scholarly journals Hostility, compassion and role reversal in West Virginia’s long opioid overdose emergency

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Jeff Ondocsin ◽  
Sarah G. Mars ◽  
Mary Howe ◽  
Daniel Ciccarone
Keyword(s):  
Drug Use ◽  
West Virginia ◽  
Harm Reduction ◽  
Ethnographic Study ◽  
Role Reversal ◽  
Opioid Overdose ◽  
Snowball Sampling ◽  
Risk Environment ◽  
Structured Interviews ◽  
Needle And Syringe Program

Abstract Background West Virginia is a largely rural state with strong ties of kinship, mutual systems of support and charitable giving. At the same time, wealth inequalities are extreme and the state’s drug overdose fatality rate stands above all others in the USA at 51.5/100,000 in 2018, largely opioid-related. In recent years, harm reduction services have been active in the state but in 2018 Charleston’s needle and syringe program was forced to close. This paper considers the risk environment in which the state’s drug-related loss of life, and those attempting to prevent it, exist. Methods This rapid ethnographic study involved semi-structured interviews (n = 21), observation and video recordings of injection sequences (n = 5), initially recruiting people who inject heroin/fentanyl (PWIH) at the Charleston needle and syringe program. Snowball sampling led the research team to surrounding towns in southern West Virginia. Telephone interviews (n = 2) with individuals involved in service provision were also carried out. Results PWIH in southern West Virginia described an often unsupportive, at times hostile risk environment that may increase the risk of overdose fatalities. Negative experiences, including from some emergency responders, and fears of punitive legal consequences from calling these services may deter PWIH from seeking essential help. Compassion fatigue and burnout may play a part in this, along with resentment regarding high demands placed by the overdose crisis on impoverished state resources. We also found low levels of knowledge about safe injection practices among PWIH. Conclusions Hostility faced by PWIH may increase their risk of overdose fatalities, injection-related injury and the risk of HIV and hepatitis C transmission by deterring help-seeking and limiting the range of harm reduction services provided locally. Greater provision of overdose prevention education and naloxone for peer distribution could help PWIH to reverse overdoses while alleviating the burden on emergency services. Although essential for reducing mortality, measures that address drug use alone are not enough to safeguard longer-term public health. The new wave of psychostimulant-related deaths underline the urgency of addressing the deeper causes that feed high-risk patterns of drug use beyond drugs and drug use.

scholarly journals Harm reduction via online platforms for people who use drugs in Russia: a qualitative analysis of web outreach work

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Arsen Davitadze ◽  
Peter Meylakhs ◽  
Aleksey Lakhov ◽  
Elizabeth J. King
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Injection Drug Use ◽  
Injection Drug ◽  
People Who Use Drugs ◽  
Structured Interviews ◽  
Advantages And Disadvantages ◽  
Online Platforms ◽  
Outreach Work ◽  
Outreach Workers

Abstract Background Harm reduction services to people who use drugs (PWUD) in Russia are insufficient in terms of quantity, government endorsement, and accessibility. The situation has recently deteriorated even further because of social distancing measures of the COVID-19 pandemic. Several organizations have started to provide some harm reduction services via online platforms by web outreach. However, little is known on how online outreach services are organized and implemented. Drawing on the example of St. Petersburg-based NGO “Humanitarian Action,” we explored web outreach work in Telegram instant messenger. Methods Our data were comprised of 4 semi-structured interviews with the NGO staff and 301 cases of web outreach work with PWUD. We used thematic analysis to study the process of web outreach, harm reduction service provision, and needs of PWUD. Results Three stages of the process of web outreach work were identified: clients initiating communication, NGO workers addressing clients’ needs, and NGO workers receiving clients’ feedback. Communication proceeded in group chat or direct messages. Challenges in addressing clients’ needs happened when clients turned for help after hours, sent recorded voice messages, sent unclear messages, and/or were unwilling to transition to telephone communication. All web outreach workers reported receiving only positive feedback on their work. The needs of PWUD were categorized into two major themes, depending on whether they can be addressed fully or partially online. In cases of online only provision of services, web outreach workers helped PWUD treat minor injection drug use complications, obtain verified harm reduction information and receive general psychological support. In instances of partial online services provision, PWUD were assisted in getting treatment of severe injection drug use complications, overdoses, and in accessing offline medical, psychological, social, legal and harm reduction services. Conclusions Our research demonstrated that web outreach work is a convenient tool for delivering some harm reduction services to PWUD either partially or completely online and for recruiting new clients (including hard-to-reach PWUD that avoid attending brick-and-mortar facilities). Harm reduction organizations should consider incorporating online harm reduction services into their activities. However, further research is needed to explore relative advantages and disadvantages of online harm reduction services.

