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Rosen JG, Thompson E, Tardif J, Collins AB, Marshall BDL, Park JN. "Make yourself un-NIMBY-able": stakeholder perspectives on strategies to mobilize public and political support for overdose prevention centers in the United States of America. Harm Reduct J 2024; 21:40. [PMID: 38355641 PMCID: PMC10868085 DOI: 10.1186/s12954-024-00955-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Overdose prevention centers (OPCs), also known as supervised injection facilities and safe consumption sites, are evidenced-based interventions for preventing overdose deaths and drug-related morbidities. The pathways to legalizing OPCs in the USA have confronted multiple social, political, and legal obstacles. We conducted a multi-site, qualitative study to explore heterogeneities in these pathways in four jurisdictions, as well as to understand stakeholder perspectives on valuable strategies for galvanizing political and public support for OPCs. METHODS From July 2022 to February 2023, we conducted 17 semi-structured, in-depth interviews with OPC policymakers, service providers, advocates, and researchers from California, New York City, Philadelphia, and Rhode Island, where efforts have been undertaken to authorize OPCs. Using inductive thematic analysis, we identified and compared contextually relevant, salient approaches for increasing support for OPCs. RESULTS Participants described several strategies clustering around five distinct domains: (1) embedding OPC advocacy into broader overdose prevention coalitions to shape policy dialogs; (2) building rapport with a plurality of powerbrokers (e.g., lawmakers, health departments, law enforcement) who could amplify the impact of OPC advocacy; (3) emphasizing specific benefits of OPCs to different audiences in different contexts; (4) leveraging relationships with frontline workers (e.g., emergency medicine and substance use treatment providers) to challenge OPC opposition, including 'NIMBY-ism,' and misinformation; and (5) prioritizing transparency in OPC decision-making to foster public trust. CONCLUSION While tailored to the specific socio-political context of each locality, multiple OPC advocacy strategies have been deployed to cultivate support for OPCs in the USA. Advocacy strategies that are multi-pronged, leverage partnerships with stakeholders at multiple levels, and tailor communications to different audiences and settings could yield the greatest impact in increasing support for, and diffusing opposition to, future OPC implementation.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E5031, Baltimore, MD, 21205, USA.
| | - Erin Thompson
- Harm Reduction Innovation Lab, Rhode Island Hospital, 1125 North Main Street, Providence, RI, 02904, USA
| | - Jessica Tardif
- Harm Reduction Innovation Lab, Rhode Island Hospital, 1125 North Main Street, Providence, RI, 02904, USA
| | - Alexandra B Collins
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA
| | - Ju Nyeong Park
- Harm Reduction Innovation Lab, Rhode Island Hospital, 1125 North Main Street, Providence, RI, 02904, USA
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA
- Department of General Internal Medicine, Warren Alpert Medical School, Brown University, 593 Eddy Street, Providence, RI, 02903, USA
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Joshi S, Rivera BD, Cerdá M, Guy GP, Strahan A, Wheelock H, Davis CS. One-Year Association of Drug Possession Law Change With Fatal Drug Overdose in Oregon and Washington. JAMA Psychiatry 2023; 80:1277-1283. [PMID: 37755815 PMCID: PMC10535015 DOI: 10.1001/jamapsychiatry.2023.3416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/18/2023] [Indexed: 09/28/2023]
Abstract
Importance Two states modified laws to remove or substantially reduce criminal penalties for any drug possession. The hypothesis was that removing criminal penalties for drug possession may reduce fatal drug overdoses due to reduced incarceration and increased calls for help at the scene of an overdose. Objective To evaluate whether decriminalization of drug possession in Oregon and Washington was associated with changes in either direction in fatal drug overdose rates. Design, Setting, and Participants This cohort study used a synthetic control method approach to examine whether there were changes in drug possession laws and fatal drug overdose rates in Oregon and Washington in the postpolicy period (February 1, 2021, to March 31, 2022, in Oregon and March 1, 2021, to March 31, 2022, in Washington). A counterfactual comparison group (synthetic controls) was