| | The public health and social impacts of drug market enforcement: A review of the evidenceReceived 27 May 2004; received in revised form 27 April 2005; accepted 28 April 2005. Abstract The primary response to the harms associated with illicit injection drug use in most settings has involved intensifying law enforcement in an effort to limit the supply and use of drugs. Policing approaches have been increasingly applied within illicit drug markets since the 1980s despite limited scientific confirmation of their efficacy. On the contrary, a growing body of research indicates that these approaches have substantial potential to produce harmful health and social impacts, including disrupting the provision of health care to injection drug users (IDU), increasing risk behaviour associated with infectious disease transmission and overdose, and exposing previously unaffected communities to the harms associated illicit with drug use. There are, however, alternatives to traditional targeted enforcement approaches that may have substantially less potential for negative health and social consequences and greater potential for net community benefit. Some of these approaches involve modifying policing practices, fostering partnerships between policing and public health agencies, and developing systems to monitor policing practices. Other alternatives involve the provision of harm reduction services, such as safer injecting facilities, that help to minimize drug-related harms, and addiction treatment services which ultimately help to reduce the demand for illicit drugs. Introduction  The primary response to the harms associated with illicit drug use in developed and developing countries has been to intensify law enforcement in an effort to limit the supply and use of drugs (Drucker, 1999; Kerr, Kaplan, Suwannawong, Jurgens, & Wood, 2004; Knutsson, 2000, Wodak, 2001). While considerable resources have been dedicated toward reducing drug supply, increasing emphasis has been placed on local enforcement efforts, including those occurring in drug markets where drugs are sold and consumed (Natarajan & Hough, 2000; Williams, 1990). Drug market enforcement is becoming increasingly controversial since a small but rapidly growing body of research has demonstrated that these approaches often produce various physical, social, and behavioural effects that result in the exacerbation of health-related harms, and the emergence of problems in completely new areas (Dixon & Coffin, 1999; Maher & Dixon, 1999). The ongoing application of these approaches demonstrates that their negative impacts are poorly understood or ignored by both the public who make repeated calls for enforcement and by the politicians eager to appease their voters. There is growing interest in ecological approaches to analysing drug-related harms and in characterizing broader “risk environments” in which various factors interact to produce harm (Burris, Blankenship, & Donoghoe, 2004; Rhodes, 2002). One aim of such approaches is the identification of elements in the physical and social environment that determine risk, and structural interventions that alter context and by consequence reduce harm (Des Jarlais, 2000; Link & Phelan, 1995; Rhodes, 2002). In light of these developments, we focus on mechanisms through which police activities, occurring in drug markets, intersect with the health and practices of illicit drug users, the delivery of health care, and dynamics within neighbouring communities. We then conclude with a discussion of the benefits and costs associated drug market with policing and alternatives to this particular approach. Literature review Published studies were identified through computerized searches of MEDLINE and Social Science Index databases using a variety of search terms (e.g., “police crackdowns”, “drug market”, and “drug enforcement”). Additional references were obtained through reference lists found in published manuscripts, and we were alerted to additional unpublished evaluations via the reviewers of this paper. While our focus is primarily on the health of injection drug users (IDU), we also refer to literature documenting the impacts upon non-injecting drug users. This review is limited by the fact that it was restricted to English language publications and relied heavily on research conducted in Australia, Canada, the United States and Great Britain. Enforcement in illicit drug markets Drug markets are typically inner-city areas characterized by high concentrations of drug users and drug dealing within a specific geographic area (Curtis & Wendel, 2000; Hough & Natarajan, 2000). Drug markets can be characterized on the basis of whether they are “open” or “closed” (May, Harocopos, Turnbull, & Hough, 2000; May & Hough, 2001a). Open markets tend to be visible public settings where few barriers to access exist, as individuals unknown to dealers are able to purchase drugs. Conversely, closed markets function in more hidden locations, where individuals seeking drugs must know or be introduced to a dealer. Methods of drug market enforcement are diverse and include: sweeps involving the deployment of numerous officers in a defined area for short periods; substantial increases in the number of officers in a given area over an extended period; deployment of undercover officers who act as prospective dealers or drug users, and who perform “buy and busts”, or may make “test purchases” of drugs which are later analysed; and surveillance using closed-circuit television and other technologies (Dixon & Coffin, 1999; Greene, 1996; Hough & Edmunds, 1999; Jacobson, 1999, Zimmer, 1990). Drug market approaches often involve traditional policing methods, including the use of “hands on” approaches (e.g., body searches), street-level chases between drug users and police, and physical restraint (Kersten, 2000). Drug market enforcement aims to achieve several goals, including: disrupting established markets and thereby reducing public disorder, as well as interrupting supply and thereby driving up drug prices and increasing the time drug users have to spend searching for drugs (Caulkins, 1993; Hough & Natarajan, 2000; Kleiman, 1992, Lee, 1996, Murji, 1998). These approaches also aim to prompt drug users to refrain from drug use or enter treatment out of fear of adverse consequences (e.g., arrest, incarceration) or by making habits difficult to sustain due to rising price (Weatherburn & Lind, 1997; Zimmer, 1990). While the impact of drug market enforcement on crime and public order has long been investigated, the health and social impacts of these approaches have only recently received attention in the scientific literature (Burris et al., 2004; Maher & Dixon, 2001). Public health and social impacts Injecting and risk behaviours Drug market enforcement can prompt changes in injection behaviour that exacerbate risk for adverse health outcomes. When police presence increases in drug markets, the time between purchasing and consuming drugs becomes one of increased legal vulnerability (Dovey, Fitzgerald, & Choi, 2001), and studies have shown in response, IDU will modify their behaviour in an effort to avoid police. In order to ensure that drugs are consumed before they are confiscated, IDU will rush during the injection process (Aitken, Moore, Higgs, Kelsall, & Kreger, 2002; Dixon & Maher, 2002; Maher and Dixon, 1999, Maher and Dixon, 2001; Small et al., in press). Rushing during injection can lead to several harms. For example, IDU are more likely to skip important steps in the preparation of drug solutions (Broadhead, Kerr, Grund, & Altice, 2002; Maher & Dixon, 1999). One example is the “shake and bake” method of drug preparation where drugs are mixed with blood or water without first being heated to kill bacteria and filtered to remove impurities (Wood et al., 2003a, Wood et al., 2003b, Wood et al., 2003c, Wood et al., 2003d). Similarly, when injecting in a hurry, IDU may be less likely to clean injection sites prior to injection or dress wounds afterward (Broadhead et al., 2002), and risk of vascular damage increases as syringes are inserted in a hurried manner (Maher & Dixon, 2001). These practices substantially increase risks for abscesses and bacterial infections (Murphy et al., 2001), a problem that has been previously found to account for a majority of hospitalisations among IDU (Palepu et al., 2001). Evidence has also indicated that IDU are more likely to engage in indirect sharing of injection equipment during the preparation of drug solutions as a result of hurried injection (Maher & Dixon, 2001). Rushing may also increase risk for overdose when drugs are injected quickly and not first tested for strength (Broadhead et al., 2002; Maher & Dixon, 2001). Accidental syringe sharing has also been observed during a police crackdown in Vancouver, Canada (Small et al., in press). In this instance, syringes were accidentally mixed up between two HIV serodiscordant IDU who had temporarily hidden their syringes to avoid arrest. The same evaluation also identified how the pressure among IDU to watch for police can increase risk during injection, as one participant reported continuously watching for police while performing an injection into a friend's jugular vein—a practice that without such distractions carries significant risk for serious injury due to vascular accident. IDU are also known to seek out locations, such as alley doorways, that provide increased privacy and camouflage during injection (Dovey et al., 2001, Latkin et al., 1994, Small et al., in press). This type of displacement is known to increase risk for overdose since these settings are often out of the view of bystanders who can provide assistance or call for help, have no address to direct emergency personnel, and are hard to reach with emergency equipment (Broadhead et al., 2002; Darke & Ross, 1998; McGregor, Darke, Ali, & Christie, 1998). In their seminal ethnographic study of the impacts of policing on public health, Maher and Dixon (1999) describe how drug users and dealers adopt dangerous practices such as nasal and oral drug storage when police pressure is intense. Both forms of storage can result in