Baltimore Police and Harm Reduction: Research Results

ALIGNING LAW ENFORCEMENT AND HARM REDUCTION IN BALTIMORE CITY

Marina Smelyanskaya, Leo Beletsky, Susan Sherman, Chris Serio-Chapman, Anne Louise Sawyer

HIV and Drug Use in Baltimore

• 10% of Baltimore city residents aged over 18 use drugs

• 2009: 829 new HIV diagnoses

• 2010: 819 new HIV diagnoses

• Baltimore City – 10th place in the number of yearly new HIV infections among US metro areas

Baltimore City Health Department Community Risk Reduction Services

• Since 1994 the Baltimore City NEP has contributed to a 30% reduction of new HIV infections among IDUs

• More than $12.6 million in savings annually.

Community Risk Reduction Services Needle Exchange Program

• operates 6 days a week • 17 locations around the

city • needle exchange,

wound care, HIV counseling, testing and drug treatment referral services

• serves an average of 560 unique IDU clients every month

Baltimore Police and Needle Exchange: Context

• Maryland State Drug Paraphernalia Law protects NEP card carriers in Baltimore City

• NEP is run by a City agency allowing for collaboration

• Syringe confiscation, other harassment reported by NEP Clients

• Trainings launched for BPD in 2009

Client/NEP PerspectiveData from other cities: Fear of police deters client participation Police may question NEP or outreach

staff Police may provide security to NEP and

outreach staff Police refer clients to NEPs and drug

treatment

Experience varies widely across US Most programs do not systematically

document police issues Poor lines of communication and

incentive are the norm

Police Perspective• Fear of needle stick injury (NSI) and

other occupational risks from contact with IDUs and SWs

• Poor knowledge of infectious disease transmission

• Cultural norms support negative attitudes toward NEPs and other interventions

• Lack of clarity about the policies governing NEPs (drug paraphernalia, reasonable suspicion)

• Frustration with tools to address the root causes of drug abuse (poverty, poor education, lack of available treatment, etc.)

• Competing priorities of politicians, media, and community groups

Needle Exchange Program Locations

Study Information: Police Training• Trainer: NEP Staffer• Audience: Police Officers and Cadets• 30 minutes – 1 hour long• 2 questionnaires with 13 pre/post test questions• 600 questionnaires administered over 2 years• 292 matched pre/post test results

Study Information: Interviews with NEP Clients

• Clients interviewed at 2 sites. • NEP sites chosen to illustrate diversity (age, race)• 11-question form administered by a volunteer• Incentive – $10 Rite Aid card• 308 clients interviewed over 2 years.

Study Demographics: Police

Total Police Cohort (n=600) Matched Questionnaires (n=292)

Age: 21-30: 80.8%

31-40: 15.1%

41+: 3.8%

Race: African American: 23.3%

White: 59.6%

Hispanic: 11.6%

Other: 4.5%

Sex:Male: 86.3%

Female: 12.7%

Age: 21-30: 50.2%

31-40: 27.8%

41+: 21%

Race: African American: 37.5%

White: 46.7%

Hispanic: 8.8%

Other: 6.2%

Sex:Male: 82%

Female: 17%

Study Demographics: PoliceYears in BPD

Total Police Cohort (n=600) Matched Questionnaires (n=292)

< 1 year60%

1 year8%

2-5 year

s9%

6-10

years

2%

>10 year

s3% unknown

17% < 1 year

26%

1 year5%

2-5 years18%

6-10 years12%

>10 years24%

unknown14%

Study Results: Occupational Safety

Pre-Test Results (n=600):

• 98% of respondents consider needle stick injuries an important concern

• 95% would use needle stick resistant gloves

Study Results: Occupational RiskPre-Test Results (n=600):• 96% are concerned about getting

HIV or other infectious diseases from drug users*

• 10% report having experienced a needle stick

• 92% believe that the probability of getting HepC from needle stick is high

• 86% believe that the probability of getting HIV from a needle stick is high

*No significant change to HIV concern was noted in the matched pre-test/post-test group

Study Results: Change in Knowledge and Attitude

• Matched n=292

Is it Legal?It is legal for needle exchange clients to carry used syringes and other drug injection equipment?

30% changeDisagree -> Agree

Pre-Test Post-Test0

50

100

150

200

250

300

Agree Disagree

Syringe ConfiscationIf syringes are found during a search but the person is not arrested, I would confiscate them.

