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Fleming T, Boyd J, Gagnon M, Kerr T, McNeil R. Using drugs alone in single room occupancy housing: Understanding environmental drivers of overdose risk. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104444. [PMID: 38754243 DOI: 10.1016/j.drugpo.2024.104444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Across North America most overdose deaths occur in housing, largely due to individuals using drugs alone. In cities, fatalities are disproportionately concentrated in low-income housing, including single room occupancy (SRO) housing. While research has highlighted how SROs operate as risk environments for various poor outcomes, there has been little attention to specific drug use practices (i.e., using alone) associated with overdose vulnerability in these spaces. This study explores how environmental contexts of SROs shape overdose risks, with specific attention to practices of using drugs alone. METHODS In-depth semi-structured interviews were conducted with 30 people who use drugs (PWUD) living in Vancouver SROs. Interviews covered topics such as social-structural environments of housing, drug use practices, and housing-based harm reduction. Thematic analysis drew on the intersectional risk environment framework. RESULTS Narratives positioned SROs as extensions of public space, with similar expectations of risks and behaviours as in public spaces. For some participants, using alone in their room was characterized as a practice in claiming privacy within the context of a public existence. Participants highlighted how certain features of SRO's social-structural environments were routinely leveraged against them (e.g., security cameras, staff surveillance), suggesting using alone as a tactic to minimize risks of hyper-surveillance and punitive policies. Further, participants discussed using alone as "safer," describing how this practice mitigated place-based risks of social-structural harms (e.g., violence, criminalization) in ways that eclipsed overdose risk. CONCLUSION Using drugs alone may be understood as a spatial negotiation of vulnerability to diverse harms produced by environmental contexts of SROs. Interventions accounting for broader contextual factors (e.g., improvements housing quality/quantity, providing a safer supply of drugs) that render using alone as instrumental to survival, and that reduce the implicit threat of punishment from intensive surveillance and control practices are critical to reduce vulnerability to overdose and other harms.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Marilou Gagnon
- School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA; Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA.
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Friedman JR, Tiako MJN, Hansen H. Understanding and Addressing Widening Racial Inequalities in Drug Overdose. Am J Psychiatry 2024; 181:381-390. [PMID: 38706336 PMCID: PMC11076008 DOI: 10.1176/appi.ajp.20230917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The fourth wave of the United States overdose crisis-driven by the polysubstance use of fentanyl with stimulants and other synthetic substances-has driven sharply escalating racial/ethnic inequalities in drug overdose death rates. Here the authors present a detailed portrait of the latest overdose trends and synthesize the literature to describe where, how, and why these inequalities are worsening. By 2022 overdose deaths among Native and Black Americans rose to 1.8 and 1.4 times the rate seen among White Americans, respectively. This reflects that Black and Native Americans have been disproportionately affected by fentanyl and the combination of fentanyl and stimulants at the national level and in virtually every state. The highest overdose deaths rates are currently seen among Black Americans 55-64 years of age as well as younger cohorts of Native Americans 25-44 years of age. In 2022-the latest year of data available-deaths among White Americans decreased relative to 2021, whereas rates among all other groups assessed continued to rise. Moving forward, Fundamental Cause Theory shows us a relevant universal truth of implementation science: in socially unequal societies, new technologies typically end up favoring more privileged groups first, thereby widening inequalities unless underlying social inequalities are addressed. Therefore, interventions designed to reduce addiction and overdose death rates that are not explicitly designed to also improve racial/ethnic inequalities will often unintentionally end up worsening them. Well-funded community-based programs, with Black and Native leadership, providing harm reduction resources, naloxone, and medications for opioid use disorder in the context of comprehensive, culturally appropriate healthcare and other services, represent the highest priority interventions to decrease inequalities.
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Affiliation(s)
- Joseph R. Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles
| | | | - Helena Hansen
- Center for Social Medicine and Humanities, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Ivsins A, Bonn M, McNeil R, Boyd J, Kerr T. A qualitative study on perceptions and experiences of overdose among people who smoke drugs in Vancouver, British Columbia. Drug Alcohol Depend 2024; 258:111275. [PMID: 38581922 PMCID: PMC11088499 DOI: 10.1016/j.drugalcdep.2024.111275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Smoking unregulated drugs has increased substantially in British Columbia. Intersecting with the ongoing overdose crisis, drug smoking-related overdose fatalities have correspondingly surged. However, little is known about the experiences of overdose among people who smoke drugs accessing the toxic drug supply. This study explores perceptions and experiences of overdose among people who smoke drugs. METHODS We conducted interviews with 31 people who smoke drugs. Interviews covered a range of topics including overdose experience. Thematic analysis was used to identify themes related to participant perceptions and experiences of smoking-related overdose. RESULTS Some participants perceived smoking drugs to pose lower overdose risk relative to injecting drugs. Participants reported smoking-related overdose experiences, including from underestimating the potency of drugs, the cross-contamination of stimulants with opioids, and responding to smoking-related overdose events. CONCLUSIONS Findings highlight the impact the unpredictable, unregulated, and toxic drug supply is having on people who smoke drugs, both among people who use opioids, and among those who primarily use stimulants. Efforts to address smoking-related overdose could benefit from expanding supervised smoking sites, working with people who use drugs to disseminate accurate knowledge around smoking-related overdose risk, and offering a smokable alternative to the unpredictable drug supply.
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Affiliation(s)
- Andrew Ivsins
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Matt Bonn
- Canadian AIDS Society, Ottawa, ON, Canada
| | - Ryan McNeil
- General Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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4
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Wang C. Oral histories: lessons we can learn from the past. Glob Health Promot 2024; 31:91-94. [PMID: 37837368 DOI: 10.1177/17579759231202629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
The COVID-19 pandemic has brought to light the importance of hindsight in response to global health crises. Although globalization has amplified worldwide perspectives, many lessons learned from past outbreaks in Indigenous communities have been overlooked. Oral histories are deeply rooted traditions that have played a significant role in the health practices of Indigenous communities across Canada. These practices can provide valuable insights into past epidemics or casualty events and their short- to long-term impacts. They have shaped responses to COVID-19, with Indigenous communities implementing self-determination efforts, such as community closures, contact tracing, and isolation measures. These traditions have heavily influenced population health practices in other contexts, such as the 1700 Cascadia earthquake, smallpox, and tuberculosis outbreaks. However, challenges remain in facilitating disease data transparency and Indigenous sovereignty. Efforts should be made to promote recognizing and respecting Indigenous knowledge and practices within the broader health system.
