Toronto's drug policy paradox: Harm reduction sites and drug police occurrences in Toronto neighborhoods (1992–2020)

Abstract Discourse around drug policy presents a stark contrast between policing and harm reduction models, sparking debates on the state's regulatory versus protective role. Canada is an ideal case to study drug policy models due to its global recognition as a leader in harm reduction alongside continued reliance on policing of drugs. Using 29 years of Toronto Police Service drug possession and sales occurrence data (1992–2020), this study analyzes the longitudinal and spatial relationship between harm reduction service provision and policing of drug possession and sales across Toronto. I ask: What is the relationship between the presence of harm reduction centers in a neighborhood and drug possession and sales police occurrences? I find that proximity to a needle exchange and/or supervised injection site significantly influences the likelihood of drug possession police occurrences in a neighborhood. I supplement these findings with panel matching, showing that the opening of a harm reduction center is associated with an immediate increase in drug possession occurrences and a more gradual increase in drug dealing occurrences over subsequent years. These findings highlight a spatial and temporal association between harm reduction service provision and police activity, raising questions about the coexistence of public health and enforcement strategies.