created for Oregon and Washington, using 48 states and the District of Columbia, that did not implement similar policies during the study period (January 1, 2018, to March 31, 2022). For 2018-2021, final multiple cause-of-death data from the National Vital Statistics System (NVSS) were used. For 2022, provisional NVSS data were used. Drug overdose deaths were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision underlying cause-of-death codes X40-X44, X60-X64, X85, and Y10-Y14. Exposures In Oregon, Measure 110 went into effect on February 1, 2021. In Washington, the Washington Supreme Court decision in State v Blake occurred on February 25, 2021. Main Outcome Monthly fatal drug overdose rates. Results Following the implementation of Measure 110, absolute monthly rate differences between Oregon and its synthetic control were not statistically significant (probability = 0.26). The average rate difference post Measure 110 was 0.268 fatal drug overdoses per 100 000 state population. Following the implementation of the policy change in Washington, the absolute monthly rate differences between Washington and synthetic Washington were not statistically significant (probability = 0.06). The average rate difference post Blake was 0.112 fatal drug overdoses per 100 000 state population. Conclusions and Relevance This study found no evidence of an association between legal changes that removed or substantially reduced criminal penalties for drug possession in Oregon and Washington and fatal drug overdose rates. Additional research could examine potential other outcomes as well as longer-term associations with fatal drug overdose overall and across racial and ethnic groups.
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Affiliation(s)
- Spruha Joshi
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Bianca D. Rivera
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Gery P. Guy
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Strahan
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Corey S. Davis
- Department of Population Health, New York University Grossman School of Medicine, New York
- Network for Public Health Law, Edina, Minnesota
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Davis CS, Joshi S, Rivera BD, Cerdá M. Changes in arrests following decriminalization of low-level drug possession in Oregon and Washington. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104155. [PMID: 37567089 DOI: 10.1016/j.drugpo.2023.104155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/08/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Despite evidence that the U.S. "War on Drugs" is associated with increases in drug-related harm and other negative outcomes, all U.S. states have long criminalized most drug possession. In early 2021, both Oregon and Washington became exceptions to this rule when they fully (Oregon) or partially (Washington) decriminalized possession of small amounts of all drugs. METHODS We obtained arrest data for 2019 to 2021 for intervention states (Oregon and Washington) and control states (Colorado, Idaho, Montana, and Nevada). We calculated monthly rates for arrests overall and for violent crimes, drug possession, equipment possession, non-drug crimes, and a set of low-level crimes termed displaced arrests. Using an interrupted time series analysis, we examined changes in monthly arrest rates after the implementation of policy change in Oregon and Washington compared to control states. RESULTS In Oregon, there were 3 fewer drug possession arrests per 100,000 in the month after the policy change; the rate decreased throughout the post-implementation period. In Washington, there were almost 5 fewer drug possession arrests per 100,000 in the month following policy change, and the rate remained stable thereafter. Both declines were significantly greater than in comparison states. There were also statistically significant reductions in arrests for possession of drug equipment in Washington and a significant increase in displaced arrests in Oregon. There were no significant changes in overall arrests, non-drug arrests or arrests for violent crime in either state, relative to controls. CONCLUSION This analysis demonstrates that it is possible for state drug decriminalization policies to dramatically reduce arrests for drug possession without increasing arrests for violent crimes, potentially reducing harm to people who use drugs and their communities. Additional research is needed to determine whether these legal reforms were associated with changes in overdose rates and other drug-related harms.