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Affiliation(s)
- Claire Wang
- Health, Behavior and Society Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Mathias H, Foster LA, Rushton A. Programs and practices that support pregnant people who use drugs' access to sexual and reproductive health care in Canada: a scoping review. BMC Pregnancy Childbirth 2024; 24:72. [PMID: 38254076 PMCID: PMC10804510 DOI: 10.1186/s12884-023-06225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Pregnant people who use unregulated drugs (PPWUD) are at high risk of health complications yet experience a range of barriers to sexual and reproductive health care. Given that improving maternal health and access to reproductive health care are key targets underpinning the Sustainable Development Goals (SDG), there is an urgent need to improve access to appropriate supports and services for this population. Little is known about what programs and practices exist to support PPWUD's access to sexual and reproductive health care. This scoping review aimed to identify the available literature on these programs and practices in Canada. METHODS A scoping review was conducted using JBI methodology and reported using PRISMA guidelines. Scholarly databases and grey literature sources were searched to identify literature published between 2016-2023 in English or French that discussed, defined, conceptualised, or evaluated programs and practices that support PPWUD's access to sexual and reproductive health care in Canada. Identified literature was screened using Covidence. Data were extracted from included texts, then analysed descriptively. Frequencies and key concepts were reported. RESULTS A total of 71 articles were included, most of which were grey literature. Of the total, 46 unique programs were identified, as well as several useful practices. Most programs were in urban centres in Western Canada, and most programs offered holistic 'wrap-around services.' Several programs delivered these services on-site or as 'drop-in' programs with the support of staff with lived/living experience of substance use. Most frequent program outcomes included keeping parents and children together, improving connection to other services, and reducing substance use harms. Noted helpful practices included non-judgmental care and the use of harm-reduction strategies. CONCLUSIONS Several programs and practices that support PPWUD exist in Canada, though few focus exclusively on sexual and reproductive health. There remain opportunities to improve access to programs, including expanding geographic availability and range of services. The review has clinical application by providing an overview of available programs that may support clinicians in identifying services for PPWUD. Future research should consider client perspectives and experiences of these programs. REVIEW REGISTRATION NUMBER Open Science Framework https://osf.io/5y64j .
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Affiliation(s)
- Holly Mathias
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
| | - Lesley Ann Foster
- Department of Cultural Studies, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Ashleigh Rushton
- Faculty of Health Sciences, The University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C, V2R 0N3, Canada
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Jiao S, Bungay V, Jenkins E, Gagnon M. How an emergency department is organized to provide opioid-specific harm reduction and facilitators and barriers to harm reduction implementation: a systems perspective. Harm Reduct J 2023; 20:139. [PMID: 37735432 PMCID: PMC10515241 DOI: 10.1186/s12954-023-00871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The intersection of dual public health emergencies-the COVID-19 pandemic and the drug toxicity crisis-has led to an urgent need for acute care based harm reduction for unregulated opioid use. Emergency Departments (EDs) as Complex Adaptive Systems (CASs) with multiple, interdependent, and interacting elements are suited to deliver such interventions. This paper examines how the ED is organized to provide harm reduction and identifies facilitators and barriers to implementation in light of interactions between system elements. METHODS Using a case study design, we conducted interviews with Emergency Physicians (n = 5), Emergency Nurses (n = 10), and clinical leaders (n = 5). Nine organizational policy documents were also collected. Interview data were analysed using a Reflexive Thematic Analysis approach. Policy documents were analysed using a predetermined coding structure pertaining to staffing roles and responsibilities and the interrelationships therein for the delivery of opioid-specific harm reduction in the ED. The theory of CAS informed data analysis. RESULTS An array of system agents, including substance use specialist providers and non-specialist providers, interacted in ways that enable the provision of harm reduction interventions in the ED, including opioid agonist treatment, supervised consumption, and withdrawal management. However, limited access to specialist providers, when coupled with specialist control, non-specialist reliance, and concerns related to safety, created tensions in the system that hinder harm reduction provision with resulting implications for the delivery of care. CONCLUSIONS To advance harm reduction implementation, there is a need for substance use specialist services that are congruent with the 24 h a day service delivery model of the ED, and for organizational policies that are attentive to discourses of specialized practice, hierarchical relations of power, and the dynamic regulatory landscape. Implementation efforts that take into consideration these perspectives have the potential to reduce harms experienced by people who use unregulated opioids, not only through overdose prevention and improving access to safer opioid alternatives, but also through supporting people to complete their unique care journeys.
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Affiliation(s)
- Sunny Jiao
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Vicky Bungay
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Emily Jenkins
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Marilou Gagnon
- School of Nursing, University of Victoria, 3800 Finnerty Road, HSD Building A402a, Victoria, BC, V8P 5C2, Canada
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Sharma R, Pooyak S, Thomas V, Zamar DS, Jongbloed K, Pearce ME, Mazzuca A, Cassidy-Mathews C, Bizzotto RN, Jafari G, Christian KWM, Teegee M, Schechter MT, Spittal PM. The Cedar Project: Racism and its impacts on health and wellbeing among young Indigenous people who use drugs in Prince George and Vancouver, BC. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001914. [PMID: 37647286 PMCID: PMC10468031 DOI: 10.1371/journal.pgph.0001914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/18/2023] [Indexed: 09/01/2023]
Abstract
Racism continues to drive health disparities between Indigenous and non-Indigenous peoples in Canada. This study focuses on racism experienced by young Indigenous people who have used drugs in British Columbia (BC), and predictors of interpersonal racism. Cedar Project is a community-governed cohort study involving young Indigenous people who use drugs in Vancouver and Prince George, BC. This cross-sectional study included data collected between August 2015-October 2016. The Measure of Indigenous Racism Experiences (MIRE) scale was used to assess experiences of interpersonal racism across 9 unique settings on a 5-point Likert scale, collapsing responses into three categories (none/low/high). Multinomial logistic regression models were used to examine associations between key variables and interpersonal racism. Among 321 participants, 79% (n = 255) experienced racism in at least one setting. Thirty two percent (n = 102) experienced high interpersonal racism from police, governmental agencies (child 'welfare', health personnel), and in public settings. Ever having a child apprehended (AOR:2.76, 95%CI:1.14-6.65), probable post-traumatic stress (AOR:2.64; 95%CI:1.08-6.46), trying to quit substances (AOR:3.69; 95%CI:1.04-13.06), leaving emergency room without receiving treatment (AOR:3.05; 95%CI:1.22-7.64), and having a traditional language spoken at home while growing up (AOR:2.86; 95%CI:1.90-6.90) were associated with high interpersonal racism. Among women, experiencing high interpersonal racism was more likely if they lived in Prince George (AOR:3.94; 95%CI:1.07-14.50), ever had a child apprehended (AOR:5.09; 95%CI:1.50-17.30), and had probable post-traumatic stress (AOR:5.21; 95%CI:1.43-18.95). Addressing racism experienced by Indigenous peoples requires immediate structural systemic, and interpersonal anti-racist reforms.
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Affiliation(s)
- Richa Sharma
- University of British Columbia, Vancouver, Canada
| | - Sherri Pooyak
- The Cedar Project Partnership and Aboriginal HIV/AIDS Community-Based Research Collaborative Centre (AHA Centre), Vancouver, Canada
| | | | - David S. Zamar
- Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Kate Jongbloed
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Margo E. Pearce
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - April Mazzuca
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Chenoa Cassidy-Mathews
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Riley N. Bizzotto
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ghazal Jafari
- McGill University Department of Psychology, The Cedar Project, Vancouver, Canada
| | | | - Mary Teegee
- The Cedar Project Partnership and Carrier Sekani Family Services, Vancouver, Canada
| | - Martin T. Schechter
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Patricia M. Spittal
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Mayer S, Boyd J, Fairbairn N, Chapman J, Brohman I, Jenkins E, McNeil R. Women's experiences in injectable opioid agonist treatment programs in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104054. [PMID: 37192557 DOI: 10.1016/j.drugpo.2023.104054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) has recently been expanded in some geographical contexts in Canada as part of a response to the escalating overdose crisis. Complex gendered dynamics, including power differentials, violence, and social norms, shape the overdose crisis and drug treatment programs which can adversely impact women's experiences. This qualitative study examines how social (e.g., gender, income, housing) and structural factors (e.g., program policies) impact women's experiences of iOAT. METHODS Qualitative interviews were completed with 16 women enrolled in four iOAT programs in Vancouver, Canada. Approximately 50 hours of ethnographic observations were conducted. Interview transcripts and ethnographic fieldnotes were analyzed using a critical feminist lens by applying the concepts of embodiment, relationality, and social control to understand women's engagement and self-reported treatment outcomes. RESULTS Initial iOAT engagement was a relational process, including initiating treatment with a partner and engaging with iOAT to (re)build personal relationships. Relationships with iOAT providers, including flexibility and support with medication administration, were important to women, providing an affirming embodied experience and a greater sense of agency. However, program operations (e.g., mandated daily attendance, program crowding) incompatible with women's needs (e.g., employment) could undermine these positive experiences. Women's reported outcomes highlight a tension between achieving more agency and the constraints of intensive and stigmatized treatment. CONCLUSION This study highlights how iOAT is both a source of care and control for women from a relational and embodied perspective. Findings underscore the need for gender-attentive and flexible drug treatment services to meet the varied needs of women and the importance of providing relational care for women accessing iOAT.
