Ontario Harm Reduction Conference April 30 to May 2, 2017 Toronto, Ontario

Transcription

1 Ontario Harm Reduction Conference April 30 to May 2, 2017 Toronto, Ontario Views expressed in the attached document do not necessarily represent those of the Ministry of Health and Long Term Care or those of Kingston Community Health Centres. If you have any questions related to the document, you are encouraged to contact the source.

2 Fostering cooperation between police and supervised injection services: development of a training program for local police Carol Strike, PhD (U of T) Tara Marie Watson, PhD (CAMH)

3 OVERVIEW Part 1: Information to inform training program development Problematic policing behaviours for SIS Relationships between NSPs and police NSP training of police evidence Police attitudes towards SIS Best practices (BPs) for SIS and police Part 2: Attendee experience with police Part 3: Existing harm reduction (HR) training for police: overview Part 4: Mini-consultation Resource handout

4 PROBLEMATIC POLICING BEHAVIOURS FOR HR PROGRAMS, INCLUDING SIS Intensive policing (aka crackdowns) Fear of arrest Rushed injections Injecting in less safe spaces Swallowing drugs Improper disposal risk of infection, vein damage, overdose access to services

5 PROBLEMATIC POLICING BEHAVIOURS FOR HR PROGRAMS, INCLUDING SIS Displacement of sex workers Increased risk of harm for sex workers Injury, rape, death, robbery

6 PROBLEMATIC POLICING BEHAVIOURS FOR HR PROGRAMS, INCLUDING SIS Surveillance of NSPs fixed and mobile services Hassle, aggravation for HR staff/managers Discourage client use of HR services Damages/perpetuates distrust between NSP and police Reduced program effectiveness

7 SIS POLICY AND TRAINING FOR POLICE BUILD ON CANADIAN BPs FOR HR PROGRAMS (NSPs): RELATIONSHIPS WITH LAW ENFORCEMENT Include law enforcement agents as one of the stakeholder groups to be engaged and informed when developing harm reduction programs Establish and sustain methods for ongoing communication between harm reduction programs and local law enforcement agencies Establish a conflict resolution protocol to address concerns that may arise between harm reduction programs and law enforcement. Adverse client-police encounters should be documented and brought to the attention of law enforcement authorities. Law enforcement includes : police, drug law enforcement, public security, military, prisons, other correctional, other uniformed services

8 SIS POLICY AND TRAINING FOR POLICE BUILD ON CANADIAN BPs FOR HR PROGRAMS (NSPs): RELATIONSHIPS WITH LAW ENFORCEMENT Provide in-service training to law enforcement agents focusing on: The purpose and goals of harm reduction programs Evidence-based approaches to NSP effectiveness, especially with regard to any impacts on community safety and public order Needle-stick injury prevention and the basics of HIV, HCV, and other pathogen transmission The health and social concerns of people who use drugs Evidence concerning the impacts of needle/syringe and other injecting equipment (e.g., cookers, filters) distribution for people who inject drugs Evidence concerning the impacts of safer smoking equipment distribution for people who smoke crack cocaine

9 SIS POLICY AND TRAINING FOR POLICE BUILD ON CANADIAN BPs FOR HR PROGRAMS (NSPs): RELATIONSHIPS WITH LAW ENFORCEMENT Develop agreements with law enforcement to ensure that: Clients can enter and exit from HR program fixed sites or vehicles without police interference Safer injection, safer smoking equipment, and overdose prevention kits (e.g., naloxone) distributed by programs are not destroyed or confiscated from clients by police Fixed, mobile, and other sites (e.g., pharmacies) are not used for police surveillance purposes

10 RELATIONSHIPS WITH POLICE CHANGE: ONTARIO 2006 BP FOR NSPs EVALUATION 2008 Survey of Ontario BPs for NSPs (unpublished data) 40.0% reported positive/mostly positive relationship with police 62.5% had a working relationship with police 40.6% offered training to police about the NSP 34.5% agreement in place to discourage confiscation of equipment 46.7% agreement that police would not use NSP for surveillance 9.4% agreement to resolve conflicts

