Attitudes of police officers towards syringe access, occupational needle-sticks, and drug use: A qualitative study of one city police department in the United States

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Abstract

Removal of legal barriers to syringe access has been identified as an important part of a comprehensive approach to reducing HIV transmission among injecting drug users (IDUs). Legal barriers include both “law on the books” and “law on the streets,” i.e., the actual practices of law enforcement officers. Changes in syringe and drug control policy can be ineffective in reducing such barriers if police continue to treat syringe possession as a crime or evidence of criminal activity. Despite the integral role of police officers in health policy implementation, little is known of their knowledge of, attitudes toward, and enforcement response to harm-minimisation schemes. We conducted qualitative interviews with 14 police officers in an urban police department following decriminalisation of syringe purchase and possession. Significant findings include: respondents were generally misinformed about the law legalising syringe purchase and possession; accurate knowledge of the law did not significantly change self-reported law enforcement behaviour; while anxious about accidental needle sticks and acquiring communicable diseases from IDUs, police officers were not trained or equipped to deal with this occupational risk; respondents were frustrated by systemic failures and structural barriers that perpetuate the cycle of substance abuse and crime, but blamed users for poor life choices. These data suggest a need for more extensive study of police attitudes and behaviours towards drug use and drug users. They also suggest changes in police training and management aimed at addressing concerns and misconceptions of the personnel, and ensuring that the legal harm reduction programs are not compromised by negative police interactions with IDUs.

Introduction

Injecting drug users (IDUs) are at significant risk of contracting HIV and other infectious diseases, and of introducing the disease to non-injecting populations (UNAIDS, 2004). Drug injection accounts for nearly one in four new HIV cases, while in some regions (like Asia and Eastern Europe), this mode of transmission has become the single most significant driving force behind the AIDS epidemic (Rhodes et al., 1999, UNAIDS, 2004). In the US, injecting drug use accounts for as many as a third of all adult and half of all paediatric HIV cases, as well as half of new hepatitis C virus (HCV) infections (CDC, 2003).

A growing body of evidence suggests that improved access to clean injection equipment reduces the incidence of blood-borne pathogens, such as HIV and HCV among IDUs, their sexual partners, their children, and other members of the community (Gollub, 1999; Hurley, Jolley, & Kaldor, 1997; MacDonald, Law, Kaldor, Hales, & Dore, 2003; Normand, Vlahov, & Moses, 1995; Raboud, Boily, Rajeswaran, O'Shaughnessy, & Schechter, 2003). Laws governing drug use (including laws restricting the purchase or possession of sterile syringes) and the practices of the law enforcement officers who implement those laws influence the feasibility and effectiveness of prevention programs targeted at IDUs (Bluthenthal, 1997, Broadhead, 1999; Burris, Finucane, Gallagher, & Grace, 1996; Collins, Summers, Aragon, & Johnson, 2002; Davis, Burris, Metzger, Becher, & Lynch, 2005; Des Jarlais, McKnight, & Milliken, 2004; Wood et al., 2003). Research has established that legal restrictions on syringe purchase and possession, and the behaviour of law enforcement officers, directly influence willingness of IDUs to obtain, carry and refrain from sharing injection equipment (Aitken, Moore, Higgs, Kelsall, & Kerger, 2002; Blankenship & Koester, 2002; Bluthenthal, Kral, Erringer, & Edlin, 1999; Bluthenthal, Lorvick, Kral, Erringer, & Kahn, 1999; Gleghorn, Jones, Dogherty, Celentano, & Vlahov, 1995; Grund, 2001, Human Rights Watch, 2003c; Klein & Levy, 2003; Koester, 1994; Lin et al., 2004; Maher & Dixon, 1999; Rhodes et al., 2002).