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Affiliation(s)
- Corey S Davis
- Department of Population Health, Grossman School of Medicine, New York University Langone, 180 Madison Ave, 4th Floor New York, NY 10016, United States; Network for Public Health Law, 7101 York Avenue South, #270 Edina, MN 55435, United States.
| | - Spruha Joshi
- Department of Population Health, Grossman School of Medicine, New York University Langone, 180 Madison Ave, 4th Floor New York, NY 10016, United States
| | - Bianca D Rivera
- Department of Population Health, Grossman School of Medicine, New York University Langone, 180 Madison Ave, 4th Floor New York, NY 10016, United States
| | - Magdalena Cerdá
- Department of Population Health, Grossman School of Medicine, New York University Langone, 180 Madison Ave, 4th Floor New York, NY 10016, United States
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Ray B, Korzeniewski SJ, Mohler G, Carroll JJ, Del Pozo B, Victor G, Huynh P, Hedden BJ. Spatiotemporal Analysis Exploring the Effect of Law Enforcement Drug Market Disruptions on Overdose, Indianapolis, Indiana, 2020-2021. Am J Public Health 2023; 113:750-758. [PMID: 37285563 PMCID: PMC10262257 DOI: 10.2105/ajph.2023.307291] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 06/09/2023]
Abstract
Objectives. To test the hypothesis that law enforcement efforts to disrupt local drug markets by seizing opioids or stimulants are associated with increased spatiotemporal clustering of overdose events in the surrounding geographic area. Methods. We performed a retrospective (January 1, 2020 to December 31, 2021), population-based cohort study using administrative data from Marion County, Indiana. We compared frequency and characteristics of drug (i.e., opioids and stimulants) seizures with changes in fatal overdose, emergency medical services nonfatal overdose calls for service, and naloxone administration in the geographic area and time following the seizures. Results. Within 7, 14, and 21 days, opioid-related law enforcement drug seizures were significantly associated with increased spatiotemporal clustering of overdoses within radii of 100, 250, and 500 meters. For example, the observed number of fatal overdoses was two-fold higher than expected under the null distribution within 7 days and 500 meters following opioid-related seizures. To a lesser extent, stimulant-related drug seizures were associated with increased spatiotemporal clustering overdose. Conclusions. Supply-side enforcement interventions and drug policies should be further explored to determine whether they exacerbate an ongoing overdose epidemic and negatively affect the nation's life expectancy. (Am J Public Health. 2023;113(7):750-758. https://doi.org/10.2105/AJPH.2023.307291).
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Affiliation(s)
- Bradley Ray
- Bradley Ray is with RTI International, Research Triangle Park, NC. Steven J. Korzeniewski is with the School of Medicine, Wayne State University, Detroit, MI. George Mohler is with the Computer Science Department, Boston College, Chestnut Hill, MA. Jennifer J. Carroll is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Brandon del Pozo is with the Warren Alpert School of Medicine, Brown University, Providence, RI. Grant Victor is with the School of Social Work, Rutgers University, New Brunswick, NJ. Philip Huynh and Bethany J. Hedden are with the Center for Behavioral Health and Justice, Wayne State University
| | - Steven J Korzeniewski
- Bradley Ray is with RTI International, Research Triangle Park, NC. Steven J. Korzeniewski is with the School of Medicine, Wayne State University, Detroit, MI. George Mohler is with the Computer Science Department, Boston College, Chestnut Hill, MA. Jennifer J. Carroll is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Brandon del Pozo is with the Warren Alpert School of Medicine, Brown University, Providence, RI. Grant Victor is with the School of Social Work, Rutgers University, New Brunswick, NJ. Philip Huynh and Bethany J. Hedden are with the Center for Behavioral Health and Justice, Wayne State University
| | - George Mohler
- Bradley Ray is with RTI International, Research Triangle Park, NC. Steven J. Korzeniewski is with the School of Medicine, Wayne State University, Detroit, MI. George Mohler is with the Computer Science Department, Boston College, Chestnut Hill, MA. Jennifer J. Carroll is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Brandon del Pozo is with the Warren Alpert School of Medicine, Brown University, Providence, RI. Grant Victor is with the School of Social Work, Rutgers University, New Brunswick, NJ. Philip Huynh and Bethany J. Hedden are with the Center for Behavioral Health and Justice, Wayne State University
| | - Jennifer J Carroll
- Bradley Ray is with RTI International, Research Triangle Park, NC. Steven J. Korzeniewski is with the School of Medicine, Wayne State University, Detroit, MI. George Mohler is with the Computer Science Department, Boston College, Chestnut Hill, MA. Jennifer J. Carroll is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Brandon del Pozo is with the Warren Alpert School of Medicine, Brown University, Providence, RI. Grant Victor is with the School of Social Work, Rutgers University, New Brunswick, NJ. Philip Huynh and Bethany J. Hedden are with the Center for Behavioral Health and Justice, Wayne State University
