Short communicationAttitudes of North Carolina law enforcement officers toward syringe decriminalization
Introduction
The burden of bloodborne disease in the United States falls disproportionately on those living in the South (Lansky et al., 2010, Qian et al., 2006), which has higher HIV and hepatitis C (HCV) incidence rates and more people living with HIV than any other region (Centers for Disease Control and Prevention, 2013a, Centers for Disease Control and Prevention, 2013b, Centers for Disease Control and Prevention, 2013c, Centers for Disease Control and Prevention, 2013d, Zou et al., 2010). In 2011, North Carolina had the country's 8th highest HIV incidence rate, the 12th highest number of cumulative AIDS cases, and an HCV incidence rate 50% greater than the national average (Centers for Disease Control and Prevention, 2013a, Centers for Disease Control and Prevention, 2013b, Centers for Disease Control and Prevention, 2013c, Centers for Disease Control and Prevention, 2013d, North Carolina Division of Public Health, 2013).
Nearly 23% of all AIDS cases in North Carolina are attributable to injection drug use (IDU) alone, with an additional 5.6% of cases among men who have sex with men (MSM) who also reported IDU (Centers for Disease Control and Prevention, 2012). Nationwide, IDU is the leading risk factor for HCV infection (Centers for Disease Control and Prevention, 2002, Centers for Disease Control and Prevention, 2013a). While acute HCV infections among Blacks have fallen over the past decade (Centers for Disease Control and Prevention, 2013a, Centers for Disease Control and Prevention, 2013b, Centers for Disease Control and Prevention, 2013c, Centers for Disease Control and Prevention, 2013d), HIV continues to be disproportionately distributed by race: Blacks comprise only 22% of North Carolina's population but 67% of AIDS cases (Centers for Disease Control and Prevention, 2012, United States Census Bureau, 2012).
Law and law enforcement practices that reduce access to new syringes and opportunities to safely dispose of used ones are a key factor in injection-related disease transmission and may contribute to racial disparities in HIV rates (Blankenship and Koester, 2002, Bluthenthal et al., 1997, Burris et al., 2002, Burris et al., 2011, Burris and Koester, 2013, Davis et al., 2005). Increased access to sterile syringes has been associated with a number of positive changes in health behavior and disease risk among people who inject drugs (PWID), including reductions in HIV and HCV infections, risky injecting behavior and improperly discarded syringes (Des Jarlais et al., 2005, Gibson et al., 2001, Hurley et al., 1997, Strathdee et al., 2006, Wodak and Cooney, 2006). Legal change to increase access to syringes has also been associated with reduced needlestick injuries (NSI) among law enforcement officers (LEOs; Groseclose et al., 1995) and may reduce the risk of NSI-related infection.
Modifying law to permit or require evidence-based public health strategies is a critical component in improving health outcomes (Hodge et al., 2013, Mello et al., 2013). Many states have responded to the large body of evidence that increased syringe access reduces infection risk without increasing drug use by modifying criminal law to permit the possession and distribution of syringes, a policy termed syringe decriminalization (Burris, 2014). Southern states have largely failed to make such amendments. As of 2014, only one Southern state (Louisiana) permitted the distribution of syringes intended to be used to inject illegal drugs, and none permitted the possession of syringes for that purpose (Burris, 2014). This failure may contribute to persistently high rates of HIV infection in North Carolina and throughout the South (Adimora et al., 2014, Human Rights Watch, 2010, Reif et al., 2012).
North Carolina has been a leader among Southern states in some areas related to syringe access. It is legal to purchase syringes in pharmacies without a prescription in the state, although sales are at the discretion of the pharmacist and research has demonstrated that Black PWID are far less likely than whites to report receiving syringes from a pharmacy (Costenbader et al., 2010). Additionally, a state law partially decriminalizing syringes was implemented in 2013. The law protects a person from charge or prosecution for paraphernalia possession if he or she is stopped by a law enforcement officer (LEO) and voluntarily reports the syringe or other sharp object to the LEO before a search is conducted (North Carolina General Assembly, 2013a, North Carolina General Assembly, 2013b). Possession or distribution of syringes for illegal drug use, however, remains illegal.
Law enforcement support is likely an important factor in both the passage and implementation of syringe access and syringe decriminalization laws (Beletsky et al., 2005b, Silverman et al., 2012). Several previous initiatives have bundled LEO occupational safety training with information regarding the legality and beneficial effects of such laws (Beletsky et al., 2011, Davis and Beletsky, 2009, Silverman et al., 2012), but little is known regarding LEO attitudes toward them. Research from several Northern states reported that LEOs were generally supportive of efforts to reduce risks associated with drug use (Banta-Green et al., 2013, Beletsky et al., 2005a, Green et al., 2013), but none asked about syringe decriminalization specifically. We present below the results of the first such survey conducted among LEOs in the Southern United States.
Section snippets
Methods
Data were collected via surveys designed and administered by a local non-profit organization that conducted trainings for officers training to join Crisis Intervention Teams (CITs). These teams are comprised of LEOs, often in conjunction with other professionals such as mental health workers, who utilize evidence-based approaches in interacting with people in acute mental health need (Watson and Fulambarker, 2012). The hour-long training, delivered at multiple sites throughout the state in 2012
Results
The convenience sample consisted of 350 officers from 20 law enforcement agencies throughout North Carolina. Approximately 80% of respondents were male and, on average, had worked in law enforcement for approximately 10 years. Approximately 25% reported their race as Black, and 65% as white (Table 1). Eighty two percent of respondents reported that contracting HIV and 85% reported that contracting hepatitis was a “big concern” for them, far exceeding the percentage that reported ever receiving
Discussion
Law enforcement support appears to have been an important factor in the passage of North Carolina's 2013 partial decriminalization law. Bills intended to increase access to sterile syringes were introduced in six of the nine legislative sessions between 1997 and 2013 (North Carolina General Assembly, 1997, North Carolina General Assembly, 2001, North Carolina General Assembly, 2005, North Carolina General Assembly, 2007, North Carolina General Assembly, 2011, North Carolina General Assembly,
Role of funding source
Nothing declared.
Contributors
C. Davis conceptualized and drafted the article. J. Johnston and K. Clark conducted data analysis. L. Zerden contributed to the research and writing. R. Childs and T. Castillo designed and conducted the training. All authors reviewed and approved the submitted manuscript.
Conflict of interest
No conflict declared.
Acknowledgement
The authors thank Leo Beletsky for helpful comments on earlier versions of the manuscript.
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