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Fast D, Charlesworth R, Thulien M, Krüsi A, Buxton J, West S, Chase C, Manson D. Staying Together No Matter What: Becoming Young Parents on the Streets of Vancouver. Cult Med Psychiatry 2023; 47:1043-1066. [PMID: 36692806 PMCID: PMC10654161 DOI: 10.1007/s11013-022-09813-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 01/25/2023]
Abstract
Among young people who use drugs in the context of entrenched poverty and homelessness, pregnancy is often viewed as an event that can meaningfully change the trajectory of their lives. However, youth's desires and decision-making do not always align with the perspectives of various professionals and systems regarding how best to intervene during pregnancies and early parenting. Drawing on longitudinal interviews and fieldwork with young people in Vancouver, Canada, we explore how their romantic relationships powerfully shaped understandings of what was right and wrong and which actions to take during pregnancy and early parenting, and how these moral worlds frequently clashed with the imperatives of healthcare, criminal justice, and child protection systems. We demonstrate how a disjuncture between youth's desires, decision-making and moralities, and the systems that are intended to help them, can further entrench young people in cycles of loss, defeat, and harm. These cycles are powerfully racialized for young Indigenous people in our context.
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Affiliation(s)
- Danya Fast
- Department of Medicine, Division of Social Medicine, University of British Columbia, Vancouver, Canada.
- British Columbia Centre on Substance Use, Vancouver, Canada.
| | | | | | - Andrea Krüsi
- Department of Medicine, Division of Social Medicine, University of British Columbia, Vancouver, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, Canada
| | - Jane Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sarah West
- Indigenous Youth Researcher, Treatment Trajectories Study, British Columbia Centre on Substance Use, Vancouver, Canada
| | - Corrina Chase
- British Columbia Centre on Substance Use, Vancouver, Canada
- First Nations Health Authority, Vancouver, Canada
- Métis, Vancouver, Canada
| | - Daniel Manson
- Department of Medicine, Division of Social Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
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Giang K, Charlesworth R, Thulien M, Mulholland A, Barker B, Brar R, Pauly B, Fast D. Risk mitigation guidance and safer supply prescribing among young people who use drugs in the context of COVID-19 and overdose emergencies. Int J Drug Policy 2023; 115:104023. [PMID: 37059025 PMCID: PMC10067449 DOI: 10.1016/j.drugpo.2023.104023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
Across North America, overlapping overdose and COVID-19 emergencies have had a substantial impact on young people who use drugs (YPWUD). New risk mitigation guidance (RMG) prescribing practices were introduced in British Columbia, Canada, in 2020 to allow people to decrease risk of overdose and withdrawal and better self-isolate. We examined how the prescribing of hydromorphone tablets specifically impacted YPWUD's substance use and care trajectories. Between April 2020 and July 2021, we conducted virtual interviews with 30 YPWUD who had accessed an RMG prescription of hydromorphone in the previous six months and 10 addiction medicine physicians working in Vancouver. A thematic analysis was conducted. YPWUD participants highlighted a disjuncture between risk mitigation prescriptions and the safe supply of unadulterated substances such as fentanyl, underscoring that having access to the latter is critical to reducing their reliance on street-based drug markets and overdose-related risks. They described re-appropriating these prescriptions to meet their needs, stockpiling hydromorphone so that it could be used as an “emergency backup” when they were unable to procure unregulated, illicit opioids. In the context of entrenched poverty, hydromorphone was also used to generate income for the purchase of drugs and various necessities. For some YPWUD, hydromorphone prescriptions could be used alongside opioid agonist therapy (OAT) to reduce withdrawal and cravings and improve adherence to OAT. However, some physicians were wary of prescribing hydromorphone due to the lack of evidence for this new approach. Our findings underscore the importance of providing YPWUD with a safe supply of the substances they are actively using alongside a continuum of substance use treatment and care, and the need for both medical and community-based safe and safer supply models.
