Jennifer Carroll first learned about harm reduction programs when she was a volunteer at a youth shelter in Portland, Oregon, 18 years ago. Among other services, the Outside In shelter operated a safe needle and syringe exchange for teens who used illegal drugs.
“It became an opportunity for me to reflect on and think about some of the preconceived biases that I had held as a young person about drugs, about people who use them,” Carroll said.
Today Carroll is a medical anthropology professor at North Carolina State University who studies drug policy, including harm reduction programs. These are community-run programs designed to improve the health and safety of people who use drugs including referrals to treatment and health care.
“The ultimate goal guiding any harm reduction effort is to have everyone come home at the end of the day,” Carroll said. “That means not overdosing. That means surviving an overdose if one does accidentally occur.”
A new study by Carroll and PhD student Brandon Morrissey suggests interactions between North Carolina law enforcement agencies and people who use syringe service programs may be inhibiting the work of harm reduction programs. The study surveyed more than 400 participants who use the services of the North Carolina Harm Reduction Coalition in seven counties.
“The purpose of the study was primarily to do a needs assessment and understand the experiences of people using syringe service programs across the state of North Carolina,” Carroll said.
In 2016, North Carolina legalized service programs that allow people to exchange used needles and syringes and receive testing for infectious diseases. The General Assembly has passed several laws in response to the opioid epidemic that seek to provide safe access to syringes and reduce fatal overdoses.
But more than half of survey respondents said they have had a negative experience with law enforcement related to their use of syringe service programs in the prior year -- including arrest for having legally obtained supplies.
“I think it's very fair to say that these actions are not in the spirit of the law,” Carroll said.
The law allows people to legally carry supplies they get from syringe service programs and not face charges if they show documentation to a law enforcement officer. Survey respondents and interview participants reported that was often not their experience.
“Negative experiences included officers not being aware of the law, refus[al] to accept whatever documentation was given, confiscation of supplies, arrest for having the supplies,” Morrissey said.
A person who is arrested in error while carrying legal supplies would likely have their charges dropped, Carroll says.
“But that still means for them possibly several days in jail. That means being separated from children, separated from home, unable to pay rent, unable to go to work,” Carroll said.
The study found variation in law enforcement practices across counties, and Black participants were more likely to have an officer doubt their documentation. The law does not define the type of documentation needed, and in practice, it is often a business card from a harm reduction program that identifies the person receiving services.
“The fact that law enforcement officers are feeling uncomfortable with the documentation presented to them a significant amount of the time tells us that we need a bit of clarity, we need a bit of training,” Carroll said.
The paper calls for more training and guidance for law enforcement officers on the application of the North Carolina law.
Carroll says the law could also be made more clear or include broader legal protections for people who call 911 in the case of an overdose. North Carolina’s law protects a person experiencing an overdose and the person who made the emergency call from receiving certain drug charges, but does not extend that protection to others on the scene.
A law recently passed in Maine provides blanket immunity to all people assisting someone experiencing an overdose and carves out specific violent crimes to which the law does not extend protection.
