No abstract

No abstract

Background In 2016, the US state of North Carolina (NC) legalized syringe services programs (SSPs), providing limited immunity from misdemeanor syringe possession when law enforcement is presented documentation that syringes were obtained from an SSP. This study explores the law enforcement interactions experienced by SSP participants since the enactment of this law. Methods This study used a convergent, mixed-methods design consisting of structured surveys and semi-structured interviews with SSP participants in seven NC counties. Survey and interview data were collected simultaneously between January and November 2019. This survey was designed to capture demographics, characteristics of drug use, SSP services used, and past-year negative experiences with law enforcement (officer did not recognize SSP card, did not believe SSP card belonged to participant, confiscated SSP card, confiscated syringes, or arrested participant for possessing syringes). Semi-structured interviews explored lived experiences with and perspectives on the same topics covered in the survey. Results A total of 414 SSP participants completed the survey (45% male, 54% female, 1% transgender or non-binary; 65% White, 22% Black, 5% American Indian/Alaskan Native, 8% some other racial identity). 212 participants (51.2%) reported at least one past-year negative experience with law enforcement. Chi-square testing suggests that Black respondents were more likely to report having experienced law enforcement doubt their SSP card belonged to them. Interview data indicate that law enforcement practices vary greatly across counties, and that negative and/or coercive interactions reduce expectations among SSP participants that they will be afforded the protections granted by NC law. Conclusion Despite laws which protect SSP participants from charges, negative law enforcement responses to syringe possession are still widely reported. Evidence-based policy interventions to reduce fatal overdose are undermined by these experiences. Our findings suggest NC residents, and officers who enforce these laws, may benefit from clarification as to what is required of the documents which identify participants of registered SSPs where they may legally obtain syringes. Likewise, more thorough trainings on NC’s syringe law for law enforcement officers may be merited. Further research is needed to assess geographic differences in SSP participants’ law enforcement interactions across race and gender.

To the Editor-The COVID-19 pandemic has exacerbated the opioid epidemic in North Carolina, evidenced by a 22% increase in opioid overdoses in 2021 [1]. This epidemic within a pandemic respects no boundaries regarding education, socioeconomic status, gender, race, or ethnicity. The toll is staggering, with increased fatal overdoses associated with intravenous drug use (IVDU) plus increased transmission of infectious diseases like HIV and hepatitis C virus (HCV) from sharing/reusing injection equipment. Drug use associated (DUA) endocarditis (infection of a heart valve) is also on the rise, placing an economic strain on our health care system; the median cost of hospitalization for DUA endocarditis that requires heart valve replacement exceeds $250,000 [2]. To combat these human and economic costs, North Carolina must rely on scientific evidence and expand the continuum of care for people who use drugs.Syringe services programs (SSPs) are an evidence-based, cost-effective method of reducing the harms associated with IVDU and were legalized in North Carolina in 2016, with broad support from state law enforcement and bipartisan legislation. SSPs provide a multifaceted approach to reducing the harms associated with drug use by offering sterile injection equipment, safe disposal of used syringes, HIV/HCV testing, access to naloxone, support with wound care, and connection to treatment, health care, and other social services. New participants of SSPs are five times more likely to enter treatment for substance use disorder (SUD) and about three times more likely to stop using drugs [3], leading to the endorsement of SSPs by major scientific and medical organizations, including the American Academy of Pediatrics [4], the National Academy of Sciences [5], the American Public Health Association [6], and the American Medical Association [7].Despite the evidence and wide political support for SSPs in North Carolina, advocacy groups continue to seek restrictions for SSPs that would ultimately eliminate their services (SB607), blatantly ignoring the evidence and supporting an implicit bias of the demoralizing stigma faced by those with SUD.A multitude of measures are required to effectively impact the rise of infections associated with IVDU and provide support and care for people with opioid, stimulant, alco-hol, and other SUDs. This includes access to evidence-based medication and psychosocial interventions, detoxification services, inpatient and residential treatment, and SSPs. In addition to reducing harms associated with IVDU, SSPs play a unique role as a portal of entry to this full continuum of care, and thus deserve our continued support.