Police
and
Needle
Exchanges:
The
Philadelphia
Story
and
Beyond
3/11/05
With injection drug use linked to 39% of new HIV cases in Philadelphia in 2001, stopping people from sharing needles is a serious but vulnerable enterprise. Prevention Point Philadelphia had been running needle exchange programs (NEPs) to reduce the spread of HIV under an executive decree from the mayor for more than a decade when the Philadelphia police launched Operation Safe Streets, an effort to crack down on the city's burgeoning and sometimes brazen drug markets by saturating hard-hit sections of the city with uniformed police. Citing declining crime statistics, police have deemed Operation Safe Streets and its successors a success, but according to Prevention Point and some recent academic research, the massive police presence has had an unintended, and unhappy, side effect: It has scared injection drug users away from the NEPs, which have been proven repeatedly, most recently by the World Health Organization, to reduce the rates of HIV infection among drug users. Philadelphia's experience could prove useful for other NEPs faced with law enforcement agencies who, while not necessarily opposed to them, fail to take them into account when planning and prosecuting heavy-duty enforcement actions. In a study of the impact of Operation Safe Streets on NEP participation, a team of University of Pennsylvania researchers led by Corey Davis found a dramatic decline in NEP use after the police action got underway. Yes, police were able to disrupt the open-air drug markets, the study found, but "this benefit came at a cost: the operation was significantly associated with a reduction in the use of Philadelphia's syringe exchange programs, especially among black and male participants. Such a reduction in syringe exchange program use can be expected to lead to increased sharing and reusing of syringes, with an attendant increase in blood-borne infectious disease incidence among IDUs who formerly used syringe exchange programs," concluded the article published last month in the American Journal of Public Health. "What we found was that after the start of Operation Safe Streets, the number of people using the NEP went down precipitously," said Davis, the study's lead author. "We saw the number of African-Americans using the NEP go down more than whites; we saw the number of males decline more than females," he said. The decline in NEP use was not because the clients were getting arrested, Davis pointed out. "It is interesting that this police operation wasn't based on arresting users. They did not arrest very many, so the decline came not because clients were incarcerated, but because they were scared off." The study jibed with what the NEPs were experiencing on the ground. "What we were hearing from our clients was that it was almost impossible to get to the exchange sites because police officers were on the corners where they were," said Casey Cook, executive director of Prevention Point Philadelphia, the group that runs the city-approved NEP. "I don't think the police planned it that way, but that's what happened. Our people felt like they had to pass through a police cordon to get to the sites, and when they would come out carrying the brown bags we give them, they would be ID'd as exchangers and get stopped and harassed. We saw an immediate impact in attendance at our outreach sites, and it had a lasting effect," she told DRCNet. Prevention Point Philadelphia tried to reduce the harm by contacting city officials, a strategy that is paying some dividends. "At our request, the Health Department intervened, and we've been having meetings with officials in the police department to address this. One thing we're doing is developing a training video on NEPs to be shown in all 23 police districts in the city." City health and law enforcement agencies responded. "When Operation Safe Streets went into place, it brought a number of new police officers into the streets who were unaware of the NEP sites and the mayor's executive order authorizing them," said Philadelphia Health Department spokesman Jeff Moran. "That created some problems. When we became aware of those problems, we met with the police department leadership and intervened to get the word out among that new group of officers. The problem has been resolved," he told DRCNet. Well, not exactly. "It's very clear that the leadership in the police department has gotten the message," said Cook, "but I don't know that it has trickled down to the officer on the street yet. We are still getting reports from participants that they're being stopped and harassed, they're getting their needles confiscated, both new and used, and police officers have even been throwing used ones in the sewer drains." While the Philadelphia experience with Operation Safe Streets is unique, the question of police-NEP relations is one faced by almost all exchanges, and the impact of police crack-downs varies. "Nationally, the situation is too varied for me to generalize," said Dave Purchase, executive director of the North American Syringe Exchange Network. "Here in Tacoma, we have a very mature program -- at more than 17 years, it's practically an institution -- and we don't get bothered by more than the occasional cowboy cop, some uniform in a cruiser who one day finds out what we're doing. We just call the sergeant, and he sets him straight." That relationship with local police was the result of careful work by the Tacoma needle exchange. "Back in the early days, there were lots of meetings," said Purchase. "We met repeatedly with the police chief and all that, but as the time wore on and the community got more comfortable with us, we tended to meet only on an as-needed basis. But I keep up with the guy who runs the downtown precinct, I make sure I meet the new one whenever they change, and I know he'll take my calls." [Tacoma is next month hosting the 15th North American Syringe Exchange Convention -- visit NASEN for info.] Enlightened police chiefs and commanders make a big difference, but there aren't enough of them, said Susan McCampbell, director of the Center of Innovative Public Policies, which has an initiative (now largely dormant for lack of funding) for promoting collaboration between police and NEPs. "The problem is that the police have been backed up against the wall by administration policy and by some police organizations to oppose NEPs. When all of this NEP stuff started with Barry McCaffrey back in the 1990s, the drug czar's office asked these police member organizations to pass resolutions opposing NEPs, and they did so. There was no debate -- the feds asked them, and they did it," she told DRCNet. "Two of them, the National Sheriffs Association and the International Association of Chiefs of Police, get money from the feds. With the sheriffs, I've talked to some members and some of them understand that was perhaps premature, but as for the IACP, there is no hope with the current leadership," she said. To work with police is a slow and laborious -- but necessary -- process, said McCampbell, a law enforcement veteran who served as head of the Broward County, Florida, Department of Detention and Community Control for four years and Assistant Sheriff in Alexandria, Virginia, for 11 years. "You have to establish relationships with police, build bridges, find commonalities, agree on public safety strategies that include needle exchange," she said. "It doesn't happen overnight." But it does happen, McCampbell argued, pointing to successful efforts by Baltimore health commissioner Dr. Peter Beilenson, who got Baltimore police to include NEP instruction in their police academy training. Dr. Jody Rich in Providence has done the same thing, said McCampbell, and so has Chuck Stoudt in Boulder. "All of these people worked with police and broke down barriers, and as a result police are working with NEPs instead of against them." While NEPs have some national ramifications, they are ultimately local issues and have to be handled locally, said McCampbell. "This is a jurisdiction by jurisdiction battle. You have to get a chief in a position where it doesn't look like he's supporting drug activity. You need to make this primarily a public health -- not a public safety -- issue. Then you can get chiefs to places where they don't have to even say anything." But it's not just police indifference or hostility toward NEPs that is a problem, said McCampbell. There is also hostility among some NEP activists toward police. "I spoke at NASEN, and I was hissed and booed when I said you need to build bridges to police," she said. "I was taken aback. I didn't understand that they are as entrenched as the police are. I understand that these people may have been victims of police actions and they maintain a skepticism or even downright dislike for the police, but unless you have saner heads you are just wasting your time." NASEN's Purchase didn't quibble with McCampbell's account of her reception. And while he could empathize with needle exchange activists who have a bad attitude about police, he didn't see it as useful, either. "Some activists do have an attitude, and I can understand why, but I think it's incorrect. Harm reduction doesn't take sides on anything other than what reduces harm," he said. "This idea of cops and robbers, cowboys and Indians, it's a game that's best not played. Meanwhile, back in Philadelphia, study author Corey Davis was pondering the lessons learned. "Policing doesn't have to be done this way," Davis said. "There is no reason that the goals of increasing public order and decreasing the negative effects of drug use have to be incompatible with the goal of providing access to harm reduction activities and drug treatment. Operation Safe Streets was a prime example of how not to do it."
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