Narcan as biomedical panic: The war on overdose and the harms of harm reduction

2020 ◽  
pp. 136248062096477
Author(s):  
Philip R Kavanaugh
Keyword(s):  
Public Health ◽  
Drug Treatment ◽  
Harm Reduction ◽  
Drug Users ◽  
Opioid Addiction ◽  
The State ◽  
Opioid Overdose ◽  
State Response ◽  
Drug Companies ◽  
The Us

As the opioid overdose crisis in the US persists, governments have coordinated with drug companies to propagate the overdose reversal drug naloxone (Narcan) as a ‘kinder/gentler’ state response, deriving from a supposedly progressive harm reduction ethos. Drawing on Derrida’s deconstruction of pharmakon, I show how Narcan is rendered paradoxical and terminal, diverting attention from the structural antecedents of opioid addiction and resources for drug treatment while reproducing corporeal suffering in those revived. I further highlight how Narcan is positioned in a wider array of regressive governing practices that legitimate the state’s punitive drug war and demonization of drug users. Narcan thus provides a useful opening between the state and contemporary biomedicine to theorize how harm reduction and public health unfurl in insidious and corrosive ways.

The neoliberal governance of heroin and opioid users in Philadelphia city

2021 ◽  
pp. 174165902199119
Author(s):  
Philip R Kavanaugh ◽  
Jennifer L Schally
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Drug Users ◽  
Policy Documents ◽  
Media Portrayals ◽  
Neoliberal Governance ◽  
Public Nuisance ◽  
Fiscal Austerity ◽  
Opioid Users ◽  
Governmental Response

Drawing on 147 news accounts and five policy documents on the heroin and opioid crisis in Philadelphia, Pennsylvania published between 2016 and 2018, our analysis highlights how media portrayals of opioid users as both tragic victims and public nuisance prompted a schizoid governmental response that draws on rhetorics of treatment and harm reduction to legitimate more punitive interventions. By describing how the state’s quasi-medical responsibilization strategy devolved to fold criminalization into its broader response, we argue the effort to wage a kinder/gentler war on overdose invests in familiar tropes of a recalcitrant drug user class that is a threat to public health. In doing so we provide a basis to critique how drug users are governed in this time of fiscal austerity, resource hoarding, and perpetual, continually evolving drug crises.

Recommendations of the Workshop on Injury Control and Public Health

PEDIATRICS ◽  
1990 ◽  
Vol 86 (6) ◽  
pp. 1091-1091
Keyword(s):  
Public Health ◽  
State Government ◽  
School Health ◽  
Local Level ◽  
The State ◽  
Injury Surveillance System ◽  
The Us ◽  
Us Government ◽  
State And Local ◽  
Injury Control

1. In each state department of public health, a focus for injury control should be responsible for developing objectives for injury control at the state and local level. 2. Injury control activities, including the state reporting of injuries and the development of a national injury surveillance system, should be funded adequately by the US government. 3. The US government and each state government should develop an explicit health policy for children. 4. The revenue that would be generated by a "user fee," a much heavier tax on tobacco and alcohol (alcohol plays a role in 40% to 50% of injuries) should be used to support public health programs for children. 5. A comprehensive school health education program should be established.

scholarly journals The State of the US Governmental Public Health Workforce, 2014–2017

2019 ◽  
Vol 109 (5) ◽  
pp. 674-680 ◽  
Author(s):  
Katie Sellers ◽  
Jonathon P. Leider ◽  
Elizabeth Gould ◽  
Brian C. Castrucci ◽  
Angela Beck ◽  
...  
Keyword(s):  
Public Health ◽  
Health Workforce ◽  
The State ◽  
Public Health Workforce ◽  
The Us

scholarly journals Becoming MSM: Sexual Minorities and Public Health Regimes in Vietnam

