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Trends in Crime and the Introduction of a Needle Exchange Program Stein, MA, Julie Hariton, MSW, and Sadye Bar- References Household Survey on Drug Abuse. Rockville, Md: tolomei, MSW; from the Rose F. Kennedy Children’s Substance Abuse and Mental Health Services Ad- Evaluation and Rehabilitation Center, University Af- 1. Juliana P, Goodman C. Children of substance ministration, Office of Applied Studies; 1998. filiated Program, Albert Einstein College of Medi- abusing parents. In: Lowinson JH, Ruiz P, Mill- 5. Fulroth R, Phillips B, Durand DJ. Perinatal out- cine, Herbert Cohen, MD, director, and Daniel Fried- man RB, Langrod JG, eds. Substance Abuse: A come of infants exposed to cocaine and/or heroin man, MPA, associate director for administration; from Comprehensive Textbook. 3rd ed. Baltimore, Md: in utero. Am J Dis Child. 1989;143:905–910. the Division of Substance Abuse, Department of Psy- Williams & Wilkins; 1997:665–671. 6. DeCristofaro JD, LaGamma EF. Prenatal expo- chiatry and Behavioral Sciences, Albert Einstein Col- 2. Black MM, Nair P, Kight C, Wachtel R, Roby P, sure to opiates. Ment Retard Dev Disabil Res Rev. lege of Medicine, Ira J. Marion, MA, executive di- Schuler M. Parenting and early development 1995;1:177–182. rector, Pat Sanders Romano, MS, deputy executive among children of drug-abusing women: effects 7. Chiriboga CA, Vibbert M, Malouf R, et al. Neu- director, Egidio Caparelli, director of business oper- of home intervention. Pediatrics. 1994;94:440–448. rological correlates of fetal cocaine exposure: ations, Patti Juliana, MSW, director of clinical serv- 3. Feig L. Drug Exposed Infants and Children: Ser- transient hypertonia of infancy and early child- ices, and Kathryn M. Williams, MSW, program man- vice Needs and Policy Questions. Washington, hood. Pediatrics. 1995;96:1070–1077. ager; and Emmanuel Shapira, MD, PhD (deceased), DC: Office of the Assistant Secretary for Plan- 8. Kliegman RM, Madura D, Kiwi R, Eisenberg I, and Karen Gore, chair in human genetics and direc- ning and Evaluation, US Dept of Health and Yamashita T. Relation of maternal cocaine use to tor, Human Genetics Program, Hayward Genetics Cen- Human Services; 1990:1–41. the risks of prematurity and low birth weight. J ter, Tulane University School of Medicine. 4. Preliminary Results From the 1997 National Pediatrics. 1994;124:751–756. Trends in Crime and the Introduction of a Needle Exchange Program ABSTRACT Melissa A. Marx, MPH, Byron Crape, MSPH, Ronald S. Brookmeyer, PhD, Benjamin Junge, MSc, Carl Latkin, PhD, David Vlahov, PhD, and Steffanie A. Strathdee, PhD Objectives. This study sought to de- termine whether introduction of a nee- Needle exchange programs have been im- 14 months of operation, 3438 active injectors dle exchange program would be associ- plemented to help reduce transmission of HIV enrolled in the program, of whom 86% were ated with increased crime rates. and other blood-borne pathogens among in- African American; participants’ average age Methods. Trends in arrests were jection drug users1–4 and to increase the fre- was 42 years. compared in program and nonprogram quency of drug abuse treatment referrals5 areas before and after introduction of a among addicted individuals. Studies have Data Collection needle exchange program in Baltimore. shown that needle exchange programs do not Trends were modeled and compared via increase rates of drug use6 or increase num- Arrest records for the period February Poisson regression. bers of discarded needles or syringes7; because 1994 through October 1995 were obtained Results. No significant differences drug use has been associated with crime,8,9 from the Baltimore City Police Department. in arrest trends emerged. Over the study however, there are concerns that crime rates This enabled comparison of data 6 months period, increases in category-specific ar- may increase in areas surrounding needle ex- before and 6 months after introduction of the rests in program and nonprogram areas, change programs after their introduction.10,11 needle exchange program. The immediate im- respectively, were as follows: drug pos- We examined trends in arrests in Baltimore pact of the program was assessed, and sea- session, 17.7% and 13.4%; economically City before and after the opening of a needle sonal variations in arrests were examined in motivated offenses, 0.0% and 20.7%; re- exchange program. a subsequent 8-month period. Dates and lo- sistance to police authority, 0.0% and 5.3%; and violent offenses, 7.2% and 8.0%. Methods Conclusions. The lack of associa- The authors are with the Johns Hopkins School of tion of overall and type-specific arrest Study Population Hygiene and Public Health, Baltimore, Md. Melissa data with program implementation ar- A. Marx, Byron Crape, Benjamin Junge, David Vla- gues against the role of needle exchange In 1997, Baltimore City had 657250 res- hov, and Steffanie A. Strathdee are with the Depart- ment of Epidemiology; Ronald S. Brookmeyer is programs in increasing crime rates. (Am idents; the average age of these residents was 12 with the Department of Biostatistics; and Carl Latkin J Public Health. 