| | - Brandon Del Pozo
- Bradley Ray is with RTI International, Research Triangle Park, NC. Steven J. Korzeniewski is with the School of Medicine, Wayne State University, Detroit, MI. George Mohler is with the Computer Science Department, Boston College, Chestnut Hill, MA. Jennifer J. Carroll is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Brandon del Pozo is with the Warren Alpert School of Medicine, Brown University, Providence, RI. Grant Victor is with the School of Social Work, Rutgers University, New Brunswick, NJ. Philip Huynh and Bethany J. Hedden are with the Center for Behavioral Health and Justice, Wayne State University
| | - Grant Victor
- Bradley Ray is with RTI International, Research Triangle Park, NC. Steven J. Korzeniewski is with the School of Medicine, Wayne State University, Detroit, MI. George Mohler is with the Computer Science Department, Boston College, Chestnut Hill, MA. Jennifer J. Carroll is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Brandon del Pozo is with the Warren Alpert School of Medicine, Brown University, Providence, RI. Grant Victor is with the School of Social Work, Rutgers University, New Brunswick, NJ. Philip Huynh and Bethany J. Hedden are with the Center for Behavioral Health and Justice, Wayne State University
| | - Philip Huynh
- Bradley Ray is with RTI International, Research Triangle Park, NC. Steven J. Korzeniewski is with the School of Medicine, Wayne State University, Detroit, MI. George Mohler is with the Computer Science Department, Boston College, Chestnut Hill, MA. Jennifer J. Carroll is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Brandon del Pozo is with the Warren Alpert School of Medicine, Brown University, Providence, RI. Grant Victor is with the School of Social Work, Rutgers University, New Brunswick, NJ. Philip Huynh and Bethany J. Hedden are with the Center for Behavioral Health and Justice, Wayne State University
| | - Bethany J Hedden
- Bradley Ray is with RTI International, Research Triangle Park, NC. Steven J. Korzeniewski is with the School of Medicine, Wayne State University, Detroit, MI. George Mohler is with the Computer Science Department, Boston College, Chestnut Hill, MA. Jennifer J. Carroll is with the Department of Sociology and Anthropology, North Carolina State University, Raleigh. Brandon del Pozo is with the Warren Alpert School of Medicine, Brown University, Providence, RI. Grant Victor is with the School of Social Work, Rutgers University, New Brunswick, NJ. Philip Huynh and Bethany J. Hedden are with the Center for Behavioral Health and Justice, Wayne State University
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Smiley-McDonald HM, Attaway PR, Wenger LD, Greenwell K, Lambdin BH, Kral AH. "All carrots and no stick": Perceived impacts, changes in practices, and attitudes among law enforcement following drug decriminalization in Oregon State, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104100. [PMID: 37356287 DOI: 10.1016/j.drugpo.2023.104100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND By passing Ballot Measure 110 (BM 110), Oregon became the first U.S. state to decriminalize noncommercial possession of drugs that are illegal under the Controlled Substances Act. This study examined the perceived impacts of BM 110 on law enforcement and Oregon communities. METHODS Our team visited four geographically distinct Oregon counties in August 2022 (two urban, two rural). The qualitative study involved conducting 34 hour-long interviews with law enforcement, other criminal legal system personnel, and representatives from emergency medical services/fire and substance use treatment and harm reduction agencies. Interviewees were asked about their perceptions of BM 110's effects on law enforcement, their communities, and agencies. RESULTS Law enforcement interviewees viewed BM 110 as a failure; they perceived it resulted in an erosion of their authority. They expressed frustration that they could not use drug possession as a "tool" for investigations to pursue and build cases, establish probable cause, and impose what they believed necessary for social order. Law enforcement personnel in all four counties indicated they routinely seized drugs and drug paraphernalia during encounters with people using drugs, even when that was the only offense being committed. Police lacked knowledge that BM 110 included support for harm reduction services, housing assistance, and employment support. Law enforcement personnel had different opinions and practices regarding issuing Class E violations; those who did not issue them viewed them as a waste of time because they are not entry points into the criminal legal system. CONCLUSION This study provides insights into drug decriminalization in Oregon. This examination is critical for informing BM 110's continued implementation as Oregon proceeds with increased treatment and support service provision. Our findings have important implications regarding other states' design and implementation of drug policy alternatives, including ones that remove law enforcement's role in addressing drug use.
