scholarly journals Space, place, and perceived illegality: the unsanctioned Parkdale Overdose Prevention Site

2021 ◽  
Author(s):  
Erika Dupuis
Keyword(s):  
Harm Reduction ◽  
Service Provision ◽  
Community Mobilization ◽  
Provincial Government ◽  
Community Activism ◽  
People Who Use Drugs ◽  
Front Line ◽  
Overdose Prevention

In August 2018 the Ontario provincial government ordered the halt of several overdose prevention sites across the province. This paper will focus on an unsanctioned site that opened out of response to resist said closures. This study aims to explore how front-line volunteers navigated opening, maintaining, and closing an unsanctioned overdose prevention site amidst a neoliberal government, and whether it had any impact on service provision. The writer interviewed volunteers who frequently worked at the unsanctioned site, discussing their community, activism, and the ongoing efforts to support people who use drugs. The findings of this research suggest that the perception of illegality had impacts on funding, burnout, and community mobilization. Keywords: governmentality, harm reduction, people who use drugs, unsanctioned overdose prevention sites

scholarly journals Space, place, and perceived illegality: the unsanctioned Parkdale Overdose Prevention Site

2021 ◽  
Author(s):  
Erika Dupuis
Keyword(s):  
Harm Reduction ◽  
Service Provision ◽  
Community Mobilization ◽  
Provincial Government ◽  
Community Activism ◽  
People Who Use Drugs ◽  
Front Line ◽  
Overdose Prevention

In August 2018 the Ontario provincial government ordered the halt of several overdose prevention sites across the province. This paper will focus on an unsanctioned site that opened out of response to resist said closures. This study aims to explore how front-line volunteers navigated opening, maintaining, and closing an unsanctioned overdose prevention site amidst a neoliberal government, and whether it had any impact on service provision. The writer interviewed volunteers who frequently worked at the unsanctioned site, discussing their community, activism, and the ongoing efforts to support people who use drugs. The findings of this research suggest that the perception of illegality had impacts on funding, burnout, and community mobilization. Keywords: governmentality, harm reduction, people who use drugs, unsanctioned overdose prevention sites

scholarly journals Naloxone Buyers Club: Overlooked Critical Public Health Infrastructure for Preventing Overdose Deaths

2021 ◽  
Author(s):  
Maya Doe-Simkins ◽  
Eliza Jane Wheeler ◽  
Mary C. Figgatt ◽  
T. Stephen Jones ◽  
Alice Bell ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Low Cost ◽  
People Who Use Drugs ◽  
Critical Element ◽  
Mutual Aid ◽  
Overdose Prevention ◽  
Service Programs ◽  
Compliance Officers ◽  
Critical Public Health ◽  
Overdose Deaths

Background Community-based naloxone distribution is an evidence-based pillar of overdose prevention. Since 2012, the naloxone Buyers Club facilitated purchase of low-cost naloxone by harm reduction and syringe service programs, the primary conduits for reaching people who use drugs. This innovative purchasing and mutual aid network has not been previously described. Methods We analyzed transactional records of naloxone orders (2017-2020, n=965), a survey of current Buyers Club members (2020, n=104), and mutual aid requests (2021, n=86). Results Between 2017 and 2020, annual orders for naloxone increased 2.6-fold. 114 unique harm reduction programs from 40 states placed orders for 3,714,110 vials of 0.4 mg/mL generic naloxone through the Buyers Club. States with most orders were: Arizona (600,000 vials), Illinois (576,800), Minnesota (347,450), California (317,200), North Carolina (315,040). Among programs that ordered naloxone in 2020, 52% (n=32) received no federal funding and ordered half as much as funded programs. During the 2021 shortage, mutual aid redistribution was common, with 80% participating as either a donor or recipient. Among 59 mutual aid requestors, 59% (n=35) were willing to accept expired naloxone; the clear preference was for generic injectable naloxone, 95% (n=56). Conclusions The naloxone Buyers Club is a critical element of overdose prevention infrastructure. Yet, barriers from corporate compliance officers and federal prescription-only status impede access. These barriers can be reduced by FDA removing the prescription requirement for naloxone and government funding for harm reduction programs.

scholarly journals A Critical Narrative Inquiry to Understand the Impacts of an Overdose Prevention Site on the Lives of Site Users

