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 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 The drug war must end: The right to life, liberty and security of the person during the COVID-19 pandemic for people who use drugs

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Russ Maynard ◽  
◽  
Ehsan Jozaghi ◽  
◽  
Keyword(s):  
British Columbia ◽  
Harm Reduction ◽  
Federal Government ◽  
Drug Users ◽  
People Who Use Drugs ◽  
Area Network ◽  
Controlled Drugs ◽  
Novel Coronavirus ◽  
The Right ◽  
Overdose Deaths

AbstractSince the start of the opioid epidemic in 2016, the Downtown Eastside community of Vancouver, Canada, has lost many pioneering leaders, activists and visionaries to the war on drugs. The Vancouver Area Network of Drug Users (VANDU), the Western Aboriginal Harm Reduction Society (WAHRS), and the British Columbia Association People on Opiate Maintenance (BCAPOM) are truly concerned about the increasing overdose deaths that have continued since 2016 and have been exacerbated by the novel coronavirus (SARS-COVID-19) despite many unique and timely harm reduction announcements by the British Columbia (B.C.) government. Some of these unique interventions in B.C., although in many cases only mere announcements with limited scope, are based on the philosophy of safe supply to illegal street drugs. Despite all the efforts during the pandemic, overdose deaths have spiked by over 100% compared to the previous year. Therefore, we urge the Canadian federal government, specifically the Honorable Patty Hajdu, the federal Minister of Health, to decriminalize simple possession immediately by granting exemption under the Controlled Drugs and Substances Act. The Canadian federal government has a moral obligation under Sect. 7 of the Canadian Charter of Rights and Freedoms to protect the basic human rights of marginalized Canadians.

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 Helping Behavior among People Who Use Drugs: Altruism and Mutual Aid in a Harm Reduction Program

2021 ◽  
Author(s):  
Geoff Bathje ◽  
Daniel Pillersdorf ◽  
Laura Kacere ◽  
Dan Bigg
Keyword(s):  
Harm Reduction ◽  
Life Experiences ◽  
Helping Behavior ◽  
People Who Use Drugs ◽  
Mutual Aid ◽  
Harm Reduction Program ◽  
Helping Others ◽  
Reduction Program ◽  
Shared Stories ◽  
Helping Behaviour

People who use drugs, and particularly people experiencing addiction, are rarely afforded the opportunity to have their voices heard when it comes to drug treatment or drug policy or even when attempting to define themselves and their life experiences. Of course, there is much more to a person than one area of their behaviour. The current study seeks to capture and understand the lived experiences of people who use drugs, with a focus on their relationships and helping behaviour. We interviewed 32 participants in a harm reduction program seeking to provide understanding beyond stigmatizing and criminalizing drug narratives, by exploring their motivation and context for helping behav- iours. Grounded theory methodology was used to under- stand the patterns of helping behaviour, along with the contexts in which help is or is not given. We particularly focus on participants' distribution of syringes and carrying medicine to reverse overdose (naloxone). Participants shared stories of altruism and mutual aid, along with barriers and disincentives to helping others. We situate these behaviours within contrasting environments of a free harm reduction program and the competitive market system of the U.S. society. Implications for practice and public pol- icy are discussed.

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 Harm Reduction Interventions to Prevent Overdose Deaths

2021 ◽  
Vol 1 (8) ◽  
Author(s):  
Jonathan Harris
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Lived Experience ◽  
Public Understanding ◽  
Opioid Overdose ◽  
Current Crisis ◽  
Overdose Prevention ◽  
Prevention Interventions ◽  
Informal Supports ◽  
Overdose Deaths

Overdose deaths have been occurring at high rates in many parts of Canada. From January 2016 (when national surveillance began) to March 2019, an estimated 12,800 Canadians died of an opioid overdose.1 In addition to opioid-related harms, stimulants such as methamphetamine have re-emerged in some regions and are also contributing to the current rise in overdose deaths. COVID-19 has resulted in a more compromised illicit drug supply, and those who use drugs have had limited access to formal and informal supports because of public health measures regarding physical distancing. As a result, overdose deaths have increased during the pandemic. Harm reduction approaches provide a mechanism to prevent overdose deaths and have additional health and public safety benefits. The current crisis has been exacerbated by COVID-19; therefore, it is an appropriate time to consider the entire continuum of harm reduction approaches available to reduce preventable overdose deaths. People with lived experience of drug use should be meaningfully included in policy discussions about harm reduction and overdose prevention interventions. This would enhance the person-centredness of programs and ensure they are reflective of the lived realities of those who use drugs. Although societal attitudes about drug use are changing, harm reduction interventions remain politically contentious. Countering stigma, being prepared to engage with community concerns, and clearly articulating that harm reduction services are intended to complement and not replace drug treatment are all important in enhancing public understanding of harm reduction.

A Thematic Analysis of Overdose Prevention and Response Efforts in States Experiencing Declines in Rates of Opioid-Involved Overdose Deaths

2021 ◽  
pp. 003335492110268
Author(s):  
Amber B. Robinson ◽  
Nida Ali ◽  
Olga Costa ◽  
Cherie Rooks-Peck ◽  
Amy Sorensen-Alawad ◽  
...  
Keyword(s):  
Thematic Analysis ◽  
Prevention Program ◽  
Data Access ◽  
Mortality Rates ◽  
Opioid Overdose ◽  
Overdose Prevention ◽  
Core Elements ◽  
Specific Activities ◽  
Context Specific ◽  
Overdose Deaths

Objective To address the opioid overdose epidemic, it is important to understand the broad scope of efforts under way in states, particularly states in which the rate of opioid-involved overdose deaths is declining. The primary objective of this study was to examine core elements of overdose prevention activities in 4 states with a high rate of opioid-involved overdose deaths that experienced a decrease in opioid-involved overdose deaths from 2016 to 2017. Methods We identified 5 states experiencing decreases in age-adjusted mortality rates for opioid-involved overdoses from 2016 to 2017 and examined their overdose prevention programs via program narratives developed with collaborators from each state’s overdose prevention program. These program narratives used 10 predetermined categories to organize activities: legislative policies; strategic planning; data access, capacity, and dissemination; capacity building; public-facing resources (eg, web-based dashboards); training resources; enhancements and improvements to prescription drug monitoring programs; linkage to care; treatment; and community-focused initiatives. Using qualitative thematic analysis techniques, core elements and context-specific activities emerged. Results In the predetermined categories of programmatic activities, we identified the following core elements of overdose prevention and response: comprehensive state policies; strategic planning; local engagement; data access, capacity, and dissemination; training of professional audiences (eg, prescribers); treatment infrastructure; and harm reduction. Conclusions The identification of core elements and context-specific activities underscores the importance of implementation and adaptation of evidence-based prevention strategies, interdisciplinary partnerships, and collaborations to address opioid overdose. Further evaluation of these state programs and other overdose prevention efforts in states where mortality rates for opioid-involved overdoses declined should focus on impact, optimal timing, and combinations of program activities during the life span of an overdose prevention program.

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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