Addressing the “Risk Environment” for Injection Drug Users: The Mysterious Case of the Missing Cop

Burris, Scott; Blankenship, Kim M.; Donoghoe, Martin C.; Sherman, Susan G.; Vernick, Jon S.; Case, Patricia; Lazzarini, Zita; Koester, Stephen

doi:10.1111/j.0887-378x.2004.00304.x

Cited by 219 publications

(172 citation statements)

References 123 publications

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“…16 Similarly, research among drug users and other at-risk groups has identified pervasive lack of clarity about the law. [27][28][29][30] Our findings underscore the critical role of policy evaluation to evidence-based tailoring of public health laws in order to guarantee their positive impact.…”

Section: Discussionmentioning

confidence: 68%

Police Officers’ and Paramedics’ Experiences with Overdose and Their Knowledge and Opinions of Washington State’s Drug Overdose–Naloxone–Good Samaritan Law

et al. 2013

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Opioid overdoses are an important public health concern. Concerns about police involvement at overdose events may decrease calls to 911 for emergency medical care thereby increasing the chances than an overdose becomes fatal. To address this concern, Washington State passed a law that provides immunity from drug possession charges and facilitates the availability of take-home-naloxone (the opioid overdose antidote) to bystanders in 2010. To examine the knowledge and opinions regarding opioid overdoses and this new law, police (n=251) and paramedics (n=28) in Seattle, WA were surveyed. The majority of police (64 %) and paramedics (89 %) had been at an opioid overdose in the prior year. Few officers (16 %) or paramedics (7 %) were aware of the new law. While arrests at overdose scenes were rare, drugs or paraphernalia were confiscated at 25 % of the most recent overdoses police responded to. Three quarters of officers felt it was important they were at the scene of an overdose to protect medical personnel, and a minority, 34 %, indicated it was important they were present for the purpose of enforcing laws. Police opinions about the immunity and naloxone provisions of the law were split, and we present a summary of the reasons for their opinions. The results of this survey were utilized in public health efforts by the police department which developed a roll call training video shown to all patrol officers. Knowledge of the law was low, and opinions of it were mixed; however, police were concerned about the issue of opioid overdose and willing to implement agency-wide training.

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Section: Discussionmentioning

confidence: 68%

Police Officers’ and Paramedics’ Experiences with Overdose and Their Knowledge and Opinions of Washington State’s Drug Overdose–Naloxone–Good Samaritan Law

et al. 2013

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“…[7][8][9][10][11][12][13][14]23,26,46,48,49 Previous studies along Mexico's North Border have contributed to this international consensus by identifying a panoply of associations between criminal justice experiences and behavioral risk factors, including syringe sharing. 29,50,51 We have also observed independent associations between arrest and HIV status.…”

Section: Discussionmentioning

confidence: 99%

“…58,59 Implementation of these policy reforms may be limited by resource constraints, lack of political will, and governance failures. 4,6,26,28,31,62 Auxiliary mechanisms such as making federal grants contingent on specific implementation targets may improve policy implementation. 63 By adding a public health dimension to the societal costs of civil and human rights violations, our analysis magnifies the imperative to use a range of tools to curb extra-judicial police practices like syringe confiscation while also amplifying the broader calls to strengthen the rule of law in Mexico.…”

Section: Discussionmentioning

confidence: 99%

“…9,[22][23][24] Formal policies and their enforcement are increasingly seen as critical structural factors that shape the "risk environment" for the production of health and disease among vulnerable groups and society at large, including vulnerability to HIV infection. 22,[24][25][26][27] This framework posits that health outcomes result from an interplay of multi-level influences originating from environmental and structural processes rather than a product of merely individual-level characteristics or behaviors. 25 Mexico represents a rare example of a jurisdiction where the formal policy environment is favorable to public health prevention among high-risk groups such as FSW-IDUs.…”

Section: Introductionmentioning

confidence: 99%

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Syringe Confiscation as an HIV Risk Factor: The Public Health Implications of Arbitrary Policing in Tijuana and Ciudad Juarez, Mexico

