Saba Rouhani is an Assistant Professor of Epidemiology and the New York University School of Global Public Health. Her research focuses on the impacts of drug policy and policing on health and racial inequities among people who use drugs and their wider communities.

Calls for decriminalization have reverberated internationally and specifically within the US amid intersecting crises of overdose, racialized policing and mass incarceration. To reduce the harms of police contact, detention and incarceration of people who use drugs (PWUD), many US prosecutors are utilizing their discretion to decline prosecuting drug possession altogether. We will present mixed-methods evidence characterizing prosecutorial policies and impacts, contrasting them with legislative decriminalization enacted at the same time in Oregon to highlight unique and shared policy features, barriers and facilitators to sustainment. Findings may be instructive for promotion of sustainable and impactful drug policy within the US, and for those exploring feasibility of de facto models elsewhere.

We utilize data from 22 in-depth interviews (IDIs) with prosecutors in 14 US jurisdictions to characterize distinct typologies of prosecutorial decriminalization policies and discuss their alignment with core harm reduction principles. Findings demonstrate wide variety in policy design and inconsistent operationalization of ‘harm reduction’ by prosecutors. We additionally conducted a mixed-methods evaluation of an expansive de facto decriminalization policy enacted by the prosecutor’s office in Baltimore, Maryland, with a stated aim to end the racist War on Drugs. Interrupted time-series models visualizing monthly drug arrests before and after the policy demonstrate significant reductions concentrated among Black residents, but also illustrate enduring racial disparities at individual and neighborhood levels. IDIs with police (N=22) and people who use drugs (N=26) illustrate divergent perceptions of policy impacts on police-community relations, police abuse of power and discretion, and consequences for overdose risk and public safety.

The proposed presentation will synthesize our research nationally and in Baltimore with an aim to shed light on the merits and challenges of using prosecutorial policy to reduce the negative impacts of punitive drug policy on PWUD and their communities.