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Affiliation(s)
- Samara Mayer
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 170-6371 Crescent Road, Vancouver, BC V6T 1Z2, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street. Vancouver, BC V6Z 1Y6, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street. Vancouver, BC V6Z 1Y6, Canada
| | - Jules Chapman
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada
| | - Isabella Brohman
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall. Vancouver, BC V6T 2B5, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street. Vancouver, BC V6Z 1Y6, Canada; Internal Medicine, Yale School of Medicine, New Haven, 06510, United States; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, 06510, United States; Department of Anthropology, Yale University, New Haven, 06510, United States.
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Toombs E, Lund JI, Mushquash AR, Mushquash CJ. Intergenerational residential school attendance and increased substance use among First Nation adults living off-reserve: An analysis of the aboriginal peoples survey 2017. Front Public Health 2023; 10:1029139. [PMID: 36743177 PMCID: PMC9895934 DOI: 10.3389/fpubh.2022.1029139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/21/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction The Truth and Reconciliation Commission of Canada (TRCC) published 94 Calls to Action in 2015 to address long-term, intergenerational effects of the residential school system, highlighting the pervasive impact of colonialism on the wellbeing of Indigenous peoples in Canada. Indeed, research with Indigenous populations in Canada has captured that prior experiences of residential schools contributes to the intergenerational transmission of mental and physical health disparities. Despite these studies, further research is needed that contextualizes the influence of residential schools within broader frameworks that consider Indigenous social determinants of health in Canada. As such, the purpose of the present study was to examine patterns of substance use and mental and physical health among individuals with a history of residential school attendance (RSA) and individuals reporting parent or two-generation (parent and grandparent) RSA. Method Data from the Aboriginal Peoples Survey (2017), involving 10,030 First Nations individuals living off reserve, were analyzed. Results Self-reported mental and physical health scores were significantly lower among those had attended residential schools, whose parents attended residential schools, and whose grandparents attended residential schools, when compared to those who did not. Further, family RSA was associated with increased substance use among participants, though the findings were variable based on sex and specific substance analyzed. Meanwhile, individual and family RSA was not associated with increased likelihood of a mental health diagnosis. Discussion These findings provide additional support for how both parental and two-generation family histories of RSA are associated with individual physical and mental health outcomes. Further, these findings articulate the need for the TRCC's Calls to Action to be actually implemented, including community-based approaches that harness the strength of Indigenous people and communities who aim to close the gap in these health disparities for their children and families.
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Affiliation(s)
- Elaine Toombs
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada,Dilico Anishinabek Family Care, Fort William First Nation, ON, Canada,*Correspondence: Elaine Toombs ✉
| | - Jessie I. Lund
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Aislin R. Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada,Dilico Anishinabek Family Care, Fort William First Nation, ON, Canada
| | - Christopher J. Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada,Dilico Anishinabek Family Care, Fort William First Nation, ON, Canada,Northern Ontario School of Medicine (NOSM) University, Lakehead University, Thunder Bay, ON, Canada,Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada,Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
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Wallace B, van Roode T, Burek P, Hore D, Pauly B. Everywhere and for everyone: proportionate universalism as a framework for equitable access to community drug checking. Harm Reduct J 2022; 19:143. [PMID: 36539747 PMCID: PMC9763810 DOI: 10.1186/s12954-022-00727-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Illicit drug overdoses have reached unprecedented levels, exacerbated by the COVID-19 pandemic. Responses are needed that address the increasingly potent and unpredictable drug supply with better reach to a wide population at risk for overdose. Drug checking is a potential response offered mainly within existing harm reduction services, but strategies are needed to increase reach and improve equitable delivery of drug checking services. METHODS The purpose of this qualitative study was to explore how to extend the reach of drug checking services to a wide population at risk of overdose. We conducted 26 in-depth interviews with potential service users to identify barriers to service use and strategies to increase equitable delivery of drug checking services. Our analysis was informed by theoretical perspectives on equity, and themes were developed relevant to equitable delivery through attention to quality dimensions of service use: accessibility, appropriateness, effectiveness, safety, and respect. RESULTS Barriers to equitable service delivery included criminalization and stigma, geographic and access issues, and lack of cultural appropriateness that deter service use for a broad population with diverse needs. Strategies to enhance equitable access include 1ocating services widely throughout communities, integrating drug checking within existing health care services, reframing away from risk messaging, engaging peers from a broad range of backgrounds, and using discrete methods of delivery to help create safer spaces and better reach diverse populations at risk for overdose. CONCLUSIONS We propose proportionate universalism in drug checking as a guiding framework for the implementation of community drug checking as an equity-oriented harm reduction intervention and as a population health response. Both a universal equity-oriented approach and multiple tailored approaches are required to facilitate drug checking services that maximize reach and appropriateness to respond to diverse needs.
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Affiliation(s)
- Bruce Wallace
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada ,grid.143640.40000 0004 1936 9465School of Social Work, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Thea van Roode
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Piotr Burek
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Dennis Hore
- grid.143640.40000 0004 1936 9465Department of Chemistry, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC Canada ,grid.143640.40000 0004 1936 9465Department of Computer Science, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Bernadette Pauly
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada ,grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
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Bardwell G, Mansoor M, Van Zwietering A, Cleveland E, Snell D, Kerr T. The "goldfish bowl": a qualitative study of the effects of heightened surveillance on people who use drugs in a rural and coastal Canadian setting. Harm Reduct J 2022; 19:136. [PMID: 36476225 PMCID: PMC9730691 DOI: 10.1186/s12954-022-00725-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A growing body of research has focused on contextual factors that shape health and well-being of people who use drugs (PWUD). However, most of this research focuses on large cities and less is known about the effects of social and structural contexts on drug use and associated risks in rural Canadian settings. Therefore, we undertook this study to examine rural-specific contextual factors that affect the day-to-day experiences of PWUD. METHODS Twenty-seven qualitative semi-structured interviews were conducted with PWUD in a rural and coastal setting in British Columbia, Canada. Participants had to be ≥ 19 years old, used illegal opioids and/or stimulants regularly, and lived in the qathet region. Interview transcripts were coded based on themes identified by the research team. RESULTS Participants described progressive shifts in politics and culture in the qathet region while also identifying resource scarcity, homelessness, and changes in the drug supply, where illicit drug contents have become highly toxic and unpredictable. Participants discussed the qualities of a small community where everyone knows each other and there is a lack of privacy and confidentiality around drug use, which resulted in experiences of stigma, discrimination, and surveillance. Participants also reported rural-specific policing issues and experiences of surveillance on ferries when traveling to larger cities to purchase drugs. This led to significantly higher drug prices for PWUD due to the time dedication and criminalized risks associated with drug possession and trafficking. CONCLUSIONS Our findings illustrate the unique experiences faced by PWUD in a rural and coastal setting. The "goldfish bowl" effect in this rural community created heightened social and structural surveillance of PWUD, which led to a variety of negative consequences. There is a clear need for interventions to address the larger contextual drivers affecting people who use drugs in rural settings, including decriminalization and peer-led anti-stigma strategies, in order to improve the lives of PWUD.