2020 ◽  
Author(s):  
Abe Oudshoorn ◽  
Michelle Sangster Bouck ◽  
Melissa McCann ◽  
Shamiram Zendo ◽  
Helene Berman ◽  
...  
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Sense Of Self ◽  
People Who Use Drugs ◽  
Transformative Change ◽  
Overdose Prevention ◽  
Caring Relationships ◽  
Starting Point ◽  
Reduction Strategies ◽  
The Impact

Abstract Background Globally, communities are struggling to gain support for harm reduction strategies being implemented to address the impacts of substance use. A key part of this discussion is understanding and engaging with people who use drugs to help shape community harm reduction strategies. This study focused on how an overdose prevention site has influenced the lives of people who use drugs.MethodsA critical narrative method was utilized, centred on photo-narratives. Twenty-seven individuals accessing an overdose prevention site were recruited to participate in preliminary interviews. 16 participants subsequently took photographs to describe the impact of the site and participated in a second round of interviews. Through independent coding and several rounds of team analysis, four themes were proposed to constitute a core narrative encompassing the diverse experiences of participants. ResultsA key message shared by participants was the sense that their lives have improved since accessing the site. The core narrative proposed is presented in a series of four themes or ‘chapters’: Enduring, Accessing Safety, Connecting and Belonging, and Transforming. The chapters follow a series of transitions, revealing a journey that participants presented through their own eyes; one of moving from utter despair to hope, opportunity, and inclusion. Where at the outset participants were simply trying to survive the challenges of chaotic substance use, through the relationships and services provided at the site they moved towards small or large life transformations.ConclusionsThis study contributes to an enhanced understanding of how caring relationships with staff at the overdose prevention site impacted site users’ sense of self. We propose that caring relationships are an intervention in and of themselves, and that these relationships contribute to transformation that extends far beyond the public health outcomes of disease reduction. The caring relationships at the site can be a starting point for significant social changes. However, the micro-environment that existed within the site needs to extend beyond its walls for true transformative change to take place. The marginalization and stigmatization that people who use drugs experience outside these sites remains a constant barrier to achieving stability in their lives.

scholarly journals Lisbon’s COVID 19 response: harm reduction interventions for people who use alcohol and other drugs in emergency shelters

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ricardo Fuertes ◽  
Elsa Belo ◽  
Cristiana Merendeiro ◽  
Adriana Curado ◽  
Diana Gautier ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Continuity Of Care ◽  
Vulnerable Populations ◽  
Service Provision ◽  
Health Interventions ◽  
People Who Use Drugs ◽  
Diverse Population ◽  
Emergency Shelters ◽  
Alcohol And Other Drugs ◽  
Reduced Mobility

AbstractFour emergency shelters were instituted in Lisbon during COVID-19, and are still in operation. Between March and August 2020, they served over 600 people. The shelters host a diverse population, including people experiencing homelessness, foreigners, LGBTI + people, those with reduced mobility, couples, those with pets, and People Who Use Drugs, including alcohol (henceforth PWUD). Individuals are provided care regardless of their immigration or residence status. In order to ensure continuity of care in the shelters and to bring in clients who usually refuse to be sheltered, a range of social and health interventions are integrated into the shelters. Harm reduction services ensure that the most vulnerable populations, PWUD and people experiencing homelessness, have access to the services they need. Innovations in service provision maximize the services impacts and pave the way for the future inclusion and development of these services.

scholarly journals A critical narrative inquiry to understand the impacts of an overdose prevention site on the lives of site users

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Abe Oudshoorn ◽  
Michelle Sangster Bouck ◽  
Melissa McCann ◽  
Shamiram Zendo ◽  
Helene Berman ◽  
...  
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Sense Of Self ◽  
People Who Use Drugs ◽  
Transformative Change ◽  
Overdose Prevention ◽  
Caring Relationships ◽  
Starting Point ◽  
Reduction Strategies ◽  
The Impact

