and attending a syringe services program. CONCLUSION Population differences in the extent of police violence exposure indicate that experiences of police violence are not uniform among PWID. Violent encounters with police were associated with disruptions in harm reduction strategies that can prevent HIV and HCV transmission. This study adds to the small body of public health literature on police violence and highlights the importance of monitoring and addressing this critical issue.
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Affiliation(s)
- Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205, USA.
| | - Sabriya L Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore MD 21205, USA
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26
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Reddon H, Marshall BDL, Milloy MJ. Elimination of HIV transmission through novel and established prevention strategies among people who inject drugs. Lancet HIV 2018; 6:e128-e136. [PMID: 30558843 DOI: 10.1016/s2352-3018(18)30292-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/01/2018] [Accepted: 10/12/2018] [Indexed: 11/16/2022]
Abstract
Despite the effectiveness of existing HIV prevention strategies for people who inject drugs (PWID), uncontrolled outbreaks of HIV among this group are common and occur around the world. In this Review, we summarise recent evidence for novel and established HIV prevention approaches to eliminate HIV transmission among PWID. Effective HIV prevention strategies include mobile needle and syringe programmes, pre-exposure prophylaxis, supervised injection facilities, and, to a lesser extent, some behavioural interventions. Studies have also shown the cost-effectiveness of long-standing HIV prevention strategies including needle and syringe programmes, opioid agonist therapy, and antiretroviral therapy for prevention. Although each individual intervention can reduce the risk of HIV acquisition among PWID, there is a consensus that a combination of approaches is required to achieve substantial and durable reductions in HIV transmission. Unfortunately, in many settings, the implementation of these interventions is often limited by public and political opposition that manifests as structural barriers to HIV prevention, such as the criminalisation of drug use. Given that there is ample evidence showing the effectiveness of several HIV prevention methods, social and political advocacy will be needed to overcome these barriers and integrate innovative HIV prevention approaches with addiction science to create effective drug policies.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada.
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27
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Watson TM, Bayoumi AM, Hopkins S, Wright A, Naraine R, Khorasheh T, Challacombe L, Strike C. Creating and sustaining cooperative relationships between supervised injection services and police: A qualitative interview study of international stakeholders. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 61:1-6. [PMID: 30290363 DOI: 10.1016/j.drugpo.2018.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/27/2018] [Accepted: 08/06/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Supervised injection services (SIS) operate with special exemptions from drug law enforcement. Given the expansion of SIS and the opioid overdose crisis in numerous jurisdictions, now is a critical time to examine factors that contribute to cooperative SIS-police relationships. We sought to learn about SIS-police relationships from international jurisdictions with well-established as well as newer SIS. METHODS We conducted 16 semi-structured telephone interviews with SIS managers (n = 10) and police liaisons (n = 6) from 10 cities in seven different countries (Australia, Canada, Denmark, France, Germany, Netherlands, and Spain). All participants provided informed consent. We focused our coding and analysis on themes that emerged from the data. RESULTS Five key contributors to cooperative SIS-police relationships emerged from the data: early engagement and dialogues; supportive police chiefs; dedicated police liaisons; negotiated boundary agreements; and regular face-to-face contact. Most participants perceived the less formalised, on-the-ground approach to relationship-building between police and SIS adopted in their city to be working well in general. SIS managers and police participants reported a lack of formal police training on harm reduction, and some thought that training was unnecessary given the relatively positive local SIS-police relationships they reported. CONCLUSION Our qualitative study provides new, in-depth empirical examples of how police in varied international jurisdictions can come to accept and work cooperatively with, not against, SIS staff and clients. Investing ongoing effort in SIS-police relationships, in a manner that best suits local needs, may hold greater and more sustainable public health value than delivering specific curricula to police.
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Affiliation(s)
- Tara Marie Watson
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Ahmed M Bayoumi
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M6, Canada; Division of General Internal Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
| | - Shaun Hopkins
- The Works, Toronto Public Health, 277 Victoria Street, Toronto, Ontario, M5B 1W2, Canada.
| | - Amy Wright
- The Works, Toronto Public Health, 277 Victoria Street, Toronto, Ontario, M5B 1W2, Canada.
| | - Renuka Naraine
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Triti Khorasheh
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Laurel Challacombe
- CATIE, 555 Richmond Street West, Suite 505, Toronto, Ontario, M5V 3B1, Canada.
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
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Des Jarlais DC, Cooper HLF, Arasteh K, Feelemyer J, McKnight C, Ross Z. Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US. PLoS One 2018; 13:e0194799. [PMID: 29596464 PMCID: PMC5875800 DOI: 10.1371/journal.pone.0194799] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/10/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE We identified potential geographic "hotspots" for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an "end of the epidemic" stage, while HCV is in a continuing, high prevalence (> 50%) stage. METHODS We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011-2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential "hotspots" for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk-passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk-injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. RESULTS Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. DISCUSSION For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.
