Legislating thresholds for drug trafficking: A policy development case study from New South Wales,Australia

BackgroundLegal thresholds are used in many parts of the world to define the quantity of illicit drugs over which possession is deemed “trafficking” as opposed to “possession for personal use”. There is limited knowledge about why or how such laws were developed. In this study we analyse the policy processes underpinning the introduction and expansion of the drug trafficking legal threshold system in New South Wales (NSW), Australia.MethodsA critical legal and historical analysis was undertaken sourcing data from legislation, Parliamentary Hansard debates, government inquiries, police reports and research. A timeline of policy developments was constructed from 1970 until 2013 outlining key steps including threshold introduction (1970), expansion (1985), and wholesale revision (1988). We then critically analysed the drivers of each step and the roles played by formal policy actors, public opinion, research/data and the drug trafficking problem.ResultsWe find evidence that while justified as a necessary tool for effective law enforcement of drug trafficking, their introduction largely preceded overt police calls for reform or actual increases in drug trafficking. Moreover, while the expansion from one to four thresholds had the intent of differentiating small from large scale traffickers, the quantities employed were based on government assumptions which led to “manifest problems” and the revision in 1988 of over 100 different quantities. Despite the revisions, there has remained no further formal review and new quantities for “legal highs” continue to be added based on assumption and an uncertain evidence-base.ConclusionThe development of legal thresholds for drug trafficking in NSW has been arbitrary and messy. That the arbitrariness persists from 1970 until the present day makes it hard to conclude the thresholds have been well designed. Our narrative provides a platform for future policy reform.     

Exploring willingness to engage with law enforcement among syringe service program participants in New York City

BackgroundIn New York City (NYC), 1,487 unintentional overdose deaths occurred in 2017, largely driven by the presence of fentanyls in the illicit drug market. In response to fentanyl-involved overdoses, law enforcement entities both nationally and in NYC have taken a new interest in overdose events. This study explored attitudes toward and willingness to engage with police among NYC syringe service program (SSP) participants, a population likely to have had experiences with overdose and/or police.MethodsBetween March and July 2017, 332 surveys were conducted with a convenience sample of NYC SSP participants.ResultsMost respondents (76%) reported ever being arrested for a drug-related crime. Few respondents (5%) reported a previous arrest in the context of an overdose event. Of the 62 respondents who had witnessed an overdose in the previous 12 months, 25% had not called 911 because of concerns about law enforcement. Over half (51%) of all respondents reported they would not be willing to aid police in their investigation of the person who supplied the drugs.ConclusionPolice investigations of both fatal and non-fatal drug overdose events have the potential to exacerbate mistrust of law enforcement and discourage emergency medical service utilization among PWUD.     

Law enforcement influences on HIV prevention for injection drug users:: Observations from a cross-border project in China and Vietnam

Law enforcement activity has had multiple influences on injection drug users’ (IDUs’) participation in a cross-border HIV prevention project in southern China and northern Vietnam. The project has successfully achieved and maintained the official support of police and other government agencies and effectively implemented its interventions. However, analysis of process data, site visit observations, and interviews with project staff, peer educators, IDUs, and police officers reveal the ongoing effects of actual and perceived threats from law enforcement, as well as community stigmatisation, on IDUs’ project participation. These effects are discernible in variations in the monthly numbers of needles/syringes provided, cross-border differences in IDUs’ preferred ways to receive new needles/syringes and retain used needles/syringes for exchange, and geographic patterns of IDUs’ receiving and redeeming pharmacy vouchers. HIV prevention programmes must not only maintain the support of police and other officials but also convince IDUs that it is both beneficial and safe for them to participate in the interventions. Programmes must also be implemented with flexibility, adapting to the potentially changeable preferences, perceptions, and needs of IDUs.     

Assessing police officers’ attitudes and legal knowledge on behaviors that impact HIV transmission among people who inject drugs

