“When people who use drugs can’t differentiate between medical care and cops, it’s a problem.” Compounding risks of law Enforcement Harassment & Punitive Healthcare Policies

Health & Justice
Bayla Ostrach1,2, Vanessa Hixon3, Anne Bryce4
1Boston University School of Medicine
2Fruit of Labor Action Research & Technical Assistance, LLC, Fairview, NC, USA
3Appalachian Medical Solidarity, Asheville, North Carolina, USA
4Holler Harm Reduction, Marshall, NC, USA

Tóm tắt

Abstract Background Community-based harm reduction programming is widely recognized as an effective strategy for reducing the increased risks for and spread of HIV, HCV, and for reducing the growing rate of overdose deaths among people who use drugs (PWUD). PWUD in the United States (US) are a highly justice-involved population, also at increased risk for law enforcement interaction, arrest, and incarceration. These risks compound and interact in the context of criminalization and law enforcement surveillance. Justice involvement increases risks for overdose and for riskier injecting behavior among PWUD, in turn increasing HCV and HIV risks. In Central and Southern Appalachia specifically, PWUD have identified fear of law enforcement harassment and arrest as a barrier to engaging in harm reduction behavior, and a deterrent to seeking help at the scene of an overdose. Moreover, stigmatizing and punitive treatment in healthcare settings can deter PWUD from seeking care, with life or death consequences. This evaluation research study assessing the successes and impacts of a grant-funded project to increase access to safer drug consumption supplies and overdose prevention education for PWUD, including justice-involved participants of a syringe access program (SAP), in public housing and beyond in a South-Central Appalachian setting used key informant and opportunistic sampling. Mixed-methods data were compiled and collected including secondary program data; primary interview and participant-observation data. Results The evaluation research identified that grant deliverables were largely achieved, despite challenges presented by the COVID-19 pandemic. In addition, SAP participants and staff reported larger themes surrounding grant-funded activities, in which they perceived that widespread local law enforcement harassment of PWUD increased participants’ risks for overdose death and infectious disease risks and that punitive local healthcare settings and policies acted as deterrents to care-seeking for many PWUD. Conclusions Overall, the evaluation research found that participants’ experiences with and perceptions of local law enforcement harassment combined with their understandings and experiences of local punitive healthcare settings and policies; together compounding and increasing overdose risks and negative health consequences for local justice-involved PWUD.

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Tài liệu tham khảo

Ahlner, J., Holmgren, A., & Jones, A. W. (2016). Demographics and post-mortem toxicology findings in deaths among people arrested multiple times for use of illicit drugs and/or impaired driving. Forensic Science International, 265, 138–143. https://doi.org/10.1016/j.forsciint.2016.01.036.

Baker, P., Beletsky, L., Avalos, L., Venegas, C., Rivera, C., Strathdee, S. A., & Cepeda, J. (2020). Policing practices and risk of HIV infection among people who inject drugs. Epidemiologic Reviews, 42(1), 27–40. https://doi.org/10.1093/epirev/mxaa010.

Banta-Green, C. J., Beletsky, L., Schoeppe, J. A., Coffin, P. O., & Kuszler, P. C. (2013). Police officers’ and paramedics’ experiences with overdose and their knowledge and opinions of Washington State’s drug overdose–naloxone–good Samaritan law. Journal of Urban Health, 90(6), 1102–1111. https://doi.org/10.1007/s11524-013-9814-y.

Barnes, J. C., Jorgensen, C., Beaver, K. M., Boutwell, B. B., & Wright, J. P. (2015). Arrest prevalence in a National Sample of adults: The role of sex and race/ethnicity. American Journal of Criminal Justice, 40(3), 457–465. https://doi.org/10.1007/s12103-014-9273-3.

Beletsky, L., Cochrane, J., Sawyer, A. L., Serio-Chapman, C., Smelyanskaya, M., Han, J., … Sherman, S. G. (2015). Police encounters among needle exchange clients in Baltimore: Drug law enforcement as a structural determinant of health. American Journal of Public Health, 105(9), 1872–1879. https://doi.org/10.2105/AJPH.2015.302681.

Biden, J. (2021). Statement by president Joe Biden on surpassing 100,000 American overdose deaths in the past year. White House Briefing Room https://www.whitehouse.gov/briefing-room/statements-releases/2021/11/17/statement-by-president-joe-biden-on-surpassing-100000-american-overdose-deaths-in-the-past-year/.

Binswanger, I. A., & Glanz, J. M. (2018). Potential risk window for opioid overdose related to treatment with extended-release injectable naltrexone. Drug Safety, 41(10), 979–980.

Binswanger, I. A., Nguyen, A. P., Morenoff, J. D., Xu, S., & Harding, D. J. (2020). The association of criminal justice supervision setting with overdose mortality: A longitudinal cohort study. Addiction, 115(12), 2329–2338. https://doi.org/10.1111/add.15077.

