Abstract
BackgroundCopious evidence indicates that syringe exchange programs (SEPs) are effective structural interventions for HIV prevention among persons who inject drugs (PWID). The efficacy of SEPs in supporting the public health needs of PWID populations is partially dependent on their accessibility and consistent utilization among injectors. Research has shown that SEP access is an important predictor of PWID retention at SEPs, yet policies exist that may limit the geographic areas where SEP operations may legally occur. Since 2000 in the District of Columbia (DC), SEP operations have been subject to the 1000 Foot Rule (§48–1121), a policy that prohibits the distribution of “any needle or syringe for the hypodermic injection of any illegal drug in any area of the District of Columbia which is within 1000 feet of a public or private elementary or secondary school (including a public charter school).” The 1000 Foot Rule may impede SEP services in areas that are in urgent need for harm reduction services, such as locations where injections are happening in “real time” or where drugs are purchased or exchanged. We examined the effects of the 1000 Foot Rule on SEP operational space in injection drug use (IDU)-related crime (i.e., heroin possession or distribution) hot spots from 2000 to 2010.MethodsData from the DC Metropolitan Police Department were used to identify IDU-related crime hot spots. School operation data were matched to a dataset that described the approximate physical property boundaries of land parcels. A 1000-ft buffer was applied to all school property boundaries. The overlap between the IDU-related crime hot spots and the school buffer zones was calculated by academic year.ResultsWhen overlaying the land space associated with IDU-related crime hot spots on the maps of school boundaries per the 1000-ft buffer zone stipulation, we found that the majority of land space in these locations was ineligible for legal SEP operations. More specifically, the ineligible space in the identified hot spots in each academic year ranged from 51.93 to 88.29 % of the total hot spot area.ConclusionsThe removal of the 1000 Foot Rule could significantly improve the public health of PWID via increased access to harm reduction services. Buffer zone policies that restrict SEP operational space negatively affect the provision of harm reduction services to PWID.
Highlights
Copious evidence indicates that syringe exchange programs (SEPs) are effective structural interventions for HIV prevention among persons who inject drugs (PWID)
The USA is in the midst of an opioid abuse epidemic; according to the 2014 National Survey on Drug Use and Health (NSDUH), there are an estimated 4.3 million persons who engaged in non-medical use of prescription painkillers in the last month [1]
School buffer zones The methods used to evaluate the effects of the 1000 Foot Rule on the overall amount of SEP operational space can be found in related research [27, 28]
Summary
Copious evidence indicates that syringe exchange programs (SEPs) are effective structural interventions for HIV prevention among persons who inject drugs (PWID). The USA is in the midst of an opioid abuse epidemic; according to the 2014 National Survey on Drug Use and Health (NSDUH), there are an estimated 4.3 million persons who engaged in non-medical use of prescription painkillers in the last month [1] This statistic serves as a call to action as persons who misuse prescription opioids may transition to heroin use [2] and experience increased vulnerability for a number of blood-borne infections. The recent outbreaks of HIV that were linked to the injection of prescription opioids in rural locations, such as in Indiana [3], demonstrate a need for expanded mental health and addiction treatment services and for more comprehensive approaches to both preventing substance abuse and reducing harm for existing persons who inject drugs (PWID). DC-specific data from the 2010 National Health and Behavior Survey (NHBS) showed that 90 % of PWID surveyed reported being HCV positive [7]
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