BackgroundPolicing practices such as syringe confiscation and arrest can act as important social-structural drivers of HIV risk among people who inject drugs (PWID). However, police referral to treatment and other services may improve the health of PWID. Little is known about the role of modifiable attitudinal and knowledge factors in shaping officer behavior. Using baseline findings from a police education program (PEP), we assessed relationships between drug policy knowledge and attitudes towards public health interventions with self-reported syringe confiscation, drug arrest, and service referral among street-level police in Tijuana, Mexico.MethodsBetween February, 2015 and May, 2016 we surveyed 1319 police officers who reported syringe contact. The self-administered survey focused on attitudes, knowledge, and behaviors related to drug policy, public health, and occupational safety. We used ordinal logistic regression to model the odds of syringe confiscation, arrest for heroin possession, and referring PWID to health/social programs.ResultsThe sample was mostly male (87%) and had at least a high school education (80%). In the last six months, a minority reported always/sometimes confiscating syringes (49%), arresting someone for heroin possession (43%), and referring PWID to health and social programs (37%). Those reporting needlestick injuries (NSI) had 1.38 (95% CI: 1.02–1.87) higher odds of reporting syringe confiscation. Officers who had favorable views on laws that treat addiction as a public health issue had lower odds (aOR = 0.78; 95% CI: 0.59–1.03) of arresting PWID. Those agreeing that it was their role to refer PWID to health and social programs had higher odds of reporting such referrals (aOR: 3.32, 95% CI: 2.52–4.37). Legal knowledge was not associated with these practices.ConclusionChanging drug policy and knowledge may be insufficient in shifting police behavior. Modifying officers’ occupational risks and attitudes towards harm reduction interventions can facilitate efforts to align police practices with PWID health.     

Qualitative evaluation of a peer-based needle syringe programme in Vietnam

BackgroundHarm reduction has been identified as an important HIV prevention strategy for injecting drug users (IDUs) in Vietnam. However, to date only small geographically limited formal needle syringe programmes (NSPs) have been implemented; and little attention has been given to assessing the effectiveness of the piloted models. Using data from a qualitative evaluation of an NSP in northern Vietnam, this paper assesses the effectiveness of the intervention, examines barriers to the NSP, and documents lessons which can be applied to replicate and scale up interventions across Vietnam.MethodsData were gathered using key informant interviews, focus group discussions, in-depth interviews, observation and intercept interviews with IDUs and other project stakeholders. IDUs were introduced to the evaluation by peer educators (PEs).ResultsThe project contributed to a shift toward safe injecting practices and safe disposal of used needles and syringes (N&;S) among IDUs. Collection of used N&;S positively influenced community attitudes toward PEs and IDUs. Reduced community discrimination, achieved as a result of project advocacy activities, encouraged IDU to access free needle syringes and other project services provided by PEs. Resistance from the local government officials and community members was turned into support for the programme through intensive advocacy activities. The project highlighted the importance of involving law enforcement in the programme and promoted a public health approach toward working with IDU. However, periodic police campaigns against drug use continued to be an obstacle to successful programme implementation and demonstrated the need for continued efforts to address the issue.ConclusionProgramme success is dependent upon community support. Resistance to NSPs can be overcome through a programme of intensive advocacy with community stakeholders including; local government, mass organizations, local residents, IDUs and their families. Garnering the support of law enforcement officials requires a sustained effort.     

Syringe access,syringe sharing,and police encounters among people who inject drugs in New York City: A community-level perspective

BackgroundInjection drug user (IDU) experience and perceptions of police practices may alter syringe exchange program (SEP) use or influence risky behaviour. Previously, no community-level data had been collected to identify the prevalence or correlates of police encounters reported by IDUs in the United States.MethodsNew York City IDUs recruited through respondent-driven sampling were asked about past-year police encounters and risk behaviours, as part of the National HIV Behavioural Surveillance study. Data were analysed using multiple logistic regression.ResultsA majority (52%) of respondents (n = 514) reported being stopped by police officers; 10% reported syringe confiscation. In multivariate modelling, IDUs reporting police stops were less likely to use SEPs consistently (adjusted odds ratio [AOR] = 0.59; 95% confidence interval [CI] = 0.40–0.89), and IDUs who had syringes confiscated may have been more likely to share syringes (AOR = 1.76; 95% CI = 0.90–3.44), though the finding did not reach statistical significance.ConclusionsFindings suggest that police encounters may influence consistent SEP use. The frequency of IDU-police encounters highlights the importance of including contextual and structural measures in infectious disease risk surveillance, and the need to develop approaches harmonizing structural policing and public health.     

Police officers’ knowledge,understanding and implementation of the Good Samaritan Drug Overdose Act in BC,Canada

IntroductionIn May 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted in Canada - amending the Controlled Drugs and Substances Act. For people present at an overdose, the GSDOA offers legal protection from simple drug possession as well as breach of charges related to simple possession including probation, pre-trial release, conditional sentences, and parole. It is unclear if the GSDOA has been fully implemented by police officers.MethodsWe conducted 22 key informant interviews with police officers across British Columbia, Canada. Convenience sampling was initially employed, followed by purposeful sampling to ensure diversity in jurisdictions and participant demographics (e.g. age, sex, policing experience). A thematic analysis was conductedResultsOur findings show that awareness and knowledge of the GSDOA vary among police officers. Many officers reported being unaware of the GSDOA or could not correctly define for whom and when the GSDOA applies. Information about the GSDOA was largely disseminated via email. Many officers expressed concerns with this dissemination method given the potential that key legal information would be overlooked. Police officers reported that not arresting for simple possession at an overdose was common practice, even before the enactment of the GSDOA. Thus, some officers did not believe that the GSDOA considerably changed police practices. Finally, police officers reported that they exercised discretion applying the GSDOA. Police officer interpretation of the intention and content of the GSDOA had critical implications for how they applied it in practice.ConclusionEffective education for law enforcement, including the dissemination of information beyond email, is needed to improve officers’ awareness and understanding of the GSDOA. Given officers’ use of discretion when applying the GSDOA, greater legal reforms, such as de jure decriminalization, may be required to fully protect persons at an overdose from simple possession for controlled substances.     