29% changeAgree -> Disagree

Pre-Test Post-Test0

50

100

150

200

250

300

Agree Disagree

Do NEPs promote Drug Use?Access to clean needles through pharmacies or needle exchange promotes drug use.

Pre-Test Post-Test0

50

100

150

200

250

300

Agree Disagree

24% changeAgree -> Disagree

NEPs and Drug TreatmentThe needle exchange program helps drug users get into drug treatment

34% changeDisagree ->Agree

Pre-Test Post-Test0

50

100

150

200

250

300

Agree Disagree

Study Results: NEP Attitudes

Access to Clean Needles Reduces the Spread of HIV and Hep C in the Community

85% Agree at the outset 87% Agree after the training

I would refer an injection drug user to the NEP

87% Agree at the outset 95% Agree after the Training

Study Demographics: NEP Clients

Total Interviewed: n=308

Race• African American 58.4%• White 40%• Other 1.6%

Sex• Female 24.4%• Male 74.4%

Age• <25: 4%• 25-34: 18%• 34-44: 24%• 45-54: 35%• Over 54: 19%

On Parole or Probation• Yes: 21%• No: 78%

Study Demographics by Site

Freemont and Riggs (n=169)

Race• African American 93.5%• White 6%• Other 1.5%

Sex• Female 15%• Male 83%

Age• <25: 0%• 25-34: 4%• 34-44: 19%• 45-54: 47%• Over 54: 30%

On Parole or Probation• Yes: 18%• No: 81%

Monroe and Ramsey (n=139)

Race• African American 16%• White 81%• Other 3%

Sex• Female 36%• Male 64%

Age• <25: 8.6%• 25-34: 35%• 34-44: 29.5%• 45-54: 20%• Over 54: 6.5%

On Parole or Probation• Yes: 25%• No: 74%

NEP Visits in the Last 6 months

Freemont and Riggs Monroe and Ramsey2%

8%

21%

39%

30%

None 1 (1x/6mos) 2-5 (>1x/6mos<1x/mo) 6-27 (>1x/mo<weekly) >28 (>weekly)

5%

6%

29%

42%

17%

None 1 (1x/6mos) 2-5 (>1x/6mos<1x/mo) 6-27 (>1x/mo<weekly) >28 (>weekly)

Police Encounters: Monroe & Ramsay

Police Encounters: Freemont & Riggs/Laurens

Study Results: Targeted Clients• Being younger and male and using the NEP site more

frequently increased the number of police encounters a NEP client was likely to experience.

Police Dos and Don’ts

Study Limitations• From 600 questionnaires collected, 292 were matched

(pre-post) • Cadets constitute the majority of the matched sample for

police• Police questionnaire forms were not always completed

and in small number of cases pre-post trends were reversed

• Clients over-reported encounters• Interruptions in funding didn’t allow for a “snapshot”

scenario

Recommendations

1. Continue and institutionalize trainings

2. Strengthen cross-agency communications on field operations, syringe disposal, and occupational safety issues

3. Create incentives for police-public health collaboration, including certificates of appreciation

4. Engage NEP Clients and Staff in conversation with police

5. Provide NEP Clients with continuous information on rights and strategies for interacting with police officers

Conclusion• Police personnel are extremely concerned about

occupational NSI, HIV and Hepatitis C, sometimes overestimating risk.

• Training can address occupational safety concerns, while also improving knowledge of the rationale and policy behind risk reduction services

• Better alignment between risk reduction and policing can insure occupational safety, while also addressing workplace stress and costs

Acknowledgements• Baltimore City Department of Health Risk Reduction

Services• Chris Serio-Chapman

• Needle Exchange Van Staff and Volunteers• Lamont Clark, Derrick Hunt• Emily Clossner, Peter Fotang

• Study PIs:• Leo Beletsky• Susan Sherman

• Project Consultants:• Anne Sawyer, Emily Peterson, Natanya Rabinowitz

• Funding: Campaign for the New Drug Policy, OSF

Contact

• Marina Smelyanskayam.smelyanskaya@gmail.com

• Leo Beletsky

l.beletsky@neu.edu

• Chris Serio-Chapman

Chris.Serio@baltimorecity.gov

• Susan Sherman

ssherman@jhsph.edu