ARRESTS AND INCARCERATION OF INJECTION-DRUG USERS FOR SYRINGE POSSESSION IN MASSACHUSETTS - IMPLICATIONS FOR HIV PREVENTION

Multiperson use of syringes is a major risk behavior responsible for t he spread of HIV-1 among injection drug users (IDUs). In Massachusetts , two laws regulate syringes: one is a prescription law prohibiting po ssession or purchase of syringes without a prescription, and the other makes it illegal to possess drug paraphernalia, including syringes. I n 1993, Massachusetts amended the prescription law to permit the estab lishment of syringe exchange programs in two cities. Enrolled particip ants are allowed to possess syringes anywhere in the state, and about 5% of the estimated 40,000 IDUs in Massachusetts are program participa nts. To understand how HIV prevention efforts with active IDUs may be constrained by the enforcement of laws criminalizing possession of syr inges after the amendment in the law, we reviewed data from multiple s ources to assess the number of arrests for syringe possession in 10 la rge cities in Massachusetts to evaluate incarceration rates and length s of sentences for those convicted of syringe possession and to estima te costs of incarceration for those convicted of syringe possession. A t least 824 persons were arrested for syringe possession in 1995. In e xamining the data on convictions, we found that 417 persons were convi cted in 1994 of syringe possession in the absence of other serious cha rges, and of these, 41.0% were sentenced to incarceration. The average sentence imposed was 5 months (range, 3 days-2 years). Assuming that those convicted serve about two thirds of their sentences, the cost of incarceration was estimated at $1,140,183 excluding costs for arrest, pretrial detention, prosecution, or other costs of enforcement. Costs for incarcerating persons convicted of both syringe and drug possessi on were not included; the total cost of incarceration of persons convi cted of possession of a syringe, with or without other major charges, is probably considerably higher. Had these funds been allocated to pay for drug treatment, 1629 admissions to drug detoxification programs c ould have been purchased. Retaining drug paraphernalia and syringe pre scription laws in Massachusetts may contribute to HIV transmission. Th ese findings support the recommendation of the American Medical Associ ation to modify drug paraphernalia laws so that IDUs can purchase and possess syringes without a prescription.