2000;90:1933–1936) 35 years, and 60% were African American. is with the Department of Health Policy and Man- Approximately 50000 Baltimore residents reg- agement. David Vlahov is also with the Center for ularly used illicit drugs at that time, a substan- Urban Epidemiological Studies, New York Academy tial proportion of whom injected.13 of Medicine, New York City. In August 1994, the Baltimore City Health Requests for reprints should be sent to Stef- fanie A. Strathdee, PhD, Johns Hopkins School of Department opened a needle exchange pro- Public Health, Department of Epidemiology, 615 N gram housed at 2 locations. Program partici- Wolfe St, Room E-6010, Baltimore, MD 21205 pants were exempt from syringe possession (e-mail: [email protected]). laws within city limits. During the first This brief was accepted April 3, 2000. December 2000, Vol. 90, No. 12 American Journal of Public Health 1933 cations of arrests and up to 5 criminal charges allowed to change in both areas. The hypothe- percentage change in overall arrests was higher were abstracted. ses tested were that changes in intercepts and in program (11.4%) than in nonprogram (7.6%) On the basis of input from law enforce- slopes would not significantly differ in pro- areas. However, there were no significant differ- ment, crime, and drug abuse experts, as well as gram and nonprogram areas before and after ences in arrest trends by category after program hypothesized associations of charges with nee- initiation of the needle exchange program and introduction relative to before program intro- dle exchange programs, arrest charges were that changes in arrest trends in program areas duction in program vs nonprogram areas (P>.05). categorized as follows: (1) drug possession, would be similar to changes in nonprogram (2) economically motivated offenses, (3) re- areas. We tested hypotheses using a likelihood sistance to police authority, or (4) violent of- ratio test with 2 degrees of freedom, account- Discussion fenses. Drug possession offenses included pos- ing for overdispersion.15 session of drug paraphernalia and distribution/ We found that increases in drug-related possession of heroin or cocaine. Economically arrests were not more pronounced in needle motivated offenses consisted of property theft Results exchange program areas than in other areas of (e.g., nonvehicular breaking and entering, bur- Baltimore after establishment of the program. glaries, vehicle break-in/theft) and prostitution, Overall, there were 53848 drug-related Although there were some differences in considered means of financing drug use. Re- arrests in Baltimore City during the study pe- category-specific arrest trends in areas of close sistance to police authority was defined as as- riod. Before introduction of the needle ex- proximity to the program relative to outlying saulting a police officer, resisting arrest, or vi- change program, there were 2500 drug-related areas, these differences were not statistically olating parole/probation; these offenses were arrests per month. After introduction of the significant. seen as indicators of increased frustration pos- program, there was a slight increase in the num- If the needle exchange program had di- sibly resulting from law enforcement practices. ber of drug-related arrests to 2775 per month. rectly influenced rates of drug use, a dispro- Violent offenses included homicide, assault, Wide fluctuations seen in monthly aver- portionate increase in drug possession arrests rape, and armed robbery, which were consid- ages of drug possession arrests citywide were would have been expected in program areas rel- ered potentially linked to drug trafficking. evidenced by high extradispersion values (co- ative to nonprogram areas.Although increases We defined the area of maximum pro- caine: 5.3; heroin: 9.8) in the Poisson model. in heroin and cocaine arrests after the program gram impact with data from an ongoing eval- Overall, the mean number of monthly arrests had been established were slightly more pro- uation of the program. We determined that 76% for drug possession rose slightly in program nounced in program than in nonprogram areas, of participants reported walking to the program areas, from 150 (range: 100–190) to 175 trends were not significantly different. Vari- site and that travel time for these individuals (range: 110–270). Average numbers increased ability in heroin and cocaine arrests reflected in averaged 15 minutes or less (median: 10 min- gradually in nonprogram areas, from 1020 the high model extradispersion values might be utes).14 At an estimated speed of 2.0 mi per (range: 825–1240) to 1160 (range: 925–1370) explained in part by “police sweeps,” which are hour (3.2 km per hour), 84% of participants per month. common and variable in Baltimore, especially were estimated to live within a 0.5-mi radius of Frequency of arrests for economically mo- in drug trafficking areas.Anecdotal reports in- the program site.
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