Finding the movement: the geographies of social movement scenes

2016 ◽  
Vol 36 (11/12) ◽  
pp. 792-807 ◽  
Author(s):  
Kimberly Creasap
Keyword(s):  
Social Movement ◽  
Central Business District ◽  
Ethnographic Study ◽  
Housing Tenure ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Content Type ◽  
Spatial Dimensions ◽  
Business District ◽  
Commercial Landscape

Purpose A social movement scene is “a network of people who share a set of subcultural or countercultural beliefs, values, norms, and convictions as well as a network of physical spaces where members of that group are known to congregate” (Leach and Haunss 2009, p. 260, emphasis in the original). The purpose of this paper is to further develop theories of social movement scenes by examining the spatial dimensions of proximity, centrality, visibility, and accessibility, arguing that different scene configurations are shaped by gentrification processes. Design/methodology/approach This is an ethnographic study based on research conducted in Sweden over a five year period (2007-2012), including several summer research trips and a sustained fieldwork period of 14 months. Using snowball sampling, the author conducted semi-structured interviews with 38 activists involved in autonomous movement scenes. The author interviewed both men (n=26) and women (n=12) who ranged in age from 18 to 37, with most interviewees in their late 20s and early 30s. Findings Findings suggest that neighborhoods in the early stages of gentrification are most conducive to strong scenes. The author’s findings suggest that, while some of these conditions are locally specific, there were common structural conditions in each city, such as changes in the commercial landscape and housing tenure. Originality/value This paper contributes to the specificity of the concept of a social movement scene by presenting three spatial dimensions of scenes: centrality (relative to the Central Business District), concentration (clustering of scene places in one area of the city), and visibility (a visible presence communicated by signs and symbols). A second contribution of this paper is to offer a set of hypotheses about the urban conditions under which social movement scenes thrive (or fizzle).

scholarly journals Drug Use, Homelessness and Health: Responding to the Opioid Overdose Crisis with Housing and Harm Reduction Services

2021 ◽  
Author(s):  
katrina milaney
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Housing Instability ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Chi Square ◽  
Increased Risk ◽  
Reported Data ◽  
Structural Inequities ◽  
Hospital Use

Abstract Background Canada is in the midst of an opioid overdose crisis and Alberta has one of the highest opioid use rates across the country. Populations made vulnerable through structural inequities who also use opioids, such as those who are unstably housed, are at an increased risk of experiencing harms associated with opioid use. The main purpose of this study was to explore if there was an association between unstable housing and hospital use for people who use opioids. Methods Analysis utilized self-reported data from the Alberta Health and Drug Use Survey which surveyed 813 Albertans in three cities. Hospital use was modeled using a logistic regression with our primary variable of interest being housing unstable status. Chi square tests were conducted between hospital use and variables associated with demographics, characteristics of drug use, health characteristics, and experiences of receiving services to establish model inclusion. Results Results revealed a significant association between housing instability and hospital use.with unstably housed individuals twice as likely torequire hospital care. Conclusions Results highlight the importance of concurrently addressing housing instability alongside the provision of harm reduction services such assafe supply and supervised consumption sites. These findings have significant implications for policy and policymakers during the opioid overdose epidemic, and provide a foundation for future areas of research.

scholarly journals A critical exploration of professional perceptions of harm reduction policy and practice in Vietnam

2021 ◽  
Author(s):  
◽  
Tuan Dung Truong
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Quantitative Methods ◽  
Brain Diseases ◽  
People Who Use Drugs ◽  
Structured Interviews ◽  
Policy And Practice ◽  
Public Health Perspective ◽  
Qualitative And Quantitative Methods ◽  
Reduction Strategies