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Affiliation(s)
- Geoff Bardwell
- grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada ,grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.416553.00000 0000 8589 2327Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Manal Mansoor
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Ashley Van Zwietering
- qathet Community Action Team, 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada
| | - Ellery Cleveland
- qathet Community Action Team, 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada ,Lift Community Services of qathet Society, 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada
| | - Dan Snell
- qathet Community Action Team, 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada ,Lift Community Services of qathet Society, 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada ,Substance Users Society Teaching Advocacy Instead of Neglect (SUSTAIN), 218-6975 Alberni Street, Powell River, BC V8A 2B8 Canada
| | - Thomas Kerr
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.416553.00000 0000 8589 2327Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
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12
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Nickel NC, Enns JE, Freier A, McCulloch SC, Chartier M, Casidsid HJM, Balogun OD, Mulhall D, Dragan R, Sarkar J, Bolton J, Konrad G, Phillips-Beck W, Sanguins J, Shimmin C, McDonald N, Mignone J, Hinds A. Characterising methamphetamine use to inform health and social policies in Manitoba, Canada: a protocol for a retrospective cohort study using linked administrative data. BMJ Open 2022; 12:e062127. [PMID: 36261234 PMCID: PMC9582321 DOI: 10.1136/bmjopen-2022-062127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Rising use of methamphetamine is causing significant public health concern in Canada. The biological and behavioural effects of methamphetamine range from wakefulness, vigour and euphoria to adverse physical health outcomes like myocardial infarction, haemorrhagic stroke, arrhythmia and seizure. It can also cause severe psychological complications such as psychosis. National survey data point to increasing rates of methamphetamine use, as well as increasing ease of access and serious methamphetamine-related harms. There is an urgent need for evidence to address knowledge gaps, provide direction to harm reduction and treatment efforts and inform health and social policies for people using methamphetamine. This protocol describes a study that aims to address this need for evidence. METHODS The study will use linked, whole population, de-identified administrative data from the Manitoba Population Research Data Repository. The cohort will include individuals in the city of Winnipeg, Manitoba, who came into contact with the health system for reasons related to methamphetamine use from 2013 to 2021 and a comparison group matched on age, sex and geography. We will describe the cohort's sociodemographic characteristics, calculate incidence and prevalence of mental disorders associated with methamphetamine use and examine rates of health and social service use. We will evaluate the use of olanzapine pharmacotherapy in reducing adverse emergency department outcomes. In partnership with Indigenous co-investigators, outcomes will be stratified by First Nations and Métis identity. ETHICS AND DISSEMINATION The study was approved by the University of Manitoba Health Research Ethics Board, and access datasets have been granted by all data providers. We also received approval from the First Nations Health and Social Secretariat of Manitoba's Health Information Research Governance Committee and the Manitoba Métis Federation. Dissemination will be guided by an 'Evidence 2 Action' group of public rightsholders, service providers and knowledge users who will ensure that the analyses address the critical issues.
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Affiliation(s)
- Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Freier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott C McCulloch
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hera J M Casidsid
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Drew Mulhall
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey Konrad
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Carolyn Shimmin
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Neil McDonald
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
| | - Javier Mignone
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aynslie Hinds
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Glegg S, McCrae K, Kolla G, Touesnard N, Turnbull J, Brothers TD, Brar R, Sutherland C, Le Foll B, Sereda A, Goyer MÈ, Rai N, Bernstein S, Fairbairn N. "COVID just kind of opened a can of whoop-ass": The rapid growth of safer supply prescribing during the pandemic documented through an environmental scan of addiction and harm reduction services in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103742. [PMID: 35679695 PMCID: PMC9170132 DOI: 10.1016/j.drugpo.2022.103742] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES In the context of the ongoing overdose crisis, a stark increase in toxic drug deaths from the unregulated street supply accompanied the onset of the COVID-19 pandemic. Injectable opioid agonist treatment (iOAT - hydromorphone or medical-grade heroin), tablet-based iOAT (TiOAT), and safer supply prescribing are emerging interventions used to address this crisis in Canada. Given rapid clinical guidance and policy change to enable their local adoption, our objectives were to describe the state of these interventions before the pandemic, and to document and explain changes in implementation during the early pandemic response (March-May 2020). METHODS Surveys and interviews with healthcare providers comprised this mixed methods national environmental scan of iOAT, TiOAT, and safer supply across Canada at two time points. Quantitative data were summarized using descriptive statistics; interview data were coded and analyzed thematically. RESULTS 103 sites in 6 Canadian provinces included 19 iOAT, 3 TiOAT and 21 safer supply sites on March 1, 2020; 60 new safer supply sites by May 1 represented a 285% increase. Most common substances were opioids, available at all sites; most common settings were addiction treatment programs and primary care clinics, and onsite pharmacies models. 79% of safer supply services were unfunded. Diversity in service delivery models demonstrated broad adaptability. Qualitative data reinforced the COVID-19 pandemic as the driving force behind scale-up. DISCUSSION Data confirmed the capacity for rapid scale-up of flexible, community-based safer supply prescribing during dual public health emergencies. Geographical, client demographic, and funding gaps highlight the need to target barriers to implementation, service delivery and sustainability.