significant harm; however, oral storage is particularly dangerous as it can prompt overdose if drugs are swallowed accidentally or as a means of concealing drugs from police (Havis & Best, 2003; Heinemann, Miyaishi, Iwersen, Schmoldt, & Puschel, 1998; Wetli, Rao, & Rao, 1997). Maher and Dixon (2001) also describe how risk for infectious disease transmission increases when dealers remove drugs from their mouth or nose and then pass these drugs onto buyers. Physical displacement and health service delivery Considerable health-related harms also result from the physical displacement of IDU into more remote non-public locations. The classic example of this type of displacement is the “shooting gallery” (Des Jarlais & Friedman, 1990). While various shootings galleries have been described, most are hidden indoor locations where drug dealing and high-risk behaviours flourish. Included are settings where drug users share syringes (Neaigus et al., 1994), store syringes for future use (Rhodes et al., 2003), or receive injections from professional dealers/injectors who use the same syringe to inject several customers (Ball, Rana, & Dehne, 1998). The use of shooting galleries in the United States has been repeatedly attributed to fear of arrest (Celentano et al., 1991, Schneider, 1998). When IDU are displaced into such locations, sterile injection equipment is often not readily available, while used syringes and unclean sources of water are often present to serve as substitutes (Chitwood et al., 1995). This serves to increase the likelihood that syringes may be reused and/or shared (Lachance et al., 1996, Latkin et al., 1994), and consequently, shooting gallery attendance has been associated with HIV infection (Battjes, Pickens, Haverkos, & Sloboda, 1994; Chaisson, Moss, Onishi, Osmond, & Carlson, 1987; Zolopa et al., 1994). A further well-noted impact of drug market enforcement involves the interruption of health service use by IDU. These impacts are typically a consequence of the displacement of IDU, although service interruption may also occur among IDU who remain in heavily policed drug markets (Aitken et al., 2002; Bluthenthal, Lorvick, Kral, Erringer, & Kahn, 1999; Rhodes et al., 2003, Small et al., in press; Wood et al., 2004a, Wood et al., 2004b). Several studies indicate that IDU are often hard to reach and maintain communication with for the purpose of delivering prevention materials, treatments, and educational messages that promote health and prevent disease (Broadhead et al., 1998; Conviser & Rutledge, 1989). When displacement due to enforcement occurs, prevention efforts are further compromised, as even the most experienced outreach worker may find it difficult to reach IDU who have moved to entirely new locations (Curtis et al., 1995). Service interruption can be further exacerbated when police presence is high, as some IDU will avoid public conversations with service providers so as to avoid being identified as drug users (Small et al., in press). Displacement can also result in IDU being under-serviced in their new location. An example of this occurred in a suburb of Melbourne, Australia, where a syringe exchange was overwhelmed with demand following a police crackdown in an adjacent neighbourhood (Aitken et al., 2002). Several studies have demonstrated that adequate access to sterile syringes may be the single most important factor in averting or reversing an HIV epidemic driven by injection drug use (Des Jarlais, 2000). However, a large number of studies have demonstrated that IDU are often reluctant to access syringe exchanges or carry syringes on their person out of fear of arrest, and that sterile syringes have been confiscated by police in some settings (Bastos & Strathdee, 2000; Bluthenthal, Kral, Lorvick, & Watters, 1997; Bluthenthal et al., 1999, Bourgois, 1998; Diaz, Vlahov, Hadden, & Edwards, 1999; Gleghorn, Jones, Doherty, Celentano, & Vlahov, 1995; Grund et al., 1992a, Grund et al., 1992b, Grund et al., 1995; Koester, 1994, Rhodes et al., 2003; Weinstein, Toce, Katz, & Ryan, 1998; Zule, 1992). This has resulted in observations of lower syringe access during police crackdowns (Aitken et al., 2002; Davis et al., in press; Grund et al., 1992a, Grund et al., 1992b; Maher & Dixon, 1999; Wood et al., 2003a, Wood et al., 2003b, Wood et al., 2003c, Wood et al., 2003d), and also low access to needle exchanges in settings where drug paraphernalia laws prohibit the possession of syringes by IDU (Calsyn, Saxon, Freeman, & Whittaker, 1991; Case, Meehan, & Jones, 1998; Cotten-Oldenburg, Carr, DeBoer, Collison, & Novotny, 2001; Taussig, Weinstein, Burris, & Jones, 2000). As such, IDU may find themselves without sterile injection equipment after drugs are obtained, and when withdrawal symptoms may be greatest. These effects are particularly worrisome given observations indicating that low access to syringe exchanges due to police presence is associated with elevated rates of syringe sharing among IDU (Aitken et al., 2002; Maher & Dixon, 1999; Rhodes et al., 2003). Unwillingness to carry injection equipment is also known to result in increases in improper disposal of syringes, as IDU may simply drop injection equipment on the street to avoid being stopped by police with used syringes in their possession (Aitken et al., 2002; Cooper, Moore, Gruskin, & Krieger, 2004; Dixon & Maher, 2002; Small et al., in press). Studies from the United States also indicate that some IDU are also unwilling to carry safe injection and bleach kits out of fear of arrest (Blankenship & Koester, 2002), and research conducted in Canada suggests that police presence may reduce uptake of safer injection facilities by IDU (Kerr, Wood, Small, Palepu, & Tyndall, 2003; Wood et al., 2004a, Wood et al., 2004b). Evidence of the impact of police presence on access to health services is also found in studies reporting that many IDU are unwilling to seek medical assistance during or following an overdose out of fear that police will accompany emergency personnel to the scene, and arrests will follow (Blankenship & Koester, 2002; Darke, Ross, & Hall, 1996; Davidson, Ochoa, Hahn, Evans, & Moss, 2002; Seal et al., 2003; Sergeev, Karpets, Sarang, & Tikhonov, 2003). Physical confrontations between IDU and police Physical confrontations between IDU and police are a common source of health-related harm (Cooper et al., 2004). Drug market enforcement involves frequent use of “hands on” policing (e.g., physical searches), greater use of physical restraint (e.g., chokeholds), and other indirect methods of physical incapacitation, such as the use of stun guns or pepper spray (Milliken, 1998; Pollanen, Chiasson, Cairns, & Young, 1998). These methods greatly increase the likelihood of physical harm for both IDU and the police involved. There is an emerging body of literature indicating that use of police restraint has been implicated in deaths related to excited delirium (Ruttenber et al., 1997), a condition known to be induced by use of cocaine at recreational dosing levels (Welti & FIshbain, 1985). Positional or postural holds, including commonly used neck holds, have also been associated with unexpected deaths in police custody (Kirschner, 1997; Reay & Eisele, 1982), and the use of pepper spray has been associated with a high incidence of corneal abrasion (Brown, Takeuchi, & Challoner, 2000). Aside from routine methods of physical restraint and incapacitation, drug market enforcement has also been associated with instances of excessive use of force by police that deviate from accepted policing practice (Caulkins, 1993). Because patrol-level policing is low-visibility policing, it is difficult to observe and exert managerial control over (Hough & Natarajan, 2000), which in turn may explain why excessive use of force and threats of violence have been noted in several countries (Cooper et al., 2004; Dixon & Maher, 2002; Human Rights Watch, 2003a, Human Rights Watch, 2004, Kerr et al., 2004, Kirschner, 1997; Zakrison, Hamel, & Hwang, 2004). Perhaps the most severe example of harm caused by drug enforcement comes from Thailand, where a federally ordered police crackdown resulted in reports of thousands of extra-judicial killings of suspected drug users and dealers (Kerr et al., 2004, Human Rights Watch, 2004). Drug enforcement has been associated with other health-related harms and human rights violations, including extortion against suspected drug users by police, forced detoxification, mandatory HIV testing, and forced labour (Human Rights Watch, 2003a, Human Rights Watch, 2003b, Human Rights Watch, 2004). Increased violence and volatility among drug users and dealers has also been associated with drug market enforcement (Brownstein, Crimmins, & Spunt, 2000; Goldstein, 1989; Maher & Dixon, 1999; May & Hough, 2001a; Small et al., in press). In particular, when drug dealers are arrested or displaced from their usual routines, established relationships within the marketplace are disrupted (Maher & Dixon, 2001). One consequence of this type of disruption observed is an increase in “bunking” (i.e., the sale of fake or low quality drugs) (Aitken et al., 2002; Maher & Dixon, 2001; Small et al., in press). Bunking becomes easier to accomplish when police presence is high, as deals are conducted more quickly, giving the buyer little time to view what has been sold to them. Because drug users have no authority to turn to in these instances, violence is commonly used to resolve debts and disputes over drug sales (Browenstein, Baci, Goldstein, & Ryan, 1992; Erickson, 2001; Taylor & Brownstein, 2003). Evidence from Bogota, Columbia indicates that enforcement initiatives that displace established dealers can also lead to losses of territory and exacerbate violent disputes over turf (Ross, 2002). A further social impact can occur when elevated police presence serves to displace street-based injection drug users to entirely different neighbourhoods (Caulkins, 1992; Cornish & Clarke, 1987; Dorn & Murji, 1992; May & Hough, 2001a; Norris & Armstrong, 1999; Wood et al., 2004a, Wood et al., 2004b; Zimmer, 1990). While the potential for improved public order can create increased feelings