2021 ◽  
Vol 1 (1) ◽  
pp. 33-45
Author(s):  
Alfred Montoya
Keyword(s):  
Public Health ◽  
Sex Workers ◽  
Drug Users ◽  
Sexual Minorities ◽  
Colonial Period ◽  
Health And Wellbeing ◽  
Aids Epidemic ◽  
The Us ◽  
French Colonial ◽  
Hiv Aids

Abstract This article explores the discursive and practical marking of male sexual minorities in Vietnam, as targets of a series of biopolitical regimes whose aim, ostensibly, was and is to secure the health and wellbeing of the population (from the French colonial period to the present), regimes which linked biology, technoscientific intervention and normative sexuality in the service of state power. Campaigns against sex workers, drug users, and briefly male sexual minorities, seriously exacerbated the marginalization and stigmatization of these groups, particularly with the emergence of HIV/AIDS in Vietnam in 1990. This article also considers how the contemporary apparatus constructed to combat the HIV/AIDS epidemic, one funded by the US, did not do away with these old forms, but reinscribed them with new language within a new regime that prioritizes quantification and technoscience.

Harm reduction in Finnish drug policy: conceptual problems and contradictions

2002 ◽  
Vol 19 (4) ◽  
pp. 239-248
Author(s):  
Toivo Hurme
Keyword(s):  
Public Health ◽  
Human Rights ◽  
Harm Reduction ◽  
Drug Policy ◽  
Drug Users ◽  
Social Research ◽  
Policy Research ◽  
General Strategy ◽  
Public Health Perspective ◽  
Wide Range

The article discusses the use of the term “harm reduction” in Finland's contemporary drug policy. The focus is not on the meaning of the term, but rather on its actual use, on how “harm reduction” has been put into play in the governing of the drug question and what is done and has been claimed in the name of “harm reduction”. This brings to light the problems and contradictions that arise if “harm reduction” is taken as a standpoint for policy making or as an analytical tool for drug policy research. The paper reviews different connections and situations where “harm reduction” has been defined or used as an argument for general or specific goals and interventions. Harm reduction is often seen as a general strategy for national drug policy, as opposed to the traditional repressive and punitive strategy. On the other hand, it is also represented as pragmatic, reactive and situational work without general ideals or principles challenging repressive politics. Two main perspectives can be distinguished in the discussion on harm reduction: the human rights perspective and the public health perspective. From a human rights perspective harm reduction is advocated by stressing the rights and equality of drug users. The focus is on the harms that the strict policy of control is causing to abusers. Harm reduction from a public health perspective stresses the harms that drug abuse causes to the nation's population, such as HIV, accidents etc. On the side of these main trends, there are however a wide range of practices which are represented in the name of “harm reduction”, among these tighter police control and surveillance to efface the nuisance problems. The article concludes that in Finland, “harm reduction” is neither a coherent political approach to the drug question nor an exact concept for analytical social research. It is rather a slogan that is used in very different occasions by various political agents as an argument for different interventions, aiming for ideals and goals that might easily contradict each other.

scholarly journals Early COVID-19 Interventions Failed to Replicate 1918 St. Louis vs. Philadelphia Outcomes in the United States

2020 ◽  
Author(s):  
Aliea M. Jalali ◽  
Brent M. Peterson ◽  
Thushara Galbadage
Keyword(s):  
Public Health ◽  
United States ◽  
State Level ◽  
The United States ◽  
The State ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Public Health Response ◽  
Health Response ◽  
The Us