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Affiliation(s)
- D. C. Des Jarlais
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - H. L. F. Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - K. Arasteh
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - J. Feelemyer
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - C. McKnight
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Z. Ross
- ZevRoss Spatial Analysis, Ithaca, New York, United States of America
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Racial Inequities in HIV Prevalence and Composition of Risk Networks Among People Who Inject Drugs in HIV Prevention Trial Network 037. J Acquir Immune Defic Syndr 2018; 76:394-401. [PMID: 28816720 DOI: 10.1097/qai.0000000000001521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND HIV prevention interventions in the United States have failed to eliminate racial inequities. Here, we evaluate factors associated with racial inequities in HIV prevalence among people who inject drugs using HIV Prevention Trial Network 037 data. METHODS We measured racial homophily (ie, all members share the same race), being in an HIV+ network (network with ≥1 HIV+ member), and drug and sex risk behaviors. A 2-level logistic regression with a random intercept evaluated the association between being in an HIV+ network and race adjusting for individual-level and network-level factors. RESULTS Data from 232 index participants and 464 network members were included in the analysis. Racial homophily was high among blacks (79%) and whites (70%); 27% of all-black, 14% of all-white, and 23% of racially mixed networks included HIV+ members. Sex risk was similar across networks, but needle sharing was significantly lower in all-black (23%) compared with all-white (48%) and racially mixed (46%) networks. All-black [adjusted odds ratio (AOR), 3.6; 95% confidence interval (CI), 1.4 to 9.5] and racially mixed (AOR, 2.0; 95% CI: 1.1 to 3.7) networks were more likely to include HIV+ network members; other factors associated with being in HIV+ network included homelessness (AOR, 2.0; 95% CI, 1.2 to 3.2), recent incarceration (AOR, 0.4; 95% CI, 0.2 to 0.7), and cocaine injection (AOR, 1.7; 95% CI, 1.0 to 2.7). Risk behaviors were not associated with being in an HIV+ network. CONCLUSION Despite having lower drug risk behavior, all-black networks disproportionately included HIV+ members. HIV prevention interventions for people who inject drugs need to go beyond individual risk and consider the composition of risk networks.
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DeCuir J, Lovasi GS, El-Sayed A, Lewis CF. The association between neighborhood socioeconomic disadvantage and high-risk injection behavior among people who inject drugs. Drug Alcohol Depend 2018; 183:184-191. [PMID: 29288913 PMCID: PMC5927611 DOI: 10.1016/j.drugalcdep.2017.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/25/2017] [Accepted: 10/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although much research has been conducted on the determinants of HIV risk behavior among people who inject drugs (PWID), the influence of the neighborhood context on high-risk injection behavior remains understudied. To address this gap in the literature, we measured associations between neighborhood socioeconomic disadvantage and high-risk injection behavior, and determined whether these associations were modified by drug-related police activity and syringe exchange program (SEP) accessibility. METHODS Our sample was comprised of 484 pharmacy-recruited PWID in New York City. Measures of neighborhood socioeconomic disadvantage were created using data from the 2006-2010 American Community Survey. Associations with high-risk injection behavior were estimated using multivariable Poisson regression. Effect modification by drug-related police activity and SEP accessibility was assessed by entering cross-product terms into adjusted models of high-risk injection behavior. RESULTS Neighborhood socioeconomic disadvantage was associated with decreased receptive syringe sharing and unsterile syringe use. In neighborhoods with high drug-related police activity, associations between neighborhood disadvantage and unsterile syringe use were attenuated to the null. In neighborhoods with high SEP accessibility, neighborhood disadvantage was associated with decreased acquisition of syringes from an unsafe source. CONCLUSIONS PWID in disadvantaged neighborhoods reported safer injection behaviors than their counterparts in neighborhoods that were relatively better off. The contrasting patterns of effect modification by SEP accessibility and drug-related police activity support the use of harm reduction approaches over law enforcement-based strategies for the control of blood borne virus transmission among PWID in disadvantaged urban areas.
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Affiliation(s)
- Jennifer DeCuir
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W 168th St, New York, NY, 10032, USA.
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31
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Marotta PL, McCullagh CA. A cross-national analysis of the association between years of implementation of opioid substitution treatments and drug-related deaths in Europe from 1995 to 2013. Eur J Epidemiol 2017; 33:679-688. [PMID: 29234968 DOI: 10.1007/s10654-017-0342-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 12/06/2017] [Indexed: 12/23/2022]
Abstract
Data at the individual-level provide evidence that opioid substitution treatment (OST) programs protect against mortality for opioid dependent populations. Prior research has not examined the merits of national implementation of opioid substitution programs for reducing mortality at the country-level. This study elucidates longitudinal associations between country-level implementation of opioid substitution treatment programs on mortality rates of drug related deaths (DRD) from 1995 to 2013 in 30 European nations. Cases of DRD were measured using National Definitions for each country from official sources of data. Preliminary analysis of dispersion of cases of DRD using means and variances justified use of the negative binomial regression model with a population offset. Year and country-level fixed effects negative binomial regression models investigated the association between years of implementation of methadone maintenance therapy (MMT), OST in prison, and high dose buprenorphine treatment (HDBT) implementation and mortality rates from drug related deaths after adjusting for unemployment rates, heroin seizures and per capita expenditures on health. Beta coefficients were converted to Incidence Rate Ratios (IRR) and standard errors bootstrapped using non-parametric methods to adjust for bias (SDbs). The mean mortality rate of DRD was 1.81 from 1995 to 2013. In adjusted models, each additional year of MMT (IRR = .61, SD = .04, p < .001; SDbs = .08, p < .001), prison OST (IRR = .90, SD = .01, p < .001; SDbs = .02, p < .001), and HDBT (IRR = .09, SD = .02, p < .001; SDbs = .02, p < .01) was significantly associated with lower rates of DRDs after adjusting for country and year fixed effects. Implementation of OST programs in the general population and in prison settings may have protected against mortality from drug use at the country-level in Europe from 1995 to 2013.