of safety within communities where drug use is targeted, the spillover to neighbouring areas has major implications for public health, as sudden increases in drug trafficking, drug use, public injecting, and unsafe syringe disposal can occur (Aitken et al., 2002; Maher & Dixon, 2001; Wood et al., 2004a, Wood et al., 2004b). This type of displacement can also exacerbate the spread of infectious diseases as social networks of IDU are disrupted and new syringe sharing networks begin to form (Curtis et al., 1995, Friedman et al., 2000, Rhodes et al., 2003). In recent years, reports of injection drug use by street youth and the growing risk of HIV transmission within this group have led to increasing emphasis on the prevention of initiation of injection drug use (Fuller et al., 2003). Youth may be particularly vulnerable to initiation into injection for a variety of reasons including lack of education about drug use, sexual risks, sexual and physical violence, poverty and neglect, and precarious living conditions (Fuller et al., 2003, Roy et al., 2003). For these reasons, adverse impacts can occur if the relocation of drug dealing and use has the effect of normalizing injection drug use among previously unexposed at-risk youth or other vulnerable populations who are subsequently initiated into injection drug use. Previous studies have demonstrated that this concern is not unfounded as new initiates into injection drug use are often vulnerable youth who are initiated by dealers, an older sex-partner, or pimp (Miller et al., 2002). The role of targeted drug enforcement strategies in illicit drug markets A careful analysis of costs and benefits is required to determine if commonly used enforcement approaches should be regarded as a legitimate strategies to address problems associated with drug markets (Maher & Dixon, 2001). In terms of benefits, there is evidence, primarily from the United States and Sweden, suggesting that drug market enforcement initiatives have been successful in achieving the goals of public order and increasing a sense of public safety, and have, in some instances, done so without simply prompting the displacement of drug markets into neighbouring areas (Caulkins, Larson, & Rich, 1993; Knutsson, 2000; Sherman & Wiesburd, 1995; Smith, 2001; Weisburd & Green, 1995). Although controversial, one study from Australia has been repeatedly cited to support the contention that enforcement practices can prompt drug users to enter drug treatment (Weatherburn & Lind, 1997). There is also some evidence to suggest that enforcement initiatives have served to increase the price of drugs (Caulkins et al., 1993, Zimmer, 1990), which is believed by some to deter casual and novice users from seeking drugs (Murji, 1998). While there is some evidence supporting the efficacy of targeted enforcement in drug markets, the majority of studies suggest that these approaches typically fail in achieving their stated goals (Dixon & Coffin, 1999). Further, there is also considerable research showing that the public order gains made by drug market enforcement are typically time-limited (Caulkins, 1992; Sherman & Rogan, 1995; Sherman & Wiesburd, 1995), and are more often completely offset by displacement of drug markets and drug users into neighbouring areas (Caulkins, 1992; Wood et al., 2004a, Wood et al., 2004b). Although displacement is not always regarded as a negative outcome (Caulkins, 1992, Moore, 1976, Zimmer, 1990), the adverse health and social consequences of displacement have been well established (Aitken et al., 2002, Celentano et al., 1991; Maher & Dixon, 2001; Schneider, 1998). Further, evidence of corrupt drug enforcement and related human rights violations have been documented in several countries (Human Rights Watch, 2003a, Human Rights Watch, 2003b, Human Rights Watch, 2004). Evidence from various countries suggests that drug enforcement typically has little if any effect on the price of drugs, their availability, and the frequency with which drugs are used (Best, Strang, Beswick, & Gossop, 2001; Polich, Ellickson, Reuter, & Kalion, 1984; Wood et al., 2003a, Wood et al., 2003b, Wood et al., 2003c, Wood et al., 2003d). However, while there is some evidence indicating that the price of drugs can increase as a result of drug market enforcement, this effect can actually serve to stimulate drug market activity and related harms (May & Hough, 2001a). This is due to the fact that while the price of drugs is generally elastic, the demand for drugs, particularly among chronic drug users, is generally inelastic (Reuter & Kleiman, 1986). Consequently, when enforcement practices stimulate increases in the price of drugs it is likely that more money will be spent on drugs to support habitual use, which in turn means that more crimes will be committed (Caulkins et al., 1993; Hough & Natarajan, 2000; Maher & Dixon, 2001). Similar dynamics pertaining to crime associated with policing can also occur if drugs are routinely confiscated. A further perverse effect of rising prices is that revenues derived from the sale of drugs will increase (Caulkins et al., 1993), and therefore more potential dealers may be attracted to drug dealing to seek the high returns, which in turn may serve to ensure that dealers who are removed from drug markets are quickly replaced (Caulkins & MacCoun, 2003; May & Hough, 2001b). Despite some evidence to the contrary, studies have indicated that police crackdowns in drug markets have not prompted increases in the number of drug users entering addiction treatment, including methadone maintenance therapy (Wood et al., 2004a, Wood et al., 2004b). Drug market enforcement does not generally lead to the arrest of high level suppliers, but rather involves the frequent arrest of low level dealers and drug users (Dixon & Coffin, 1999). Finally, it has been argued that the opportunity cost of investing in drug enforcement under limited policing budgets has been other police activity (e.g., traffic enforcement, community policing) that is foregone (Benson, Leburn, & Rasmussen, 2001). There is ample evidence indicating that drug markets are remarkably resilient in the face of enforcement pressures due to changes that occur in both the location of and methods used within drug markets (Caulkins, 1992, Chaiken, 1988; Hough & Natarajan, 2000; May et al., 2000; Natarajan, Clarke, & Johnson, 1995; Pearson & Hobbs, 2001; Sterk & Elifson, 2000; Worden, Bynum, & Frank, 1994). Among the more common effects is that open markets quickly become closed markets (Bless, Korf, & Freeman, 1995; Edmunds, Hough, & Urquia, 1996; Johnson, Hamid, & Sanabria, 1992), which are inherently more difficult to police, as users and dealers resume their activities in hidden locations (May & Hough, 2001b). Other well-noted changes involve increasing sophistication of drug markets, including increasing complexity in use of personnel, such as the use of intermediaries (e.g., “steerers”) between dealers and buyers (Maher & Dixon, 2001), drug “runners” (Mieczkowski, 1986), and “lookouts” who keep watch for police (Ross, 2002, Small et al., in press). Among the most pervasive forms of drug market adaptation involves the use of technologies (e.g., pagers, cell phones) which are presently virtually impossible for police to trace and follow (Aitken et al., 2002; Caulkins & MacCoun, 2003; Chaiken, 1988, Chattterton et al., 1995, Edmunds et al., 1996, Murji, 1998). Drug supply networks are generally not limited to a few central “kingpins”, but rather include numerous diverse enterprises, and therefore removing the entire supply network is beyond the resources and scope of even the most well-supplied enforcement agency (Dorn & South, 1990). For instance, estimates derived in the 1980s suggested that there were at least 750,000 street-based drug dealers in the U.S., and in 1990 there were an estimated 24,000 dealers in Washington, DC alone (Reuter & Kleiman, 1986; Reuter, MacCoun, Murphy, Abrahamsen, & Simon, 1990). In light of these numbers and evidence of rapid replacement of dealers lost to incarceration (Cornish & Clarke, 1987; Dixon & Maher, 2002; May & Hough, 2001b), any sustained attempt to arrest all active dealers would ultimately overwhelm the justice system (Caulkins, 1992) and result in further harms associated with incarceration (Beyrer et al., 2003; Frost & Tchertkov, 2002). Implications for policy and practice The present review indicates that drug market enforcement activities interact strongly with elements in the broader risk environment of IDU and thereby exacerbate health and social harms through a variety of mechanisms. As well, drug market enforcement has been associated with severe human rights violations in various settings. These dynamics indicate the need to direct attention to this particular environmental determinant of health in effort to modify its harm producing impacts (Burris et al., 2004). Efforts have been made to change policing practices as a means of reducing the health and social consequences commonly associated with drug market policing. Alternatives to conventional policing methods include greater use of problem solving and discretion (Goldstein, 1990; Maher & Dixon, 1999). In using discretion, police employ alternatives to arrest and confiscation of injecting equipment through use of warnings or cautioning, and use of referrals to appropriate health and social services (Maher & Dixon, 1999; Reardon et al., 1993). Others have suggested that police officers maintain adequate distance from health services used by drug users so as not to deter individuals from accessing such services (Kerr et al., 2003). Maher and Dixon (1999) also recommend that police avoid interacting with IDU during the injection process, since interaction at this time may quickly result in avoidable harms. However, this approach may be counter to the wishes of the public who frequently demand public order, and therefore public education may be required to ensure that such policing practices are accepted (Maher & Dixon, 1999). Other alternatives involve the provision of harm reduction training for police officers, or involving police directly in harm reduction