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Affiliation(s)
- Stephanie Glegg
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
| | - Karen McCrae
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, Health and Wellness Building Room 273, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Natasha Touesnard
- Canadian Association of People Who Use Drugs, 102-68 Highfield Park Drive, Dartmouth, NS B3A 1X4, Canada
| | - Jeffrey Turnbull
- Ottawa Inner City Health, 5 Myrand Ave, Ottawa, ON K1N 5N7, Canada
| | - Thomas D Brothers
- Department of Medicine, Dalhousie University, Suite 442 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada
| | - Rupinder Brar
- Vancouver Coastal Health Authority, 801-601 West Broadway, Vancouver, BC V5Z 4C2, Canada; Department of Family Medicine, The University of British Columbia, 3(rd) Floor, David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Christy Sutherland
- Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; PHS Community Services Society, 350 Columbia Street, Vancouver, BC V6A 4J1 Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; Faculty of Medicine, Institute of Medical Science, Departments of Psychiatry, Family and Community Medicine, and Pharmacology and Toxicology, University of Toronto, 250 Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada
| | - Andrea Sereda
- Schulich School of Medicine, Western University, Clinical Skills Building, London, ON V6A 5C1, Canada
| | - Marie-Ève Goyer
- Department of Family Medicine, Université de Montréal, 2900 Edouard Montpetit Boulevard, QC H3T 1J4, Canada
| | - Nanky Rai
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 3157, Toronto, ON V5S 1A8, Canada
| | - Scott Bernstein
- Canadian Drug Policy Coalition, Simon Fraser University, 2400 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
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14
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Gehring ND, Speed KA, Wild TC, Pauly B, Salvalaggio G, Hyshka E. Policy actor views on structural vulnerability in harm reduction and policymaking for illegal drugs: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103805. [PMID: 35907373 DOI: 10.1016/j.drugpo.2022.103805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Health risks associated with drug use are concentrated amongst structurally vulnerable people who use illegal drugs (PWUD). We described how Canadian policy actors view structural vulnerability in relation to harm reduction and policymaking for illegal drugs, and what solutions they suggest to reduce structural vulnerability for PWUD. METHODS The Canadian Harm Reduction Policy Project is a mixed-method, multiple case study. The qualitative component included 73 semi-structured interviews conducted with harm reduction policy actors across Canada's 13 provinces and territories between November 2016 and December 2017. Interviews explored perspectives on harm reduction and illegal drug policies and the conditions that facilitate or constrain policy change. Our sub-analysis utilized a two-step inductive analytic process. First, we identified transcript segments that discussed structural vulnerability or analogous terms. Second, we conducted latent content analysis on the identified excerpts to generate main findings. RESULTS The central role of structural vulnerability (including poverty, unstable/lack of housing, racialization) in driving harm for PWUD was acknowledged by participants in all provinces and territories. Criminalization, in particular, was seen as a major contributor to structural vulnerability by justifying formal and informal sanctions against drug use and, by extension, PWUD. Many participants expressed that their personal understanding of harm reduction included addressing the structural conditions facing PWUD, yet identified that formal government harm reduction policies focused solely on drug use rather than structural factors. Participants identified several potential policy solutions to intervene on structural vulnerability including decriminalization, safer supply, and enacting policies encompassing all health and social sectors. CONCLUSIONS Structural vulnerability is salient within Canadian policy actors' discourses; however, formal government policies are seen as falling short of addressing the structural conditions of PWUD. Decriminalization and safer supply have the potential to mitigate immediate structural vulnerability of PWUD while policies evolve to advance social, economic, and cultural equity.
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Affiliation(s)
- Nicole D Gehring
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Kelsey A Speed
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Bernie Pauly
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
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15
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Madison T, Reith C, Haleigh A, Rainbow D, Katey K, Kali S, Rod K, Danya F. Navigating treatment in the shadow of the overdose crisis: Perspectives of youth experiencing street-involvement across British Columbia. CANADIAN JOURNAL OF ADDICTION 2022; 13:S62-S71. [PMID: 36506907 PMCID: PMC9731385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective Youth experiencing street-involvement are particularly vulnerable to substance use-related harms. Since an overdose public health emergency was declared in British Columbia (BC) in 2016, there have been concerted efforts to expand youths' access to integrated mental health and substance use treatment across the province. The present study sought to explore how youth were navigating this rapidly evolving treatment landscape. Methods Focus groups were conducted with youth experiencing street-involvement in three BC cities, followed by a summit event in Vancouver. Audio recordings were transcribed verbatim and coded thematically alongside observational field notes. All activities were undertaken in collaboration with a Youth Advisory Council. Results Across BC, youth expressed desires to achieve aspects of what some called a "normal life" following treatment, which required having "somewhere to go next." In the absence of desirable housing and adequate income, youth were often left with the crushing sense that, despite their efforts, treatment would not ultimately help them to "get somewhere better." Negative experiences in treatment settings were also shaped by the files that "followed" youth across care settings, inappropriate information sharing between providers, and an overemphasis on pharmacotherapies (namely, opioid agonist therapies and psychotropic medications). Conclusion Our findings point to the inability of existing services and systems to address entrenched marginalization and chronic instability, and underscore the importance of relationship-, trust-, and future-building to providing treatment and care to youth. Young people must be empowered with control over their treatment trajectories, including decision-making surrounding pharmacotherapies and information sharing.
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Affiliation(s)
| | | | | | | | | | - Sedgemore Kali
- Youth Health Advisory Council, Vancouver, Canada,Coalition of Peers Dismantling the Drug War, Vancouver, Canada
| | - Knight Rod
- British Columbia Center on Substance Use, Vancouver, Canada,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Fast Danya
- British Columbia Center on Substance Use, Vancouver, Canada,Department of Medicine, University of British Columbia, Vancouver, Canada
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Xavier J, Greer A, Pauly B, Loyal J, Mamdani Z, Ackermann E, Barbic S, Buxton JA. "There are solutions and I think we're still working in the problem": The limitations of decriminalization under the good Samaritan drug overdose act and lessons from an evaluation in British Columbia, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103714. [PMID: 35561485 DOI: 10.1016/j.drugpo.2022.103714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/20/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Drug prohibition has been associated with increased risk of overdose. However, drug prohibition remains the dominant drug policy, including in Canada with the Controlled Drugs and Substances Act. In 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted, to encourage people to contact emergency medical services by providing bystanders at the scene of an overdose with legal protection for simple possession and conditions related to simple possession. METHODS We conducted an evaluation of the GSDOA in British Columbia, Canada that included one-on-one interviews with people who use illicit drugs (PWUD), to determine peoples' experiences and perceptions surrounding this form of decriminalization. We present findings from a thematic analysis of 37 interviews. RESULTS We identified limitations of the GSDOA at overdose events; key themes and concerns causing PWUD to hesitate to or avoid contacting emergency medical services included drug confiscation, the thin line between simple possession and drug trafficking, and enforcement of other charges and court ordered conditions that are not legally protected by the GSDOA. Moreover, participants discussed the GSDOA as inequitable; benefiting some while excluding PWUD with intersecting marginalized identities. CONCLUSION Our findings are pertinent in light of many jurisdictions across the world considering dejure decriminalization, including BC and Vancouver. The GSDOA and associated limitations that emerged in our evaluation can serve to guide jurisdictions implementing or amending dejure decriminalization policies.
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Affiliation(s)
- Jessica Xavier
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University,8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Bernadette Pauly
- School of Nursing, University of Victoria, 3800 Finnerty Road, HSD Building, Victoria, BC V8P 5C2, Canada
| | - Jackson Loyal
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Zahra Mamdani
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Emma Ackermann
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Skye Barbic
- Occupational Science & Occupational Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z8, Canada; British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
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The generative potential of mess in community-based participatory research with young people who use(d) drugs in Vancouver. Harm Reduct J 2022; 19:30. [PMID: 35337350 PMCID: PMC8956276 DOI: 10.1186/s12954-022-00615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Community-based participatory research (CBPR) is increasingly standard practice for critical qualitative health research with young people who use(d) drugs in Vancouver, Canada. One aim of CBPR in this context is to redress the essentialization, erasure, and exploitation of people who use(d) drugs in health research. In this paper, we reflect on a partnership that began in 2018 between three university researchers and roughly ten young people (ages 17–28) who have current or past experience with drug use and homelessness in Greater Vancouver. We focus on moments when our guiding principles of shared leadership, safety, and inclusion became fraught in practice, forcing us in some cases to re-imagine these principles, and in others to accept that certain ethical dilemmas in research can never be fully resolved. We argue that this messiness can be traced to the complex and diverse positionalities of each person on our team, including young people. As such, creating space for mess was ethically necessary and empirically valuable for our CBPR project.
