scholarly journals Towards cross-Canada monitoring of the unregulated street drug supply

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emily Biggar ◽  
Kristi Papamihali ◽  
Pascale Leclerc ◽  
Elaine Hyshka ◽  
Brittany Graham ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Monitoring System ◽  
Well Being ◽  
People Who Use Drugs ◽  
Drug Supply ◽  
Knowledge Mobilization ◽  
Survey Tool ◽  
Urine Toxicology ◽  
Early Results ◽  
Crack Use

Abstract Background The well-being of people who use drugs (PWUD) continues to be threatened by substances of unknown type or quantity in the unregulated street drug supply. Current efforts to monitor the drug supply are limited in population reach and comparability. This restricts capacity to identify and develop measures that safeguard the health of PWUD. This study describes the development of a low-barrier system for monitoring the contents of drugs in the unregulated street supply. Early results for pilot sites are presented and compared across regions. Methods The drug content monitoring system integrates a low-barrier survey and broad spectrum urine toxicology screening to compare substances expected to be consumed and those actually in the drug supply. The system prototype was developed by harm reduction pilot projects in British Columbia (BC) and Montreal with participation of PWUD. Data were collected from harm reduction supply distribution site clients in BC, Edmonton and Montreal between May 2018–March 2019. Survey and urine toxicology data were linked via anonymous codes and analyzed descriptively by region for trends in self-reported and detected use. Results The sample consisted of 878 participants from 40 sites across 3 regions. Reported use of substances, their detection, and concordance between the two varied across regions. Methamphetamine use was reported and detected most frequently in BC (reported: 62.8%; detected: 72.2%) and Edmonton (58.3%; 68.8%). In Montreal, high concordance was also observed between reported (74.5%) and detected (86.5%) cocaine/crack use. Among those with fentanyl detected, the percentage of participants who used fentanyl unintentionally ranged from 36.1% in BC, 78.6% in Edmonton and 90.9% in Montreal. Conclusions This study is the first to describe a feasible, scalable monitoring system for the unregulated drug supply that can contrast expected and actual drug use and compare trends across regions. The system used principles of flexibility, capacity-building and community participation in its design. Results are well-suited to meet the needs of PWUD and inform the local harm reduction services they rely on. Further standardization of the survey tool and knowledge mobilization is needed to expand the system to new jurisdictions.

scholarly journals Shifting the paradigm: physician-authorized, student-led efforts to provide harm reduction services amidst legislative opposition

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Timothy P. McMullen ◽  
Mahan Naeim ◽  
Carol Newark ◽  
Haden Oliphant ◽  
Jeffrey Suchard ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Harm Reduction ◽  
Orange County ◽  
Well Being ◽  
The United States ◽  
Needle Exchange Program ◽  
People Who Use Drugs ◽  
State Governments ◽  
Syringe Access ◽  
Increased Risk

Abstract Background For over 30 years, syringe services programs (SSPs) have served as an efficacious intervention for the prevention of HIV and Hepatitis C transmission among persons who use drugs. Despite a strong body of evidence for the effectiveness of SSPs as a preventative public health measure, numerous local and state governments in the United States continue to resist the establishment of new SSPs and aggressively pursue the closure of those already in operation. Commentary In Orange County, California, local officials have repeatedly mobilized in opposition of the establishment of syringe access – thereby hindering access to healthcare for thousands of predominantly unhoused individuals. The county was previously served by the Orange County Needle Exchange Program from 2016 until 2018 when a civil suit brought by the Orange County Board of Supervisors resulted in the closure of the program. For more than 2 years, persons who inject drugs in Orange County lacked reliable access to clean syringes, placing them at increased risk for contracting HIV and Hepatitis C. Here, we comment on the ongoing effort to restore syringe access in Orange County. This collaborative physician-directed endeavor has brought together students and community volunteers to provide vital harm reduction services to a remarkably underserved population. Since the reestablishment of syringe access in Orange County by the Harm Reduction Institute, new legal barriers have arisen including the passage of new municipal legislation banning the operation of syringe exchanges. We are well-equipped to overcome these obstacles. This work serves as an affirmation of assertions made by previous authors regarding the unique qualifications of medical & graduate students as effective harm reductionists. Conclusion Harm reduction services are vital to the health and well-being of people who use drugs. The provision of these services should not be impeded by legislative interference by municipal, county, or state governments.

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.

