Structural Vulnerability and Police Interaction among Women Who Use Drugs amid De Facto Decriminalization in Baltimore, Maryland.

Exposure to criminal-legal systems, including policing, arrest, and incarceration, has deleterious effects on access to health and social services among people who use drugs. Women who use drugs (WWUD) may be especially vulnerable to policing, due to the high prevalence of sex work among them, which is also a criminalized behavior. Recent epidemiologic events and policy reforms are thought to have reduced exposure to arrests for low-level, non-violent crimes; in Baltimore City, this decline was demonstrated following the COVID-19 pandemic and implementation of de facto decriminalization of misdemeanor offenses including drug possession and solicitation (prostitution). However, possible impacts of these changes on experiences of policing among WWUD remain unknown. This analysis explores self-reported police interactions and pandemic-related structural vulnerability among a cohort of WWUD in Baltimore City. We used multinomial and logistic regression to explore the association of ability to meet basic needs during the pandemic with the intensity and breadth of police interaction. We observed that overlapping unmet needs, such as access to medications, bathrooms, and harm reduction supplies, were associated with exposure to more intensive enforcement and greater breadth of police practices, as well as exposure to more egregious forms of policing. Despite broad changes to both policing and social service policies amid the pandemic, our results indicate that WWUD continued to experience both disproportionately high levels of material need insecurity and exposure to police. Findings have implications for tailoring policies and interventions to meet the needs of multiply marginalized women amid big events and policy volatility.