Bohnert, A., Nandi, A., Tracey, M., Cerda, M., Tardiff, K., Vlahov, D., & Galea, S. (2011). Policing and risk of overdose mortality in urban neighborhoods. Drug and Alcohol Dependence, 113(2011), 62–68. https://doi.org/10.1016/j.drugalcdep.2010.07.008.

Brinkley-Rubinstein, L., Cloud, D., Drucker, E., & Zaller, N. (2018a). Opioid use among those who have criminal justice experience: Harm reduction strategies to lessen HIV risk. Current HIV/AIDS Reports, 15(3), 255–258. https://doi.org/10.1007/s11904-018-0394-z.

Brinkley-Rubinstein, L., Zaller, N., Martino, S., Cloud, D. H., McCauley, E., Heise, A., & Seal, D. (2018b). Criminal justice continuum for opioid users at risk of overdose. Addictive Behaviors, 86, 104–110. https://doi.org/10.1016/j.addbeh.2018.02.024.

Bryce, A., Brown, H., Goldstein, R., & Ostrach, B. (2021). Druge Use Harm Reduction Best Practices for Western North Carolina: Contextually Informed, Locally Specific Evidence-Based Recommendations for Funders & Practitioners.

Carpenter, D. M., Zule, W. A., Hennessy, C. M., Evon, D. M., Hurt, C. B., & Ostrach, B. (2022). Factors Associated with Perceived Ease of Access to Syringes in Appalachian North Carolina. The Journal of Rural Health.

Carroll, J., Green, T., & Noonan, R. (2018). Evidence-based strategies for preventing opioid overdose: What’s working in the United States, 2018 (p. 40). Centers for disease control. https://www.cdc.gov/drugoverdose/pdf/pubs/2018-evidence-based-strategies.pdf

Carroll, J. J., Ostrach, B., Wilson, L., Dunlap, J. L., Getty, R., & Bennett, J. (2021). Drug induced homicide laws may worsen opioid related harms: An example from rural North Carolina. International Journal of Drug Policy, 97, 103406. https://doi.org/10.1016/j.drugpo.2021.103406.

Caulkins, J. P., & Reuter, P. (2021). Ending the war on drugs need not, and should not, involve legalizing supply by a for-profit industry. The American Journal of Bioethics, 21(4), 31–35. https://doi.org/10.1080/15265161.2021.1893064.

CDC (2020). Recent HIV clusters and outbreaks across the United States among people who inject drugs and considerations during the COVID-19 pandemic. CDC Health Advisory.

CDC. (2021). Drug Overdose Deaths in the U.S. Top 100,000 Annually. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm

Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative research. London: Sage Publications Ltd.

Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches, (3rd ed., ). Sage Publications Ltd.

Davis, S. M., Kristjansson, A. L., Davidov, D., Zullig, K., Baus, A., & Fisher, M. (2019). Barriers to using new needles encountered by rural Appalachian people who inject drugs: Implications for needle exchange. Harm Reduction Journal, 16(1), 1–8. https://doi.org/10.1186/s12954-019-0295-5.

Des Jarlais, D. C., Perlis, T., Arasteh, K., Torian, L. V., Hagan, H., Beatrice, S., … Friedman, S. R. (2005). Reductions in hepatitis C virus and HIV infections among injecting drug users in new York City, 1990–2001. AIDS, 19, S20. https://doi.org/10.1097/01.aids.0000192066.86410.8c.

Dixon, P. (2023, January 30). A refresher on North Carolina’s needle exchange law and other harm reduction immunities. Coates’ Canons NC Local Government Law https://canons.sog.unc.edu/2023/01/a-refresher-on-north-carolinas-needle-exchange-law-and-other-harm-reduction-immunities/.

G.S.90-113.22. Possession of drug paraphernalia, (2019). https://www.ncleg.gov/EnactedLegislation/Statutes/PDF/BySection/Chapter_90/GS_90-113.22.pdf

Hamilton, L. K., Wheeler-Martin, K., Davis, C. S., Martins, S. S., Samples, H., & Cerdá, M. (2022). A modified Delphi process to identify experts’ perceptions of the most beneficial and harmful laws to reduce opioid-related harm. International Journal of Drug Policy, 108, 103809. https://doi.org/10.1016/j.drugpo.2022.103809.

Jafari, S., Joe, R., Elliot, D., Nagji, A., Hayden, S., & Marsh, D. C. (2015). A Community Care Model of Intravenous Antibiotic Therapy for Injection Drug Users with Deep Tissue Infection for “Reduce Leaving Against Medical Advice”. International Journal of Mental Health and Addiction, 13(1), 49–58. https://doi.org/10.1007/s11469-014-9511-4.

