Linn Gjersing & Anne Line Bretteville-Jensen Rates and reasons for incarceration and the possible influence of drug policy liberalization among a cohort of street- and low threshold service recruited polysubstance users Linn Gjersing & Anne Line Bretteville-Jensen

Background The societal burden of drug-related crime is high Argument for drug policy liberalization Recent drug policy changes are expected to reduce crime rates

Aims In a cohort of 884 street- and low threshold service recruited polysubstance users Estimate Incarceration rate and total number of incarceration episodes Examine The associations with self-reported demographics, income and substances used Investigate and categorize reasons for incarcerations The potential changes in rates and reasons for incarcerations following a drug policy liberalization

Methods A prospective and retrospective cohort study 884 illegal opioid and/or stimulant users Recruited September and November 2013 Low threshold services, housing facilities, street magasines, street Norwegian Correctional Service Registry 1.9.2011 - 31.12.2015 Incarceration dates (in/out) and reason for incarceration

Results 42% incarcerated 610 incarceration episodes 42.8 39.8   No n=511 Yes n=373 OR (95% CI) Mean age 42.8 39.8 0.97 [0.96,0.98]*** Male 69% 82% 2.06 [1.49,2.86]*** Homeless or shelter user 22% 37% 2.09 [1.56,2.81]*** Overdose experience 17% 25% 1.69 [1.22,2.35]** In OST 41% 40% 0.99 [0.75,1.30]

Incarceration and income sources   No n=511 Yes n=373 OR (95% CI) Work 12% 9% 0.77 [0.49,1.20] Social benefits 87% 84% 0.76 [0.52,1.12] Other 26% 24% 0.89 [0.65,1.21] Prostitution 2% 0.80 [0.31,2.04] Theft 8% 16% 2.27 [1.48,3.49]*** Dealing 22% 37% 2.09 [1.55,2.82]***

Incarceration and substance use   No n=511 Yes n=373 OR (95% CI) Mean no of substances injected 1.9 2.2 1.33 [1.20,1.49]*** Injected one or more substance 75% 87% 2.20 [1.54,3.15]*** Injected heroin 35% 50% 1.83 [1.39,2.40]*** Injected amphetamine 53% 70% 2.07 [1.56,2.75]*** Injected prescription drugs 23% 29% 1.40 [1.03,1.90]* Injected cocaine 3% 8% 3.00 [1.59,5.64]*** Cannabis (≥4 days a week) 30% 38% 1.43 [1.08,1.89]*

Reasons for 610 incarcerations

Income-generating n=211 Theft 75% Robbery 10% Handling stolen goods 8% Fraud 2% Forgery Embezzlement 1% Other acquisitive crime 0.1% Counterfeit money

Less serious drug law violation* 95% Serious drug law violation** 3% Reasons Drugs and dealing n=147 Less serious drug law violation* 95% Serious drug law violation** 3% Act of Medicinal Products *Max 2 yrs **Max 21 yrs

Violence n=108 Bodily harm 25% Threats 19% 17% Assault Crime towards public servant 6% Murder 5% Vandalism 4% Crimes against personal freedom 3% Violation of the Firearms Act 2% Murder-negligent Sexual offence Rape 1%

Other n=39 Driving under the influence 25% 19% Disturbing public order 17% Failure to report to jail Immigration Act 6% Negligent handling of weapon or explosives 5% Road Traffic Act 4%

Unpaid fines 105 unpaid fines In Norway, fines are the primary reaction to use and possession of small quantities of illegal substances (Act of Medicinal products §31.2)

3 Drug Policy Scenarios Decriminalisation Legalization A Use and possession of all psychoactive substances are decriminalised No legal sanctions for use and possession in terms of fines or incarceration No specification of any alternative non-legal reactions Legalization A Use and possession as well as production and sales of all psychoactive substances are no longer punishable under the criminal law We assume that users’ drug expenditure (including drug prices and their drug consumption) will remain the same due to policy measures such as taxation, regulations on sale etc. Legalization B Same as Legalization A, but with a 50% reduction in users’ illegal income-generating activities due to lower drug prices We assume that the level of drug consumption remain the same

  Original setting Scenario 1: Decriminalisation Scenario 2: Legalization A Scenario 3: Legalization B Reduction in incarcerations 109 (-18%) 252 (-41%) 357 (-59%) Incarceration episodes 610 501 358 253 Income-generating 211 106 Act of Medicinal Products 4 Drug law violation* 143 Violence 108 Unpaid fines 105 Other 39 Reduction in incarcerated individuals 55 (-15%) 142 (-38%) 236 (-63%) Total no of individuals incarcerated 373 318 231 137

Conclusion Incarceration was common Those incarcerated Theft, less serious drug law violations and unpaid fines Those incarcerated Younger, male, unstable living situation, theft and dealing as an income source and more serious drug use behaviours Our three drug policy scenarios imply that A radical change in drug policy is required if the incarceration rates in street- and low threshold facility populations of drug users should be largely affected