<p>Throughout the 1990s, Vietnam experienced a dramatic rise in the prevalence of HIV among people who use drugs. In response, Vietnam’s Ministry of Health implemented several legal and policy interventions in the name of harm reduction. However, perceptions about drug use, people who use drugs, addiction and the nature of official interventions are contested. For many Vietnamese officials, abstinence remains the dominant philosophy. Drug use is considered a ‘social evil’ in Vietnam and people who use drugs face draconian controls and incarceration in the name of treatment and crime prevention.  Against this background, this thesis explores how key stakeholders perceive harm reduction philosophy and how they apply it in policy and practice. Based on qualitative and quantitative methods, it presents findings from a survey with 250 respondents and 26 semi-structured interviews, all with professionals involved in responding to drug use in Vietnam. The thesis illustrates that these professionals prefer abstinence approaches, and often see addiction as the result of moral failings and brain diseases.  While some interventions in the name of harm reduction are accepted, they are firmly rooted within a narrow public health perspective. Professional misperceptions about the key principles and practices of ‘authentic’ harm reduction are widespread. Many professionals believe, for example, that harms can only be limited through reductions in the demand and supply of drugs, or that detaining people who use drugs in compulsory treatment centres is a form of harm reduction.  These rationales have resulted in continuing police crackdowns, and the use of ‘pseudo’ harm reduction strategies to control and punish people who use drugs. Meanwhile, there are limited official attempts to address problems experienced by people who use drugs, like social isolation, stigma, discrimination, human rights violations, or problems of community reintegration. In conclusion, while a harm reduction rhetoric is regularly employed in Vietnam, ‘pseudo’ harm reduction strategies are carried out.</p>

scholarly journals "Drugs Are a Taboo”: A Qualitative Study on Young People's Perspective on The Role of Education and Harm Reduction Strategies Associated With The Use of Psychoactive Substances Before Adulthood

2020 ◽  
Author(s):  
Gabriela Almeida Pinto da Silva ◽  
Catarina Pinto Pereira ◽  
Marta Sofia de Sousa Pinto
Keyword(s):  
Young People ◽  
Drug Use ◽  
Harm Reduction ◽  
School Environment ◽  
Psychoactive Substances ◽  
Structured Interviews ◽  
Policy And Practice ◽  
Online Questionnaire ◽  
Lack Of Information ◽  
Multi Method Approach

Abstract Background The use of psychoactive substances frequently starts at a younger age than adulthood. Having in mind the advantages of taking into consideration the youth perspective, this retrospective study tried to provide them with a role in identifying their own needs regarding drug use focused interventions, the obstacles in accessing both general health and harm reduction services; the changes needed for a more effective, congruent and empowering response to the use of psychoactive substances before the age of 18.Methods The study was divided into two parts. Both parts had a qualitative focus complemented with a quantitative dimension and were supported by a multi-method approach. The first part was comprised of a questionnaire sent online to all harm reduction teams and two focus groups with eight harm reduction professionals and six people who use(d) drugs. The second part used an online questionnaire applied to 143 participants aged between the age of 18 to 25 complemented by two semi-structured interviews.Results The need for Information, Education and Communication (IEC) Activities in the drug education field, namely in the educational context; the lack of information about available services; the need for confidentiality were the most mentioned issues by the young people. Also, the informal network played a significant role in the participants relationship with psychoactive substances.Conclusions The lack of information was the most highlighted obstacle. Also, there is a confluence of various vulnerabilities such as being under 18, using drugs and the different social situations that they live in. To improve policy and practice regarding drug use among young people, harm reduction interventions must be scaled-up as well as intentionally driven to empower youth to deal with. School environment was chosen by participants as one of the elected environments to implement Harm Reduction services.

scholarly journals Assessment of Policies and Harm Reduction Services for Young People Who Use Drugs in Kathmandu Valley of Nepal: Identifying Gaps and Opportunities

2022 ◽  
Author(s):  
Ishwor Maharjan
Keyword(s):  
Young People ◽  
Harm Reduction ◽  
Service Providers ◽  
People Who Use Drugs ◽  
Kathmandu Valley ◽  
Risk Environment ◽  
Structured Interviews ◽  
Donor Funding ◽  
Border Regions ