Do law enforcement interactions reduce the intiation of injection drug use? An investigation in three North American settings

– Melo JS, Garfein RS, Hayashi K, Milloy MJ, DeBeck K, Sun S, Jain S, Strathdee SA, Werb D

Importance of this Study:

  • Experts suggest that preventing injection initiation is likely to be more effective in reducing disease incidence than seeking to reduce risks experienced by individuals after they initiate injection.

  • The prevention of drug injecting is often cited as a justification for the deployment of law enforcement as well as for the continuation of drug criminalization policies.

  • Limited research exists on how interactions between people who inject drugs (PWID) and law enforcement may influence the risk that PWID provide injection initiation assistance.

  • Previous research suggests that police interactions with PWID may increase behavioral risks for injection-driven disease transmission.

  • We sought to characterize the impact of law enforcement interactions on the risk that PWID report assisting others with injection initiation in three North American countries.

Key Concepts

  • A syndemic is the interaction of two or more coexistent conditions in a population that exacerbates disease morbidity and mortality.

  • Injection drug use initiation is the transition from non-injection drug use into drug injecting.

  • PWID may provide injection initiation assistance to injection-naïve persons who use drugs.

Key Findings

Law enforcement may not effectively reduce the capacity of PWID to initiate others but may instead be associated with an increased risk that PWID assist others into drug injection

Public Health Implications

  • Interventions aiming to prevent syndemics of injection drug use and blood-borne disease should ensure that enforcement-based efforts to deter drug use behaviors do not paradoxically increase risk of their expansion.

  • Policymakers should consider alternatives to enforcement-based interventions.

How This Study Was Conducted

  • Cross-sectional data from PWID participating in cohort studies in three cities (San Diego, USA; Tijuana, Mexico; Vancouver, Canada) were pooled for analysis. Data collection took place from August 2014 to December 2016.

  • The dependent variable was defined as recently (i.e., past six months) providing injection initiation assistance; the primary independent variable was the frequency of recent law enforcement interactions, defined categorically (0, 1, 2-5, 6+).

  • Multivariable logistic regression analysis was used to assess this relationship while controlling for potential confounders (e.g., age, gender, etc.).

What This Study Found

  • Reporting interactions with law enforcement was not associated with a reduced likelihood that PWID reported initiating others into injection drug use.

  • Contrary to theories of the preventive impact of increased enforcement intensity, we identified a positive association between reporting law enforcement interactions and providing injection initiation assistance among PWID.

  • PWID reporting 2-5 interactions with authorities were 1.74 times more likely to assist others into drug injection compared to those reporting no recent interactions.

A global, evidence-based approach on drug use.


© 2019 PRIMER