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 10
th
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 Perspective
Data 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: Police
Years in BPD
Total Police Cohort (n=600)


Matched Questionnaires (n=292)
< 1 year
60%
1 year
8%
2-5
years
9%
6-10
years
2%
>10
years
3%
unknown
18%
< 1 year
26%
1 year
5%
2-5
years
18%
6-10
years
12%
>10
years
24%
unknown
15%
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 Risk
Pre-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% change
Disagree -> Agree
0
50
100
150
200
250
300
Pre-Test Post-Test
Agree
Disagree
Syringe Confiscation
If syringes are found during a search but the person is not arrested, I
would confiscate them.
29% change
Agree -> Disagree
0
50
100
150
200
250
300
Pre-Test Post-Test
Agree
Disagree
Do NEPs promote Drug Use?
Access to clean needles through pharmacies or needle exchange
promotes drug use.
0
50
100
150
200
250
300
Pre-Test Post-Test
Agree
Disagree
24% change
Agree -> Disagree
NEPs and Drug Treatment
The needle exchange program helps drug users get into drug treatment
34% change
Disagree ->Agree
0
50
100
150
200
250
300
Pre-Test Post-Test
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 Ramsey
2%
8%
21%
39%
30%
None 1 (1x/6mos)
2-5 (>1x/6mos<1x/mo) 6-27 (>1x/mo<weekly)
>28 (>weekly)
5%
6%
30%
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 Donts
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 didnt 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 Smelyanskaya
m.smelyanskaya@gmail.com

Leo Beletsky
l.beletsky@neu.edu

Chris Serio-Chapman
Chris.Serio@baltimorecity.gov

Susan Sherman
ssherman@jhsph.edu