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Affiliation(s)
- Phillip L Marotta
- School of Social Work, New York, NY, USA.
- Columbia University, New York, NY, USA.
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Dertadian G, Iversen J, Dixon TC, Sotiropoulos K, Maher L. Pharmaceutical opioid use among oral and intravenous users in Australia: A qualitative comparative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 41:51-58. [PMID: 28107670 DOI: 10.1016/j.drugpo.2016.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/13/2016] [Accepted: 12/13/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Between 1992 and 2012 dispensing episodes for pharmaceutical opioids (PO) in Australia increased from 500000 to 7500000. In the US, increases in the prescription of PO have been linked to increases in opioid-related morbidity and mortality and transitions to heroin injection. However, Australian data indicate that morbidity and mortality related to PO are relatively low, particularly when compared to heroin and other drugs. This paper explores the characteristics and patterns of non-medical pharmaceutical opioid (NMPO) use among a sample of young people in Sydney, Australia. METHODS During 2015, we conducted in-depth qualitative interviews with 34 young people who use PO non-medically by oral (n=22) and intravenous (n=12) routes of administration. RESULTS Oral NMPO users were a more affluent group who clustered around the Northern, Inner and Eastern suburbs of Sydney, while the intravenous users came from a range of locations including rural/regional areas of NSW and socioeconomically disadvantaged suburbs of South Western Sydney. Oral users were characterised by intermittent and largely self-limiting NMPO use and reported few health and social consequences. Intravenous users reported heavy and frequent drug, including NMPO, use and a range of adverse health and social consequences including overdose, injecting risk behaviour, hepatitis C virus (HCV) infection and residential instability. CONCLUSION Results highlight the significance of social and structural factors in trajectories of opioid use and related harms. Factors such as stable housing and family relationships, disposable income and close social networks observed in young oral NMPO users may help to explain differences in patterns of NMPO use and related outcomes between the two groups.
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Affiliation(s)
- George Dertadian
- Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW, Australia, Sydney, Australia; School of Social Sciences and Psychology, Western Sydney University, Australia.
| | - Jenny Iversen
- Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW, Australia, Sydney, Australia
| | | | | | - Lisa Maher
- Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW, Australia, Sydney, Australia
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Declining trends in exposures to harmful policing among people who inject drugs in Vancouver, Canada. J Int AIDS Soc 2016; 19:20729. [PMID: 27435707 PMCID: PMC4951540 DOI: 10.7448/ias.19.4.20729] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 04/03/2016] [Accepted: 04/24/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction In 2006, the Vancouver Police Department (VPD) developed an organization-wide drug policy approach, which included endorsing harm reduction strategies for people who inject drugs (PWID). We sought to examine rates of potentially harmful policing exposures and associated HIV risk behaviour among PWID in Vancouver, Canada before and after the VPD policy change. Methods Data were derived from two prospective cohort studies of PWID. Multivariable generalized estimating equation models were used to examine changes in the risk of confiscation of drug use paraphernalia and physical violence by the police, as well as changes in the relationship between exposures to the two policing practices and sharing of drug use paraphernalia, before and after the policy change. Results Among 2193 participants, including 757 (34.5%) women, the rates of experiencing police confiscation of drug use paraphernalia declined from 22.3% in 2002 to 2.8% in 2014, and the rates of reporting experiencing physical violence by the police also declined from 14.1% in 2004 to 2.9% in 2014. In multivariable analyses, the post-policy change period remained independently and negatively associated with reports of confiscation of drug use paraphernalia (adjusted odds ratio (AOR): 0.25; 95% confidence interval (CI): 0.21 to 0.31) and reported physical violence by the police (AOR: 0.76; 95% CI: 0.63 to 0.91). However, experiencing both confiscation of drug use paraphernalia and physical violence by the police (AOR: 1.92; 95% CI: 1.10 to 3.33) and experiencing only confiscation of drug use paraphernalia (AOR: 1.71; 95% CI: 1.34 to 2.19) remained independently and positively associated with sharing of drug use paraphernalia during the post-policy change period. Conclusions In our study, two policing practices known to increase HIV risk among PWID have declined significantly since the local police launched an evidence-based drug policy approach. However, these practices remained independently associated with elevated HIV risk after the post-policy change. Although there remains a continued need to ensure that policing activities do not undermine public health efforts, these findings demonstrate that a major shift towards a public health approach to policing is possible for a municipal police force.
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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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Werb D, Strathdee SA, Vera A, Arredondo J, Beletsky L, Gonzalez-Zuniga P, Gaines T. Spatial patterns of arrests, police assault and addiction treatment center locations in Tijuana, Mexico. Addiction 2016; 111:1246-56. [PMID: 26879179 PMCID: PMC4899159 DOI: 10.1111/add.13350] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/06/2015] [Accepted: 02/10/2016] [Indexed: 12/19/2022]
Abstract
AIMS In the context of a public health-oriented drug policy reform in Mexico, we assessed the spatial distribution of police encounters among people who inject drugs (PWID) in Tijuana, determined the association between these encounters and the location of addiction treatment centers and explored the association between police encounters and treatment access. DESIGN Geographically weighted regression (GWR) and logistic regression analysis using prospective spatial data from a community-recruited cohort of PWID in Tijuana and official geographical arrest data from the Tijuana Municipal Police Department. SETTING Tijuana, Mexico. PARTICIPANTS A total of 608 participants (median age 37; 28.4% female) in the prospective Proyecto El Cuete cohort study recruited between January and December 2011. MEASUREMENTS We compared the mean distance of police encounters and a randomly distributed set of events to treatment centers. GWR was undertaken to model the spatial relationship between police interactions and treatment centers. Logistic regression analysis was used to investigate factors associated with reporting police interactions. FINDINGS During the study period, 27.5% of police encounters occurred within 500 m of treatment centers. The GWR model suggested spatial correlation between encounters and treatment centers (global R(2) = 0.53). Reporting a need for addiction treatment was associated with reporting arrest and police assault [adjusted odds ratio = 2.74, 95% confidence interval (CI) = 1.25-6.02, P = 0.012]. CONCLUSIONS A geospatial analysis suggests that, in Mexico, people who inject drugs are at greater risk of being a victim of police violence if they consider themselves in need of addiction treatment, and their interactions with police appear to be more frequent around treatment centers.