Auras of Detection: Power and Knowledge in Drug Prohibition

2021 ◽  
pp. 009145092110354
Author(s):  
Jennifer J. Carroll
Keyword(s):  
Law Enforcement ◽  
Knowledge Production ◽  
Illicit Drug ◽  
Drug Market ◽  
Epistemic Authority ◽  
People Who Use Drugs ◽  
Drug Supply ◽  
Political Implications ◽  
Starting Point ◽  
Drug Checking

Drug checking is an evidence-based strategy for overdose prevention that continues to operate (where it operates) in a legal “gray zone” due to the legal classification of some drug checking tools as drug paraphernalia—the purview of law enforcement, not public health. This article takes the emergence of fentanyl in the U.S. drug supply as a starting point for examining two closely related questions about drug checking and drug market expertise. First, how is the epistemic authority of law enforcement over the material realities of the drug market produced? Second, in the context of that authority, what are the socio-political implications of technologically advanced drug checking instruments in the hands of people who use drugs? The expertise that people who use drugs maintain about the nature of illicit drug market and how to navigate the illicit drug supply has long been discounted as untrustworthy, irrational, or otherwise invalid. Yet, increased access to drug checking tools has the potential to afford the knowledge produced by people who use drugs a technological validity it has never before enjoyed. In this article, I engage with theories of knowledge production and ontological standpoint from the field of science, technology, and society studies to examine how law enforcement produces and maintains epistemic authority over the illicit drug market and to explore how drug checking technologies enable new forms of knowledge production. I argue that drug checking be viewed as a form of social resistance against law enforcement’s epistemological authority and as a refuge against the harms produced by drug criminalization.

scholarly journals Civil society involvement in harm reduction drug policy: reflections on the past, expectations for the future

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Aileen O’Gorman ◽  
Eberhard Schatz
Keyword(s):  
Civil Society ◽  
Harm Reduction ◽  
Lived Experience ◽  
Political Institutions ◽  
Drug Policy ◽  
Policy Development ◽  
Policy Decision ◽  
People Who Use Drugs ◽  
Annual Conference ◽  
Health Crisis

Abstract Background A range of civil society organisations (CSOs) such as drug user groups, non-governmental/third sector organisations and networks of existing organisations, seek to shape the development of drugs policy at national and international levels. However, their capacity to do so is shaped by the contexts in which they operate nationally and internationally. The aim of this paper is to explore the lived experience of civil society participation in these contexts, both from the perspective of CSOs engaged in harm reduction advocacy, and the institutions they engage with, in order to inform future policy development. Methods This paper is based on the presentations and discussions from a workshop on ‘Civil Society Involvement in Drug Policy hosted by the Correlation - European Harm Reduction Network at the International Society for the Study of Drugs Policy (ISSDP) annual conference in Paris, 2019. In the aftermath of the workshop, the authors analysed the papers and discussions and identified the key themes arising to inform CSI in developing future harm reduction policy and practice. Results Civil society involvement (CSI) in policy decision-making and implementation is acknowledged as an important benefit to representative democracy. Yet, the accounts of CSOs demonstrate the challenges they experience in seeking to shape the contested field of drug policy. Negotiating the complex workings of political institutions, often in adversarial and heavily bureaucratic environments, proved difficult. Nonetheless, an increase in structures which formalised and resourced CSI enabled more meaningful participation at different levels and at different stages of policy making. Conclusions Civil society spaces are colonised by a broad range of civil society actors lobbying from different ideological standpoints including those advocating for a ‘drug free world’ and those advocating for harm reduction. In these competitive arena, it may be difficult for harm reduction orientated CSOs to influence the policy process. However, the current COVID-19 public health crisis clearly demonstrates the benefits of partnership between CSOs and political institutions to address the harm reduction needs of people who use drugs. The lessons drawn from our workshop serve to inform all partners on this pathway.

scholarly journals Peer driven or driven peers? A rapid review of peer involvement of people who use drugs in HIV and harm reduction services in low- and middle-income countries

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Judy Chang ◽  
Shaun Shelly ◽  
Machteld Busz ◽  
Claudia Stoicescu ◽  
Arif Rachman Iryawan ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Resource Scarcity ◽  
Rapid Review ◽  
People Who Use Drugs ◽  
Financial Barriers ◽  
Community Knowledge ◽  
Middle Income ◽  
Peer Involvement ◽  
Stigma And Discrimination ◽  
Low And Middle Income