activities (Burris et al., 2004; Forell & Price, 1997; Grund et al., 1992a, Grund et al., 1992b). It is important to note, however, that there is considerable variation in public perception of the role of police and policing practices across cultures and nations, and not all alternatives to conventional drug market enforcement will apply equally. For example, while referral may be used as an alternative to arrest in some settings, elsewhere police are discouraged from exercising such discretion and instead offer referrals only after an arrest has been made (Hough, 2002). There are also examples of partnerships between police and health agencies that have been established to ensure that police practices are, as much as is possible, complementary to public health efforts (Lough, 1998; Midford, Acres, Lenton, Loxley, & Boots, 2002; Smith, Novak, Frank, & Travis, 2000). Among the earliest of such approaches is the “problem-oriented” approach advocated by Goldstein (1990), which involves establishing partnerships with local communities that focus on identifying the root causes of community problems and the most effective actions for addressing them. Another popular approach involves creating Drug Action Teams (DATs), which were first developed in Great Britain and are also based on partnerships between police, social service and health agencies (Smith et al., 2000). Common products of DATs include the development of health-focused trainings for police, and the development of referral cards that are handed out by police and which list available health and social services. While a small number of evaluations have indicated some positive benefits of DATs, such as increased awareness of health issues and harm reduction among police and greater collaboration among partners, the impacts have generally been modest, and success in achieving many of the more ambitious goals associated with DATs has proved difficult (Hough, 2002, Midford et al., 2002, Smith et al., 2000). Clearly, more work must be done to ensure the success of such partnerships, which have been found to be difficult to foster for several reasons. For example, police and service providers often have different objectives, values, and treatment philosophies (i.e., abstinence versus harm reduction), and therefore have difficulty cultivating healthy working partnerships, especially if forced into partnerships in a top-down fashion (Hough, 2002, Smith et al., 2000). It has therefore been recommended that particular attention be paid to the implementation of such partnerships, and that non-specialist low-ranking police officers be involved in designing and implementing these types of partnership (Forell & Price, 1997; Hough, 2002). It should be noted, however, that while steps can be taken to redefine the role and goals of policing in a manner more congruent with public health goals, evidence indicates that substantial barriers to change exist within police structures and cultures (Goldstein, 1990, Paoline, 2004; Zhao, Lovrich, & Robinson, 2001). As well, while police departments may accept policies that complement public health efforts, the behaviour of individual police officers on the street may deviate from department policies (Burris et al., 2004, Goldstein, 1990, Hough, 2002). It is also important to note that, despite efforts to promote policing approaches that are more congruent with public health goals, evidence of ongoing police corruption and brutality associated with drug market policing have been documented in many countries (Human Rights Watch, 2003a, Human Rights Watch, 2003b, Human Rights Watch, 2004). There is, therefore, need to consider methods that address policing practices that compromise health and violate established international human rights standards. Some of these practices have been targeted in the United States and Australia through the use of specialized trainings, public and police surveys, and proactive police oversight mechanisms (Prenzler & Ronken, 2003). However, novel monitoring approaches, such as integrity testing, have been successfully applied in some settings (Newham, 2003). Integrity testing typically involves creating a situation in a real-life setting during which the integrity of individual police officers is tested (Prenzler & Ronken, 2003). During the test, police officers are given the opportunity to commit an offence (e.g., stealing money belonging to a suspect) while being monitored closely (Newham, 2003). Integrity testing is often used randomly so that police officers could believe that any encounter with the public could in fact be an integrity test (Newham, 2003). However, while integrity testing has generated considerable interest, legal, ethical, and practical concerns have prevented the implementation of this approach in several settings (Prenzler & Ronken, 2001). Research has shown that various health-focused approaches may also be employed to address the harms associated with drug markets. Included are safer injection facilities (SIFs), where injection drug users can inject pre-obtained illicit drugs under supervision (Broadhead et al., 2002). SIFs have been implemented in several cities with large public illicit drug markets, including many Western European cities, one city in Australia, and one city in Canada (Broadhead et al., 2002, Kerr et al., 2003). There are now reports of public drug use and related public disorder (e.g., discarded syringes) declining after the implementation of SIFs in several settings (Kemmesies, 1999; Wood et al., 2004a, Wood et al., 2004b). SIFs are also unique in that they offer opportunities to couple enforcement and public health efforts, as police officers working on the street can direct IDU who inject in public spaces to these venues. It is also well recognized that addiction treatment can be a highly effective intervention to prevent community and health-related harms of illicit drug use by removing addicted individuals from the market altogether, or by enabling individuals to reduce their level of illicit drug use (Wood et al., 2003a, Wood et al., 2003b, Wood et al., 2003c, Wood et al., 2003d). This is particularly relevant to the present review since there is substantial evidence to suggest that the provision of addiction treatment may be more cost-effective than employing enforcement-based resources to address problem drug use (Cartwright, 1988; Rydell, Caulkins, & Everingham, 1996). However, in most settings, the demand for addiction treatment services substantially exceeds supply (Wenger & Rosenbaum, 1994). In moving toward more effective solutions to problem drug use it is essential that evidence-based drug treatment services be substantially increased. Summary A prerequisite for addressing drug-related harm involves consideration of the environmental factors which determine health. A review of the available evidence indicates that drug market enforcement approaches interact with and transform various practices and social dynamics in the broader risk environment of IDU, and thereby constitute a potent source of harm within drug markets. These approaches have been increasingly applied within drug markets despite limited scientific confirmation of their efficacy and the harm they often produce. There are, however, alternatives to traditional enforcement approaches that can be applied within drug markets. Some of these approaches involve novel enforcement practices that seek to complement public health efforts, while other approaches involve the provision of harm reduction services and addiction treatment. Since there is ample scientific evidence to suggest that these alternative approaches are substantially more cost effective and less harmful than drug market enforcement, reducing the massive public order and public health problems of illicit drug use will require courage on the part of policy-makers so that the drug-related harms can be addressed in an evidence-based fashion. Acknowledgments We would like to express our sincere gratitude to the two reviewers who provided supportive and helpful comments on the first draft of this manuscript. We feel our manuscript was greatly improved as a result of the advice we received. We would also like to acknowledge Peter Vann for his administrative assistance. References Aitken et al., 2002. 1.Aitken C, Moore D, Higgs P, Kelsall J, Kerger M. The impact of a police crackdown on a street drug scene: Evidence from the street. International Journal of Drug Policy. 2002;13:189–198. Ball et al., 1998. 2.Ball AL, Rana S, Dehne KL. HIV prevention among injecting drug users: Responses in developing and transitional countries.. Public Health Reports. 1998;113(Suppl. 1):170–181. MEDLINE Bastos and Strathdee, 2000. 3.Bastos FI, Strathdee SA. Evaluating effectiveness of syringe exchange programmes: Current issues and future prospects. Social Science and Medicine. 2000;51(12):1771–1782. MEDLINE |
CrossRef
Battjes et al., 1994. 4.Battjes RJ, Pickens RW, Haverkos HW, Sloboda Z. HIV risk factors among injecting drug users in five US cities. AIDS. 1994;8(5):681–687. MEDLINE Benson et al., 2001. 5.Benson BL, Leburn IS, Rasmussen DW. The impact of drug enforcement on crime: An investigation of the opportunity cost of police resources. Journal of Drug Issues. 2001;31(4):989–1006. Best et al., 2001. 6.Best D, Strang J, Beswick T, Gossop M. Assessment of a concentrated high-profile police operation: No discernible impact on drug availability price or purity. British Journal of Criminology. 2001;41:738–745. Beyrer et al., 2003. 7.Beyrer C, Jittiwutikarn J, Teokul W, Razak MH, Suriyanon V, Srirak N, et al. Drug use, increasing incarceration rates, and prison-associated HIV risks in Thailand. AIDS and Behavior. 2003;7(2):153–161. MEDLINE |
CrossRef
Blankenship and Koester, 2002. 8.Blankenship KM, Koester S. Criminal law, policing policy, and HIV risk in female street sex workers and injection drug users. Journal of Law, Medicine and Ethics. 2002;30(4):548–559. MEDLINE |
CrossRef
Bless et al., 1995. 9.Bless R, Korf DJ, Freeman M. Open drug scenes: A cross-national comparison of concepts and urban strategies. European Addiction Research. 1995;1:128–138.
