• Saba Rouhani, Catherine Tomko, Bradley E Silberzahn, Noelle P Weicker, and Susan G Sherman.
• Department of Epidemiology, New York University School of Global Public Health, New York, New York; Center for Anti-racism, Social Justice & Public Health, New York University School of Global Public Health, New York, New York; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: Saba.Rouhani@nyu.edu.
• Am J Prev Med. 2023 Oct 1; 65 (4): 560567560-567.

IntroductionTo mitigate the harms of arrest and incarceration on health and racial equity, jurisdictions are increasingly enacting reforms to decriminalize drug possession through prosecutorial discretion (de facto). Impacts on health outcomes rely on whether this policy can reduce exposure to the carceral system among people who use drugs; however, data evaluating effects on arrest are lacking. This study explores the possible impacts of Baltimore City's enactment of de facto decriminalization on arrests by race.MethodsPolice and court records were used to explore the possible impacts of Baltimore City's de facto decriminalization on street arrests and (processed) arrests advancing through the courts among people who use drugs. Interrupted time series models were used to compare pre-policy (January 2018-March 2020) trends with post-policy (April 2020-December 2021) trends in arrests for possession of drugs/paraphernalia and estimate racial disparities in street arrests (Black versus other races). Analyses were performed in February-May 2022.ResultsThe policy was associated with a significant and immediate decline in street and processed arrests for possession, which was not seen for other crime categories. Although declines were concentrated in the Black community, disparities in arresting persisted after the policy.ConclusionsDe facto decriminalization may be a promising strategy to reduce exposure to the carceral system, an established risk factor for overdose and other drug-related sequelae and a driver of racial disparities in the U.S. Further research is needed to elucidate the drivers of persisting racial disparities and disentangle policy effects from pandemic-related closures.Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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