Bias Against People Who Inject Drugs Undermines Police Training on Needlestick Injury

Policing and public health have the same goal: the creation and maintenance of safe and healthy communities. In practice, however, the two are often in tension. Whereas public health initiatives preferentially benefit the most vulnerable, policing—in both design and application—often reinforces existing social structures and perpetuates inequities based on race, class, and membership in stigmatized groups, including people who inject drugs (PWID).^1,2

In particular, lack of access to new syringes increases bloodborne disease risk among PWID, and police actions such as syringe confiscation and possession-related arrests are a key barrier to the acquisition, use, and proper disposal of syringes.^3,4 These actions also increase needle stick injury (NSI) risk among officers by making it less likely that PWID will inform an officer that they are carrying syringes prior to a frisk or other search and may increase the likelihood that an NSI will result in bloodborne disease risk.⁵

Both changes to the “law on the books” and training to modify “law on the streets” can help reduce these risks to the health, safety, and dignity of police officers, PWID, and other community members.⁶ As noted by Arredondo et al. (p. 921) in this issue, law in Tijuana, Mexico, is facially supportive of syringe access, which is not a crime in that jurisdiction. However, both police and PWID report widespread lack of knowledge of this fact, and many officers report that they confiscate and sometimes destroy syringes and engage in extrajudicial arrests for syringe possession, needlessly and often illegally increasing risk among these vulnerable individuals as well as among themselves and their fellow officers.

CHANGING POLICE BEHAVIORS

Arredondo et al. report on a training initiative designed, in part, to encourage officers to inform PWID whom they encounter that it is not illegal to carry syringes. The training was focused on conveying to officers the importance of providing this information as a means of improving their occupational safety, and the reported outcome was framed as an officer protection measure. Although the researchers did not ascertain whether trained officers changed their behavior, the training was associated with a significant increase in the percentage of officers who reported that they would inform PWID of the law. The increases were greater among individuals who engaged in interactive training as opposed to viewing a video and greater among female than male officers.

Previous research has demonstrated that officers systematically and dramatically overestimate the risks associated with NSI, which, although real, tend to be relatively low.^5,7 It may therefore be reasonable, from a pedagogical standpoint, to emphasize officers’ own perception when attempting to change the ways in which they interact with PWID and other stigmatized groups in the context of syringe acquisition and disposal.⁷ Indeed, the Arredondo et al. study suggests that such an emphasis can be effective in changing the self-reported predicted behavior of those officers.

ADDRESSING NEGATIVE STEREOTYPES

Many, including myself, have argued in favor of applying the harm reduction principle of meeting people where they are to engage law enforcement officers and others who interact with PWID as an effective method of understanding and addressing their concerns while simultaneously benefiting vulnerable populations.⁷ That approach, which often stresses the benefits to law enforcement as well as community members of adopting evidence-based approaches to drugs and people who use them, has proved to be well received by officers in a variety of jurisdictions.⁷ However, one must be careful how it is implemented. If training portrays PWID primarily as a source of occupational safety risk, as opposed to members of the community who deserve dignity, respect, and protection, it may have little or no effect on the many other potentially negative ways in which police interactions may harm PWID.

In fact, such an approach may serve to reinforce existing stigma against those individuals, particularly against the backdrop of a “war on drugs” mindset in which some drugs and the individuals who use them are viewed not primarily as people with unmet needs but rather as criminals who deserve judicial (and, in some cases, extrajudicial) punishment. Focusing on benefits to officers without also highlighting benefits to PWID may also discourage officers from supporting interventions that do not have a clear benefit to the officers themselves, such as evidence-based treatment, low-threshold naloxone distribution, and drug decriminalization.

OPPORTUNITIES AND NEXT STEPS

In addition to providing valuable information on modalities of training that may be more effective in changing officer attitudes, the Arredondo et al. study highlights the importance not only of improving the initial training that officers receive—it should be scandalous that, in a department described as one of the most professional and highest paid in the country, nearly half of all officers reported ignorance of the syringe law—but also of recruiting a more diverse workforce. In that study, similar to research conducted in the United States, female officers proved more receptive to evidence-based training than their male counterparts, which argues for a concerted effort to recruit and retain such officers.⁵

Perhaps more importantly, the Arredondo et al. study can serve as a reminder that although training designed to improve police interactions with PWID is both laudable and necessary, care must be taken to ensure that it is undertaken in a way that reduces, rather than perpetuates, existing anti-PWID bias. Researchers and others working with PWID must scrupulously guard against potential unintended consequences and ensure that any police training is conducted in a manner that portrays PWID as individuals who are as deserving as and perhaps more in need of protection than other members of the community. Also, such training must value the health and safety of PWID on a par with that of the officers being trained.