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Effective Interventions Unit: Reducing the impact of local drug markets: A research review

Chapter 5 Harm Reduction

This chapter examines the evidence on approaches which incorporate harm reduction principles into policing practice. The focus of such approaches is the reduction of harm to drug users and / or to the community in which low-level drug markets operate. This focus does not involve abandoning police enforcement activities, and indeed the reduction of supply and demand may be seen as contributing to an overarching harm reduction strategy.

It is argued that the adoption of a harm reduction approach requires a re-appraisal of the rationale underpinning the policing of drugs. This may include recognition of the following principles:

• Strict law enforcement may sometimes increase drug-related harm and is therefore not always appropriate.

• Law enforcement may therefore not automatically / necessarily be the primary aim of police interventions. ⁴¹

• The criteria for success of police interventions need to be examined closely and not simply assumed. While reductions in levels of recorded crimes are the commonly used criteria, there are others, and levels of drug-related harms may also be included when measuring 'success'.. The production of counterproductive effects may as a result be included. ⁴²

The chapter begins by reviewing the evidence from international studies on how police enforcement approaches may impact on the risk of harm to drug users health and to the wider community. It then considers some ways in which harm reduction principles may be incorporated into policing practice.

The impact of policing upon drug-related harms

Research has identified potential harms to public health, community safety and police-community relations which may arise from specific approaches to control or reduce drug dealing and / or use. The majority of this research has concentrated on the impact upon public health, particularly the health concerns of drug users.

Studies of the effects of a recent heroin 'drought' in Australia indicate that while supply-side enforcement has a role in harm reduction, it is also important for enforcement agencies to be mindful of the unintended adverse consequences that might flow from successfully disrupting a drug market ⁴³.

As heroin availability decreased, research found that the price of heroin increased, while purity, consumption and expenditure on the drug decreased. There were positive public health benefits to this development: namely, that the rate of drug overdoses fell. However, this may have been offset by an increase in the use of other drugs (mainly cocaine) ⁴⁴.

A study of the impact of street-level law enforcement in Sydney identified a number of increased health risks resulting from police crackdowns. One example stemmed from intensified police pressure which led to a change in the ways dealers and users chose to carry drugs. A shift towards oral and nasal storage and transfer of heroin between dealers and users resulted in increased risk of infections and blood-borne viruses, and risk of overdose in cases when orally stored heroin was swallowed to avoid detection.

Another reported consequence was the increased reluctance of users to carry injecting equipment for fear of detection. This was caused by a policing practice in the area which targeted drug users for stop and search. If found, users' injecting equipment was removed (although possession of injecting equipment is not an offence in New South Wales). This, in turn, led to riskier injection practices among users such as sharing and re-using needles. The greater urgency in which users found themselves injecting also appeared to lead to other health risks such as hurried (therefore more dangerous) injecting, including damage to veins, and higher risk of overdose due to not 'tasting' the heroin before using it all. Finally, the displacement of the street market from public areas to private and semi-private areas, it was argued, spread the problem over a wider geographical area and exposed a greater number of people to the various harms to the community caused by the presence of drug dealing ⁴⁵.

A qualitative study of drug markets in Rotterdam examined the effect of a 'more repressive' enforcement operation upon residential drug dealing practices ⁴⁶. Dealers raised the minimum unit of sale of heroin and cocaine to reduce the number of customers and the number of transactions. They no longer allowed buyers to use drugs on the premises, or limited the time that drug buyers were permitted to stay at the address to consume drugs. There was also a shift from selling cocaine hydrochloride to ready-to-smoke cocaine base, again to reduce the length of time buyers spent at the dealing address. The study concluded that:

"increased police repression of a local drug market is followed by a reorganisation of drug dealing practices that is aimed at the 'self protection' of the dealers and that might be at the expense of drug users' interests" ⁴⁷.

These problems were identified as resulting from 'zero tolerance' policing practices in evidence in the particular area. They also inevitably reflect particular local circumstances and practices. While it is not necessarily the case that the findings from these studies will be directly transferable to the situation in Scotland, some of the themes and mechanisms identified from international research are very likely to have validity in other settings.

A recent study in England and Wales by the Police Complaints Authority (PCA) examined the frequency and circumstances of drug-related deaths in police custody or care to identify risk factors and recommendations for minimising risk in the future. There was clear evidence that drugs ingested for the purpose of concealment caused 17 of the 43 drug-deaths in the study. Two of the cases were thought to be 'body packers': people who had systematically prepared drugs for concealment. The research concluded that the remaining 15 cases of concealed drugs were likely to have occurred as a response to actual or anticipated contact with the police ⁴⁸.

