Contents lists available at ScienceDirect International Journal of Drug Policy journal homepage: www.elsevier.com/locate/drugpo Research Paper Creating and sustaining cooperative relationships between supervised injection services and police: A qualitative interview study of international stakeholders Tara Marie Watson a, ⁎ , Ahmed M. Bayoumi b,c,d,e , Shaun Hopkins f , Amy Wright f , Renuka Naraine a , Triti Khorasheh a , Laurel Challacombe g , Carol Strike a a Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada b Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada c Department of Medicine, University of Toronto, 1 King’s College Circle, Toronto, Ontario, M5S 1A8, Canada d Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M6, Canada e Division of General Internal Medicine, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada f The Works, Toronto Public Health, 277 Victoria Street, Toronto, Ontario, M5B 1W2, Canada g CATIE, 555 Richmond Street West, Suite 505, Toronto, Ontario, M5V 3B1, Canada ARTICLE INFO Keywords: Harm reduction Supervised injection services Police Qualitative International ABSTRACT Background: Supervised injection services (SIS) operate with special exemptions from drug law enforcement. Given the expansion of SIS and the opioid overdose crisis in numerous jurisdictions, now is a critical time to examine factors that contribute to cooperative SIS-police relationships. We sought to learn about SIS-police relationships from international jurisdictions with well-established as well as newer SIS. Methods: We conducted 16 semi-structured telephone interviews with SIS managers (n = 10) and police liaisons (n = 6) from 10 cities in seven different countries (Australia, Canada, Denmark, France, Germany, Netherlands, and Spain). All participants provided informed consent. We focused our coding and analysis on themes that emerged from the data. Results: Five key contributors to cooperative SIS-police relationships emerged from the data: early engagement and dialogues; supportive police chiefs; dedicated police liaisons; negotiated boundary agreements; and regular face-to-face contact. Most participants perceived the less formalised, on-the-ground approach to relationship- building between police and SIS adopted in their city to be working well in general. SIS managers and police participants reported a lack of formal police training on harm reduction, and some thought that training was unnecessary given the relatively positive local SIS-police relationships they reported. Conclusion: Our qualitative study provides new, in-depth empirical examples of how police in varied interna- tional jurisdictions can come to accept and work cooperatively with, not against, SIS staff and clients. Investing ongoing effort in SIS-police relationships, in a manner that best suits local needs, may hold greater and more sustainable public health value than delivering specific curricula to police. Introduction Numerous international studies demonstrate that drug enforcement activities by police (e.g., intensified community surveillance, arrests, and confiscation of drug-use equipment) can negatively impact the health and well-being of people who use drugs and undermine pro- grams that provide public health services to this population (e.g., Aitken, Moore, Higgs, Kelsall, & Kerger, 2002; Beletsky et al., 2014; Cooper, Moore, Gruskin, & Krieger, 2005; Davis, Burris, Kraut-Becher, Lynch, & Metzger, 2005; Ivsins, Roth, Nakamura, Krajden, & Fischer, 2011; Maher & Dixon, 1999; Sarang, Rhodes, Sheon, & Page, 2010; Small, Kerr, Charette, Schechter, & Spittal, 2006; Ti, Wood, Shannon, Feng, & Kerr, 2013; Volkmann et al., 2011; Wagner, Simon-Freeman, & Bluthenthal, 2013; Werb et al., 2008; Wood et al., 2004). Therefore, it is https://doi.org/10.1016/j.drugpo.2018.08.001 Received 12 June 2018; Received in revised form 27 July 2018; Accepted 6 August 2018 ⁎ Corresponding author. E-mail addresses: tara.watson@utoronto.ca (T.M. Watson), ahmed.bayoumi@utoronto.ca (A.M. Bayoumi), shaun.hopkins@toronto.ca (S. Hopkins), amy.wright@toronto.ca (A. Wright), renuka.naraine@utoronto.ca (R. Naraine), triti.khorasheh@mail.utoronto.ca (T. Khorasheh), lchallacombe@catie.ca (L. Challacombe), carol.strike@utoronto.ca (C. Strike). International Journal of Drug Policy 61 (2018) 1–6 0955-3959/ © 2018 Elsevier B.V. All rights reserved. T