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Affiliation(s)
- Karen Giang
- Department of Family Practice, University of British Columbia, 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Reith Charlesworth
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Madison Thulien
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Alanna Mulholland
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Vancouver Coastal Health Authority, 520 West 6(th) Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Brittany Barker
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Canadian Institute of Substance Use Research, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada
| | - Rupinder Brar
- Department of Family Practice, University of British Columbia, 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Vancouver Coastal Health Authority, 520 West 6(th) Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Bernie Pauly
- Canadian Institute of Substance Use Research, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada; School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria BC V8W 2Y2, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine (Division of Social Medicine), 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
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Canêdo J, Sedgemore KO, Ebbert K, Anderson H, Dykeman R, Kincaid K, Dias C, Silva D, Charlesworth R, Knight R, Fast D. Harm reduction calls to action from young people who use drugs on the streets of Vancouver and Lisbon. Harm Reduct J 2022; 19:43. [PMID: 35505320 PMCID: PMC9064719 DOI: 10.1186/s12954-022-00607-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/03/2022] [Indexed: 12/02/2022] Open
Abstract
Vancouver, Canada, and Lisbon, Portugal, are both celebrated for their world-leading harm reduction policies and programs and regarded as models for other cities contending with the effects of increasing levels of drug use in the context of growing urban poverty. However, we challenge the notion that internationally celebrated places like Lisbon and Vancouver are meeting the harm reduction needs of young people who use drugs (YPWUD; referring here to individuals between the ages of 14 and 29). In particular, the needs of YPWUD in the context of unstable housing, homelessness, and ongoing poverty—a context which we summarize here as “street involvement”—are not being adequately met. We are a group of community and academic researchers and activists working in Vancouver, Lisbon, and Pittsburgh. Most of us identify as YPWUD and have lived and living experience with the issues described in this comment. We make several calls to action to support the harm reduction needs of YPWUD in the context of street involvement in and beyond our settings.
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Affiliation(s)
- Joana Canêdo
- GAT (Grupo de Ativistas Em Tratamentos), Avenida Paris, 4 - 1º direito, 1000-228, Lisbon, Portugal.,MANAS, Lisbon, Portugal
| | - Kali-Olt Sedgemore
- 'Namgis First Nation, Alert Bay, Canada.,Coalition of Peers Dismantling the Drug War, Vancouver, Canada.,British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada
| | | | - Haleigh Anderson
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada
| | - Rainbow Dykeman
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada
| | - Katey Kincaid
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada
| | - Claudia Dias
- GAT (Grupo de Ativistas Em Tratamentos), Avenida Paris, 4 - 1º direito, 1000-228, Lisbon, Portugal.,MANAS, Lisbon, Portugal
| | | | | | - Reith Charlesworth
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada
| | - Rod Knight
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Danya Fast
- British Columbia Center on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, Vancouver, Canada.
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Charlesworth R, Warner M, Livermore DM, Wilson APR. Comparison of four methods for detection of teicoplanin resistance in methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother 2006; 58:186-9. [PMID: 16641117 DOI: 10.1093/jac/dkl151] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To determine which method of determining the MIC of teicoplanin produces a result closely related to outcome in the critically ill patient. METHODS Four methods of teicoplanin susceptibility testing-disc diffusion, Etest, VITEK (Legacy and VITEK 2) and agar incorporation-were compared for 47 methicillin-resistant Staphylococcus aureus (MRSA) isolates from invasive intensive care unit (ICU) infections and 83 isolates from ICU patients colonized with the organism. Clinical outcome was recorded prospectively for all the patients. Another 13 reference laboratory strains of MRSA with reduced susceptibility to teicoplanin were tested. RESULTS Both VITEK systems failed to demonstrate resistance in the three isolates identified as resistant by Etest or agar incorporation, and disc testing detected only one resistant isolate. A higher MIC, as found by Etest or agar incorporation, was associated with lower survival (n = 130, 95% CI -0.082 to -0.006, P = 0.023, Etest; n = 130, 95% CI -0.156 to -0.020, P = 0.011, agar). The findings for the 13 reference strains were similar, with a > or = 4-fold reduction in MIC between agar incorporation or Etest and VITEK2 for six isolates. CONCLUSIONS Neither disc diffusion nor the VITEK systems are reliable for detection of teicoplanin resistance in MRSA. Etest and agar incorporation remain the methods of choice.
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Affiliation(s)
- R Charlesworth
- Department of Clinical Microbiology, University College London Hospitals, Windeyer Institute of Medical Sciences, London W1T 4JF, UK
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Wilson P, Andrews JA, Charlesworth R, Walesby R, Singer M, Farrell DJ, Robbins M. Linezolid resistance in clinical isolates of Staphylococcus aureus. J Antimicrob Chemother 2003; 51:186-8. [PMID: 12493812 DOI: 10.1093/jac/dkg104] [Citation(s) in RCA: 201] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Charlesworth R, Hartup WW. Positive social reinforecement in the nursery school peer group. Child Dev 1967; 38:993-1002. [PMID: 5583075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Hartup WW, Glazer JA, Charlesworth R. Peer reinforcement and sociometric status. Child Dev 1967; 38:1017-24. [PMID: 4867866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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