Decriminalization of Drug Paraphernalia: Reviewing Evidence of Syringe Services Programs and its Intersection with the Law

This mixed methods study evaluates a syringe access program in a mostly urban Southern Appalachian county where the Syringe Access Program (SAP) operated at multiple sites, including a public housing area and a local business. Data were collected from 2019 to 2021, including secondary program data and primary data, including informal interviews with 10 SAP participants, semi-structured interviews and focus groups with 3 SAP staff, and participant-observation at three outreach sites. The current review focuses on qualitative findings and omits program utilization results, based on the relevance of each to the bill and current research corner. 

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The study indicates that SAP served approximately 1900 participants during the study period. SAP staff reported that the majority of participants had a history of justice involvement, and the most common arrest was for possession of drug paraphernalia because local law enforcement often disregarded a limited immunity clause in the North Carolina syringe exchange law. This law provides immunity from arrest for possession of injection supplies, including used syringes, if the person presents a state-registered SSP participant card.  

 

One of the major study themes that resulted from qualitative analysis was that law enforcement presented barriers to overdose prevention. One participant reported that he called 911 after someone in his car overdosed, but was arrested for paraphernalia possession despite disclosing the syringes in his car and presenting a valid SAP participation card. The case was dropped after he went to court. However, this experience has made him avoid calling 911 in the event of an overdose. Another participant also reported that fear of arrest deterred them from using emergency services because “police come first [before EMS]”. One participant stated, “I would be more likely to call 911 [for an overdose] if I hadn’t been cuffed, searched, and charged after doing so.”  

 

Increased law enforcement presence near SAP outreach sites also deterred some participants from accessing harm reduction supplies and services. Participants reported that being stopped by law enforcement repeatedly made it harder to pick up overdose and infection prevention supplies from the SAP. SAP staff estimated that local law enforcement ignored SAP participants’ cards “about 40% of the time”, which should have provided legal immunity. 

 

Based on the findings, authors recommended increased training for law enforcement on relevant public health laws. They further recommended expanding legal immunity beyond syringes to include all harm reduction supplies including snorting or smoking equipment, which may have greater potential to reduce overdose deaths. Authors note that since non-injection supplies were more commonly used by non-White SAP participants, and these residents were disproportionately targeted by law enforcement, that expanding these protections would help increase service access and support improved health outcomes for diverse populations. Overall, authors findings were consistent with the broader literature on this topic – that punitive policies and enforcement around drug paraphernalia act as deterrents to care-seeking and harm reduction services, which in turn create barriers to vital disease and overdose prevention among people who use drugs.