The Coronavirus disease 2019 (COVID-19) pandemic has elicited an abrupt pause in the United States in multiple sectors of commerce and social activity. As the US faces this health crisis, the magnitude, and rigor of their initial public health response was unprecedented. As a response, the entire nation shutdown at the state-level for the duration of approximately one to three months. These public health interventions, however, were not arbitrarily decided, but rather, implemented as a result of evidence-based practices. These practices were a result of lessons learned during the 1918 influenza pandemic and the city-level non-pharmaceutical interventions (NPIs) taken across the US. During the 1918 pandemic, two model cities, St. Louis, MO, and Philadelphia, PA, carried out two different approaches to address the spreading disease, which resulted in two distinctly different outcomes. Our group has evaluated the state-level public health response adopted by states across the US, with a focus on New York, California, Florida, and Texas, and compared the effectiveness of reducing the spread of COVID-19. Our assessments show that while the states mentioned above benefited from the implementations of early preventative measures, they inadequately replicated the desired outcomes observed in St. Louis during the 1918 crisis. Our study indicates that there are other factors, including health disparities that may influence the effectiveness of public health interventions applied. Identifying more specific health determinants may help implement targeted interventions aimed at preventing the spread of COVID-19 and improving health equity.

scholarly journals Effectiveness of harm reduction intervention: results of low threshold service centres‘ activity

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Perminiene ◽  
N Fatkulina
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Injection Drug Users ◽  
Drug Users ◽  
Health Centre ◽  
Risky Behaviour ◽  
The Public ◽  
Public Health Activity ◽  
Sexual Contacts ◽  
Low Threshold

Abstract Background Harm reduction programmes are recommended as an effective HIV prevention among injection drug users by the WHO and UN. Monitoring of clients' risky behaviour is carried out to evaluate the effectiveness of low threshold centres' (LTCs) activity, which allows assessment of services' effect on the public health. Aim Evaluation of effectiveness of LTCs' activity, changing clients' behaviour, during 1997-2019. Methods Analysis of LTCs’ documentation during 1997–2019; survey of the anonymous questionnaire carried out in the LTC of Klaipėda Mental Health Centre in 2019 (sample 130 people), comparison of the data with the results of 2001 survey. Results during 1997-2019 the average number of one client visits to the centre per year increased from 5 to131. The number of means supplied to clients was increasing: the amount of returned used syringes (83% in 1998, 101% in 2019) was increasing in comparison with the amount of issued sterile means. In 2001 58% of respondents who did not attend the centre would hand over used syringes to others while in 2019, after taking the centre services, the number dropped to 13%. A certain number of clients would accept used syringes until coming to the centres (in 2001 25% did not do this), after visits to the centres in 2019 91% did not use used syringes. Clients more often started using condoms with casual partners (17% in 2001, 84% in 2019). The more often clients attend the centres, the more of them take HIV tests (62% in 2001, 96% in 2019). 58% of respondents in 2001 and 97% of respondents in 2019 expressed a wish to give up drug use. Conclusions the activity of the LTCs during 1997-2019 attracted increasing number of drug users. The study demonstrated: activity of LTCs is effective in changing risky behaviour of drug users to a more safe one while injecting drugs and having sexual contacts. Majority of clients have a wish to stop using drugs and the more they attend the LTCs the more realistic possibility to do this they see. Key messages Monitoring of clients‘ risky behaviour is carried out to evaluate the effectiveness of low threshold centres‘ (LTCs) activity, which allows assessment of services‘ effect on the public health. Activity of LTCs is effective in changing risky behaviour of drug users to a more safe one while injecting drugs and having sexual contacts.

Using Surveillance With Near–Real-Time Alerts During a Cluster of Overdoses From Fentanyl-Contaminated Crack Cocaine, Connecticut, June 2019

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 18S-23S
Author(s):  
Peter Canning ◽  
Suzanne Doyon ◽  
Sarah Ali ◽  
Susan B. Logan ◽  
Aliese Alter ◽  
...  
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Real Time ◽  
Crack Cocaine ◽  
State Department ◽  
Poison Control ◽  
Opioid Overdose ◽  
Public Health Response ◽  
Mapping Tool ◽  
Health Response

