Needle Exchanges

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Needle and syringe exchange programmes (NEPs) are a scientifically proven intervention to reduce a wide range of harms for drug injectors (not least HIV/AIDS, hepatitis, bacterial infections, injecting wounds and overdose). However, as a result of the criminal nature of illicit drug use, the success of NEPs is largely dependent on the attitudes and actions of local police. This section includes examples of best practice, worst practice (and legal challenges), advocacy guides aimed at the police, and studies on the attitudes of law enforcement personnel towards NEPs and their clients.

American Civil Liberties Union (2001) CT Court is First in Nation to Protect Needle Exchange Program from Police Harassment. URL Document

This website article documents the positive outcome from a legal test case in Connecticut, USA. In response to the alleged police harassment and arrest of drug users at a needle exchange facility, a federal court ruled that police may not interfere with these public health initiatives. Although effective partnership working is always preferable to conflict and litigation, this case underlines the scientific and judicial support for drug treatment and harm reduction endeavours.

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Beletsky L, Macalino GE & Burris S (2005) 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. International Journal of Drug Policy, 16(4), 267-274

This study investigates the attitudes of 14 US police officers towards needle exchange programmes. Although the legal barriers to syringe access had been removed, officers were largely unaware of this law change, and their practice (the “law on the streets”) had not adapted accordingly. Worryingly, the participants were also poorly trained on how to avoid needle-stick injuries, and generally had negative attitudes towards drug users (blaming them for “poor life choices”). We cannot provide free access to this article at this stage – we hope to correct this soon.

Bluthenthal RN, Kral AH, Lorvick J & Watters JK (1997) Impact of law enforcement on syringe exchange programs: A look at Oakland and San Francisco. Medical Anthropology, 18, 61-83

This study (dating to before needle exchanges were legalised in the USA), compares an underground scheme in West Oakland to a police-tolerated one in Fillmore, San Francisco. Although dated, it is a useful resource to demonstrate how inappropriate police action (actual and threatened) can dramatically reduce service uptake (as it did in West Oakland). The authors concluded that such barriers must be removed “if preventing HIV infections is truly a priority”. We cannot provide free access to this article at this stage – we hope to correct this soon.

Bluthenthal RN, Lovrick J, Kral AH, Erringer EA & Kahn JG (1999) Collateral damage in the war on drugs: HIV risk behaviours among injection drug users. International Journal of Drug Policy, 10, 25-38

This paper focuses on the macro drug policy rather than policing per se, but it does provide good scientific evidence for how inappropriate law enforcement policies (such as the criminalisation of syringe possession) can directly hinder harm reduction interventions such as needle exchanges. A third of this large sample were reportedly concerned about being arrested for syringe possession, and this sub-group were likelier to share syringes (one of the main injecting risk behaviours that needle exchanges seek to reduce) than unconcerned drug users. We cannot provide free access to this article at this stage – we hope to correct this soon.

Centre for Innovative Public Policies (2000) Needle exchange initiatives: Getting out the facts and promoting collaboration between law enforcement and public health. URL Documents

This is a series of reports and URL documents that aimed at law enforcement and police personnel. Its goals are to enable communication between public health and law enforcement personnel, introduce police officials to the evidence and arguments for needle exchanges, enable debates and find compromises and common strategies to reduce drug-related harms. One of the items in this series is listed separately in this section (McCampbell & Rubin, 2000).

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Davis CS, Burris S, Kraut-Becher J, Lynch KG & Metzger D (2005) Effects of an intensive street-level police intervention on syringe exchange program use in Philadelphia, Pa. American Journal of Public Health, 95(2), 233-236

This report analyses the use of local needle exchange schemes before and after “an intensive long-term street-level police intervention”. The use of the schemes fell across all categories and time periods studied, with significant declines in use among total participants, male participants, and Black participants – providing further evidence on the impact that policing strategies can have on harm reduction (and needle exchange in particular). Unfortunately, we are unable to provide free access to this resource.

McCampbell SW & Rubin PN (2000) A Needle Exchange Program: What’s In It For Police?

This report, aimed at police officers, tries to describe the science behind needle exchange interventions, highlight the potential benefits for the police (such as reduced needle-stick injury risks), and allay fears that such interventions increase crime, condone drug use and encourage social disorder. The authors advocate for more objective (and less moralistic and passionate) debates on the topic, as the cost of “not giving a darn” is estimated as $3billion a year!

Rhodes T, Platt L, Sarang A, Vlasov A, Mikhailova L & Monaghan G (2006) Street policing, injecting drug use and harm reduction in a Russian city: A qualitative case study of police perspectives. Journal of Urban Health, 83(5), 911-925

This recent study describes the attitudes of 26 Russian police officers towards drug users. Against a backdrop of rising HIV prevalence amongst drug users, the relationship between the police and needle exchanges is described as “uneasy” due to local policing strategies such as drug user surveillance and the criminalisation of syringe possession.

United Kingdom Harm Reduction Alliance (2003) Protocol for the replacement of injecting equipment in police station custody suites. London: UKHRA

This document (based on a template protocol from Kent, England) aims to provide operational guidelines for police and custody personnel for when a detainee arrives in custody with needles or syringes. By encouraging drug users to hand in their injecting paraphernalia, the risks of needle-stick injuries to law enforcement personnel are reduced. By providing sterile replacements to drug users upon their release, they can also benefit from the proven harm reducing approach of sterile needle distribution.

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