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Affiliation(s)
- Dan Werb
- Division of Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
| | - Alicia Vera
- Division of Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
| | - Jaime Arredondo
- Division of Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
| | - Leo Beletsky
- Division of Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
- Northeastern University School of Law and Bouvé College of Health Sciences, Boston, MA, USA
| | - Patricia Gonzalez-Zuniga
- Division of Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
| | - Tommi Gaines
- Division of Global Public Health, Department of Medicine, University of California, San Diego, CA, USA
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Abstract
Police brutality, a longstanding civil rights issue, has returned to the forefront of American public debate. A growing body of public health research shows that excessive use of force by police and racial profiling have adverse effects on health for African Americans and other marginalized groups. Yet, interventions to monitor unlawful policing have been met with fierce opposition at the federal, state, and local levels. On April 30, 2015, the mayor of Newark, New Jersey signed an executive order establishing a Civilian Complaint Review Board (CCRB) to monitor the Newark Police Department (NPD). Using a mixed-methods approach, this study examined how advocates and government actors accomplished this recent policy change in the face of police opposition and after a 50-year history of unsuccessful attempts in Newark. Drawing on official public documents, news media, and interviews conducted in April and May 2015, I propose that: (1) a Department of Justice investigation of the NPD, (2) the activist background of the Mayor and his relationships with community organizations, and (3) the momentum provided by the national Black Lives Matter movement were pivotal in overcoming political obstacles to reform. Examining the history of CCRB adoption in Newark suggests when and where advocates may intervene to promote policing reforms in other US cities.
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Mazhnaya A, Bojko MJ, Marcus R, Filippovych S, Islam Z, Dvoriak S, Altice FL. In Their Own Voices: Breaking the Vicious Cycle of Addiction, Treatment and Criminal Justice Among People who Inject Drugs in Ukraine. DRUGS (ABINGDON, ENGLAND) 2016; 23:163-175. [PMID: 27458326 PMCID: PMC4957015 DOI: 10.3109/09687637.2015.1127327] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 11/27/2015] [Indexed: 11/13/2022]
Abstract
AIMS To understand how perceived law enforcement policies and practices contribute to the low rates of utilization of opioid agonist therapies (OAT) among people who inject drugs (PWIDs) in Ukraine. METHODS Qualitative data from 25 focus groups (FGs) with 199 opioid-dependent PWIDs in Ukraine examined domains related to lived or learned experiences with OAT, police, arrest, incarceration, and criminal activity were analyzed using grounded theory principles. FINDINGS Most participants were male (66%), in their late 30s, and previously incarcerated (85%) mainly for drug-related activities. When imprisoned, PWIDs perceived themselves as being "addiction-free". After prison-release, the confluence of police surveillance, societal stress contributed to participants' drug use relapse, perpetuating a cycle of searching for money and drugs, followed by re-arrest and re-incarceration. Fear of police and arrest both facilitated OAT entry and simultaneously contributed to avoiding OAT since system-level requirements identified OAT clients as targets for police harassment. OAT represents an evidence-based option to 'break the cycle', however, law enforcement practices still thwart OAT capacity to improve individual and public health. CONCLUSION In the absence of structural changes in law enforcement policies and practices in Ukraine, PWIDs will continue to avoid OAT and perpetuate the addiction cycle with high imprisonment rates.
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Affiliation(s)
- Alyona Mazhnaya
- ICF International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
| | - Martha J. Bojko
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Ruthanne Marcus
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | | | | | - Sergey Dvoriak
- Ukrainian Institute for Public Health Policy, Kyiv, Ukraine
| | - Frederick L. Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
- Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
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Markwick N, McNeil R, Small W, Kerr T. Exploring the Public Health Impacts of Private Security Guards on People Who Use Drugs: a Qualitative Study. J Urban Health 2015; 92:1117-30. [PMID: 26453195 PMCID: PMC4675737 DOI: 10.1007/s11524-015-9992-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Private security guards occupy an increasingly prominent role in the policing of private and public spaces. There are growing concerns regarding security guards' potential to shape violence, discrimination, and adverse health outcomes among vulnerable populations, including people who use drugs (PWUD). This is relevant in Vancouver, Canada, where private security guards have increasingly been employed by private organizations to manage public and private spaces, including those within urban drug scenes. This qualitative study sought to understand interactions between PWUD and private security guards and explore their impacts on health care access, risks, and harms among PWUD. Semi-structured interviews were conducted with 30 PWUD recruited from two ongoing prospective cohort studies. Interviews were transcribed and analyzed using a coding framework comprised of a priori and emergent categories. Study data indicate that participants experience pervasive, discriminatory profiling and surveillance by security guards, which exacerbates existing social marginalization and structural vulnerability, particularly among PWUD of Aboriginal ancestry. Participants reported that security guards restrict PWUD's access to public and private spaces, including pharmacies and hospitals. PWUD also reported that their interactions with security guards often involved interpersonal violence and aggression, experiences that served to increase their vulnerability to subsequent risks and harms. Our findings highlight that private security forces contribute significantly to the everyday violence experienced by PWUD within drug scenes and elsewhere and do so in a manner very similar to that of traditional police forces. These findings point to the urgent need for greater oversight and training of private security guards in order to protect the health and safety of PWUD.
