Abstract
BackgroundLaw enforcement officers (LEOs) come into frequent contact with people who inject drugs (PWID). Through service referrals, LEOs may facilitate PWID engagement in harm reduction, substance use treatment, and other health and supportive services. Little is known about PWID and LEO attitudes and concerns about service referrals, however. The objective of this mixed-methods study was to examine the alignment of service referral preferences and acceptability among PWID and LEOs in Tijuana, Mexico.MethodsWe assessed service referral preferences and perceived likelihood of participation in health and social services, integrating data from structured questionnaires with 280 PWID and 306 LEOs, contextualized by semi-structured interviews and focus groups with 15 PWID and 17 LEOs enrolled in two parallel longitudinal cohorts in Tijuana, Mexico.ResultsAmong potential service referral options, both PWID (78%) and LEOs (88%) most frequently cited assistance with drug- and alcohol-use disorders. Over half of PWID and LEOs supported including harm reduction services such as syringe service programs, overdose prevention, and HIV testing. The majority of PWID supported LEO referrals to programs that addressed basic structural needs (e.g. personal care [62%], food assistance [61%], housing assistance [58%]). However, the proportion of LEOs (30–45%) who endorsed these service referrals was significantly lower (p < 0.01). Regarding referral acceptability, 71% of PWID reported they would be very likely or somewhat likely to make use of a referral compared to 94% of LEOs reporting that they thought PWID would always or sometimes utilize them. These results were echoed in the qualitative analysis, although practical barriers to referrals emerged, whereby PWID were less optimistic that they would utilize referrals compared to LEOs.ConclusionsWe identified strong support for LEO service referrals among both LEO and PWID respondents, with the highest preference for substance use treatment. LEO referral programs offer opportunities to deflect PWID contact with carceral systems while facilitating access to health and social services. However, appropriate investments and political will are needed to develop an evidence-based (integrated) service infrastructure.
Highlights
Drug law enforcement practices have been shown to increase public health risks, such as Human immunodeficiency virus (HIV) transmission [1,2,3,4,5,6,7]
Eligibility criteria included having been incarcerated in Tijuana in the past 6 months for more than 30 days in order to capture participants that had previously been exposed to Law enforcement officer (LEO) and would be able to better relate to the concept of referral to services instead of incarceration
We asked participants about past experiences of referral to services by LEOs, views regarding the feasibility of a police referral intervention through the use of vouchers, perceptions related to police referral to services addressing drug use or health problems and about services that would be useful to them in the context of this intervention
Summary
Drug law enforcement practices (e.g. syringe confiscation, arrest) have been shown to increase public health risks, such as HIV transmission [1,2,3,4,5,6,7]. This has been evidenced in numerous global settings such as the United States; Kiev, Ukraine; Bangkok, Thailand; and Tijuana, Mexico [8,9,10,11,12]. The objective of this mixed-methods study was to examine the alignment of service referral preferences and acceptability among PWID and LEOs in Tijuana, Mexico
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