Kaiser Family Foundation. (2017). Rurality in the United States, by county (using index of relative rurality). https://public.tableau.com/views/RuralityintheU_S_byCounty/RuralityintheUnitedStatesbyCounty?%3Aembed=y&%3AshowVizHome=no&%3Adisplay_count=y&%3Adisplay_static_image=y&%3AbootstrapWhenNotified=true&%3Alanguage=en&:embed=y&:showVizHome=n&:apiID=host0#navType=0&navSrc=Parse

Kattakuzhy, S., & Rosenthal, E. (2020). To eliminate hepatitis C in people who inject drugs. Stop Ignoring Drug User Health. Clinical Infectious Diseases.

Leiner, C., Cody, T., Mullins, N., Ramage, M., & Ostrach, B. M. M. (2021). “The elephant in the room;” a qualitative study of perinatal fears in opioid use disorder treatment in southern Appalachia. BMC Pregnancy and Childbirth, 21(1), 143. https://doi.org/10.1186/s12884-021-03596-w.

Linas, B. P., Savinkina, A., Madushani, R., Wang, J., Yazdi, G. E., Chatterjee, A., … Assoumou, S. A. (2021). Projected estimates of opioid mortality after community-level interventions. JAMA Network Open, 4(2), e2037259–e2037259. https://doi.org/10.1001/jamanetworkopen.2020.37259.

McNeil, R., Small, W., Wood, E., & Kerr, T. (2014). Hospitals as a ‘risk environment’: An ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs. Social Science & Medicine, 105, 59–66. https://doi.org/10.1016/j.socscimed.2014.01.010.

Meyerson, B. E., Russell, D. M., Kichler, M., Atkin, T., Fox, G., & Coles, H. B. (2021). I don’t even want to go to the doctor when I get sick now: Healthcare experiences and discrimination reported by people who use drugs, Arizona 2019. International Journal of Drug Policy, 103112. https://doi.org/10.1016/j.drugpo.2021.103112.

Naumann, R. B., Durrance, C. P., Ranapurwala, S. I., Austin, A. E., Proescholdbell, S., Childs, R., … Shanahan, M. E. (2019). Impact of a community-based naloxone distribution program on opioid overdose death rates. Drug and Alcohol Dependence, 204, 107536. https://doi.org/10.1016/j.drugalcdep.2019.06.038.

Ostrach, B., Buer, L.-M., Armbruster, S., Brown, H., Yochym, G., & Zaller, N. (2021). COVID-19 and rural harm reduction challenges in the US Southern Mountains. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 37(1), 252–255. https://doi.org/10.1111/jrh.12499.

Paquette, C. E., Syvertsen, J. L., & Pollini, R. A. (2018). Stigma at every turn: Health services experiences among people who inject drugs. International Journal of Drug Policy, 57, 104–110. https://doi.org/10.1016/j.drugpo.2018.04.004.

Ranapurwala, S. I., Shanahan, M. E., Alexandridis, A. A., Proescholdbell, S. K., Naumann, R. B., Edwards Jr., D., & Marshall, S. W. (2018). Opioid overdose mortality among former North Carolina inmates: 2000–2015. American Journal of Public Health, 108(9), 1207–1213. https://doi.org/10.2105/AJPH.2018.304514.

Rouhani, S., Schneider, K. E., Rao, A., Urquhart, G. J., Morris, M., LaSalle, L., & Sherman, S. G. (2021). Perceived vulnerability to overdose-related arrests among people who use drugs in Maryland. International Journal of Drug Policy, 98, 103426. https://doi.org/10.1016/j.drugpo.2021.103426.

Singer, M. (2007). Drugging the poor: Legal and illegal drugs and social inequality. Waveland Press.

Singer, M., & Page, J. B. (2016). The social value of drug addicts: Uses of the useless. Routledge.

Singer, M., & Ziegler, J. (2017). The role of drug user stigmatization in the making of drug-related Syndemics, (p. 1). Foundations of Biosocial Health: Stigma and Illness Interactions.

Small, D., Glickman, A., Rigter, G., & Walter, T. (2010). The Washington needle depot: Fitting healthcare to injection drug users rather than injection drug users to healthcare: Moving from a syringe exchange to syringe distribution model. Harm Reduction Journal, 7(1), 1.

Strike, C., & Miskovic, M. (2018). Scoping out the literature on mobile needle and syringe programs—Review of service delivery and client characteristics, operation, utilization, referrals, and impact. Harm Reduction Journal, 15(1), 6. https://doi.org/10.1186/s12954-018-0212-3.

USDA Economic Research Service. (2020, August 17). Documentation 2010 Rural-Urban Commuting Area (RUCA) Codes https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx

Wagner, K. D., Simon-Freeman, R., & Bluthenthal, R. N. (2013). The association between law enforcement encounters and syringe sharing among IDUs on skid row: A mixed methods analysis. AIDS and Behavior, 17(8), 2637–2643. https://doi.org/10.1007/s10461-013-0488-y.

Wodak, A., Cooney, A., & World Health Organization (2004). Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. World Health Organization.

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