Abstract
In various settings, drug market policing strategies have been found to have unintended negative effects on health service use among injection drug users (IDU). This has prompted calls for more effective coordination of policing and public health efforts. In Vancouver, Canada, a supervised injection facility (SIF) was established in 2003. We sought to determine if local police impacted utilization of the SIF. We used generalized estimating equations (GEE) to prospectively identify the prevalence and correlates of being referred by local police to Vancouver's SIF among IDU participating in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort during the period of December 2003 to November 2005. Among 1090 SIF clients enrolled in SEOSI, 182 (16.7%) individuals reported having ever been referred to the SIF by local police. At baseline, 22 (2.0%) participants reported that they first learned of the SIF via police. In multivariate analyses, factors positively associated with being referred to the SIF by local police when injecting in public include: sex work (Adjusted Odds Ratio [AOR] = 1.80, 95%CI 1.28 – 2.53); daily cocaine injection (AOR = 1.54, 95%CI 1.14 – 2.08); and unsafe syringe disposal (AOR = 1.46, 95%CI 1.00 – 2.11). These findings indicate that local police are facilitating use of the SIF by IDU at high risk for various adverse health outcomes. We further found that police may be helping to address public order concerns by referring IDU who are more likely to discard used syringes in public spaces. Our study suggests that the SIF provides an opportunity to coordinate policing and public health efforts and thereby resolve some of the existing tensions between public order and health initiatives.
Highlights
In various urban settings, street-level policing practices targeting drug related public disorder, such as open drug dealing and drug consumption, have been shown to interrupt health service use by injection drug users (IDU) [1,2]
The local Vancouver Police Department supported the opening of a pilot supervised injection facility (SIF) in Vancouver in September 2003 and subsequently adopted the strategy of actively encouraging individuals found injecting in public to attend the local SIF [14]
The current analysis is based on longitudinal data derived from the Scientific Evaluation of Supervised Injecting (SEOSI) cohort which is a representative sample of supervised injection facility users
Summary
Street-level policing practices targeting drug related public disorder, such as open drug dealing and drug consumption, have been shown to interrupt health service use by injection drug users (IDU) [1,2]. Pressures introduced by street level police crackdowns have been found to displace IDU away from needle exchange programs and other specialized HIV prevention and health promotion services, as well as exacerbate risky injection practices among street injectors including rushing injections and injecting with used syringes [3,4,5,6,7]. This has prompted calls for more effective (page number not for citation purposes). Given the continued call for more effective policing-public health partnerships [16,17] we sought to determine if local police were facilitating the use of Vancouver's SIF
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