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Affiliation(s)
- Nicole Markwick
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Lunze K, Lunze FI, Raj A, Samet JH. Stigma and Human Rights Abuses against People Who Inject Drugs in Russia--A Qualitative Investigation to Inform Policy and Public Health Strategies. PLoS One 2015; 10:e0136030. [PMID: 26305697 PMCID: PMC4549320 DOI: 10.1371/journal.pone.0136030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 07/29/2015] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Drug policing practices in the Russian Federation (Russia) are often punitive and have been shown to be associated with HIV risk behaviors among people who inject drugs (PWID). Less is known about strategies to address the problem in that setting, where substance use stigma is highly persistent. A better understanding of forms, causes and consequences of drug policing in Russia could inform drug policy in a context of substantial policy resistance. This qualitative study's goal is to characterize the phenomenon of police involvement with Russian PWID and to explore strategies for drug policing in the Russian country context. METHODS Using a semi-structured interview guide, we collected data from a purposive sample of 23 key informants including PWID, police officers, and experts from civil society and international organizations in Russia. We used a thematic analysis approach to inductively generate new insight into the phenomenon of police involvement and potential strategies to address it. RESULTS Policing practices involving PWID include unjustified arrests, planting of false evidence and extrajudicial syringe confiscations, and often constitute human rights violations. Russian PWID personally experienced police violence as ubiquitous, taking on various forms such as beating, unjustified arrests, verbal harassment, and coercion. The persistent societal stigma dehumanizes PWID, and such stigmatization facilitates police abuse. To address stigma and overcome the PWID-police adversity, study participants suggested fostering a mutual understanding between the police and public health sectors. CONCLUSIONS Participants describe substantial human rights violations as part of policing illicit drug use in Russia. Police should include principles of effective prevention of substance use and HIV risk reduction in their trainings. Alignment of public safety and public health goals could address drug use-related risks and HIV prevention among key populations in Russia.
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Affiliation(s)
- Karsten Lunze
- Boston University School of Medicine, Boston, MA, United States of America
- * E-mail:
| | - Fatima I. Lunze
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Anita Raj
- Division of Global Public Health, Department of Medicine, University of California at San Diego School of Medicine, San Diego, CA, United States of America
| | - Jeffrey H. Samet
- Boston University School of Medicine, Boston, MA, United States of America
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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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Beletsky L, Cochrane J, Sawyer AL, Serio-Chapman C, Smelyanskaya M, Han J, Robinowitz N, Sherman SG. Police Encounters Among Needle Exchange Clients in Baltimore: Drug Law Enforcement as a Structural Determinant of Health. Am J Public Health 2015; 105:1872-9. [PMID: 26180948 DOI: 10.2105/ajph.2015.302681] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We piloted a monitoring mechanism to document police encounters around programs targeting people who inject drugs (PWID), and assessed their demographic predictors at 2 Baltimore, Maryland, needle exchange program (NEP) sites. METHODS In a brief survey, 308 clients quantified, characterized, and sited recent police encounters. Multivariate linear regression determined encounter predictors, and we used geocoordinate maps to illustrate clusters. RESULTS Within the past 6 months, clients reported a median of 3 stops near NEP sites (interquartile range [IQR] = 0-7.5) and a median of 1 arrest in any location (IQR = 0-2). Three respondents reported police referral to the NEP. Being younger (P = .009), being male (P = .033), and making frequent NEP visits (P = .02) were associated with reported police stops. Among clients reporting arrest or citation for syringe possession, Whites were significantly less likely than non-Whites to report being en route to or from an NEP (P < .001). Reported encounters were clustered around NEPs. CONCLUSIONS Systematic surveillance of structural determinants of health for PWID proved feasible when integrated into service activities. Improved monitoring is critical to informing interventions to align policing with public health, especially among groups subject to disproportionate levels of drug law enforcement.
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Affiliation(s)
- Leo Beletsky
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Jess Cochrane
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Anne L Sawyer
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Chris Serio-Chapman
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Marina Smelyanskaya
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Jennifer Han
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Natanya Robinowitz
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
| | - Susan G Sherman
- Leo Beletsky is with the School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA. At the time of the study, Jess Cochrane was with the Northeastern University School of Law and Tufts University School of Medicine, Boston. Chris Serio-Chapman, Jennifer Han, and Natanya Robinowitz were with the Baltimore City Health Department, Baltimore, MD. Susan G. Sherman and Anne L. Sawyer were with the Bloomberg School of Public Health, Baltimore. Marina Smelyanskaya is an independent consultant in Baltimore
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Davis CS, Carr D, Southwell JK, Beletsky L. Engaging Law Enforcement in Overdose Reversal Initiatives: Authorization and Liability for Naloxone Administration. Am J Public Health 2015; 105:1530-7. [PMID: 26066921 DOI: 10.2105/ajph.2015.302638] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Opioid overdose is reversible through the timely administration of naloxone, which has been used by emergency medical services for decades. Law enforcement officers (LEOs) are often the first emergency responders to arrive at an overdose, but they are not typically equipped with naloxone. This is rapidly changing; more than 220 law enforcement agencies in 24 states now carry naloxone. However, rollout in some departments has been hampered by concerns regarding officer and agency liability. We systematically examined the legal risk associated with LEO naloxone administration. LEOs can be authorized to administer naloxone through a variety of mechanisms, and liability risks related to naloxone administration are similar to or lower than those of other activities in which LEOs commonly engage.