Abstract Introduction Peer involvement of people who use drugs within HIV and harm reduction services is widely promoted yet under-utilised. Alongside political and financial barriers is a limited understanding of the roles, impacts, contexts and mechanisms for peer involvement, particularly in low- and middle-income settings. We conducted a rapid review of available literature on this topic. Methods Within a community-academic partnership, we used a rapid review approach, framed by realist theory. We used a network search strategy, focused on core journals and reference lists of related reviews. Twenty-nine studies were included. We developed thematic summaries framed by a realist approach of exploring interventions, their mechanisms, outcomes and how they are shaped by contexts. Results Reported outcomes of peer involvement included reduced HIV incidence and prevalence; increased service access, acceptability and quality; changed risk behaviours; and reduced stigma and discrimination. Mechanisms via which these roles work were trust, personal commitment and empathy, using community knowledge and experience, as well as ‘bridge’ and ‘role model’ processes. Contexts of criminalisation, under-resourced health systems, and stigma and discrimination were found to shape these roles, their mechanisms and outcomes. Though contexts and mechanisms are little explored within the literature, we identified a common theme across contexts, mechanisms and outcomes. Peer outreach interventions work through trust, community knowledge and expertise, and ‘bridge’ mechanisms (M) to counter criminalisation and constraining clinic and service delivery environments (C), contributing towards changed drug-using behaviours, increased access, acceptability and quality of harm reduction services and decreased stigma and discrimination (O). Conclusion Peer involvement in HIV and harm reduction services in low- and middle-income settings is linked to positive health outcomes, shaped by contexts of criminalisation, stigma, and resource scarcity. However, peer involvement is under-theorised, particularly on how contexts shape mechanisms and ultimately outcomes. Efforts to study peer involvement need to develop theory and methods to evaluate the complex mechanisms and contexts that have influence. Finally, there is a need to expand the range of peer roles, to embrace the capacities and expertise of people who use drugs.

scholarly journals Features and trends of offenses in economic activity

2020 ◽  
Vol 2 (2) ◽  
pp. 309-316
Author(s):  
Olena Parshyna ◽  
Yuriy Parshyn
Keyword(s):  
Monitoring System ◽  
National Economy ◽  
Economic Activity ◽  
Negative Impact ◽  
Well Being ◽  
Research Subjects ◽  
Systematic Analysis ◽  
The Government ◽  
Complex Monitoring ◽  
Economic Crimes

Offenses have a negative impact on the socio-economic development of the country and make a threat to the security of the national economy. Systematic analysis of the offenses in the sphere of economic activity with the quantitative as-sessment of their reimbursement and identification of the main trends during the research has been carried out. The offenses in the field of economic activity are the object of the research. The research subjects are scientific, methodological and applied aspects of the offenses analysis in relation to the main types of economic activity in the national economy. It has been noted that the criminal situation in our country is characterized by increasing in the economic crimes. Economic crimes are becoming systematic and have organized character. The high level of correlation between the unemployment situation and the negative crimes trends has been discovered. Economic crimes include economic, political, legal, socio-psychological and organizational reasons and conditions. The complex monitoring system in order to solve problem of the combating economic crimes has been proposed. The effectiveness of such system can be achieved in two main ways. The first way concerns the development of measures that is aimed at the economic crimes preventing. Thus, we have the reduction of the crimes number. The second way involves the development of measures for the disclosure of the committed offenses of economic nature and the achievement of full reimbursement for the incurred losses. However, an important component of the complex system should be the ability to monitor, forecast and identify these sectors of the economy in which the possible offenses in the strategic foresight should be expected. The continuous monitoring with forecasting enables to develop and implement the appropriate preventive measures. Studies of the economic activities with their efficiency in the formation of GDP of Ukraine have been conducted. Dynamics of the committed offenses on the types of economic activity has been analyzed. The quantitative assessment of the material losses reimbursement of these offenses has been provided. The main causes of the committed offenses in the economic sectors have been considered. The national measures for the prevent economic crimes are: strengthening of the role and increasing of the trust to the government and its institutions; paradigm shift of the decision-making mechanism in the field of credit and financial system; development of the special mechanisms for preventing of the destabilizing tendencies both at the level of regional development and at the level of national economy. The complex monitoring system allows to identify sectors of the national economy in the aspect of strategic forecasting. Monitoring enables to develop the preventative measures which are aimed at the improving of the environment, creating of the preconditions for the economic growth and improving of the well-being of population.

scholarly journals Online Child’s Health Assessment Tool for Obesity Prevention Programming

2018 ◽  
Vol 13 (3) ◽  
pp. 237-258
Author(s):  
Laura A. Palmer ◽  
Kimberly J. McCarthy ◽  
Daniel F. Perkins ◽  
Lynne M. Borden ◽  
Jennifer M. DiNallo
Keyword(s):  
Online Survey ◽  
Technical Assistance ◽  
Assessment Tool ◽  
Health Assessment ◽  
Well Being ◽  
Program Improvement ◽  
Quality Improvements ◽  
Survey Tool ◽  
Continuous Quality ◽  
Physical Activity Programming

To optimize public health in the next decade, prevention of childhood obesity will remain a central focus. To impact behavioral change, data must be linked to continuous quality improvements within existing nutrition and physical activity programming. The Children, Youth, and Families At-Risk Professional Development and Technical Assistance Center has developed a picture-based, online survey tool, the CYFAR Health Assessment Tool (CHAT), to assess health behaviors in youth ages 6 to18 years of age. Used for continuous program improvement, aggregate data results are coupled with tailored health recommendations in 4 domains (behavior and environmental modifications, education, and direct strategies) and evidence-informed resources for dissemination to youth and parents. Program implementers use the data and resources for targeted programmatic improvements that more effectively promote health and well-being. CHAT also informs our collective understanding of youth’s perceptions of health in comparison to their actual behaviors.  

scholarly journals Impact of COVID-19 on the mental health of healthcare workers in different regions of the world

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S258-S258
Author(s):  
Mahfuja Islam ◽  
Philip George ◽  
Sindhu Sankaran ◽  
Janet Leu Su Hui ◽  
Tzun Kit
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Psychological Distress ◽  
Healthcare Workers ◽  
Well Being ◽  
Subjective Assessment ◽  
Survey Tool ◽  
Frontline Workers ◽  
The World ◽  
The Impact

AimsThe global health system is facing a serious challenge after the recent outbreak of COVID-19 coronavirus infection which was first identified in Wuhan, China in November 2019 and declared as a pandemic in March 2020 by WHO. There is a wide consensus that this pandemic has negative psychosocial consequences as well as unforeseeable provision of mental health care services and just not on physical health alone. The aim of this research study is to determine the prevalence of psychological distress and to identify the sociodemographic variables with the main attributable factors associated with the psychological distress among healthcare workers and suggestions on how to reduce the impact on the mental health of healthcare workers during the COVID-19 pandemic in different regions of the world.MethodWe performed a cross-sectional study from September-November 2020. We used a self-administered survey tool which was distributed electronically to healthcare workers across the globe. The data were stored on an online database with password protected devices where survey responses were restricted to investigators exclusively.Data collected were: 1) Socio-demographic data (age, gender, marital status, ethnicity, religion, role in the healthcare, region of practice); 2) Psychological General Well-Being Index (PGWBI) questionnaire which contains 22 standardized items. This is a subjective assessment to score the degree of psychological well-being by focusing on 6 domains: depression; anxiety; positive-well-being; self-control; vitality and general health; 3) Subjective assessment from respondents of the main attributable factors causing psychological distress and suggested methods to help reduce the impact on mental health on health care workers.ResultMajority out of the 217 respondents were from a younger age group; females and married/domestic partnership, mainly from Western Pacific Region, South East Asian and the African Region. More than half the respondents were moderate-severely psychologically distressed and the three main attributable factors causing psychological distress were: fear of family/friends contracting COVID-19 followed by lack of PPE and discomfort caused by wearing PPE for long hours. Respondents suggested that the distress would be reduced if: more resources were provided in hospital; protocols and guidelines were implemented and counselling facilities with recreational activities were available to frontline workers.ConclusionThis study showed that the COVID-19 pandemic has affected the mental health of healthcare workers and more support or strategies need to come in place to protect frontline workers at the time of crises.

Harm Reduction Policy for the Opioid Epidemic

2019 ◽  
Author(s):  
Yngvild Olsen ◽  
Joshua M. Sharfstein
Keyword(s):  
Social Justice ◽  
Drug Use ◽  
Harm Reduction ◽  
People Who Use Drugs ◽  
Opioid Epidemic ◽  
Negative Consequences

What is harm reduction? Harm reduction is “a set of practical strategies aimed at reducing negative consequences associated with drug use.” It is also “a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”...

scholarly journals Community-Based Watershed Change: A Case Study in Eastern Congo

Forests ◽  
2019 ◽  
Vol 10 (6) ◽  
pp. 475
Author(s):  
Scott Sabin ◽  
Birori Dieudonne ◽  
John Mitchell ◽  
Jared White ◽  
Corey Chin ◽  
...  
Keyword(s):  
Well Being ◽  
Community Action ◽  
Tree Planting ◽  
Theory Of Change ◽  
Environmental Restoration ◽  
Community Forest Management ◽  
Community Based ◽  
Early Results ◽  
Eastern Congo

Conflict and environmental degradation in the Democratic Republic of the Congo are interrelated and complex. The authors conducted a case study of a community-based environmental restoration project in Eastern Congo and provide early results which suggest a link between community environmental action and multidimensional outcomes such as peace and reconciliation. The project examined in this study is based on a framework (Theory of Change) which networks communities through autonomous savings groups, churches, mosques, schools, and a community leadership network with the goal of catalyzing sustainable farming, reforestation, and community forest management. The primary project input was training, and the resulting voluntary community action included tree planting and the management of common forest areas. A mixed-methods approach was used to evaluate project results comparing two watersheds, and included a difference in differences analysis, participatory workshops, remote sensing analysis, and community activity reports. Positive change was observed in the treatment watershed in terms of ecosystem health and household economic condition. Results suggest a possible influence on peace conditions which, while fragile, offers hope for continued restorative action by communities. This study provides evidence that a community-based approach to environmental restoration may have a positive influence on multidimensional issues such as forests, watershed health, economic well-being, and peace.

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