Experiences of a drug decriminalization policy among police and people who use drugs in Baltimore City: a post-structural policy analysis

Drug decriminalization aims to reduce the harms of punitive enforcement while improving police-community relations. Baltimore City implemented de facto decriminalization in 2020, declining to prosecute simple drug possession cases. We examined perspectives of 26 people who use drugs (PWUD) and 22 police officers on policy impacts using semi-structured interviews conducted in 2023–2024. Using post-structural policy analysis, we explored support for criminalization, experiences of and support for the decriminalization policy, and perceptions of persistent or emerging challenges after its implementation. Both PWUD and police criticized criminalization of drug possession as ineffective and inefficient, agreeing that policing should focus on more serious and violent crime rather than personal drug use. Reflecting on decriminalization, PWUD reported persistent distrust and fear of police despite reduced risk of arrest and described encounters as unpredictable. Police officers described the policy as compromising their ability to maintain public order or respond effectively to community complaints about drug activity. Both groups identified police inaction as problematic but framed it differently—PWUD perceived intentional negligence on the part of police, while police perceived the policy to fundamentally constrain their ability to fulfill their role. Participants from both groups highlighted underlying neighborhood disinvestment and absence of social services as key challenges to improving public health and safety. Effective drug policy reform requires comprehensive approaches that couple non-punitive policies with clearly refocused policing protocols and robust community investment. • Baltimore City enacted a de facto drug decriminalization policy in 2020. • Both police and people who use drugs expressed dissatisfaction with the policy. • People who use drugs reported persistent fear and distrust of police officers. • Police felt constrained and unable to maintain public order. • Both wanted policies to address neighborhood disinvestment and lack of services.