Abstract：
BACKGROUND: Health and human rights organizations have endorsed drug decriminalization to promote public health-oriented approaches to substance use. In the US, policymakers have begun to pursue this via prosecutorial discretion-or the decision by a prosecutor to decline criminal charges for drug possession in their jurisdiction. This study characterizes drivers of adoption, policy design and implementation processes, and barriers to impact and sustainability of this approach to inform evolving policy efforts promoting the health of people who use drugs (PWUD).
METHODS: We conducted n=22 key informant interviews with policymakers and national policy experts representing 13 jurisdictions implementing de facto drug policy reforms. Analyses were informed by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and analyzed using a hybrid inductive-deductive approach.
RESULTS: Drivers of policy adoption included racial inequities, perceived failures of criminalization, and desires to prioritize violent crime given resource constraints. Three distinct policy typologies are described with varying conditions for eligibility, linkage to services, and policy transparency and dissemination. Public misinformation, police resistance and political opposition were seen as threats to sustainability.
CONCLUSIONS: Given evidence that criminalization amplifies drug-related harms, many policymakers are adopting de facto drug policy reforms in the absence of formal legislation. This is the first study to systematically describe relevant implementation processes and emerging policy models. Findings have implications for designing rigorous evaluations on health outcomes and informing sustainable evidence-based policies to promote health and racial equity of PWUD in the US.
METHODS: We conducted n=22 key informant interviews with policymakers and national policy experts representing 13 jurisdictions implementing de facto drug policy reforms. Analyses were informed by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and analyzed using a hybrid inductive-deductive approach.
RESULTS: Drivers of policy adoption included racial inequities, perceived failures of criminalization, and desires to prioritize violent crime given resource constraints. Three distinct policy typologies are described with varying conditions for eligibility, linkage to services, and policy transparency and dissemination. Public misinformation, police resistance and political opposition were seen as threats to sustainability.
CONCLUSIONS: Given evidence that criminalization amplifies drug-related harms, many policymakers are adopting de facto drug policy reforms in the absence of formal legislation. This is the first study to systematically describe relevant implementation processes and emerging policy models. Findings have implications for designing rigorous evaluations on health outcomes and informing sustainable evidence-based policies to promote health and racial equity of PWUD in the US.
摘要：
背景：卫生和人权组织已批准药物非刑事化，以促进以公共卫生为导向的药物使用方法。在美国,政策制定者已经开始通过检察自由裁量权或检察官决定拒绝在其管辖范围内持有毒品的刑事指控来追求这一点。这项研究描述了采用的驱动因素，政策设计和实施过程，以及这种方法的影响和可持续性的障碍，以告知不断发展的政策努力，以促进吸毒人员的健康（PWUD）。
方法：我们对代表13个实施事实上的药物政策改革的司法管辖区的政策制定者和国家政策专家进行了n=22次关键线人访谈。分析是由勘探部门提供的，准备工作,实施与持续(EPIS)框架，并使用混合归纳-演绎方法进行分析。
结果：政策采用的驱动因素包括种族不平等，感知到的刑事定罪失败，并希望在资源有限的情况下优先考虑暴力犯罪。描述了三种不同的政策类型，具有不同的资格条件，与服务的联系，以及政策透明度和传播。公开的错误信息,警察抵抗和政治反对被视为对可持续性的威胁。
结论：鉴于有证据表明刑事定罪会放大与毒品有关的危害，在没有正式立法的情况下，许多政策制定者正在采取事实上的毒品政策改革。这是第一项系统地描述相关实施过程和新兴政策模型的研究。研究结果对于设计对健康结果的严格评估以及为可持续的循证政策提供信息，以促进美国PWUD的健康和种族平等具有重要意义。
方法：我们对代表13个实施事实上的药物政策改革的司法管辖区的政策制定者和国家政策专家进行了n=22次关键线人访谈。分析是由勘探部门提供的，准备工作,实施与持续(EPIS)框架，并使用混合归纳-演绎方法进行分析。
结果：政策采用的驱动因素包括种族不平等，感知到的刑事定罪失败，并希望在资源有限的情况下优先考虑暴力犯罪。描述了三种不同的政策类型，具有不同的资格条件，与服务的联系，以及政策透明度和传播。公开的错误信息,警察抵抗和政治反对被视为对可持续性的威胁。
结论：鉴于有证据表明刑事定罪会放大与毒品有关的危害，在没有正式立法的情况下，许多政策制定者正在采取事实上的毒品政策改革。这是第一项系统地描述相关实施过程和新兴政策模型的研究。研究结果对于设计对健康结果的严格评估以及为可持续的循证政策提供信息，以促进美国PWUD的健康和种族平等具有重要意义。