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Affiliation(s)
| | - Peyton R Attaway
- Justice Practice Area, RTI International, Research Triangle Park, NC, United States
| | - Lynn D Wenger
- Health Practice Area, RTI International, Berkeley, CA, United States
| | - Kathryn Greenwell
- Justice Practice Area, RTI International, Research Triangle Park, NC, United States
| | - Barrot H Lambdin
- Health Practice Area, RTI International, Berkeley, CA, United States
| | - Alex H Kral
- Health Practice Area, RTI International, Berkeley, CA, United States
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Ali F, Russell C, Greer A, Bonn M, Werb D, Rehm J. "2.5 g, I could do that before noon": a qualitative study on people who use drugs' perspectives on the impacts of British Columbia's decriminalization of illegal drugs threshold limit. Subst Abuse Treat Prev Policy 2023; 18:32. [PMID: 37322496 PMCID: PMC10268332 DOI: 10.1186/s13011-023-00547-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND In May 2022, Health Canada approved a three-year exemption from the Controlled Drugs and Substances Act decriminalizing possession of certain illegal substances for personal use among adults in the province of British Columbia. The exemption explicitly includes a cumulative threshold of 2.5 g of opioids, cocaine, methamphetamine, and MDMA. Threshold quantities are commonly included in decriminalization policies and justified within law enforcement systems to delineate personal use among people who use drugs versus drug dealers who are carrying for trafficking purposes. Understanding the impact of the 2.5g threshold can help define the extent to which people who use drugs will be decriminalized. METHODS From June-October 2022, 45 people who use drugs from British Columbia were interviewed to gain an understanding of their perceptions on decriminalization, particularly on the proposed threshold of 2.5 g. We conduced descriptive thematic analyses to synthesize common interview responses. RESULTS Results are displayed under two categories: 1) Implications for substance use profiles and purchasing patterns, including implications on the cumulative nature of the threshold and impacts on bulk purchasing, and 2) Implications of police enforcement, including distrust of police use of discretion, potential for net widening and jurisdictional discrepancies in enforcing the threshold. Results illustrate the need for the decriminalization policy to consider diversity in consumption patterns and frequency of use among people who use drugs, the inclination to purchase larger quantities of substances for reduced costs and to guarantee a safe and available supply, and the role police will play in delineating between possession for personal use or trafficking purposes. CONCLUSIONS The findings underscore the importance of monitoring the impact of the threshold on people who use drugs and whether it is countering the goals of the policy. Consultations with people who use drugs can help policymakers understand the challenges they may face when trying to abide by this threshold.
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Affiliation(s)
- Farihah Ali
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, 33 Usrula Frank St., Toronto, ON, M5S 2S1, Canada.
