Municipal police support for harm reduction services in officer-led referrals of people who inject drugs in Tijuana, Mexico

Abstract

Background Police constitute a structural determinant of health and HIV risk of people who inject drugs (PWID), and negative encounters with law enforcement present significant barriers to PWID access to harm reduction services. Conversely, police may facilitate access via officer-led referrals, potentiating prevention of HIV, overdose, and drug-related harms. We aimed to identify police characteristics associated with support for officer-led referrals to addiction treatment services and syringe service programs (SSP). We hypothesized that officers who believe harm reduction services are contradictory to policing priorities in terms of safety and crime reduction will be less likely to support police referrals. Methods Between January and June 2018, police officers (n = 305) in Tijuana, Mexico, completed self-administered surveys about referrals to harm reduction services during the 24-month follow-up visit as part of the SHIELD police training and longitudinal cohort study. Log-binomial regression was used to estimate adjusted prevalence ratios and model policing characteristics and attitudes related to officers’ support for including addiction treatment and SSP in referrals. Results Respondents were primarily male (89%), patrol officers (86%) with a median age of 38 years (IQR 33–43). Overall, 89% endorsed referral to addiction services, whereas 53% endorsed SSP as acceptable targets of referrals. Officers endorsing addiction services were less likely to be assigned to high drug use districts (adjusted prevalence ratio [APR] = 0.50, 95% CI 0.24, 1.08) and more likely to agree that methadone programs reduce crime (APR = 4.66, 95% CI 2.05, 9.18) than officers who did not support addiction services. Officers endorsing SSPs were younger (adjusted prevalence ratio [APR] = 0.96 95% CI 0.93, 0.98), less likely to be assigned to high drug use districts (APR = 0.50, 95% CI 0.29, 0.87), more likely to believe that methadone programs reduce crime (APR = 2.43, 95% CI 1.30, 4.55), and less likely to believe that SSPs increase risk of needlestick injury for police (APR = 0.44, 0.27, 0.71). Conclusions Beliefs related to the occupational impact of harm reduction services in terms of officer safety and crime reduction are associated with support for referral to related harm reduction services. Efforts to deflect PWID from carceral systems toward harm reduction by frontline police should include measures to improve officer knowledge and attitudes about harm reduction services as they relate to occupational safety and law enforcement priorities. Trial Registration: NCT02444403.

Law enforcement and syringe services program implementation in rural counties in Kentucky: a qualitative exploration

“…This finding has many parallels to emerging research that examines how law enforcement officials may interact with SSPs and their clients. For example, a recent study found that police officers who endorsed SSPs were less likely to believe that SSP implementation increased risks for needlestick injury [ 33 ]. In addition, a 2019 study found that law enforcement officials who experienced a needlestick injury were more critical of SSPs, reporting that they believed SSPs enabled drug use [ 17 ].…”

Public Health Approaches to Public Safety in North America: An overview of results from GLEPHA’s Envisioning the Future project

“…These responders generally are social workers or behavioural/ mental health clinicians or specialists, with a particular focus on stabilizing individuals in crisis. Usually, these responders monitor police radios and are dispatched in response to very specific call types clearly identified as involving mental or behavioural health needs that do not involve the presence of a weapon at the time of dispatch (Baker et al, 2021;Blais & Brisebois, 2021;Lum et al, 2021). These teams are also dispatched for issues related to substance use and homelessness.…”

“…Individuals often cycle repetitively through these systems-from jails to emergency rooms and back again (Milgram et al, 2018). This results in a small number of individuals with unmet needs using an outsized proportion of public resources across systems (Baker et al, 2021;Milgram et al, 2018). For example, researchers in Camden, New Jersey, analyzed local hospital and arrest data to find that more than half of individuals arrested between 2010 and 2014 also made five or more visits to the emergency room during that same period.…”