Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Whaley, Rachel


This dissertation explores the criminalization of hypodermic syringes as drug paraphernalia specifically in relation to the extent to which criminalization may impact individual’s connection with harm reduction services, implementation of harm reduction strategies, and healthcare. I utilize a critical criminological perspective to identify and explore the ways in which criminalization works to perpetuate and reinforce the marginalized status of and control and constrain the lives of people who inject drugs. I conducted secondary data analysis of interviews with twenty-five people who inject drugs in rural southern Illinois to explore the extent to which criminalization impacts accessibility and engagement with needed harm reduction and health services and identify the mechanisms through which this impact is enacted. Participants were asked to describe their knowledge of state laws and polices related to drug paraphernalia and calling emergency services in the event of witnessing an overdose. Lastly, this dissertation examined how people who inject drugs cope with their experiences with law enforcement. Findings illustrate that criminalization constricts accessibility and engagement with harm reduction and healthcare services among rural people who inject drugs through frequent violent encounters with law enforcement in which participants are routinely degraded, harassed, and abused. These encounters, coupled with pervasive community stigma, lock participants into a hyper-stigmatized master status further interrupting access and engagement with harm reduction and health services and diminishing networks of social support. Additionally, participants reported a lack of confidence in their understanding of state laws and policies related to paraphernalia and calling emergency services during overdose events; and, those who were most knowledgeable indicated that due to previous abusive encounters, they lacked trust in local law enforcement to uphold these protections. The local harm reduction agency served as a site of hope for participants as they leveraged services to restore a sense of control over their lives and drug use. Engagement with such services make it possible for participants to implement numerous harm reduction strategies in their daily lives and provided them with social support that was otherwise unavailable. Drug use associated stigma and violent encounters with police create significant barriers to accessing harm reduction services for rural people who inject drugs. As such, reducing drug use associated stigma is necessary to ensure that people who inject drugs can safely access needed harm reduction, health care, and treatment services.




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