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Affiliation(s)
- Corey S Davis
- Derek Carr and Corey S. Davis are with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is with the North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Leo Beletsky is with the Northeastern University School of Law and Bouvé College of Health Sciences, Boston, MA
| | - Derek Carr
- Derek Carr and Corey S. Davis are with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is with the North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Leo Beletsky is with the Northeastern University School of Law and Bouvé College of Health Sciences, Boston, MA
| | - Jessica K Southwell
- Derek Carr and Corey S. Davis are with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is with the North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Leo Beletsky is with the Northeastern University School of Law and Bouvé College of Health Sciences, Boston, MA
| | - Leo Beletsky
- Derek Carr and Corey S. Davis are with the Network for Public Health Law-Southeastern Region, Carrboro, NC. Jessica K. Southwell is with the North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Leo Beletsky is with the Northeastern University School of Law and Bouvé College of Health Sciences, Boston, MA
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Maher L, Dixon T, Phlong P, Mooney-Somers J, Stein E, Page K. Conflicting Rights: How the Prohibition of Human Trafficking and Sexual Exploitation Infringes the Right to Health of Female Sex Workers in Phnom Penh, Cambodia. Health Hum Rights 2015; 17:E102-13. [PMID: 26204575 PMCID: PMC6915836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
While repressive laws and policies in relation to sex work have the potential to undermine HIV prevention efforts, empirical research on their interface has been lacking. In 2008, Cambodia introduced antitrafficking legislation ostensibly designed to suppress human trafficking and sexual exploitation. Based on empirical research with female sex workers, this article examines the impact of the new law on vulnerability to HIV and other adverse health outcomes. Following the introduction of the law, sex workers reported being displaced to streets and guesthouses, impacting their ability to negotiate safe sex and increasing exposure to violence. Disruption of peer networks and associated mobility also reduced access to outreach, condoms, and health care. Our results are consistent with a growing body of research which associates the violation of sex workers' human rights with adverse public health outcomes. Despite the successes of the last decade, Cambodia's AIDS epidemic remains volatile and the current legal environment has the potential to undermine prevention efforts by promoting stigma and discrimination, impeding prevention uptake and coverage, and increasing infections. Legal and policy responses which seek to protect the rights of the sexually exploited should not infringe the right to health of sex workers.
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Affiliation(s)
- Lisa Maher
- Professor, Program Head and NHMRC Senior Research Fellow at the Kirby Institute for Infection and Immunity in the Faculty of Medicine at UNSW Australia in Sydney, Australia
| | - Thomas Dixon
- Student in the Faculty of Law at the University of Sydney in Sydney, Australia
| | - Pisith Phlong
- Anthropologist at the Royal University of Fine Arts in Phnom Penh, Cambodia
| | - Julie Mooney-Somers
- Senior Lecturer in the Centre for Values, Ethics and the Law in Medicine at the University of Sydney in Sydney, Australia
| | - Ellen Stein
- Academic Coordinator in Global Health Sciences at the University of California San Francisco, USA. Kimberly Page is Professor and Chief of Epidemiology in the Division of Biostatistics and Preventive Medicine at the University of New Mexico Health Sciences and Center in Albuquerque, New Mexico, USA
| | - Kimberly Page
- Professor and Chief of Epidemiology in the Division of Biostatistics and Preventive Medicine at the University of New Mexico Health Sciences and Center in Albuquerque, New Mexico, USA
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Wood JD, Taylor CJ, Groff ER, Ratcliffe JH. Aligning policing and public health promotion: Insights from the world of foot patrol. POLICE PRACTICE & RESEARCH : AN INTERNATIONAL JOURNAL 2015; 16:211-223. [PMID: 26085825 PMCID: PMC4465110 DOI: 10.1080/15614263.2013.846982] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Foot patrol work is rarely described in relation to public health, even though police routinely encounter health risk behaviors and environments. Through a qualitative study of foot patrol policing in violent 'hotspots' of Philadelphia, we explore some prospects and challenges associated with bridging security and public health considerations in law enforcement. Noting existing efforts to help advance police officer knowledge of, and attitudes toward health vulnerabilities, we incorporate perspectives from environmental criminology to help advance this bridging agenda. Extending the notion of capable guardianship to understand foot patrol work, we suggest that the way forward for theory, policy and practice is not solely to rely on changing officer culture and behavior, but rather to advance a wider agenda for enhancing collective guardianship, and especially 'place management' for harm reduction in the city.