CrossRef
Bluthenthal et al., 1997. 10.Bluthenthal RN, Kral AH, Lorvick J, Watters JK. Impact of law enforcement on syringe exchange programs: A look at Oakland and San Francisco. Medical Anthropology. 1997;18(1):61–83. Bluthenthal et al., 1999. 11.Bluthenthal RN, Lorvick J, Kral A, Erringer EA, Kahn JG. Collateral damage in the war on drugs: HIV risk behaviors among injection drug users. International Journal of Drug Policy. 1999;10:25–38. Bourgois, 1998. 12.Bourgois P. The moral economics of homeless heroin addicts: Confronting ethnography, HIV risk, and everyday violence in San Francisco shooting encampments. Substance Use and Misuse. 1998;33:2323–2351. MEDLINE |
CrossRef
Broadhead et al., 1998. 13.Broadhead RS, Heckathorn DD, Weakliem DL, Anthony DL, Madray H, Mills RJ, et al. Harnessing peer networks as an instrument for AIDS prevention: Results from a peer-driven intervention. Public Health Reports. 1998;113(Suppl. 1):42–57. Broadhead et al., 2002. 14.Broadhead RS, Kerr TH, Grund JP, Altice FL. Safer injection facilities in North America: Their place in public policy and health initiatives. Journal of Drug Issues. 2002;32(1):329–355. Browenstein et al., 1992. 15.Browenstein HH, Baci HRS, Goldstein PJ, Ryan PJ. The relationship of drugs, drug trafficking, and drug traffickers to homicide. Journal of Crime and Justice. 1992;15:25–44. Brown et al., 2000. 16.Brown L, Takeuchi D, Challoner K. Corneal abrasions associated with pepper spray exposure. American Journal of Emergency Medicine. 2000;18(3):271–272. Abstract |
Full-Text PDF (236 KB)
|
CrossRef
Brownstein et al., 2000. 17.Brownstein HH, Crimmins SM, Spunt BJ. A conceptual framework for operationalizing the relationship between violence and drug market stability. Contemporary Drug Problems. 2000;27:867–890. Burris et al., 2004. 18.Burris S, Blankenship KM, Donoghoe M. Addressing the “risk environment” for injection drug users: The mysterious case of the missing cop. Milbank Quarterly. 2004;82(1):125–156.
CrossRef
Calsyn et al., 1991. 19.Calsyn DA, Saxon AJ, Freeman G, Whittakar S. Needle-use practices among intravenous drug users in an area where needle purchase is legal. AIDS. 1991;5(2):187–193. MEDLINE Cartwright, 1988. 20.Cartwright WS. Cost–benefit and cost-effectiveness analysis of drug abuse treatment services. Evaluation Review. 1988;22(5):609–636.
CrossRef
Csae et al., 1998. 21.Case P, Meehan T, Jones TS. Arrests and incarceration of injection drug users for syringe possession in Massachusetts: Implications for HIV prevention. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1998;18(Suppl. 1):71–75. Caulkins, 1992. 22.Caulkins JP. Thinking about displacement in drug markets: Why observing change of venue isn’t enough. Journal of Drug Issues. 1992;22(1, Winter):17–30. Caulkins, 1993. 23.Caulkins JP. Local drug markets response to focused police enforcement. Operations Research. 1993;41(5):848–863.
CrossRef
Caulkins et al., 1993. 24.Caulkins JP, Larson RC, Rich TF. Geography's impact on the success of focused local drug enforcement operations. Socio-Economic Planning Sciences. 1993;27:119–130.
CrossRef
Caulkins and MacCoun, 2003. 25.Caulkins JP, MacCoun R. Limited rationality and the limits of supply reduction. Journal of Drug Issues. 2003;33(2, Spring):433–464. Celentano et al., 1991. 26.Celentano DD, Vlahov D, Cohn S, Anthony JC, Solomon L, Nelson KE. Risk factors for shooting gallery use and cessation among intravenous drug users. American Journal of Public Health. 1991;81(10):1291–1295. MEDLINE |
CrossRef
Chaiken, 1988. 27.In: Chaiken MR editors. Street-level drug enforcement. Washington: National Institute of Justice; 1988;. Chaisson et al., 1987. 28.Chaisson RE, Moss AR, Onishi R, Osmond D, Carlson JR. Human immunodeficiency virus infection in heterosexual intravenous drug users in San Francisco. American Journal of Public Health. 1987;77(2):169–172. MEDLINE |
CrossRef
Chattterton et al., 1995. 29.Chattterton, M., Gibson, G., Gilman, M., Godfrey, C., Sutton, M., & Wright, A. (1995). Performance indicators for local anti-drugs strategies: A preliminary analysis (No. Crime Detection and Prevention Series, Paper #62). London: Home Office Police Research Group. Chitwood et al., 1995. 30.Chitwood DD, Griffin DK, Comerford M, Page JB, Trapido EJ, Lai S, et al. Risk factors for HIV-1 seroconversion among injection drug users: A case–control study. American Journal of Public Health. 1995;85(11):1538–1542. MEDLINE |
CrossRef
Conviser and Rutledge, 1989. 31.Conviser R, Rutledge JH. Can public policies limit the spread of HIV among IV drug users. Journal of Drug Issues. 1989;19:113–128. Cooper et al., 2004. 32.Cooper H, Moore L, Gruskin S, Krieger N. Characterizing perceived police violence: Implications for public health. American Journal of Public Health. 2004;94(7):1109–1118. MEDLINE |
CrossRef
Cornish and Clarke, 1987. 33.Cornish D, Clarke R. Understanding crime displacement: An application of rational choice theory. Criminology. 1987;25:933–947. Cotten-Oldenburg et al., 2001. 34.Cotten-Oldenburg NU, Carr P, DeBoer JM, Collison EK, Novotny G. Impact of pharmacy-based syringe access on injection practices among injecting drug users in Minnesota, 1998 to 1999. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1999;27(2):183–192. Curtis et al., 1995. 35.Curtis R, Friedman SR, Neaigus A, Jose B, Goldstein M, Ildefonso G. Street-level drug markets: Network structure and HIV risk. Social Networks. 1995;17:229–249. Curtis and Wendel, 2000. 36.Curtis R, Wendel T. Toward the development of a typology of illegal drug markets. In: Hough M, Natarajan M editor. Illegal drug markets: From research to policy. Monsey, NJ: Criminal Justice Press; 2000;p. 121–152. Darke and Ross, 1998. 37.Darke, S., & Ross, J. (1998). Heroin-related deaths in South Western Sydney (No. Technical Report No. 52). Sydney: National Drug and Alcohol Research Centre. Darke et al., 1996. 38.Darke S, Ross J, Hall W. Overdose among heroin users in Sydney Australia: I. Prevalence and correlates of non-fatal overdose. Addiction. 1996;91(3):405–411. MEDLINE |
CrossRef
Davidson et al., 2002. 39.Davidson PJ, Ochoa KC, Hahn JA, Evans JL, Moss AR. Witnessing heroin-related overdoses: The experiences of young injectors in San Francisco. Addiction. 2002;97(12):1511–1516. MEDLINE |
CrossRef
Davis et al., in press. 40.Davis, C. B. S., Metzger, D., Becher, J., & Lynch, K. (in press). Effects of an intensive street-level police intervention on syringe exchange program utilization: Philadelphia, Pennsylvania. American Journal of Public Health. Des Jarlais, 2000. 41.Des Jarlais DC. Structural interventions to reduce HIV transmission among injecting drug users. AIDS. 2000;14(Suppl. 1):41–46. Des Jarlais and Friedman, 1990. 42.Des Jarlais DC, Friedman SR. Shooting galleries and AIDS: Infection probabilities and ‘tough’ policies. American Journal of Public Health. 1990;80(2):142–144. MEDLINE |
CrossRef
Diaz et al., 1999. 43.Diaz T, Vlahov D, Hadden B, Edwards V. Needle and syringe acquisition among young injection drug users in Harlem, New York City. National HIV Prevention Conference. 1999;654. Dixon and Coffin, 1999. 44.Dixon D, Coffin P. Zero tolerance policing of illegal drug markets. Drug and Alcohol Review. 1999;18:477–486.