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada.
| | - Cayley Russell
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, 33 Usrula Frank St., Toronto, ON, M5S 2S1, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, 102-68 Highfield Park Drive, Dartmouth, NS, B3A 1X4, Canada
| | - Daniel Werb
- Centre On Drug Policy Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, 9500 Gilman Dr., La Jolla, CA, USA
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, 33 Usrula Frank St., Toronto, ON, M5S 2S1, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada
- Canadian Association of People Who Use Drugs, 102-68 Highfield Park Drive, Dartmouth, NS, B3A 1X4, Canada
- Department of PsychiatryDalla Lana School of Public Health, &Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada
- Institut Für Klinische Psychologie Und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
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Cloud DH, Garcia-Grossman IR, Armstrong A, Williams B. Public Health and Prisons: Priorities in the Age of Mass Incarceration. Annu Rev Public Health 2023; 44:407-428. [PMID: 36542770 PMCID: PMC10128126 DOI: 10.1146/annurev-publhealth-071521-034016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Mass incarceration is a sociostructural driver of profound health inequalities in the United States. The political and economic forces underpinning mass incarceration are deeply rooted in centuries of the enslavement of people of African descent and the genocide and displacement of Indigenous people and is inextricably connected to labor exploitation, racial discrimination, the criminalization of immigration, and behavioral health problems such as mental illness and substance use disorders. This article focuses on major public health crises and advances in state and federal prisons and discusses a range of practical strategies for health scholars, practitioners, and activists to promote the health and dignity of incarcerated people. It begins by summarizing the historical and sociostructural factors that have led to mass incarceration in the United States. It then describes the ways in which prison conditions create or worsen chronic, communicable, and behavioral health conditions, while highlighting priority areas for public health research and intervention to improve the health of incarcerated people, including decarceral solutions that can profoundly minimize-and perhaps one day help abolish-the use of prisons.
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Affiliation(s)
- David H Cloud
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, California, USA;
- Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - Ilana R Garcia-Grossman
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, California, USA;
| | - Andrea Armstrong
- College of Law, Loyola University New Orleans, New Orleans, Louisiana, USA
| | - Brie Williams
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, California, USA;
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CERDÁ MAGDALENA, KRAWCZYK NOA, KEYES KATHERINE. The Future of the United States Overdose Crisis: Challenges and Opportunities. Milbank Q 2023; 101:478-506. [PMID: 36811204 PMCID: PMC10126987 DOI: 10.1111/1468-0009.12602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Policy Points People are dying at record numbers from overdose in the United States. Concerted action has led to a number of successes, including reduced inappropriate opioid prescribing and increased availability of opioid use disorder treatment and harm-reduction efforts, yet ongoing challenges include criminalization of drug use and regulatory and stigma barriers to expansion of treatment and harm-reduction services. Priorities for action include investing in evidence-based and compassionate policies and programs that address sources of opioid demand, decriminalizing drug use and drug paraphernalia, enacting policies to make medication for opioid use disorder more accessible, and promoting drug checking and safe drug supply.
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Affiliation(s)
- MAGDALENA CERDÁ
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
| | - NOA KRAWCZYK
- Center for Opioid Epidemiology and PolicyNYU Grossman School of Medicine
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Pamplin JR, Rouhani S, Davis CS, King C, Townsend TN. Persistent Criminalization and Structural Racism in US Drug Policy: The Case of Overdose Good Samaritan Laws. Am J Public Health 2023; 113:S43-S48. [PMID: 36696623 PMCID: PMC9877371 DOI: 10.2105/ajph.2022.307037] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
The US overdose crisis continues to worsen and is disproportionately harming Black and Hispanic/Latino people. Although the "War on Drugs" continues to shape drug policy-at the disproportionate expense of Black and Hispanic/Latino people-states have taken some steps to reduce War on Drugs-related harms and adopt a public health-centered approach. However, the rhetoric regarding these changes has, in many cases, outstripped reality. Using overdose Good Samaritan Laws (GSLs) as a case study, we argue that public health-oriented policy changes made in some states are undercut by the broader enduring environment of a structurally racist drug criminalization agenda that continues to permeate and constrict most attempts at change. Drawing from our collective experiences in public health research and practice, we describe 3 key barriers to GSL effectiveness: the narrow parameters within which they apply, the fact that they are subject to police discretion, and the passage of competing laws that further criminalize people who use illicit drugs. All reveal a persisting climate of drug criminalization that may reduce policy effectiveness and explain why current reforms may be destined for failure and further disadvantage Black and Hispanic/Latino people who use drugs. (Am J Public Health. 2023;113(S1):S43-S48. https://doi.org/10.2105/AJPH.2022.307037).
