A Plea From People Who Use Drugs to Clinicians

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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Quality of life among people who use drugs living in poor urban communities in the Philippines

International Journal of Drug Policy ◽

10.1016/j.drugpo.2021.103160 ◽

2021 ◽

Vol 93 ◽

pp. 103160

Author(s):

Chika Yamada ◽

Atsuro Tsutsumi ◽

Takashi Izutsu ◽

Maria T.R. Tuliao ◽

Hiroya Matsuo ◽

...

Keyword(s):

Quality Of Life ◽

Urban Communities ◽

The Philippines ◽

People Who Use Drugs

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“We're actually more of a likely ally than an unlikely ally”: relationships between syringe services programs and law enforcement

Harm Reduction Journal ◽

10.1186/s12954-021-00515-2 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Carol Y. Franco ◽

Angela E. Lee-Winn ◽

Sara Brandspigel ◽

Musheng L. Alishahi ◽

Ashley Brooks-Russell

Keyword(s):

Law Enforcement ◽

Police Officers ◽

Wound Care ◽

Phenomenological Approach ◽

Treatment Programs ◽

People Who Use Drugs ◽

Positive Relationships ◽

Structured Interviews ◽

Program Staff ◽

Compliance With The Law

Abstract Background Syringe services programs provide sterile injection supplies and a range of health services (e.g., HIV and HEP-C testing, overdose prevention education, provision of naloxone) to a hard-to-reach population, including people who use drugs, aiming to prevent the transmission of infectious diseases. Methods We performed a qualitative needs assessment of existing syringe services programs in the state of Colorado in 2018–2019 to describe—their activities, needs, and barriers. Using a phenomenological approach, we performed semi-structured interviews with key program staff of syringe services programs (n = 11). All interviews were digitally recorded, transcribed, and validated. A data-driven iterative approach was used by researchers to develop a coding scheme to organize the data into major themes found across interviews. Memos were written to synthesize main themes. Results Nearly all the syringe program staff discussed their relationships with law enforcement at length. All syringe program staff viewed having a positive relationship with law enforcement as critical to the success of their program. Main factors that influence the quality of relationships between syringe services programs and law enforcement included: (1) alignment in agency culture, (2) support from law enforcement leadership, (3) police officers’ participation and compliance with the Law Enforcement Assisted Diversion (LEAD) program, which provides intensive case management for low-level drug offenders, and (4) implementation of the “Needle-Stick Prevention Law” and Drug Paraphernalia Law Exemption. All syringe program staff expressed a strong desire to have positive relationships with law enforcement and described how a collaborative working relationship was critical to the success of their programs. Conclusions Our findings reveal effective strategies to foster relationships between syringe services programs and law enforcement as well as key barriers to address. The need exists for both syringe services programs and law enforcement to devote time and resources to build a strong, positive partnership. Having such positive relationships with law enforcement has positive implications for syringe services program clients, including law enforcement being less likely to ticket persons for having used syringes, and encourage people who use drugs to seek services from syringe services programs, which can then lead them to other resources, such as housing, wound care, and substance use treatment programs.

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The Complexity of Drug Consumption Room Policy and Progress in Finland

Contemporary Drug Problems ◽

10.1177/00914509211002542 ◽

2021 ◽

pp. 009145092110025

Author(s):

Ali Unlu ◽

Fatih Demiroz ◽

Tuukka Tammi ◽

Pekka Hakkarainen

Keyword(s):

Complexity Theory ◽

Government Policy ◽

Policy Process ◽

Central Government ◽

Drug Consumption ◽

People Who Use Drugs ◽

Local Response ◽

Local Actors ◽

Moral Frameworks ◽

Drug Consumption Room

Drug consumption rooms (DCRs) have been established to reach high-risk people who use drugs (PWUDs) and reduce drug-associated harm. Despite effectiveness, their establishment requires strong advocacy and efforts since moral perspectives tend to prevail over health outcomes in many countries. DCRs have generally emerged as a local response to inadequate central government policy. Likewise, the initiative of the Municipality of Helsinki in 2018 opened up a discussion between central government, society, and local actors in Finland. This would be the first DCR in Finland, which makes the policy process and the progress of the initiative interesting for analysis. In this article, the identification of agents, structures of interactions, environmental challenges, and policy opportunities are analyzed within the framework of complexity theory. Our results show that the initiative faces policy barriers that have mainly arisen from the conceptualization of DCRs in moral frameworks that result in the prolongation of political and professional actors to take a position on DCRs.

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

Public Health Reports ◽

10.1177/0033354921999396 ◽

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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“Running myself ragged”: stressors faced by peer workers in overdose response settings

Harm Reduction Journal ◽

10.1186/s12954-020-00449-1 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Zahra Mamdani ◽

Sophie McKenzie ◽

Bernadette Pauly ◽

Fred Cameron ◽

Jennifer Conway-Brown ◽

...

Keyword(s):

Drug Use ◽

Focus Groups ◽

Mixed Methods Research ◽

Financial Burden ◽

People Who Use Drugs ◽

Frequency Distributions ◽

Sequential Mixed Methods ◽

Health Quality ◽

Mental Health Effects ◽

Perception Of Health

Abstract Background Peer workers or “peers” (workers with past or present drug use experience) are at the forefront of overdose response initiatives, and their role is essential in creating safe spaces for people who use drugs (PWUD). Working in overdose response settings has benefits for peer workers but is also stressful, with lasting emotional and mental health effects. Yet, little is known about the stressors peer workers face and what interventions can be implemented to support them in their roles. Methods This project used a community-based sequential mixed-methods research design. Eight peer researcher-led focus groups (n = 31) were conducted between November 2018 and March 2019 to assess needs of peer workers. The transcripts were thematically coded and analysed using interpretative description. These results informed a survey, which was conducted (n = 50) in September 2019 to acquire quantitative data on peer workers’ perception of health, quality of life, working conditions and stressors. Frequency distributions were used to describe characteristics of participants. X2 distribution values with Yates correction were conducted to check for association between variables. Results Five themes emerged from the focus groups that point to stressors felt by peer workers: (1) financial insecurity; (2) lack of respect and recognition at work; (3) housing challenges; (4) inability to access and/or refer individuals to resources; and (5) constant exposure to death and trauma. Consistent with this, the factors that survey participants picked as one of their “top three stressors” included financial situation, work situation, and housing challenges. Conclusion Peer workers are faced with a diversity of stressors in their lives which often reflect societal stigmatization of drug use. Recognition of these systemic stressors is critical in designing interventions to ease the emotional, physical and financial burden faced by peer workers.

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