CrossRef
Dixon and Maher, 2002. 45.Dixon D, Maher L. Anh Hai: Policing culture and social exclusion in a street heroin market. Policing & Society. 2002;12(2):93–110. Dorn and Murji, 1992. 46.Dorn N, Murji K. Low level drug enforcement. International Journal of the Sociology of Law. 1992;20:159–171. Dorn and South, 1990. 47.Dorn N, South N. Drug markets and law enforcement. British Journal of Criminology. 1990;30(2, Spring):171–188. Dovey et al., 2001. 48.Dovey K, Fitzgerald J, Choi Y. Safety becomes danger: Dilemmas of drug-use in public space. Health and Place. 2001;7(4):319–331. MEDLINE |
CrossRef
Drucker, 1999. 49.Drucker E. Drug prohibition and public health: 25 years of evidence. Public Health Reports. 1999;114(1):14–29. MEDLINE |
CrossRef
Edmunds et al., 1996. 50.Edmunds, M., Hough, M., & Urquia, N. (1996). Tackling local drug markets. London: Home Office. Erickson, 2001. 51.Erickson PG. Drugs, violence and public health: What does the harm reduction approach have to offer. Vancouver: Fraser Institute; 2001;. Forell and Price, 1997. 52.Forell, S., & Price, L. (1997). Using harm reduction policing within drug law enforcement in the NSW Police Services, Australia. Retrieved November 14, 2004, from https://www.drugtext.org/library/articles/forell.htm. Friedman et al., 2000. 53.Friedman SR, Kottiri BJ, Neaigus A, Curtis R, Vermund SH, Des Jarlais DC. Network-related mechanisms may help explain long-term HIV-1 seroprevalence levels that remain high but do not approach population-group saturation [in process citation]. American Journal of Epidemiology. 2000;152(10):913–922. Frost and Tchertkov, 2002. 54.Frost L, Tchertkov V. Prisoner risk taking in the Russian Federation. AIDS, Education and Prevention. 2002;14(Suppl. B):7–23. MEDLINE |
CrossRef
Fuller et al., 2003. 55.Fuller CM, Vlahov D, Latkin CA, Ompad DC, Celentano DD, Strathdee SA. Social circumstances of initiation of injection drug use and early shooting gallery attendance: Implications for HIV intervention among adolescent and young adult injection drug users. Journal of Acquired Immune Deficiency Syndromes and Retrovirology. 2003;32(1):86–93. Gleghorn et al., 1995. 56.Gleghorn AA, Jones TS, Doherty MC, Celentano DD, Vlahov D. Acquisition and use of needles and syringes by injecting drug users in Baltimore, Maryland. Journal of Acquired Immune Deficiency Syndromes and Retrovirology. 1995;10(1):97–103. Goldstein, 1990. 57.Goldstein H. Problem-oriented policing. Philadelphia: Temple University Press; 1990;. Goldstein, 1989. 58.Goldstein PJ. Drugs and violent crimes. In: Weiner NA, Wolfgang ME editor. Pathways to criminal violence. Newbury Park, CA: Sage; 1989;. Greene, 1996. 59.Greene L. Policing places with drug problems. Thousand Oaks, CA: Sage; 1996;. Grund et al., 1992a. 60.Grund JP, Blanken P, Adriaans NF, Kaplan CD, Barendregt C, Meeuwsen M. Reaching the unreached: Targeting hidden IDU populations with clean needles via known user groups. Journal of Psychoactive Drugs. 1992;24(1):41–47. MEDLINE Grund et al., 1995. 61.Grund JP, Heckathorn DD, Broadhead RS, Anthony DL. In eastern Connecticut, IDUs purchase syringes from pharmacies but don’t carry syringes. Journal of Acquired Immune Deficiency Syndromes and Retrovirology. 1995;10(1):104–105. Grund et al., 1992b. 62.Grund JP, Stern LS, Kaplan CD, Adriaans NF, Drucker E. Drug use contexts and HIV-consequences: The effect of drug policy on patterns of everyday drug use in Rotterdam and the Bronx. British Journal of Addiction. 1992;87(3):381–392. MEDLINE Havis and Best, 2003. 63.Havis S, Best D. Drug-related deaths in police custody (1997–2003) a police complaints authority study. London: Police Complaints Authority; 2003;. Heinemann et al., 1998. 64.Heinemann A, Miyaishi S, Iwersen S, Schmoldt A, Puschel K. Body-packing as cause of unexpected sudden death. Forensic Science International. 1998;92(1):1–10. Abstract | Full Text |
Full-Text PDF (287 KB)
|
CrossRef
Hough, 2002. 65.Hough M. Drug user treatment within a criminal justice context. Substance Use and Misuse. 2002;37(8–10):985–996. MEDLINE |
CrossRef
Hough and Edmunds, 1999. 66.Hough M, Edmunds M. Tackling drug markets: An eclectic approach. Studies on Crime & Crime Prevention. 1999;8(1):107–131. Hough and Natarajan, 2000. 67.Hough M, Natarajan M. Introduction: Illegal drug markets, research and policy. In: Hough M, Natarajan M editor. Illegal drug markets: From research to policy. Monsey, NJ: Criminal Justice Press; 2000;p. 1–18. Human Rights Watch, 2003a. 68.Human Rights Watch. (2003a). Locked doors: The human rights of people living with HIV/AIDS in China (Vol. 14 (7C)). New York: Human Rights Watch. Human Rights Watch, 2003b. 69.Human Rights Watch. (2003b). Ravaging the vulnerable: Abuses against persons at high risk of HIV in Bangladesh (Vol. 15 (6C)). New York: Human Rights Watch. Human Rights Watch, 2004. 70.Human Rights Watch. (2004). Not enough graves: The war on drugs, HIV/AIDS, and violations of human rights in Thailand (Vol. 16 (8C)). New York: Human Rights Watch. Jacobson, 1999. 71.Jacobson J. Policing drug hot-spots. London: Home Office; 1999;. Johnson et al., 1992. 72.Johnson BD, Hamid A, Sanabria H. Emerging models of crack distribution. In: Meiczkowski T editors. Drugs, crime and social policy. Boston, MA: Allyn and Bacon; 1992;. Kemmesies, 1999. 73.Kemmesies, U. (1999). Final Report: The open drug scene and the safe injection room offers in Frankfurt am Main. Kerr et al., 2004. 74.Kerr T, Kaplan K, Suwannawong P, Jurgens R, Wood E. The global fund to fight AIDS tuberculosis and Malaria: Funding for unpopular public-health programmes. Lancet. 2004;364(9428):11–12. Full Text |
Full-Text PDF (140 KB)
|
CrossRef
Kerr et al., 2003. 75.Kerr T, Wood E, Small D, Palepu A, Tyndall MW. Potential use of safer injecting facilities among injection drug users in Vancouver's Downtown Eastside. Canadian Medical Association Journal. 2003;169(8):759–763. MEDLINE Kersten, 2000. 76.Kersten, J. (2000, September 23). Drug enforcement policing. Paper presented at Illegal Drug Use in North America and Europe: Comparative Issues, Problems and Policies, University of British Columbia, Vancouver. Kirschner, 1997. 77.Kirschner RH. Police brutality in the USA. Lancet. 1997;350(9088):1395. Full Text |
Full-Text PDF (330 KB)
|
CrossRef
Kleiman, 1992. 78.Kleiman MAR. Against excess: Drug policy for results. New York: Basic Books; 1992;. Knutsson, 2000. 79.Knutsson J. Swedish drug markets and drugs policy. In: Hough M, Natarajan M editor. Illegal drug markets: From research to policy. Monsey, NJ: Criminal Justice Press; 2000;p. 179–202. Koester, 1994. 80.Koester SK. Copping, running, and paraphernalia laws: Contextual variables and needle risk behavior among injection drug users in Denver. Human Organization. 1994;53(3):287–295. Lachance et al., 1996. 81.Lachance N, Lamothe F, Bruneau J, Franco E, Vincelette J, Soto J. Injecting and sharing IV equipment in different cities: A potential risk for HIV dissemination. International Conference on AIDS. 1996;11(1):351;. Latkin et al., 1994. 82.Latkin C, Mandell W, Vlahov D, Oziemkowska M, Knowlton A, Celentano D. My place, your place, and no place: Behavior settings as a risk factor for HIV-related injection practices of drug users in Baltimore Maryland. American Journal of Community Psychology. 1994;22(3):415–430. MEDLINE |
CrossRef