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Affiliation(s)
- John R Pamplin
- John R. Pamplin II is with the Department of Epidemiology, Columbia University Mailman School of Public Health, and the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Saba Rouhani is with the Department of Epidemiology at the New York University School of Global Public Health, New York, NY, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Corey S. Davis is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY, and the Network for Public Health Law, Edina, MN. Carla King is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Tarlise N. Townsend is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, and the New York University Rory Meyers College of Nursing, New York, NY
| | - Saba Rouhani
- John R. Pamplin II is with the Department of Epidemiology, Columbia University Mailman School of Public Health, and the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Saba Rouhani is with the Department of Epidemiology at the New York University School of Global Public Health, New York, NY, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Corey S. Davis is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY, and the Network for Public Health Law, Edina, MN. Carla King is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Tarlise N. Townsend is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, and the New York University Rory Meyers College of Nursing, New York, NY
| | - Corey S Davis
- John R. Pamplin II is with the Department of Epidemiology, Columbia University Mailman School of Public Health, and the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Saba Rouhani is with the Department of Epidemiology at the New York University School of Global Public Health, New York, NY, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Corey S. Davis is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY, and the Network for Public Health Law, Edina, MN. Carla King is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Tarlise N. Townsend is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, and the New York University Rory Meyers College of Nursing, New York, NY
| | - Carla King
- John R. Pamplin II is with the Department of Epidemiology, Columbia University Mailman School of Public Health, and the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Saba Rouhani is with the Department of Epidemiology at the New York University School of Global Public Health, New York, NY, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Corey S. Davis is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY, and the Network for Public Health Law, Edina, MN. Carla King is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Tarlise N. Townsend is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, and the New York University Rory Meyers College of Nursing, New York, NY
| | - Tarlise N Townsend
- John R. Pamplin II is with the Department of Epidemiology, Columbia University Mailman School of Public Health, and the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Saba Rouhani is with the Department of Epidemiology at the New York University School of Global Public Health, New York, NY, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Corey S. Davis is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY, and the Network for Public Health Law, Edina, MN. Carla King is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, New York, NY. Tarlise N. Townsend is with the Center for Opioid Epidemiology and Policy, New York University Grossman School of Medicine, and the New York University Rory Meyers College of Nursing, New York, NY
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10
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Shin SS, LaForge K, Stack E, Pope J, Leichtling G, Larsen JE, Leahy JM, Seaman A, Hoover D, Chisholm L, Blazes C, Baker R, Byers M, Branson K, Korthuis PT. "It wasn't here, and now it is. It's everywhere": fentanyl's rising presence in Oregon's drug supply. Harm Reduct J 2022; 19:76. [PMID: 35818072 PMCID: PMC9275036 DOI: 10.1186/s12954-022-00659-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade. Methods We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes. Results PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers. Conclusion PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00659-9.
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Affiliation(s)
- Sarah S Shin
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA.
| | - Kate LaForge
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | - Erin Stack
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | - Justine Pope
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | | | - Jessica E Larsen
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Judith M Leahy
- Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Andrew Seaman
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA.,Old Town Clinic/Central City Concern, Portland, OR, USA.,Better Life Partners, Hanover, NH, USA
| | - Daniel Hoover
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Laura Chisholm
- Injury and Violence Prevention Program, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Christopher Blazes
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Robin Baker
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | | | - Katie Branson
- Injury and Violence Prevention Program, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - P Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA.,School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
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