Twenty-six of the 31 forces in England and Wales contacted by researchers did not have a policy on how to deal with suspects who swallowed drug packages ⁴⁹. The study highlighted a need for clear policies on drug swallowing and associated training for custody officers and staff. In particular they emphasise the need to treat suspected package swallowing as a medical emergency that requires urgent hospitalisation ⁵⁰.

Incorporating harm reduction principles into policing practice

This section examines studies of police interventions that have attempted to develop enforcement approaches to drug markets that incorporate harm reduction considerations.

Studies in Australia suggest this may be achieved through the implementation of diversionary schemes and 'hands off' policies in relation to needle exchanges (i.e. not targeting clients in the vicinity of needle exchanges) and other selected areas. Partnerships at the local level could provide a formal mechanism for health and user groups to inform police of the wider impacts of enforcement activities, such as when these appear to be inducing or exacerbating drug-related harms.

An evaluated programme of interventions adopting this approach is Operation Mantle, a problem-oriented policing operation in Adelaide. It involved specific changes to policing practice and a general increase in multi-agency working to facilitate an integrated approach to drug reduction and harm minimisation ⁵¹. The specific changes included policies preserving needle exchanges as non-targeted locations and limiting police attendance at overdose incidents to exceptional circumstances (as fear of arrest may deter companions of the drug user from seeking medical help) ⁵². The operation succeeded in halting a previously escalating crime rate.

Enforcement agencies may not possess the information necessary to allow them to take account of any possible counterproductive effects of their interventions. Further work in Australia on routine police practice found that the police did not systematically collect and monitor local level data on drug related harms. As a result, they were unable to make well informed judgements about the possible impact of their activities on drug related harms. This research informed a programme of work which aimed to reform policing practice, partly to facilitate information sharing which would make police aware of any counterproductive effects that may result from enforcement activity ⁵³.

Reducing 'social' harm to the community

There is little research evidence that examines the harmful impact of low-level drug markets on local communities nor much that evaluates whether and how interventions reduce such 'social' harm.

Research conducted in Rotterdam explored the feasibility of modifying retail drug dealing. This project brought together representatives from different parties affected by the undesired side-effects of drug dealing under prohibition in order to discuss the potential ways in which drug dealing could contribute to - as formulated by participants in the discussion - "the general well-being of both drug-using and non-drug-using citizens" ⁵⁴. This helped to identify ways in which drug dealing could be organised to reduce nuisance to the community. In other words, this project aimed to transform the drug market rather than aiming to eradicate it, to ensure its operation minimised any negative impact on the community.

Other researchers have noted that the driving force behind changes to a local drug market may come from within the community. Communities are not powerless and drivers for change may come from within the community, rather than outside. For example, the role of changing community dynamics was observed in ethnographic research in New York's inner-city neighbourhoods, which examined the role of communities in regulating their local drug markets and reducing levels of violent drug related crime ⁵⁵. Further work may be needed to examine the role the community might play in modifying drug markets, including the ways in which communities can be empowered to do so.

Chapter 2 noted that evaluations of interventions have used a variety of definitions of 'effectiveness' with a range of different outcome measures. Not all have included community perceptions and experiences as a measure, so there are no straightforward answers to the question of 'what works' in improving the quality of life for a community experiencing high levels of drug dealing.

There has been disagreement between researchers about whether the displacement of a market may in itself constitute 'success'. Some of the studies evaluated by Mason and Bucke have shown that open street markets may move indoors as a reaction to intensified enforcement efforts. This may mean that the market itself becomes less socially damaging, for example by becoming less public ⁵⁶.

There are a number of other ways in which interventions may impact positively on a community. The reduction and / or disruption of drug dealing specifically, and the reduction of crime rates more generally, may be a positive outcome for a community. However reductions in crime do not straightforwardly increase a community's quality of life, and may not be reflected in a community's perceptions ⁵⁷.

It may be that the success of interventions need to be looked at in a broader way than simply expecting any changes of crime rates to directly impact on community perceptions. Rather, factors such as environmental improvements, qualitative research into community perceptions, and other measures which indicate the level of harm caused to a community (such as calls for service and needle finds) may be more helpful.

Finally, when examining the harms that drug dealing causes to a community, and the effects of policing drug dealing, drug users also need to be regarded as a part of the community. In measuring harm, information needs to be collected on the patterns of drug use emerging within markets, to expose any potential problems that may be developing.

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