Lee, 1996. 83.Lee M. London: “Community damage limitation” through policing. In: Dorn N, Jepsen J, Savona E editor. European drug policy and enforcement. Basingstoke: Macmillan; 1996;. Link and Phelan, 1995. 84.Link B, Phelan MJ. Social conditions and fundamental causes of disease. Journal of Health & Social Behavior. 1995;38:80–94. Lough, 1998. 85.Lough G. Law enforcement and harm reduction: Mutually exclusive or mutually compatible. International Journal of Drug Policy. 1998;3(1):169–173. Maher and Dixon, 1999. 86.Maher L, Dixon D. Policing and public health: Law enforcement and harm minimization in a street-level drug market. British Journal of Criminology. 1999;39(4):488–512. Maher and Dixon, 2001. 87.Maher L, Dixon D. The cost of crackdowns: Policing Cabramatta's heroin market. Current Issues in Criminal Justice. 2001;13(1):5–22. May et al., 2000. 88.May T, Harocopos A, Turnbull PJ, Hough M. Serving Up: The impact of low-level police enforcement on drug markets. London: Home Office; 2000;. May and Hough, 2001a. 89.May T, Hough M. Illegal dealings: The impact of low-level police enforcement on drug markets. European Journal on Criminal Policy & Research. 2001;9(2):137–162. May and Hough, 2001b. 90.May T, Hough M. Illegal dealings: The impacts of low-level police enforcement on drug markets. European Journal on Criminal Policy and Research. 2001;9:137–162. McGregor et al., 1998. 91.McGregor C, Darke S, Ali R, Christie P. Experience of non-fatal overdose among heroin users in Adelaide, Australia: Circumstances and risk perceptions. Addiction. 1998;93(5):701–711. MEDLINE Midford et al., 2002. 92.Midford R, Acres J, Lenton S, Loxley W, Boots K. Cops, drugs and the community: Establishing consultative harm reduction structures in two Western Australian locations. International Journal of Drug Policy. 2002;13(3):181–188. Mieczkowski, 1986. 93.Mieczkowski T. Geeking up and throwing down: Heroin street life in Detroit. Criminology. 1986;24(4):645–666. Miller et al., 2002. 94.Miller CL, Spittal PM, LaLiberte N, Li K, Tyndall MW, O'Shaughnessy MV, et al. Females experiencing sexual and drug vulnerabilities are at elevated risk for HIV infection among youth who use injection drugs. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 2002;30(3):335–341. Milliken, 1998. 95.Milliken D. Death by restraint. Canadian Medical Association Journal. 1998;158(12):1611–1612. MEDLINE Moore, 1976. 96.Moore, M. H. (1976). Buy and bust: The effective regulation of an illicit market in heroin. Lexington, MA: Heath. Murji, 1998. 97.Murji, K. (1998). Policing drugs. Aldershot: Ashgate. Murphy et al., 2001. 98.Murphy EL, DeVita D, Liu H, Vittinghoff E, Leung P, Ciccarone DH, et al. Risk factors for skin and soft-tissue abscesses among injection drug users: A case–control study. Clinical Infectious Diseases. 2001;33(1):35–40. MEDLINE |
CrossRef
Natarajan et al., 1995. 99.Natarajan M, Clarke R, Johnson BD. Telephones as facilitators of drug dealing: A research agenda. European Journal of Criminal Policy and Research. 1995;3(3):137–154. Natarajan and Hough, 2000. 100.In: Natarajan M, Hough M editor. Illegal drug markets: From research to prevention policy. Vol. 11:Monsey, NY: Criminal Justice Press; 2000;. Neaigus et al., 1994. 101.Neaigus A, Friedman SR, Curtis R, Des Jarlais DC, Furst RT, Jose B, et al. The relevance of drug injectors’ social and risk networks for understanding and preventing HIV infection. Social Science and Medicine. 1994;38(1):67–78. MEDLINE |
CrossRef
Newham, 2003. 102.Newham, G. (2003). Preventing police corruption: Lessons from the New York Police Department. Johannesburg: Centre for the Study of Violence and Reconciliation: http://www.csvr.org.za/papers/papnypd.htm. Norris and Armstrong, 1999. 103.Norris C, Armstrong G. The maximum surveillance society: The rise of CCTV. Oxford: Berg; 1999;. Palepu et al., 2001. 104.Palepu A, Tyndall MW, Leon H, Muller J, O'Shaughnessy MV, Schechter MT, et al. Hospital utilization and costs in a cohort of injection drug users. Canadian Medical Association Journal. 2001;165(4):415–420. MEDLINE Paoline, 2004. 105.Paoline EA. Shedding light on police culture: An examination of officers’ occupational attitudes. Police Quarterly. 2004;7(2):205–236. Pearson and Hobbs, 2001. 106.Pearson G, Hobbs D. Middle market drug distribution. London: Home Office; 2001;. Polich et al., 1984. 107.Polich, J. M., Ellickson, P. L., Reuter, P., & Kalion, J. P. (1984). Strategies for controlling adolescent drug use. Santa Monica, CA: RAND Corporation. Pollanen et al., 1998. 108.Pollanen MS, Chiasson DA, Cairns JT, Young JG. Unexpected death related to restraint for excited delirium: A retrospective study of deaths in police custody and in the community. Canadian Medical Association Journal. 1998;158(12):1603–1607. MEDLINE Prenzler and Ronken, 2001. 109.Prenzler T, Ronken C. Police integrity testing in Australia. Criminal Justice. 2001;1(3):319–342. Prenzler and Ronken, 2003. 110.Prenzler T, Ronken C. A survey of innovations in the development and maintenance of ethical standards by Australian police departments. Police Practice and Research. 2003;4(2):149–161. Reardon et al., 1993. 111.Reardon J, Warren N, Keilch R, Jenssen D, Wise F, Brunner W. Are HIV-infected injection drug users taking HIV tests. American Journal of Public Health. 1993;83(10):1414–1417. MEDLINE |
CrossRef
Reay and Eisele, 1982. 112.Reay DT, Eisele JW. Death from law enforcement neck holds. American Journal of Forensic Medical Pathology. 1982;3(3):253–258. Reuter and Kleiman, 1986. 113.Reuter, P., & Kleiman, M. A. R. (1986). Risks and prices: An economic analysis of drug enforcement. In M. Tonry & N. Morris (Eds.), Crime and justice: An annual review of research (Vol. 7, pp. 289–340). Chicago: University of Chicago Press. Reuter et al., 1990. 114.Reuter, P., MacCoun, R., Murphy, Abrahamsen, A., & Simon, B. (1990). Money from crime: A study of the economics of drug retailing (No. R-3894_RF). Santa Monica: RAND Corporation. Rhodes, 2002. 115.Rhodes T. The ‘risk environment’: A framework for understanding and reducing drug-related harm. International Journal of Drug Policy. 2002;13(2):85–94. Rhodes et al., 2003. 116.Rhodes T, Mikhailova L, Sarang A, Lowndes CM, Rylkov A, Khutorskoy M, et al. Situational factors influencing drug injecting, risk reduction and syringe exchange in Togliatti City Russian Federation: A qualitative study of micro risk environment. Social Science and Medicine. 2003;57(1):39–54. MEDLINE |
CrossRef
Ross, 2002. 117.Ross T. Using and dealing in Calle 19: A high risk street community in central Bogota. International Journal of Drug Policy. 2002;13(1):45–56. Roy et al., 2003. 118.Roy E, Haley N, Leclerc P, Cedras L, Blais L, Boivin JF. Drug injection among street youths in Montreal: Predictors of initiation. Journal of Urban Health. 2003;80(1):92–105. MEDLINE |
CrossRef
Ruttenber et al., 1997. 119.Ruttenber AJ, Lawler-Heavner J, Yin M, Wetli CV, Hearn WL, Mash DC. Fatal excited delirium following cocaine use: Epidemiologic findings provide new evidence for mechanisms of cocaine toxicity. Journal of Forensic Sciences. 1997;42(1):25–31. MEDLINE Rydell et al., 1996. 120.Rydell CP, Caulkins JP, Everingham SE. Enforcement or treatment? Modeling the relative efficacy of alternatives for controlling cocaine. Operations Research. 1996;44(5):687–695.