Governments may respond to this problem by changing the law. In the US, 17 states have taken legislative action to ease restrictions on purchase and possession of syringes by IDUs, and/or to authorise syringe exchange programs (SEPs) (Burris, Strathdee, & Vernick, 2003). These changes in the formal law, or “law on the books,” do not, however, automatically lead to changes in the behaviour of law enforcement officers, whose activities constitute the “law on the streets” (Burris et al., 2004). Because police officers exercise a great deal of discretion in their work (Maher & Dixon, 1999; Shearing & Ericsson, 1991), law on the streets and law on the books can differ significantly. In places where syringe possession is formally legal, police may use their de facto power to confiscate syringes, or arrest IDUs on other charges, such as possession of a residue of illegal drug in the “legal” syringe. Law enforcement practices inconsistent with official harm reduction policies have been documented in Canada, Australia and the United States (Davis et al., 2005; Doe v. Bridgeport Police Department, 2001; Grund, Hechathorn, Broadhead, & Anthnony, 1995; Human Rights Watch, 2003a, Human Rights Watch, 2003b; Maher & Dixon, 1999; Roe v. City of New York, 2002, Wood et al., 2003).

Needles and syringes also directly affect the occupational health and safety of police officers. A study of police officers in one city found that nearly 30% of respondents had been stuck by a syringe at one point in their career, with over 27% experiencing two or more needle stick injuries (NSI) (Lorentz, Hill, & Samimi, 2000). There is some evidence that syringe access reform can influence NSI among law enforcement officers by making drug users less likely to hide syringes during a police pat-down (Groseclose et al., 1995).

The importance of police in the effective implementation of syringe access policies combined with the occupational risk in handling needles highlight the need for greater efforts to understand police attitudes and behaviour in relation to harm reduction and drug control policy more generally. Such an understanding is key to developing interventions that meet the needs of law enforcement professionals and make them more accepting of harm-reduction initiatives. There has been little study of this subject, however, and the research conducted so far has been confined to the attitudes of higher-level officers (Beyer, Crofts, & Reid, 2002). As a way of addressing this gap, this paper presents the results of interviews with police officers working on the streets of a medium-sized municipality in the U.S. state of Rhode Island.

Section snippets

Setting and subjects

Historically, the state of Rhode Island's drug paraphernalia law—which included restrictions relating to syringes—was one of the most stringent in the nation: possession of injection equipment was punishable by up to 5 years in prison per syringe. Resulting street scarcity of syringes meant that sharing practices were extremely common among IDUs (Rich et al., 1998). By the mid-1990s, Rhode Island had become one of only 4 US states where over half of all HIV cases could be attributed to

Sample

All 14 police officers (about 10% of the department) we recruited agreed to participate. Participants were older (average age: 36), more experienced (average years on the job: 12), and better educated (21% had Master's degrees) compared to non-participants. We attribute this difference to younger officers customarily working late-night shifts, which left them less available for interviews during daytime hours. Half of the respondents were in supervisory or administrative positions (sergeant or

Discussion

We have identified several important gaps in the implementation of the Rhode Island syringe deregulation policy. Only half of officers in our sample were aware that syringe possession had been completely legalised. Even officers who knew of the change in law continued to use syringes as probable cause for searches or as evidence of drug possession. Real change in the extent to which IDUs obtain, carry and use sterile injection equipment depends upon what is done to ensure that police officers

Conclusion

Policy changes designed to increase IDU access to sterile injection equipment cannot be successfully implemented without the co-operation of the police officers who enforce drug control laws. Policy changes unaccompanied by efforts to secure police co-operation through training, management changes, and monitoring are unlikely to succeed to the desired degree. Collaboration between police and public health agencies has the potential to yield new, more effective methods of reducing risk behaviour

Acknowledgements

This study was supported by grants from the National Institutes on Drug Abuse (NIDA RO1-DA 14853) and the National Institutes of Health, Centre for AIDS Research (NIH CFAR-P30-AI-42853).

We extend our deepest gratitude to the participating officers for candidly sharing their opinions and experiences. Special thanks are due to the leadership of the department's Planning and Training division, whose logistical assistance made this study possible. Additional guidance was provided by Ricky

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