In 2019, Connecticut launched an opioid overdose–monitoring program to provide rapid intervention and limit opioid overdose–related harms. The Connecticut Statewide Opioid Response Directive (SWORD)—a collaboration among the Connecticut State Department of Public Health, Connecticut Poison Control Center (CPCC), emergency medical services (EMS), New England High Intensity Drug Trafficking Area (HIDTA), and local harm reduction groups—required EMS providers to call in all suspected opioid overdoses to the CPCC. A centralized data collection system and the HIDTA overdose mapping tool were used to identify outbreaks and direct interventions. We describe the successful identification of a cluster of fentanyl-contaminated crack cocaine overdoses leading to a rapid public health response. On June 1, 2019, paramedics called in to the CPCC 2 people with suspected opioid overdose who reported exclusive use of crack cocaine after being resuscitated with naloxone. When CPCC specialists in poison information followed up on the patients’ status with the emergency department, they learned of 2 similar cases, raising suspicion that a batch of crack cocaine was mixed with an opioid, possibly fentanyl. The overdose mapping tool pinpointed the overdose nexus to a neighborhood in Hartford, Connecticut; the CPCC supervisor alerted the Connecticut State Department of Public Health, which in turn notified local health departments, public safety officials, and harm reduction groups. Harm reduction groups distributed fentanyl test strips and naloxone to crack cocaine users and warned them of the dangers of using alone. The outbreak lasted 5 days and tallied at least 22 overdoses, including 6 deaths. SWORD’s near–real-time EMS reporting combined with the overdose mapping tool enabled rapid recognition of this overdose cluster, and the public health response likely prevented additional overdoses and loss of life.

scholarly journals Evidence of Modeling Impact in Development of Policies for Controlling the Opioid Epidemic and Improving Public Health: A Scoping Review

2019 ◽  
Vol 13 ◽  
pp. 117822181986621 ◽  
Author(s):  
Nasser Sharareh ◽  
Shabnam S Sabounchi ◽  
Mary McFarland ◽  
Rachel Hess
Keyword(s):  
Public Health ◽  
Scoping Review ◽  
Conceptual Modeling ◽  
The United States ◽  
Opioid Addiction ◽  
Dynamics Simulation ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Opioid Epidemic ◽  
The Impact

Background: Opioid addiction and overdose rates are reaching unprecedented levels in the U.S., with around 47,736 overdose deaths in 2017. Many stakeholders affect the opioid epidemic, including government entities, healthcare providers and policymakers, and opioid users. Simulation and conceptual modeling can help us understand the dynamics of the opioid epidemic by simplifying the real world and informing policymakers about different health interventions that could reduce the deaths caused by opioid overdose in the United States every year. Objectives: To conduct a scoping review of simulation and conceptual models that propose policies capable of controlling the opioid epidemic. We demonstrate the strengths and limitations of these models and provide a framework for further improvement of future decision support tools. Methods: Using the methodology of a scoping review, we identified articles published after 2000 from eight electronic databases to map the literature that uses simulation and conceptual modeling in developing public health policies to address the opioid epidemic. Results: We reviewed 472 papers of which 14 were appropriate for inclusion. Each used either system dynamics simulation modeling, mathematical modeling, conceptual modeling, or agent-based modeling. All included studies tested and proposed strategies to improve health outcomes related to the opioid epidemic. Factors considered in the models included physicians prescribing opioids, trafficking, users recruiting new users, and doctor shopping; no model investigated the impact of age and spatial factors on the dynamics of the epidemic. Key findings from these studies were (1) prevention of opioid initiation is better than treatment of opioid addiction, (2) the analysis of an intervention’s impact should include both benefits and harms, and (3) interventions with short-term benefits might have a counterproductive impact on the epidemic in long run. Conclusions: While most studies examined the role of prescription opioids and trafficking on this epidemic, the transition of patients from prescription opioid use to nonprescription use including heroin and synthetic opioids such as fentanyl impacts the system significantly and results in an epidemic with quite different characteristics than what it had a decade ago. We recommend including the impact of age and geographic location on the opioid epidemic using modeling methods.

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