The policy conflict between syringe exchange programs and policing practices in the United States, and its influence on the health risk behaviors of injecting drug users: A quantitative assessment.

摘要

Since the early years of the twentieth century, developments in United States (US) drug policy have cycled between tolerance for drug use, on the one hand, and restraint to prevent drug use, on the other (Musto, 1999). In the 1980s, AIDS emerged, just as neoliberalism grew to dominate the national policy agenda, reinforcing normative social standards with coercion and punishment (Abramovitz, 2004). With evidence for injecting drug users' particular vulnerability to HIV infection, advocates introduced syringe exchange programs to reduce the epidemic's escalation.;A conflict in drug policy persists for these programs, however. Most programs operate in states where syringes remain criminalized, and where syringe possession is authorized only as a public health emergency. The results of this conflict are evident 'on the streets,' in encounters between police officers and injecting drug users participating in syringe exchange programs.;This study examines the experiences of injecting drug users with police 'on the streets,' aiming to understand which individual characteristics of injecting drug users influence the likelihood for and severity of police encounters. The literature suggests the negative influence of these encounters on the health risks experienced by this population. Secondary analysis was conducted with an existing dataset of injecting drug users participating in US syringe exchange programs. Three characteristics of respondents -- recent homelessness (street, and 'other place') and recent illegal income -- were leading predictors for two scales assessing police encounters, measuring the likelihood and severity of encounters, respectively.;Findings from this analysis suggest opportunities for policy development. In some cities, law enforcement has become involved with human services partnerships, addressing homelessness as a social problem rather than a crime. Introducing syringe exchange programs into these 'helping' relationships could radically improve the experiences of homeless injecting drug users, while re-shaping the social environment developed by US drug policy. Syringe deregulation could accomplish this goal at the structural level, with legislative change.