11 RELATIONSHIPS WITH POLICE CHANGE: CANADIAN NSPs Online survey: NSP managers across Canada, including content about NSP-police relationships and training Response rate 89% (n=75) Positive/mostly positive relationship with police 69% Types of in-service training provided to police Purpose and goals of NSPs 46% Prevention of needle-stick injuries Health and social concerns of people who use drugs Effectiveness of distribution of injection equipment Impact of distribution of safer crack smoking equipment 38% 42% 45% 35% 0% 10% 20% 30% 40% 50% 60% 70% 80% Strike C, Watson TM. Relationships between needle and syringe programs and police: an exploratory analysis of the potential role of inservice training. Drug and Alcohol Dependence. 2017, 175(1):

12 RELATIONSHIPS WITH POLICE: CANADIAN NSPs Factors associated with positive NSP-police relationships Unadjusted OR 95% Confidence Interval Training about NSP program goals Training about needle stick injury prevention Training about health and social concerns of people who inject drugs Training about evidence about the impact of needle distribution for people who inject drugs Factors not associated: (i.e., program size, program age, parent organization, region, past-year needle distribution volumes, and distribution of safer crack cocaine smoking equipment) <50% had negotiated any agreements to prevent police from interfering with clients as they enter and exit NSP sites, confiscating or destroying safer drug use and/or overdose prevention equipment, and conducting surveillance of NSP fixed or mobile sites. 75% did not have any protocols to resolve conflicts between NSP staff and police. Strike C, Watson TM. Relationships between needle and syringe programs and police: an exploratory analysis of the potential role of inservice training. Drug and Alcohol Dependence. 2017, 175(1):

13 POLICE ATTITUDES: SUPERVISED CONSUMPTION TOSCA Study (2010): interviews (n=4) and focus groups (n=2) police Police perceptions of supervised consumption Ineffective response to problems associated with illicit drug use Will not reduce disease transmission Do not address addiction Send ambiguous messages regarding the acceptability of illicit drug use Interfere with law enforcement efforts Exacerbate crime and have destructive, long-lasting effects on local businesses and residents. Preferred responses Treatment and rehabilitation, consistent anti-drug messaging Law enforcement to keep communities safe. Need harm reduction for the community (minimize impact of drug use on other citizens) Some police perceived benefits of NSPs, MMT and outreach Toronto Chief of Police is supportive of SIS and training project Watson TM, Bayoumi A, Kolla G, Penn R, Fischer B, Luce J, Strike C. Police perceptions of supervised consumption sites (SCSs): a qualitative study. Substance Use and Misuse. 2012;47(4):364-74[SRA]

14 POLICING AND SIS CHANGES IN VANCOUVER Evaluated 2006 Vancouver Police Department policy change to support the department on sharing of drug use equipment Data from two cohort studies After policy change, observed decline Confiscation of HR supplies Physical violence by the police However, both independently associated with elevated HIV risk sharing of drug use equipment - after the post-policy change Landsberg A, Kerr T, Milloy MJ, Dong H, Nguyen P, Wood E, Hayashi K. Declining trends in exposures to harmful policing among people who inject drugs in Vancouver, Canada. J Int AIDS Soc Jul 18;19(4 Suppl 3): doi: /IAS

15 SUMMARY Policing behaviours around NSPs may be problematic for SIS BPs for NSP related to policing can be modified for SIS Relationships between police and NSPs in Ontario improved Training police about NSP improved relationship May transfer to SIS Police attitudes about SIS negative but are changeable This may change after opening as shown in Vancouver Toronto Chief of Police is now supportive of SIS

16 SIS TRAINING FOR POLICE: PROJECT Team Strike, Watson, Hopkins, Altenberg, Robertson, Dicenso, Wright, police (?) 1. Conduct brief, telephone consultations with managers of operational SIS (including Canadian, European, and Australian sites) and their police liaisons 2. Host focus group discussions with police officers, SIS sites potential clients, potential workers (NSP workers) 3. Synthesize literature and consultation information into evidence briefs and use this information to prepare a draft SIS training program for police 4. Apply for funding to pilot test and do an evaluation of the training program 5. Widely disseminate the knowledge and training products from this project using presentations, webinars, and manuscripts

17 ATTENDEE EXPERIENCE Positive experiences/policies/practices with police and HR program - helpful for others Negative experiences with police and HR program address in future BPs

18 TRAINING CONTENT Basic information about HIV, HBV, HCV, and STI epidemiology, transmission, and prevention Overview of psychoactive drug use, effects of different drugs, and common drug-related harms also, the health and social concerns of people who use drugs