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Affiliation(s)
- Jennifer D Wood
- Department of Criminal Justice and Center for Security and Crime Science, Temple University, 1115 Polett Walk, 512 Gladfelter Hall, Philadelphia, PA 19122 USA
| | - Caitlin J Taylor
- Department of Sociology and Criminal Justice, La Salle University, 1900 W. Olney Avenue, 351 Olney Hall, Philadelphia, PA 19141 USA, 215-951-1105,
| | - Elizabeth R Groff
- Department of Criminal Justice and Center for Security and Crime Science, Temple University, 1115 Polett Walk, 512 Gladfelter Hall, Philadelphia, PA 19122 USA
| | - Jerry H Ratcliffe
- Department of Criminal Justice and Center for Security and Crime Science, Temple University, 1115 Polett Walk, 512 Gladfelter Hall, Philadelphia, PA 19122 USA
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Sherman SG, Patel SA, Ramachandran DV, Galai N, Chaulk P, Serio-Chapman C, Gindi RM. Consequences of a restrictive syringe exchange policy on utilisation patterns of a syringe exchange program in Baltimore, Maryland: Implications for HIV risk. Drug Alcohol Rev 2015; 34:637-44. [PMID: 25919590 DOI: 10.1111/dar.12276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/15/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Syringe distribution policies continue to be debated in many jurisdictions throughout the USA. The Baltimore Needle and Syringe Exchange Program (NSP) operated under a 1-for-1 syringe exchange policy from its inception in 1994 through 1999, when it implemented a restrictive policy (2000-2004) that dictated less than 1-for-1 exchange for non-program syringes. DESIGN AND METHODS Data were derived from the Baltimore NSP, which prospectively collected data on all client visits. We examined the impact of this restrictive policy on program-level output measures (i.e. distributed : returned syringe ratio, client volume) before, during and after the restrictive exchange policy. Through multiple logistic regression, we examined correlates of less than 1-for-1 exchange ratios at the client level before and during the restrictive exchange policy periods. RESULTS During the restrictive policy period, the average annual program-level ratio of total syringes distributed : returned dropped from 0.99 to 0.88, with a low point of 0.85 in 2000. There were substantial decreases in the average number of syringes distributed, syringes returned, the total number of clients and new clients enrolling during the restrictive compared to the preceding period. During the restrictive period, 33 508 more syringes were returned to the needle exchange than were distributed. In the presence of other variables, correlates of less than 1-for-1 exchange ratio were being white, female and less than 30 years old. DISCUSSION AND CONCLUSIONS With fewer clean syringes in circulation, restrictive policies could increase the risk of exposure to HIV among Injection Drug Users (IDUs) and the broader community. The study provides evidence to the potentially harmful effects of such policies.
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Affiliation(s)
- Susan G Sherman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shivani A Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Daesha V Ramachandran
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Department of Statistics, University of Haifa, Haifa, Israel
| | | | | | - Renee M Gindi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Gaines TL, Beletsky L, Arredondo J, Werb D, Rangel G, Vera A, Brouwer K. Examining the spatial distribution of law enforcement encounters among people who inject drugs after implementation of Mexico's drug policy reform. J Urban Health 2015; 92:338-51. [PMID: 25300503 PMCID: PMC4411320 DOI: 10.1007/s11524-014-9907-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 2009, Mexico decriminalized the possession of small amounts of illicit drugs for personal use in order to refocus law enforcement resources on drug dealers and traffickers. This study examines the spatial distribution of law enforcement encounters reported by people who inject drugs (PWID) in Tijuana, Mexico to identify concentrated areas of policing activity after implementation of the new drug policy. Mapping the physical location of law enforcement encounters provided by PWID (n = 461) recruited through targeted sampling, we identified hotspots of extra-judicial encounters (e.g., physical/sexual abuse, syringe confiscation, and money extortion by law enforcement) and routine authorized encounters (e.g., being arrested or stopped but not arrested) using point density maps and the Getis-Ord Gi* statistic calculated at the neighborhood-level. Approximately half of the participants encountered law enforcement more than once in a calendar year and nearly one third of these encounters did not result in arrest but involved harassment or abuse by law enforcement. Statistically significant hotspots of law enforcement encounters were identified in a limited number of neighborhoods located in areas with known drug markets. At the local-level, law enforcement activities continue to target drug users despite a national drug policy that emphasizes drug treatment diversion rather than punitive enforcement. There is a need for law enforcement training and improved monitoring of policing tactics to better align policing with public health goals.
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Affiliation(s)
- Tommi L Gaines
- Division of Global Public Health, School of Medicine, University of California at San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA,
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de Saxe Zerden L, O'Quinn E, Davis C. Evidence-based policy versus morality policy: the case of syringe access programs. ACTA ACUST UNITED AC 2015; 12:425-37. [PMID: 25747745 DOI: 10.1080/15433714.2013.873751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Evidence-based practice (EBP) combines proven interventions with clinical experience, ethics, and client preferences to inform treatment and services. Although EBP is integrated into most aspects of social work and public health, at times EBP is at odds with social policy. In this article the authors explore the paradox of evidence-based policy using syringe access programs (SAP) as a case example, and review methods of bridging the gap between the emphasis on EBP and lack of evidence informing SAP policy. Analysis includes the overuse of morality policy and examines historical and current theories why this paradox exists. Action steps are highlighted for creating effective policy and opportunities for public health change. Strategies on reframing the problem and shifting target population focus to garner support for evidence-based policy change are included. This interdisciplinary understanding of the way in which these factors converge is a critical first step in moving beyond morality-based policy toward evidence-based policy.
