“They don’t go by the law around here”: law enforcement interactions after the legalization of syringe services programs in North Carolina

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.

Differential risks of syringe service program participants in Central Ohio: a latent class analysis

“…We observed disparate levels of risk among SSP participants, using a dataset limited to one SSP in a large Midwestern city, so these findings may not be generalizable to rural contexts in Ohio, other Midwestern urban centers, or other regions of the USA. Despite being located in a metropolitan center, limited diversity, in terms of race, ethnicity, sexual orientation, and gender identity, was observed among Safe Point clients, which may be explained by long-standing disparities in SSP access and participation [ 57 – 59 ].…”

Demographic patterns and disparities in new HIV diagnoses attributed to injection drug use in the United States

“…Rates of new HIV diagnoses attributed to injection drug use per 100 000 people who inject drugs in the United States, by sex at birth and race, 2008-2020. outside metropolitan settings. Studies have illustrated how even in US metropolitan areas that are majority black or Hispanic, a disproportionate fraction of SSP clients are white[9] -a likely product of racialized stigma affecting SSP accessibility[10][11][12]. Alternatives to SSP-based HIV prevention strategies (e. g. mobile PrEP delivery) are, thus, warranted for nonmale, racial minority PWID at risk of HIV infection.…”

“…Furthermore, IDU-related stigma in nonmetropolitan areas, stemming in part from heightened visibility and lack of privacy/confidentiality in service-seeking [8], also poses structural barriers to accessibility of HIV prevention services for PWID outside metropolitan settings. Studies have illustrated how even in US metropolitan areas that are majority black or Hispanic, a disproportionate fraction of SSP clients are white [9] – a likely product of racialized stigma affecting SSP accessibility [10–12]. Alternatives to SSP-based HIV prevention strategies (e.g.…”