Impacts of intensified police activity on injection drug users: Evidence from an ethnographic investigation

In an effort to dismantle the open drug market and improve public order, a large-scale police initiative named the Citywide Enforcement Team (CET), began in Vancouver's Downtown Eastside (DTES) on 7th April 2003. This research sought to assess the CET's impact upon drug consumption activities as well as access to sterile syringes and health services among injection drug users (IDUs). Ethnographic research methods including participant observation and semi-structured interviews were employed. Interviews were conducted with 30 individuals recruited from an ongoing cohort study of IDUs and nine individuals who provide health services to drug users. In addition, an ongoing participant-observation program investigating public drug use in the DTES yielded data during the period of the CET, as well as seven months prior to its commencement. With regard to drug use patterns, intensified police presence prompted ‘rushed’ injections, injecting in riskier environments, discouraged safer injection practices, and increased unsafe disposal of syringes. Service providers indicated that the CET negatively impacted contact between health services and IDUs, as outreach was compromised due to the displacement of IDUs. Police activities also negatively influenced IDUs’ access to syringes and their willingness to carry syringes, and syringe confiscation was reported. The intensification of police activities led to less drug related activity in the area where the drug market was traditionally concentrated, but widespread displacement of drug use activities to other locations also occurred. The adverse impact of concentrated police activities upon urban drug problems and the implications for both public order and public health should be recognized.     

Street-level policing in the Downtown Eastside of Vancouver, Canada, during the 2010 Winter Olympics

BackgroundPolice presence within street-based drug scenes has the potential to disrupt injection drug users’ (IDUs) access to health services and prompt increased injection-related risk behaviour. We examined street-level policing in the Downtown Eastside (DTES) of Vancouver during the Olympic Winter games, to assess the potential impact on access to harm reduction services and injection-related risk behaviour.MethodsWe analysed data from observational activities documenting police and drug user behaviour, unstructured interviews with drug users in street settings (n = 15), expert interviews with legal and health professionals (n = 6), as well as utilisation statistics from a local supervised injection facility (SIF).ResultsAlthough police presence was elevated within the DTES during the Olympics, there was little evidence to suggest that police activities influenced IDUs’ access to health services or injection-related risk behaviour. SIF attendance during the Olympics was consistent with regular monthly patterns.ConclusionPolice presence during the Olympics did not reduce access to health services amongst local IDUs or prompt increased injection-related risk behaviour. Increased cooperation between local law enforcement and public health bodies likely offset the potential for negative health consequences resulting from police activity.     

Sources of injecting equipment for drug users in Moscow, Russia

Syringe exchange programmes (SEPs) were approved in Moscow in 2002 and studies to evaluate access to sterile syringes are now needed. Clients of a non-governmental organisation (NGO) providing outreach to IDUs were interviewed concerning behaviours within the previous 30 days. Of 232 IDUs, 64% were male, mean age was 25 and mean duration of injection drug use was 5.8 years. Twelve percent reported injecting with used syringes and using prefilled syringes; 6% passed syringes to others and 91% shared paraphernalia. Seventy nine per cent admitted that they had never had a sterile syringe every time they needed it. Among women, 45% used pharmacies as their only source of injecting equipment. Out of 10 potential syringe sources, pharmacies were the major source, especially for women. The other two major sources were other drug users and drug dealers. NGOs offering syringe exchange were mentioned by 9%, whereas medical institutions were reported as the least popular source. Almost all (99%) reported that syringes are not expensive and their procurement is not difficult, but 83% mentioned that buying syringes at pharmacies often involves a risk of being examined by law enforcement staff. These results indicate that significant barriers for procurement and use of sterile syringes exist in Moscow.     

Syringe disposal options for injection drug users: a community-based perspective.

This study was a qualitative exploration of syringe disposal interventions for injection drug users (IDUs). Data were collected through in-depth interviews with 26 community members who injected drugs and 32 noninjecting community members in Atlanta, Georgia. Both groups supported syringe exchange programs as syringe disposal interventions, while noninjecting community members favored a one-way drop box. IDUs identified fear of arrest for possession of syringes as the most salient barrier to safe syringe disposal, revealing the negative consequences of drug paraphernalia laws.     