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Mansoor M, McNeil R, Fleming T, Barker A, Vakharia S, Sue K, Ivsins A. Characterizing stimulant overdose: A qualitative study on perceptions and experiences of "overamping". THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103592. [PMID: 35114520 PMCID: PMC9381030 DOI: 10.1016/j.drugpo.2022.103592] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The dominant focus of North America's current overdose crisis has been opioids, resulting in considerable research and harm reduction efforts to address opioid-related overdose risks. Less attention has been paid to people who use stimulants (PWUS) despite recent increases in stimulant use and stimulant-involved overdoses (i.e., "overamping"). Stimulant users' definitions, risk factors and experiences of, and responses to, overamping are poorly understood, thereby putting PWUS at heightened risk of adverse health outcomes. This study explores how PWUS understand, experience, and respond to overamping. METHODS In-depth qualitative interviews were conducted with 61 PWUS in Vancouver, Canada's Downtown Eastside neighbourhood. Thematic analysis of interviews focused on contextualizing stimulant overdoses, including how PWUS understand, define, experience, and respond to overamping. RESULTS Participants associated overamping experiences with commonly identified signs and symptoms, such as rapid onset, elevated heart rate, incontinence, and audiovisua hallucinations, but also reported more serious indicators of overamping, such as unconsciousness, cardiac arrests and seizures. Our findings demonstrate that, among PWUS, there was no unified understanding of overamping such as with opioid overdose and individual experiences had substantial variation in severity and presentation. This impacted the ability to adequately respond to stimulant overdoses, which were primarily self-managed through methods including stabilizing breathing, polysubstance use, and cold showers. CONCLUSION Given the growing role of stimulants in North America's overdose crisis, there is an urgent need to improve the identification of stimulant overdoses in real world settings. Our findings identify a gap in current understandings of stimulant overdose, and demonstrate the need for public health and harm reduction interventions to better address overamp risk among PWUS, including harm reduction campaigns to disseminate information regarding identifying signs of, and proper responses to, overamping.
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Affiliation(s)
- Manal Mansoor
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States.
| | - Taylor Fleming
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Allison Barker
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Sheila Vakharia
- Department of Research and Academic Engagement, Drug Policy Alliance, 131 West 33rd Street, New York, NY 10001, United States
| | - Kimberly Sue
- School of Medicine, Yale University, 333 Cedar Street, New Haven, CT 06510, United States
| | - Andrew Ivsins
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Maina G, Marshall K, Sherstobitof J. Untangling the Complexities of Substance Use Initiation and Recovery: Client Reflections on Opioid Use Prevention and Recovery From a Social-Ecological Perspective. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:11782218211050372. [PMID: 34675526 PMCID: PMC8524687 DOI: 10.1177/11782218211050372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022]
Abstract
Background: In Canada, the rate of opioid use, opioid use disorder (OUD), and associated
mortality and morbidity are higher among Indigenous Peoples than the general
population. Indigenous Peoples on medications for opioid use disorders
(MOUD) often face distinct barriers that hinder their clinical progress,
leading to treatment attrition. Methods: We used a social-ecological model to inquire into clients’ experiences with a
history of treatment failure for OUD. We used exploratory qualitative
research to engage 22 clients with a history of OUD treatment dropouts and
who are currently on MOUD. In-depth, semi-structured interviews lasting an
average of 30 minutes were conducted on-site. Results: We identified 4 themes from the study: (a) risk for substance use; (b)
factors sustaining substance use; (c) factors leading to treatment, and (d)
treatment failure and re-enrollment. Conclusion: Using a socio-ecological model helps to understand factors that influence an
individual’s risk for OUD, decision to pursue treatment, and treatment
outcomes. Furthermore, social ecological model also creates possibilities to
develop supportive, multilevel interventions to prevent OUD risks and
support for clients on MOUD. Such interventions include mitigating adverse
childhood experiences, supporting families, and creating safe community
environments.
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Wallace B, MacKinnon K, Strosher H, Macevicius C, Gordon C, Raworth R, Mesley L, Shahram S, Marcellus L, Urbanoski K, Pauly B. Equity-oriented frameworks to inform responses to opioid overdoses: a scoping review. JBI Evid Synth 2021; 19:1760-1843. [PMID: 34137739 DOI: 10.11124/jbies-20-00304] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this scoping review was to systematically identify and describe literature that uses a health equity-oriented approach for preventing and reducing the harms of stigma or overdose for people who use illicit drugs or misuse prescription opioids. INCLUSION CRITERIA To be included, papers had to both: i) use a health equity-oriented approach, defined as a response that addresses health inequities and aims to reduce drug-related harms of stigma or overdose; and ii) include at least one of the following concepts: cultural safety, trauma- and violence-informed care, or harm reduction. We also looked for papers that included an Indigenous-informed perspective in addition to any of the three concepts. METHODS An a priori protocol was published and the JBI methodology for conducting scoping reviews was employed. Published and unpublished literature from January 1, 2000, to July 31, 2019, was included. The databases searched included CINAHL (EBSCOhost), MEDLINE (Ovid), Academic Search Premier (EBSCOhost), PsycINFO (EBSCOhost), Sociological Abstracts and Social Services Abstracts (ProQuest), JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews, PROSPERO, Aboriginal Health Abstract Database, First Nations Periodical Index, and the National Indigenous Studies Portal. The search for unpublished studies included ProQuest Dissertations and Theses, Google Scholar, and targeted web searches. Screening and data extraction were performed by two reviewers using templates developed by the authors. Data extraction included specific details about the population, concepts, context, and key findings or recommendations relevant to the review objectives. RESULTS A total of a total of 1065 articles were identified and screened, with a total of 148 articles included. The majority were published in the previous five years (73%) and were from North America (78%). Most articles only focused on one of the three health equity-oriented approaches, most often harm reduction (n = 79), with only 16 articles including all three. There were 14 articles identified that also included an Indigenous-informed perspective. Almost one-half of the papers were qualitative (n = 65; 44%) and 26 papers included a framework. Of these, seven papers described a framework that included all three approaches, but none included an Indigenous-informed perspective. Recommendations for health equity-oriented approaches are: i) inclusion of people with lived and living experience; ii) multifaceted approaches to reduce stigma and discrimination; iii) recognize and address inequities; iv) drug policy reform and decriminalization; v) ensure harm-reduction principles are applied within comprehensive responses; and vi) proportionate universalism. Gaps in knowledge and areas for future research are discussed. CONCLUSIONS We have identified few conceptual frameworks that are both health equity-oriented and incorporate multiple concepts that could enrich responses to the opioid poisoning emergency. More research is required to evaluate the impact of these integrated frameworks for action.
