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Expanding Understanding of Enforcement’s Role in Harm Reduction

Expanding Understanding of Enforcement’s Role in Harm Reduction. Jonathan Caulkins Carnegie Mellon University Qatar Campus and Heinz College RAND, Drug Policy Research Center Peter Reuter University of Maryland RAND, Drug Policy Research Center.

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Expanding Understanding of Enforcement’s Role in Harm Reduction

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  1. Expanding Understanding of Enforcement’s Role in Harm Reduction Jonathan Caulkins Carnegie Mellon University Qatar Campus and Heinz College RAND, Drug Policy Research Center Peter Reuter University of Maryland RAND, Drug Policy Research Center

  2. What Do You Associate With the Phrase “Harm Reduction”? • Public health • Protect users • Syringe exchange • Controlling HIV/AIDS • Supervised injection

  3. What Will You Associate With the Phrase “Harm Reduction”? • Public health • Protect users • Syringe exchange dddd • Controlling HIV/AIDS • Supervised injection • Police • Protect non-users • Driving flagrant markets underground • Controlling crime & violence • Specific deterrence

  4. What Is “Harm Reduction”?Classic Definition • Total Harm = Total Use * Harm/Unit Use • Use reduction tries to reduce Total Harm by reducing 1st term • HR tries to reduce Total Harm by reducing 2nd term

  5. What Is “Total Harm”?Extension Total Harm = Total Use * Harm/Unit Use + Production * Harm/Unit Produced + Distribution * Harm/Unit Distributed + Drug Control * Harm/Unit of Control

  6. What Is Harmfulness?Elaborate Extension Harmfulness = Harmfulness to users + Harmfulness to users’ intimates + Harmfulness to users’ neighbors + Harmfulness to general public

  7. Law Enforcement Can Reduce Total Harm by Reducing: • Total use • Traditional focus of drug enforcement (in US) • Harm to users • Traditional goal of public health harm reduction • Harm users impose on others • Harm caused by markets & distribution

  8. Ways Users Harm Others • Total use • Traditional focus of drug enforcement (in US) • Harm to users • Traditional goal of public health harm reduction • Harm users impose on others • Crime (Economic-compulsive) • Intoxication (& Psychopharmacological crime) • Families • Harm caused by markets & distribution

  9. Ways Markets & Distribution Harm • Total use • Traditional focus of drug enforcement (in US) • Harm to users • Traditional goal of public health harm reduction • Harm users impose on others • Harm caused by markets & distribution • Violence by dealers • Disorder of public/flagrant markets • Other: corruption, terror, environmental damage, having political power, etc.

  10. Major Sources of Harm in the US • Total use • Traditional focus of drug enforcement (in US) • Harm to users • Traditional goal of public health harm reduction • Harm users impose on others • Harm caused by markets & distribution • Violence by dealers • Disorder of public/flagrant markets • Other: corruption, terror, environmental damage, having political power, etc.

  11. Targeting Violent Dealers & Flagrant Markets • Closing public markets • Traditional crackdowns • Deterrence: Reuben Greenberg, Link Valley, etc. • Specific deterrence • Boston gun project, Highpoint • Police targeting individuals • Community-generated “Most Wanted” list • Targeting behaviors • Usually via enhanced sentences • Could be via policing prioritization

  12. Enhanced Sanctions: Classic Examples That Fail • Quantity possessed • Long sentences for couriers & mules • Crack vs. powder cocaine • Crack is made out of powder cocaine, • Drug free school zones • Not specific enough; cover most of city • (Could augment with time of day)

  13. Enhanced Sanctions: More Promising Ideas • Currently exist • Firearm enhancements • Arguably this works; many dealers do not carry their guns • Worth considering (?) • Corrupting an official • Adult selling to a minor • Being part of a drug selling organization • Employing someone who carries a gun • Key: Lower baseline sanction severity

  14. Issue of Measures:Two Ironclad Rules • “You can’t manage what you can’t measure.” • Peter Drucker (?) • “Anything can be measured in a way that is superior to not measuring it at all.” • Gilb’s Law

  15. Tentative Suggestions of Measures to Prompt Discussion • # of homicides or aggravated assaults in area • Flagrant drug markets • There exists a research protocol for this directly, and indirectly via search time measures • Surveys of residents • # of people arrested from Most Wanted list • # of ED trauma cases for people on heroin registry

  16. Conclusions • Harm reduction isn’t just for public health • Law enforcement has a key role too • Harm reduction isn’t just about drug users • Family and markets matter too • Law enforcement for harm reduction is a vision, not a specific program • Same true of classic harm reduction • Translating vision into reality will be done by practitioners • Same true of classic harm reduction

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