Academic journal article Journal of Drug Issues

Drug Paraphernalia Laws and Injection-Related Infectious Disease Risk among Drug Injectors

Academic journal article Journal of Drug Issues

Drug Paraphernalia Laws and Injection-Related Infectious Disease Risk among Drug Injectors

Article excerpt

Drug paraphernalia laws in 47 U.S. states make it illegal for injection drug users (IDUs) to possess syringes. It has been suggested that these laws lead to syringe sharing by deterring IDUs from carrying their own syringes. We examined the relationship between concern about arrest while carrying drug paraphernalia and injection-related risk behaviors among street-recruited IDUs in Northern California. In 1996, 424 IDUs were interviewed, of whom 76 percent were African American, 36 percent were female, and 15 percent were HIV positive. Thirty-five percent (150) reported concern about being arrested while carrying drug paraphernalia. In multivariate analyses that controlled for potential confounders, IDUs concerned about being arrested were significantly more likely than other IDUs to share syringes (adjusted odds ratio [AOR] =2.28; 95 percent confidence interval [CI]=1. 19, 4.34) and injection supplies (AOR= 3.23; 95 percent CI=2.03, 5.13). These data suggest that decriminalizing syringes and needles would likely result in reductions in the behaviors that expose IDUs to blood borne viruses.

INTRODUCTION

In the United States, injection drug users (IDUs) continue to be at significant risk for infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) (Alter 1993; Holmberg 1996; Levine et al. 1994). For IDUs, a principal route of acquiring HIV, HBV, and HCV is through shared use of syringes and injection supplies (i.e. cookers and filters). One way for IDUs to protect themselves from these infectious diseases is to have their own syringes and injection supplies available when injecting. Several studies have found that when IDUs have increased access to syringes through either decriminalization of syringes, pharmacy sales, and/or syringe exchange programs (SEPs), they respond by reducing syringe sharing (Diaz et al. 1998; Groseclose et al. 1995; Singer et al. 1995; Vlahov et al. 1997; Watters et al. 1994; Bluthenthal, Kral, et al. 1998).

However, efforts to provide IDUs with increased access to syringes and injection supplies have been hampered by legal restrictions on injection equipment, especially, syringes and needles. State-level drug paraphernalia laws are the main nation-wide legal barrier to IDUs accessing syringes. Such laws prohibit the possession of a wide variety of items if such items can be used to "introduce into the human body a controlled substance"(Veal 1981). As of 1997, 47 states assigned criminal penalties to individuals possessing drug paraphernalia (e.g. syringes and other objects) for the purpose of using a controlled substance (Gostin and Lazzarini 1997).

As a consequence of these laws, IDUs possessing injection equipment are subject to arrest, citation, or confiscations of their injection equipment. The confiscation of injection equipment may lead to syringe sharing among IDUs. In addition, while criminal penalties typically range from a few days of incarceration to six months, in at least one state (Rhode Island), drug paraphernalia violations are a felony and carry a possible prison sentence of up to five years (Rich et al.1998). To avoid possible arrest related to these charges, IDUs may not carry their own set of injection equipment and as a consequence may find themselves sharing syringes, cookers, or filters when injecting. Qualitative studies have consistently reported that IDUs are reluctant to carry their own syringes due to fear of arrest for violating state laws against possession of syringes (Bluthenthal and Watters 1995; Booth et al. 1993; Bourgois et al. 1997; Feldman and Biernacki 1988; Koester 1994; Waldorf et al., 1990; Zule 1992). In one early ethnographic study, a female heroin addict when asked whether she carried her own syringe replied, "I would rather get AIDS than go to jail" (Feldman and Biernacki 1988). In 1992, a quantitative study of syringe accessibility found that 55 percent of IDUs were concerned about possible arrest due to drug paraphernalia laws (Gleghorn et al. …

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