Abstract Background Globally, communities are struggling to gain support for harm reduction strategies being implemented to address the impacts of substance use. A key part of this discussion is understanding and engaging with people who use drugs to help shape community harm reduction strategies. This study focused on how an overdose prevention site has influenced the lives of people who use drugs. Methods A critical narrative method was utilized, centred on photo-narratives. Twenty-seven individuals accessing an overdose prevention site were recruited to participate in preliminary interviews. Sixteen participants subsequently took photographs to describe the impact of the site and participated in a second round of interviews. Through independent coding and several rounds of team analysis, four themes were proposed to constitute a core narrative encompassing the diverse experiences of participants. Results A key message shared by participants was the sense that their lives have improved since accessing the site. The core narrative proposed is presented in a series of four themes or “chapters”: Enduring, Accessing Safety, Connecting and Belonging, and Transforming. The chapters follow a series of transitions, revealing a journey that participants presented through their own eyes: one of moving from utter despair to hope, opportunity, and inclusion. Where at the outset participants were simply trying to survive the challenges of chaotic substance use, through the relationships and services provided at the site they moved towards small or large life transformations. Conclusions This study contributes to an enhanced understanding of how caring relationships with staff at the overdose prevention site impacted site users’ sense of self. We propose that caring relationships are an intervention in and of themselves, and that these relationships contribute to transformation that extends far beyond the public health outcomes of disease reduction. The caring relationships at the site can be a starting point for significant social changes. However, the micro-environment that existed within the site needs to extend beyond its walls for true transformative change to take place. The marginalization and stigmatization that people who use drugs experience outside these sites remains a constant barrier to achieving stability in their lives.

scholarly journals Harm reduction must be recognised an essential public health intervention during crises

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Robert Csák ◽  
Sam Shirley-Beavan ◽  
Arielle Edelman McHenry ◽  
Colleen Daniels ◽  
Naomi Burke-Shyne
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Social Services ◽  
Public Health Intervention ◽  
Health Interventions ◽  
People Who Use Drugs ◽  
Front Line ◽  
Public Health Interventions ◽  
Substantial Impact ◽  
Health And Social Services

AbstractThe COVID-19 had a substantial impact on the provision of harm reduction services for people who use drugs globally. These front-line public health interventions serve a population that due to stigma, discrimination and criminalisation, faces barriers to accessing health and social services and are particularly vulnerable to public health crises. Despite this, the pandemic has seen many harm reduction services close, reduce operations or have their funding reduced. Simultaneously, around the world, harm reduction services have been forced to adapt, and in doing so have demonstrated resilience, flexibility and innovation. Governments must recognise the unique abilities of harm reduction services, particularly those led by the community, and identify them as essential health services that must be protected and strengthened in times of crisis.

scholarly journals Willful ignorance as resistance, harm reduction workers and ruling relations

2021 ◽  
Author(s):  
Christopher Maxim Piercey Dalton
Keyword(s):  
Harm Reduction ◽  
People Who Use Drugs ◽  
Front Line ◽  
Willful Ignorance ◽  
Organizational Policies ◽  
Staff Members ◽  
Neoliberal Governance ◽  
Policies And Procedures ◽  
Study Results ◽  
A Site

This paper will explore how front-line harm reduction workers govern the space of agency services. In order to study how this is done this writer completed an institutional ethnography to illuminate how power operates in the day-to-day practice of a harm reduction agency. Harm reduction services have been criticized as a site of neoliberal governance through risk-management. This study aims to explore how harm reduction workers perform and understand their role within their agency. This writer interviewed front-line staff members that distribute harm reduction material, asking them about their adherence to their organizational policies and procedures. The policies represented by the text of the signage within agencies was also analyzed. Study results showed that staff members used wilful ignorance to allow people to use drugs on agency premises, provided they did so in a discreet manner. Harm reduction workers also tried to reduce the suffering, and promote the larger political goals of harm reduction, to help people who use drugs.

scholarly journals Willful ignorance as resistance, harm reduction workers and ruling relations

2021 ◽  
Author(s):  
Christopher Maxim Piercey Dalton
Keyword(s):  
Harm Reduction ◽  
People Who Use Drugs ◽  
Front Line ◽  
Willful Ignorance ◽  
Organizational Policies ◽  
Staff Members ◽  
Neoliberal Governance ◽  
Policies And Procedures ◽  
Study Results ◽  
A Site

This paper will explore how front-line harm reduction workers govern the space of agency services. In order to study how this is done this writer completed an institutional ethnography to illuminate how power operates in the day-to-day practice of a harm reduction agency. Harm reduction services have been criticized as a site of neoliberal governance through risk-management. This study aims to explore how harm reduction workers perform and understand their role within their agency. This writer interviewed front-line staff members that distribute harm reduction material, asking them about their adherence to their organizational policies and procedures. The policies represented by the text of the signage within agencies was also analyzed. Study results showed that staff members used wilful ignorance to allow people to use drugs on agency premises, provided they did so in a discreet manner. Harm reduction workers also tried to reduce the suffering, and promote the larger political goals of harm reduction, to help people who use drugs.