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Affiliation(s)
- Lisa de Saxe Zerden
- a School of Social Work, University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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48
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Werb D, Wagner KD, Beletsky L, Gonzalez-Zuniga P, Rangel G, Strathdee SA. Police bribery and access to methadone maintenance therapy within the context of drug policy reform in Tijuana, Mexico. Drug Alcohol Depend 2015; 148:221-5. [PMID: 25655577 PMCID: PMC4330115 DOI: 10.1016/j.drugalcdep.2015.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 01/12/2015] [Accepted: 01/12/2015] [Indexed: 12/29/2022]
Abstract
AIMS In 2009, Mexico passed legislation to decriminalize drug possession and improve access to addiction treatment. We undertook research to assess the implementation of the reform among a cohort of people who inject drugs (PWID) in Tijuana. This study specifically sought to determine whether discretionary policing practices like extortion impact access to methadone maintenance therapy (MMT) in Tijuana, a city characterized by high levels of drug-related harms. METHODS Generalized estimating equation analyses were used to construct longitudinal confounding models to determine the association between paying a police bribe and MMT enrolment among PWID in Tijuana enrolled in a prospective cohort study. Outcome of interest was MMT enrolment in the past six months. Data on police interactions and MMT enrolment were also obtained. RESULTS Between October, 2011 and September, 2013, 637 participants provided 1825 observations, with 143 (7.8%) reports of MMT enrolment during the study period. In a final confounding model, recently reporting being forced to pay a bribe to police was significantly associated with an increased likelihood of accessing MMT (adjusted odds ratio=1.69, 95% confidence interval: 1.02-2.81, p=0.043). However, in 56 (39.2%) cases, MMT enrolment ceased within six months. The majority of participant responses cited the fact that MMT was too expensive (69.1%). DISCUSSION Levels of MMT access were low. PWID who experienced police extortion were more likely to access MMT at baseline, though this association decreased during the study period. Coupled with the costs of MMT, this may compromise MMT retention among PWID.
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Affiliation(s)
- D Werb
- Division of Global Public Health, Department of Medicine, University of California, San Diego, United States; BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - K D Wagner
- Division of Global Public Health, Department of Medicine, University of California, San Diego, United States
| | - L Beletsky
- Division of Global Public Health, Department of Medicine, University of California, San Diego, United States; Northeastern University School of Law, Bouvé College of Health Sciences, Boston, United States
| | - Patricia Gonzalez-Zuniga
- Division of Global Public Health, Department of Medicine, University of California, San Diego, United States
| | | | - S A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, United States.
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Harvey HH, Koller DL, Lowrey KM. The four stages of youth sports TBI Policymaking: engagement, enactment, research, and reform. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43 Suppl 1:87-90. [PMID: 25846174 DOI: 10.1111/jlme.12225] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article advances, for the first time, a framework for situating public health law interventions as occurring in a predictable four-stage process. Whether the intervention is related to mandatory seat-belt laws, HIV prevention through needle-exchanges, or distracted-driving laws, these public health law interventions have generally been characterized by the following four stages. First, a series of publicized incidents, observances, or outcomes generate significant media attention, and are framed as public health harms. Then, a few select states evaluate such harms and proactively seek testimony or evidence designed to support a law-based intervention. After this initial public engagement, states enact legal frameworks designed to minimize or reduce the harm, often in the absence of full information about the scope of harm or potential effectiveness of the intervention. In contrast, scholars have proposed that at these early stages, lawmaking should be evidence-based and “developed through a continuous process that uses the best available quantitative and qualitative evidence.”5 Our experience evaluating youth sports traumatic brain injury (TBI) lawmaking suggests that, like other public health issues with sudden and intense media (and, therefore, constituent) attention, an evidence-based approach was lacking during these early stages.
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Affiliation(s)
- Hosea H Harvey
- Associate Professor of Law at the Temple University Beasley School of Law in Philadelphia, PA
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50
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Attitudes of North Carolina law enforcement officers toward syringe decriminalization. Drug Alcohol Depend 2014; 144:265-9. [PMID: 25193720 PMCID: PMC4428167 DOI: 10.1016/j.drugalcdep.2014.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 08/06/2014] [Accepted: 08/10/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND North Carolina, like much of the U.S. South, is disproportionately affected by HIV and hepatitis. This persistently high disease burden may be driven in part by laws that criminalize the possession and distribution of syringes for illicit drug use. Legal change to decriminalize syringes may reduce infection rates in the state, but is unlikely absent support from law enforcement actors. METHODS We analyzed the responses of 350 North Carolina law enforcement officers to a confidential, anonymous survey. The survey instrument collected data regarding self-reported needle-stick injury (NSI), blood borne disease risk perception and attitudes toward syringe decriminalization. RESULTS 82% of respondents reported that contracting HIV was a "big concern" for them. 3.8% of respondents reported ever receiving a job-related NSI, a rate of 36 NSI per 10,000 officer-years. Majorities of respondents reported positive views regarding syringe decriminalization, with approximately 63% agreeing that it would be "good for the community" and 60% agreeing that it would be "good for law enforcement." Black and female officers were significantly less likely to agree that on-the-job NSI was a "big concern" and significantly more likely to agree that it would be good for law enforcement. CONCLUSIONS These findings suggest that many North Carolina LEOs understand the public health benefits of syringe access programs and may be inclined to support syringe decriminalization legislation. Further research is indicated to determine the causes of observed differences in perceptions of bloodborne disease risk and attitudes toward syringe decriminalization by race and sex.
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