Lozada²,

et al. 2012

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Female sex workers who inject drugs (FSW-IDUs) face elevated risk for HIV/ STIs and constitute a key population for public health prevention. Through direct and indirect pathways including human rights violations, policing practices like syringe confiscation can compound FSW-IDU health risk and facilitate the spread of disease. We studied correlates of experiencing syringe confiscation among FSW-IDUs in northern Mexico, where formal policy allows for syringes to be available over the counter without a prescription, but police practices are often at odds with the law. FSWIDUs reporting recent syringe sharing and unprotected sex with clients in Tijuana and Ciudad Juarez were administered surveys and HIV/STI testing. Logistic regression was used to identify correlates of syringe confiscation. Among 624 respondent FSW-IDUs, prevalence of syringe confiscation in the last 6 months was 48 %. The following factors were positively associated with syringe confiscation: testing positive for HIV (adjusted odds ratio [aOR]=2.54, 95 % confidence interval [CI]=1.11-5.80), reporting sexual abuse by police (aOR=12.76, 95 % CI=6.58-24.72), engaging in groin injection (aOR=1.84, 95 % CI=1.15-2.93), injecting in public (aOR=1.64; 95 % CI=1.14-2.36), and obtaining syringes from pharmacies (aOR=1.54; 95 % CI=1.06-2.23). Higher education level was negatively associated with syringe confiscation (aOR= 0.92, 95 % CI=0.87-0.98) as was frequent injection with clients within the last month (aOR=0.64,). This analysis adds to the body of evidence linking unauthorized law enforcement actions targeting high-risk groups with HIV and other adverse health outcomes. Using a public health lens to conceptualize abuse as a structural risk factor, we advocate for multi-prong prevention, systematic monitoring, and evidence-based intervention response to deleterious police practices.

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“…35 Existing laws and policies can themselves be structural determinants that influence the transmission of HIV, like prohibiting the sale and distribution of sterile injection equipment, which in turn may increase the likelihood of needle sharing. 36 …”

Section: Theoretical Foundations: Structural Change and Community Mobmentioning

confidence: 99%

Laying the Foundation for Connect to Protect ®: A Multi-Site Community Mobilization Intervention to Reduce HIV/AIDS Incidence and Prevalence among Urban Youth

et al. 2006

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Despite the considerable resources that have been dedicated to HIV prevention interventions and services over the past decade, HIV incidence among young people in the United States remains alarmingly high. One reason is that the majority of prevention efforts continue to focus solely on modifying individual behavior, even though public health research strongly suggests that changes to a community's structural elements, such as their programs, practices, and laws or policies, may result in more effective and sustainable outcomes. Connect to Protect is a multi-city community mobilization intervention that focuses on altering or creating community structural elements in ways that will ultimately reduce youth HIV incidence and prevalence. The project, which spans 6 years, is sponsored by the Adolescent Medicine Trials Network for HIV/AIDS Interventions at multiple urban clinical research sites. This paper provides an overview of the study's three phases and describes key factors in setting a firm foundation for the initiation and execution of this type of undertaking. Connect to Protect's community mobilization approach to achieving structural change represents a relatively new and broad direction in HIV prevention research. To optimize opportunities for its success, time and resources must be initially placed into laying the groundwork. This includes activities such as building a strong overarching study infrastructure to ensure protocol tasks can be met across sites; tapping into local site and community expertise and knowledge; forming collaborative relationships between sites and community organizations and members; and fostering community input on and support for changes at a structural level. Failing to take steps such as these may lead to insurmountable implementation problems for an intervention of this kind.

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Addressing the “Risk Environment” for Injection Drug Users: The Mysterious Case of the Missing Cop

Cited by 219 publications

References 123 publications

Police Officers’ and Paramedics’ Experiences with Overdose and Their Knowledge and Opinions of Washington State’s Drug Overdose–Naloxone–Good Samaritan Law

Police Officers’ and Paramedics’ Experiences with Overdose and Their Knowledge and Opinions of Washington State’s Drug Overdose–Naloxone–Good Samaritan Law

Syringe Confiscation as an HIV Risk Factor: The Public Health Implications of Arbitrary Policing in Tijuana and Ciudad Juarez, Mexico

Laying the Foundation for Connect to Protect ®: A Multi-Site Community Mobilization Intervention to Reduce HIV/AIDS Incidence and Prevalence among Urban Youth

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