CrossRef
Schneider, 1998. 121.Schneider CL. Racism drug policy and AIDS. Political Science Quarterly. 1998;113(3):427–446. Seal et al., 2003. 122.Seal KH, Downing M, Kral AH, Singleton-Banks S, Hammond JP, Lorvick J, et al. Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: A survey of street-recruited injectors in the San Francisco Bay Area. Journal of Urban Health. 2003;80(2):291–301. MEDLINE |
CrossRef
Sergeev et al., 2003. 123.Sergeev B, Karpets A, Sarang A, Tikhonov M. Prevalence and circumstances of opiate overdose among injection drug users in the Russian Federation. Journal of Urban Health. 2003;80(2):212–219. MEDLINE |
CrossRef
Sherman and Rogan, 1995. 124.Sherman LW, Rogan DP. Deterrent effects on of police raids on crack houses: A randomized, controlled experiment. Justice Quarterly. 1995;12(4):755–781. Sherman and Wiesburd, 1995. 125.Sherman LW, Wiesburd D. General deterrent effects of police patrol in crime “hot spots”: A randomized, controlled trial. Justice Quarterly. 1995;12(4):625–648. Small et al., in press. 126.Small, W., Kerr, T., Charette, J., Wood, E., Schechter, M. T., & Spittal, P. M. (in press). Impact of intensified police activity upon injection drug users in Vancouver's Downtown Eastside: Evidence from an ethnographic investigation. International Journal of Drug Policy. Smith et al., 2000. 127.Smith BW, Novak KJ, Frank J, Travis LF. Multijurisdictional drug task forces: An analysis of impacts. Journal of Criminal Justice. 2000;28(6):543–556. Smith, 2001. 128.Smith MR. Police-led crackdowns and clean-ups: An evaluation of a crime control initiative in Richmond Virginia. Crime & Delinquency. 2001;47(1):60–83. Sterk and Elifson, 2000. 129.Sterk CE, Elifson KW. Fluctuating drug markets and HIV risk taking: Female drug users and their relationship with drug markets. Medical Anthropology. 2000;18(4):439–455. Taussig et al., 2000. 130.Taussig JA, Weinstein B, Burris S, Jones TS. Syringe laws and pharmacy regulations are structural constraints on HIV prevention in the US. AIDS. 2000;14(Suppl. 1):47–51. Taylor and Brownstein, 2003. 131.Taylor B, Brownstein HH. Toward the operationalization of drug markets stability: An illustration using arrestee data from crack cocaine markets in four urban communities. Journal of Drug Issues. 2003;33(1):173–198. Weatherburn and Lind, 1997. 132.Weatherburn D, Lind B. The impact of law enforcement activity on a heroin market. Addiction. 1997;92(5):. Weinstein et al., 1998. 133.Weinstein B, Toce P, Katz D, Ryan LL. Peer education of pharmacists and supplying pharmacies with IDU packets to increase injection drug users’ access to sterile syringes in Connecticut. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1998;18(Suppl. 1):S146–S147. Weisburd and Green, 1995. 134.Weisburd D, Green L. Policing drug hot spots: The Jersey City drug market analysis experiment. Justice Quarterly. 1995;12:711–735. Welti and FIshbain, 1985. 135.Welti CV, FIshbain DA. Cocaine-induced psychosis and sudden death in recreational cocaine users. Journal of Forensic Science. 1985;30(3):873–880. Wenger and Rosenbaum, 1994. 136.Wenger LD, Rosenbaum M. Drug treatment on demand—Not. Journal of Psychoactive Drugs. 1994;26(1):1–11. MEDLINE Wetli et al., 1997. 137.Wetli CV, Rao A, Rao VJ. Fatal heroin body packing. American Journal of Forensic Medicine and Pathology. 1997;18(3):312–318. MEDLINE |
CrossRef
Williams, 1990. 138.Williams H. Drug control strategies of United States law enforcement. Bulletin on Narcotics. 1990;42:27–39. Wodak, 2001. 139.Wodak A. Drug laws war on drugs does more harm than good. British Medical Journal. 2001;323(7317):866. Wood et al., 2003a. 140.Wood E, Kerr T, Small W, Jones J, Schechter MT, Tyndall MW. The impact of police presence on access to needle exchange programs. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 2003;34(1):116–118. Wood et al., 2003b. 141.Wood E, Kerr T, Spittal PM, Tyndall MW, O'Shaughnessy MV, Schechter MT. The healthcare and fiscal costs of the illicit drug use epidemic: The impact of conventional drug control strategies and the impact of a comprehensive approach. British Columbia Medical Journal. 2003;45(3):130–136. Wood et al., 2004a. 142.Wood E, Kerr T, Small W, Li K, Marsh D, Montaner JS, et al. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal. 2004;171:731–734. MEDLINE |
CrossRef
Wood et al., 2004b. 143.Wood E, Spittal PM, Small W, Kerr T, Li K, Hogg RS, et al. Displacement of Canada's largest public illicit drug market in response to a police crackdown. Canadian Medical Association Journal. 2004;170(10):1551–1556. MEDLINE |
CrossRef
Wood et al., 2003c. 144.Wood E, Tyndall MW, Spittal PM, Li K, Anis AH, Hogg RS, et al. Impact of supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: Investigation of a massive heroin seizure. Canadian Medical Association Journal. 2003;168(2):165–169. MEDLINE Wood et al., 2003d. 145.Wood RA, Zettel P, Stewart W. Harm reduction nursing practice: The Dr Peter Centre Centre supervised injection project. Canadian Nurse. 2003;99(5):20–24. MEDLINE Worden et al., 1994. 146.Worden RE, Bynum TS, Frank J. Police crackdowns on drug abuse and trafficking. In: MacKenzie DL, Uchida CD editor. Drugs and crime. Sage: Thousand Oaks; 1994;. Zakrison et al., 2004. 147.Zakrison TL, Hamel PA, Hwang SW. Homeless people's trust and interactions with police and paramedics. Journal of Urban Health. 2004;81(4):596–605. MEDLINE |
CrossRef
Zhao et al., 2001. 148.Zhao J, Lovrich NP, Robinson TH. Community policing—Is it changing the basic functions of policing? Findings from a longitudinal study of 200+ municipal police agencies. Journal of Criminal Justice. 2001;29:365–377. Zimmer, 1990. 149.Zimmer L. Proactive policing against street-level drug trafficking. American Journal of Police. 1990;9(1):43–74. Zolopa et al., 1994. 150.Zolopa AR, Hahn JA, Gorter R, Miranda J, Wlodarczyk D, Peterson J, et al. HIV and tuberculosis infection in San Francisco's homeless adults. Prevalence and risk factors in a representative sample. Journal of the American Medical Association. 1994;272(6):455–461. MEDLINE Zule, 1992. 151.Zule WA. Risk and reciprocity: HIV and the injection drug user. Journal of Psychoactive Drugs. 1992;24(3):243–249. MEDLINE a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Burrard Street, Vancouver, BC, Canada V6Z 1Y6 b Canadian HIV/AIDS Legal Network, Canada c Department of Medicine, University of British Columbia, Canada  Corresponding author. Tel.: +1 604 806 9116; fax: +1 604 806 9044.
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