BOX 1—

Domain 1: Enforcement and Punitive Governance of Drug Use Equipment: Maryland, January–December 2019

Community stigma and discretionary gaps affecting syringe access: “If we wanted to go to [pharmacy retail store] and buy a box of 100 [syringes] at a time at $13 a box. If they would sell them to you, depending on who was there and if they gave a shit, also depending on who they [the drug users] were. So, a lot of people aren’t even allowed to go [to retail store] around here because they got caught stealing from there. . . . [That retail store is] your only option . . . if you do not have a diabetic card and have a prescription for them [the retail store] is not going to give them to you.” 32-y-old White man, Calvert County

Inconsistent practices at retailers: “There’s always been problems with [pharmacy retail store]. One day you’ll be able to buy a box and the next day they’ll be like, ‘Oh, we stopped selling needles’ or ‘We stopped selling 10-packs. You’ve got to buy a whole box’ or ‘We stopped selling needles altogether.’ And it was always a lie, because there’s supposed to be a harm reduction model where pharmacies are supposed to . . . sell you needles regardless. But they don’t care there.” 27-y-old White man, St. Mary’s County

Fear of arrest and anticipated stigma when engaging with police and first responders: “If you get pulled over and you don’t have nothing on you, but you’ve got Narcan, they’re going to think like, ‘Oh, yeah. Now the police know.’ Or they think, ‘Somewhere I’m associated with it. So, now they’re going to dig in my car more.’ Or they think, ‘They’re going to harass me.’ You know what I’m saying? Because I have seen people that’s clear in active use that have denied Narcan. This on the street.” Community organizer, St. Mary’s County

Lack of trust when engaging with police: “They’ll charge you right off the jump . . . they’ll charge you straight possession . . . If it’s a new needle, they’ll get you for distribution of paraphernalia. If it’s a used needle, they’ll get you for possession of drugs. Then you got to fight it in court to get the lab results to prove that it just has residue.” 32-y-old White man, Calvert County