Syringe Disposal Options for Injection Drug Users: A Community-Based Perspective

This study was a qualitative exploration of syringe disposal interventions for injection drug users (IDUs). Data were collected through in-depth interviews with 26 community members who injected drugs and 32 noninjecting community members in Atlanta, Georgia. Both groups supported syringe exchange programs as syringe disposal interventions, while noninjecting community members favored a one-way drop box. IDUs identified fear of arrest for possession of syringes as the most salient barrier to safe syringe disposal, revealing the negative consequences of drug paraphernalia laws.     

Topic-Focused Bibliography: Syringe Exchange: HIV Prevention,Key Findings,and Future Directions

HIV among injecting drug users (IDUs) has now been documented in over 60 countries in the world, and there are an additional 40 countries where injecting drug use has been reported including widespread epidemics in Southeast and southern Asia and in Latin America. At present HIV infection is almost always fatal, and there is no promise that a preventive vaccine will become available soon. Given the enormity of the HIV epidemic among IDUs and the critical need to reduce the spread of HIV transmission to and from IDUs, prevention efforts are essential. Syringe-exchange programs have become a major component of HIV prevention strategies in most developed countries and work within the philosophy of harm reduction. Increasing access to sterile syringes has been met with considerable controversy. Opponents of syringe exchange have generally argued that increasing access to sterile syringes would simultaneously increase the number of injecting drug users, increase the frequency of injection for already active IDUs, and appear to “condone” an illegal behavior. To date many research studies and four major reviews of syringe exchange literature have been conducted. All studies thus far have shown no increase in illicit drug injection associated with syringe exchanges, and significant decrease in drug risk behaviors.     

The influence of Thailand's 2003 ‘war on drugs’ policy on self-reported drug use among injection drug users in Chiang Mai,Thailand

In February 2003, the Thai Government enacted a ‘war on drugs’ to reduce supply and demand for illicit drugs. This study aimed to examine the impact of this policy on injection drug users (IDUs) drug utilisation patterns and to explore IDU attitudes toward and experiences with the policy in Chiang Mai province. In April 2003, 263 IDU who participated in a study in the preceding year were followed up and 165 IDUs (63%) were available and consented to participate in a cross-sectional survey. Of these 85% had ceased injecting and 70% had done so since the implementation of the policy, with a higher percentage of rural compared to urban IDUs ceasing injection (78% versus 55%, p < 0.001). One-third of those who had ceased drug injection reported smoking opium or methamphetamine, with a lower percentage of urban compared to rural dwellers (24% versus 36%, p < 0.01). Paradoxically, 88% of participants reported that government policy was “good,” ostensibly because it might reduce the temptation to use drugs among the non-initiated by reducing the supply. The majority of study participants reported ceasing injection, often transitioning to other substance use. Differences in drug utilisation patterns were found between urban and rural dwellers. The fear produced by the policy probably led to an underreporting of injection practices and could lead to increased risky syringe behaviours. Continued research is needed to monitor the effects of the policy on patterns of drug use, routes of administration, and HIV risk behaviours.     

Avoiding the stigma. A qualitative study of socially included women's experiences of drug use and dealing,health services and the police in France

The figure of drug user and dealer is stigmatized, linked to violence and illness. This is due to a reductionist discourse which implements othering processes generating scapegoat figures in the drug world. All drug users and sellers are assimilated with these spoiled identities in the media or in drug policies, while the reality is much more diverse. This article draws on relational sociology to focus on figures who are the antithesis of stereotypes: socially integrated women who use or sell drugs (WUSD) and are invisible to the health and control enforcement agencies. By seeking to avoid the stigma of the drug user's and dealer's identities, how do socially included WUSD distance themselves from the control enforcement agencies and health institutions? This qualitative research is based on 26 semi-structured interviews conducted with socially included WUSD in France. Participants were recruited using a snowball sampling strategy. It appears that the participants normalized their drug use and integrated it into their professional and personal lives. Some were drug user-dealers and had social supply practices, selling the drugs they used to their friends in order to finance their consumption. None of the participants have ever been in contact with harm reduction and addiction services, both because they do not identify with the users of these services, and because these services are not designed to support this population. With the police, the participants play gender games and show their social inclusion to protect themselves from arrest. In both cases, the stigmatized figure of the drug user and drug seller alienate the participants from the health systems and control enforcement agencies. One of the consequences of the othering process is the invisibility of those who do not want to be identified as “others” by the health and law enforcement services. Rethinking drug policy is essential to reach populations that may need information and support.