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Affiliation(s)
- Bruce Wallace
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
| | - Karen MacKinnon
- School of Nursing, University of Victoria, Victoria, BC, Canada
- Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Affiliated Group, University of Victoria, Victoria, BC, Canada
| | - Heather Strosher
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
| | - Celeste Macevicius
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
| | - Carol Gordon
- Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Affiliated Group, University of Victoria, Victoria, BC, Canada
- Library Service, University of Victoria, Victoria, BC, Canada
| | - Rebecca Raworth
- Library Service, University of Victoria, Victoria, BC, Canada
| | - Lacey Mesley
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
| | - Sana Shahram
- School of Nursing, University of British Columbia: Okanagan campus, Kelowna, BC, Canada
| | - Lenora Marcellus
- School of Nursing, University of Victoria, Victoria, BC, Canada
- Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Affiliated Group, University of Victoria, Victoria, BC, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
- School of Nursing, University of Victoria, Victoria, BC, Canada
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21
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McCaughran-Contreras C, Fernando S, Sikora M, Hawkins J, Kniseley M, Snyder D, Long C, Robson J, Slaunwhite A, Salmon A. Substance use and overdose risk: documenting the perspectives of formerly incarcerated persons in the Fraser East region of BC. Harm Reduct J 2021; 18:77. [PMID: 34320983 PMCID: PMC8317346 DOI: 10.1186/s12954-021-00525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between incarceration and risk of overdose has been well-documented in the literature, but few studies document the perspectives of persons at risk of overdose who were incarcerated. This sub-inquiry aimed to understand the experiences of persons with a history of substance use and incarceration in the Fraser East region of BC and how involvement with the criminal justice system affected their drug use and perceived risk of overdose. METHODS The Fraser East Overdose Response project utilized a community-based participatory action approach that included peer researchers with lived experience in all parts of the research process. This qualitative pilot study aimed to better understand individuals at risk of an unwitnessed overdose in order to prevent deaths and identify effective local responses. A snowball sampling technique was used to recruit persons aged 19 and over who used illicit drugs over the past 3 years in the Fraser East since 2016. In total, 22 participants were interviewed. Of these, 13 participants identified a history of incarceration. Interviews were analyzed using a framework analysis approach. RESULTS The perspectives that participants shared revealed that impacts from incarceration are influenced by policies but also highly individualized. Our inquiry found three broader themes, within which were situated differing and sometimes conflicting interpretations and experiences of systemic environments: (1) incarceration was associated with harms and was perceived to increase risk of overdose following release, (2) incarceration was perceived to have limited impact on substance use and overdose risk, and (3) incarceration was associated with a perceived reduction of substance use and overdose risk. CONCLUSIONS Understanding the complexities of the perceptions of those with lived experience of substance use and incarceration is of importance to better inform interventions in this population. The existing knowledge base urgently requires further inquiry into the intersections between qualitative perspectives, environments and policies, and quantitative outcomes of overdose vís-a-vís correctional institution.
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Affiliation(s)
| | - Saranee Fernando
- CHEOS: Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | | | | | - Marinel Kniseley
- CHEOS: Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - Daniel Snyder
- Langley Community Overdose Response, Langley, Canada
| | | | | | | | - Amy Salmon
- University of British Columbia, Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
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22
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Navigating post-eviction drug use amidst a changing drug supply: A spatially-oriented qualitative study of overlapping housing and overdose crises in Vancouver, Canada. Drug Alcohol Depend 2021; 222:108666. [PMID: 33766440 PMCID: PMC8117050 DOI: 10.1016/j.drugalcdep.2021.108666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND North American cities are experiencing intersecting housing and overdose crises as illicit drug markets become marked by the proliferation of fentanyl and methamphetamine. Despite recent research documenting associations between evictions and drug-related risks and harms, including overdose, the mechanisms through which these occur remain poorly understood. This study to examines how evictions shape the drug use practices of people who use drugs in Vancouver's Downtown Eastside - a neighbourhood with an established drug scene - as the illicit drug supply changed. METHODS Qualitative interviews and geo-spatial data collection were conducted with 56 recently evicted PWUD. Data were analyzed by interfacing qualitative and geo-spatial data, and interpreted focusing on how structural vulnerability shaped spatial practices and drug-related risks post-eviction. RESULTS Findings demonstrate how post-eviction spatial practices and routines produced risk and harm as participants navigated the uncertainties of housing vulnerability and drug supply changes. Post-eviction disruptions complicated participants' ability to engage with trusted drug sellers. Changes to spatial patterns and access to private spaces rendered public drug use inevitable, though this was mitigated to some degree by harm reduction supports. Abrupt changes to drug use patterns occurred due to post-eviction disruptions and included instrumental uses of methamphetamine to increase alertness and navigate survival amidst severe hardship. CONCLUSIONS Findings demonstrate how post-eviction changes to routines and spatial patterns are framed by structural vulnerability and can exacerbate drug-related harms, particularly in the context of a changing drug supply. There is an urgent need for structural interventions and harm reduction responses to mitigate harms associated with evictions.
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23
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Fast D. Going Nowhere: Ambivalence about Drug Treatment during an Overdose Public Health Emergency in Vancouver. Med Anthropol Q 2021; 35:209-225. [PMID: 33866590 PMCID: PMC8370101 DOI: 10.1111/maq.12638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 12/16/2020] [Accepted: 01/19/2021] [Indexed: 12/01/2022]
Abstract
The declaration of an overdose public health emergency in Vancouver has generated an "affective churn" of intervention across youth-focused drug treatment settings, including the expanded provision of opioid agonist therapy. In this article, I track moments when young people became swept up in the momentum of this churn and the future possibilities that treatment seemed to promise. I also track moments when treatment and what happened next engendered a sense of stagnation, arguing that the churn of intervention ensnared many youth in rhythms of starts and stops that generated significant ambivalence toward treatment. The colonial past and present deepened this ambivalence among some Indigenous young people and informed moments of refusal. Youth's lives unfolded through but also around treatment programs, in zones of the city where drug use could generate a sense of momentum that was hooked not on futures, but on the sensorial possibilities of the now. [North America, overdose, drug treatment interventions, youth, affect].