scholarly journals Service providers’ use of harm reduction approaches in working with older adults experiencing abuse: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Donna Goodridge ◽  
Kerstin Stieber Roger ◽  
Christine A. Walsh ◽  
Elliot PausJenssen ◽  
Marina Cewick ◽  
...  
Keyword(s):  
Older Adults ◽  
Harm Reduction ◽  
Professional Practice ◽  
Service Provision ◽  
Service Providers ◽  
Qualitative Interviews ◽  
Risk Environment ◽  
Intervention Process ◽  
Process Enactment ◽  
Humanistic Approach

Abstract Background Although abuse experienced by older adults is common and expected to increase, disclosure, reporting and interventions to prevent or mitigate abuse remain sub-optimal. Incorporating principles of harm reduction into service provision has been advocated as a strategy that may improve outcomes for this population. This paper explores whether and how these principles of harm reduction were employed by professionals who provide services to older adults experiencing abuse. Methods Thematic analysis of qualitative interviews with 23 professionals providing services to older adults experiencing abuse across three Western provinces of Canada was conducted. Key principles of harm reduction (humanism, incrementalism, individualism, pragmatism, autonomy, and accountability without termination) were used as a framework for organizing the themes. Results Our analysis illustrated a clear congruence between each of the six harm reduction principles and the approaches reflected in the narratives of professionals who provided services to this population, although these were not explicitly articulated as harm reduction by participants. Each of the harm reduction principles was evident in service providers’ description of their professional practice with abused older adults, although some principles were emphasized differentially at different phases of the disclosure and intervention process. Enactment of a humanistic approach formed the basis of the therapeutic client-provider relationships with abused older adults, with incremental, individual, and pragmatic principles also apparent in the discourse of participants. While respect for the older adult’s autonomy figured prominently in the data, concerns about the welfare of the older adults with questionable capacity were expressed when they did not engage with services or chose to return to a high-risk environment. Accountability without termination of the client-provider relationship was reflected in continuation of support regardless of the decisions made by the older adult experiencing abuse. Conclusions Harm reduction approaches are evident in service providers’ accounts of working with older adults experiencing abuse. While further refinement of the operational definitions of harm reduction principles specific to their application with older adults is still required, this harm reduction framework aligns well with both the ethical imperatives and the practical realities of supporting older adults experiencing abuse.

scholarly journals Harm Reduction for Adolescents and Young Adults During the COVID-19 Pandemic: A Case Study of Community Care in Reach

2021 ◽  
pp. 003335492199939
Author(s):  
Elizabeth Noyes ◽  
Ellis Yeo ◽  
Megan Yerton ◽  
Isabel Plakas ◽  
Susan Keyes ◽  
...  
Keyword(s):  
Young Adults ◽  
Harm Reduction ◽  
Community Care ◽  
Control Measures ◽  
Adolescents And Young Adults ◽  
People Who Use Drugs ◽  
Staff Members ◽  
Infection Control Measures ◽  
Semistructured Interviews ◽  
High Level

The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of harm reduction programs to provide vital services to adolescents, young adults, and people who use drugs, thereby increasing the risk of overdose, infection, withdrawal, and other complications of drug use. To evaluate the effect of the COVID-19 pandemic on harm reduction services for adolescents and young adults in Boston, we conducted a quantitative assessment of the Community Care in Reach (CCIR) youth pilot program to determine gaps in services created by its closure during the peak of the pandemic (March 19–June 21, 2020). We also conducted semistructured interviews with staff members at 6 harm reduction programs in Boston from April 27 through May 4, 2020, to identify gaps in harm reduction services, changes in substance use practices and patterns of engagement with people who use drugs, and how harm reduction programs adapted to pandemic conditions. During the pandemic, harm reduction programs struggled to maintain staffing, supplies, infection control measures, and regular connection with their participants. During the 3-month suspension of CCIR mobile van services, CCIR missed an estimated 363 contacts, 169 units of naloxone distributed, and 402 syringes distributed. Based on our findings, we propose the following recommendations for sustaining harm reduction services during times of crisis: pursuing high-level policy changes to eliminate political barriers to care and fund harm reduction efforts; enabling and empowering harm reduction programs to innovatively and safely distribute vital resources and build community during a crisis; and providing comprehensive support to people to minimize drug-related harms.

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