Human Organization, Vol. 53, No. 3, 1994 Copyright 1994 by the Society tor Applied Anthropology 0018-7259/94/030287-09$!.40/1 Copping, Running, and Paraphernalia Laws: Contextual Variables and Needle Risk Behavior among Injection Drug Users in Denver STEPHEN K. KOESTER This paper addresses syringe sharing, the primary method of HIV transmission among drug injectors. It argues that this high risk drug injection behavior cannot be adequately understood by relying on psychological and cultural explanations alone. Rather, this ethnographic study contends that, among drug injectors in Denver, syringes are shared because they are scarce, and they are scarce because they are illegal to possess without medical justification. A legal mandate combines with other aspects of law en- forcement to discourage street-based drug users from carrying syringes, particularly when they are in the process of obtaining drugs. The result is that drug injectors are least likely to have syringes when they need them the most. This study concludes by suggesting that the paraphernalia laws currently in place in approximately 44 states and numerous municipalities may no longer be serving the public interest. Key words: drug injectors, HIV, hustling strategies, needle sharing, paraphernalia laws T HIS ARTICLE describes injection drug use in Denver and identifies how contextual factors that influence hypo- dermic needle availability contribute to high risk needle use prac- tices. This study specifically explains how a legal mandate re- stricting needle possession, combined with strategies commonly used by injection drug users (IDUs) to obtain drugs, increases the likelihood of needle sharing, which occurs even though needles can be purchased without a prescription in Colorado. The research presented has direct social policy implications, and it demonstratesthe important contribution of the ethnographic perspective and methods to our understanding of disease and its prevention. Since the advent of the AIDS epidemic in the United States, a major emphasis of applied, government-funded research has been on developing public health interventionsdesigned to change the behaviors that place drug injectors and their sexual partners Stephen Koester, Ph. D. is an assistant professor in the Psychiatry Department at the University of Colorado School of Medicine, and an adjunct associate professor in anthropology at the University of Colorado at Denver. This study was supported by the National Institute on Drug Abuse Contract 271-87-8208 and Grant DA-06912. The following assisted in this study: Robert Booth, Tom Crowley, Tom Brewster, Ken An- derson, Joni Zisman, Anthony Prieto, k n g y Santistevan, Patricia Nevarrez and Jose Martinez. Several co1league.s reviewed earlier versions of this manuscript; Paul Shankman, Bryan Page, Michael Clatts, and Laurie Price. The author especiallythanks Robert Carlson for his repeated and valuable editorial comments. In addition, he also thanks the anonymous reviewers for their suggestions. at risk for HIV infection. Research efforts quickly identified sy- ringe "sharing" as the dominant mode of HIV transmission among injectors, and offered explanations for this practice. Needle sharing was portrayed as a way drug injectors could reduce the mistrust that permeates their illegal and insecure lifestyle, as a means for individuals to "bond with each other. as a substitute for sexual intimacy, and as a ritual (Des Jarlais, Friedman and Strug 1986, Howard and Borges 1972). With the increase in eth- nographic research among IDUs, these explanations for the ra- tionale underlying needle sharing are being re-examined (Calsyn, et al. 1991, Kane and Mason 1992, Koester 1992). By studying the context in which syringes are "shared and by eliciting in- jectors' own explanations for this behavior, ethnographers have demonstrated that sharing needles and syringes is not an essen- tial trait of a deviant subculture, and that the meanings researchers initially attached to this high-risk drug using activity are not necessarily the meanings injectors assign it. Instead, increasing evidence suggests that much of what we call "needle sharing" is a pragmatic response to needle scarcity. A primary reason syringes are scarce is because most states and many cities have legal sanctions restricting their availability (CDC 1993, Pascal 1988). In some states and municipalitiesavail- ability is restricted by laws requiring a prescription to purchase and possess syringes (Clatts, et al. in press, CDC 1993, Murphy 1987, O'Keefe 1991, Singer, Irizarry, and Schensul 1991, Singer, et al. 1992, Watters 1989). In other locations, the availability of syringes is curtailed because syringes are defined as drug par- aphernalia, and their possession is illegal (Booth et al. 1993, Celentano et al. 1991, Kane and Mason 1992, Koester 1988). By requiring a prescription to purchase syringes and/or making their possession illegal, drug paraphernalia laws create an ar- VOL. 53, NO. 3 FALL 1994 287