19 TRAINING CONTENT (CONTINUED) Public health rationale and goals of HR programs such as NSPs, SIS, safer crack cocaine smoking equipment distribution, and opioid substitution treatment (OST), including an overview of principles and evidence of program effectiveness and cost-effectiveness Laws relevant to NSPs and SIS e.g., authorizing carrying injection equipment, exemptions from drug laws

20 TRAINING CONTENT (CONTINUED) Basic design and geographic scope of HR programs, include contact information for local NSPs, SIS, etc. Relevant occupational health and safety procedures such as handling and disposing of used syringes and other injection equipment, safer and respectful search procedures, communication about needle-stick injury prevention, prophylaxis strategies in the event of an injury, and other infection control procedures

21 TRAINING CONTENT (CONTINUED) Overdose prevention and response an increasingly broad area that should include specific content on rates of opioid use and overdose, the risk factors for overdose, recognition of and response to overdose (including policies/protocols about when to attend or not attend a 911 call about an overdose), and naloxone delivery

22 TRAINING CONTENT (CONTINUED) Increasing cultural knowledge and awareness of drug enforcement impacts on racialized communities - include discussion of marginalized and vulnerable populations (e.g., Indigenous, Black communities, LGBTQ, women, sex workers) and intersections stigma and discrimination, and applicable examples of positive and negative encounters between police and harm reduction program clients

23 TRAINING CONTENT (CONTINUED) SIS specific training! Important messaging for police should include: do not deter people from using SIS do not target people who use drugs nor enforce drug laws right outside SIS no stopping and searching and/or seizing drugs or drug use equipment from people before they enter or while exiting SIS no uniformed police inside (except in an emergency involving public safety) no charging people with drug possession or use inside SIS

24 TRAINING CONTENT (CONTINUED)

25 TARGET AUDIENCE The UNODC training manual defines law enforcement officials as all uniform personnel who in the course of their duty may interact with [people who use drugs] and other key populations includes incoming police cadets up to senior police administrative officials Wide-reaching education and training may seem desirable, but entail more logistical barriers such as time and resources Training often delivered to active-duty police officers

26 FACILITATORS Who is going to deliver training and perceived credibility of the facilitators; existing partnerships are beneficial Train the trainer models are often used Harm reduction program staff Public health researchers/study teams Trained police staff People who use drugs

27 LOCATION Not a lot of detail in the literature on training location, but options include police academy/college, workplace/in-station training, online training, and harm reduction program sites more work needs to be done to determine optimal training locations

28 DURATION Multi-hour/multi-day courses not as common as shorter trainings or educational interventions (e.g., 30- to 60-minute presentations) Separate training opportunities or integrated/bundled with existing training for police can also integrate modules over time But what is most effective for learning and retention? (same question applies to format)

29 METHODS Accessible, modifiable and adaptable Commonly used formats include: PowerPoint presentations Videos Brochures and handouts Wallet- or pocket-sized cards Toolkits and hands-on practice Built-in evaluation components

30 MINI CONSULTATION: PURPOSE AND ETHICS The goal of our project is to develop a training program for Toronto Police Officers The Project Team includes researchers, managers of the planned SIS, and representatives from the community and Toronto Police Services Consultation will last up to 30 minutes Ask four questions about the types of training needed by police and SIS workers to ensure appropriate and productive interactions No direct benefits or direct harms for you No one who participates will be identified You do not have to answer any question that you do not feel like You can stop participating at any time We ask that you do not repeat what others have said we hope but cannot promise that they will do so Session will be audio-recorded

31 MINI CONSULTATION: PURPOSE AND ETHICS Review the consent form If you don t want to participate Thanks so much for coming We hope you enjoy the remainder of your day

32 CONSULTATION QUESTION 1 What topics do you think police officers need training about to work effectively with SIS and their clients? What are the most important to ensure successful training for police about SIS? Why?

33 CONSULTATION QUESTION 2 What barriers might there be to delivery of training to police about SIS?

34 CONSULTATION QUESTION 3 What rules do you think should be in place to guide how the SIS is policed? Which are the most important?

35 CONSULTATION QUESTION 4 What types of training do you think SIS workers need to work effectively with police?

36 RESOURCES - HANDOUTS Thank you very much!