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Affiliation(s)
- Danya Fast
- Department of Medicine, University of British Columbia
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24
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Bardwell G, Austin T, Maher L, Boyd J. Hoots and harm reduction: a qualitative study identifying gaps in overdose prevention among women who smoke drugs. Harm Reduct J 2021; 18:29. [PMID: 33678163 PMCID: PMC7937364 DOI: 10.1186/s12954-021-00479-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/26/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Smoking or inhaling illicit drugs can lead to a variety of negative health outcomes, including overdose. However, most overdose prevention interventions, such as supervised consumption services (SCS), prohibit inhalation. In addition, women are underrepresented at SCS and are disproportionately impacted by socio-structural violence. This study examines women's experiences smoking illicit drugs during an overdose epidemic, including their utilization of a women-only supervised inhalation site. METHODS Qualitative research methods included on-site ethnographic observation and semi-structured interviews with 32 participants purposively recruited from the women-only site. Data were coded and analyzed using NVivo 12 and thematic analysis was informed by gendered and socio-structural understandings of violence. RESULTS Participants had preferences for smoking drugs and these were shaped by their limited income, inability to inject, and perceptions of overdose risk. Participants expressed the need for services that attend to women's specific experiences of gendered, race-based, and structural violence faced within and outside mixed-gender social service settings. Results indicate a need for sanctioned spaces that recognize polysubstance use and drug smoking, accommodated by the women-only SCS. The smoking environment further fostered a sociability where participants could engage in perceived harm reduction through sharing drugs with other women/those in need and were able to respond in the event of an overdose. CONCLUSIONS Findings demonstrate the ways in which gendered social and structural environments shape women's daily experiences using drugs and the need for culturally appropriate interventions that recognize diverse modes of consumption while attending to overdose and violence. Women-only smoking spaces can provide temporary reprieve from some socio-structural harms and build collective capacity to practice harm reduction strategies, including overdose prevention. Women-specific SCS with attention to polysubstance use are needed as well as continued efforts to address the socio-structural harms experienced by women who smoke illicit drugs.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Tamar Austin
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Lisa Maher
- Faculty of Medicine, Kirby Institute for Infection and Immunity, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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25
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Policy Brief: CSAM in Support of the Decriminalization of Drug Use and Possession for Personal Use. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Bardwell G, Fleming T, McNeil R, Boyd J. Women's multiple uses of an overdose prevention technology to mitigate risks and harms within a supportive housing environment: a qualitative study. BMC WOMENS HEALTH 2021; 21:51. [PMID: 33530987 PMCID: PMC7856712 DOI: 10.1186/s12905-021-01196-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
Background North America is amidst an opioid overdose epidemic. In many settings, particularly Canada, the majority of overdose deaths occur indoors and impact structurally vulnerable people who use drugs alone, making targeted housing-based interventions a priority. Mobile applications have been developed that allow individuals to solicit help to prevent overdose death. We examine the experiences of women residents utilizing an overdose response button technology within a supportive housing environment. Methods In October 2019, we conducted semi-structured qualitative interviews with 14 residents of a women-only supportive housing building in an urban setting where the overdose response button technology was installed. Data was analyzed thematically and framed by theories of structural vulnerability. Results While participants described the utility and disadvantages of the technology for overdose response, most participants, unexpectedly described alternate adoptions of the technology. Participants used the technology for other emergency situations (e.g., gender-based violence), rather than its intended purpose of overdose response. Conclusions Our findings highlight the limitations of current technologies while also demonstrating the clear need for housing-based emergency response interventions that address not just overdose risk but also gender-based violence. These need to be implemented alongside larger strategies to address structural vulnerabilities and provide greater agency to marginalized women who use drugs.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Taylor Fleming
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Yale School of Medicine, 367 Cedar Street, New Haven, CT, 06510, USA
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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27
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Eydt E, Glegg S, Sutherland C, Meador K, Trew M, Perreault M, Goyer MÈ, Le Foll B, Turnbull J, Fairbairn N. Service delivery models for injectable opioid agonist treatment in Canada: 2 sequential environmental scans. CMAJ Open 2021; 9:E115-E124. [PMID: 33622764 PMCID: PMC8034381 DOI: 10.9778/cmajo.20200021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) is an emerging evidence-based option in the continuum of care for opioid use disorder in parts of Canada. Our study objective was to identify and describe iOAT programs operating during the ongoing opioid overdose crisis. METHODS We conducted 2 sequential environmental scans. Programs were eligible to participate if they were in operation as of Sept. 1, 2018, and Mar. 1, 2019. Information was collected over 2-3 months for each scan (September-October 2018, March-May 2019). Programs that participated in the first scan and newly established programs were invited to participate in the second scan. The scans included questions about location, service delivery model, clinical and operational characteristics, numbers and demographic characteristics of clients, and program barriers and facilitators. Descriptive analysis was performed. RESULTS We identified 14 unique programs across the 2 scans. Eleven programs located in urban centres in British Columbia and Ontario participated in the first scan. At the time of the second scan, 2 of these programs were on hold and 2 of 3 newly established programs were in Alberta. The total capacity of all participating programs was 420 clients at most. Four service delivery models were identified; iOAT was most commonly integrated within existing health and social services. All programs offered hydromorphone, and 1 program also offered diacetylmorphine. In the first scan, 73% of clients (133/183) were male; the mean age of clients was 47 years. Limited capacity, pharmacy operations and lack of diacetylmorphine access were among the most frequently reported barriers. The most commonly reported facilitators included client-centred care, client relationships and access to other health and social support. INTERPRETATION Evidence indicates that iOAT can be successfully implemented using diverse service delivery models. Future work should facilitate scale-up of this evidence-based treatment where gaps persist in high-risk communities.
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Affiliation(s)
- Erin Eydt
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Stephanie Glegg
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Christy Sutherland
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Karine Meador
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Michael Trew
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Michel Perreault
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Marie-Ève Goyer
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Bernard Le Foll
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Jeffrey Turnbull
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use (Eydt, Glegg, Sutherland, Fairbairn); Department of Medicine (Glegg, Fairbairn), University of British Columbia, St. Paul's Hospital; Department of Family Medicine (Sutherland), University of British Columbia; PHS Community Services Society (Sutherland), Vancouver, BC; Alberta Health Services (Meador), Royal Alexandra Hospital; Department of Family Medicine (Meador), University of Alberta, Edmonton, Alta.; Alberta Health Services (Trew), Foothills Medical Centre; Department of Psychiatry (Trew), University of Calgary, Calgary, Alta.; Department of Psychiatry (Perreault), McGill University; Douglas Hospital Research Centre (Perreault); Department of Family Medicine (Goyer), University of Montreal, Montréal, Que.; Centre for Addiction and Mental Health (Le Foll), Toronto, Ont.; Ottawa Inner City Health (Turnbull), Ottawa, Ont
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28
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Boyd J, Lavalley J, Czechaczek S, Mayer S, Kerr T, Maher L, McNeil R. "Bed Bugs and Beyond": An ethnographic analysis of North America's first women-only supervised drug consumption site. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102733. [PMID: 32247720 DOI: 10.1016/j.drugpo.2020.102733] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 02/14/2020] [Accepted: 03/04/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Attention to how women are differentially impacted within harm reduction environments is salient amidst North America's overdose crisis. Harm reduction interventions are typically 'gender-neutral', thus failing to address the systemic and everyday racialized and gendered discrimination, stigma, and violence extending into service settings and limiting some women's access. Such dynamics highlight the significance of North America's first low-threshold supervised consumption site exclusively for women (transgender and non-binary inclusive), SisterSpace, in Vancouver, Canada. This study explores women's lived experiences of this unique harm reduction intervention. METHODS Ethnographic research was conducted from May 2017 to June 2018 to explore women's experiences with SisterSpace in Vancouver's Downtown Eastside, an epicenter of Canada's overdose crisis. Data include more than 100 hours of ethnographic fieldwork, including unstructured conversations with structurally vulnerable women who use illegal drugs, and in-depth interviews with 45 women recruited from this site. Data were analyzed in NVivo by drawing on deductive and inductive approaches. FINDINGS The setting (non-institutional), operational policies (no men; inclusive), and environment (diversity of structurally vulnerable women who use illegal drugs), constituted a space affording participants a temporary reprieve from some forms of stigma and discrimination, gendered and social violence and drug-related harms, including overdose. SisterSpace fostered a sense of safety and subjective autonomy (though structurally constrained) among those often defined as 'deviant' and 'victims', enabling knowledge-sharing of experiences through a gendered lens. CONCLUSION SisterSpace demonstrates the value and effectiveness of initiatives that engage with socio-structural factors beyond the often narrow focus of overdose prevention and that account for the complex social relations that constitute such initiatives. In the context of structural inequities, criminalization, and an overdose crisis, SisterSpace represents an innovative approach to harm reduction that accounts for situations of gender inequality not being met by mixed-gender services, with relevance to other settings.
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Affiliation(s)
- Jade Boyd
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Jennifer Lavalley
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Sandra Czechaczek
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, St. Paul's Hospital, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, 2052, Australia and Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Ryan McNeil
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street New Haven CT 06510, USA; General Internal Medicine, Yale School of Medicine, 367 Cedar Street New Haven CT 06510, USA
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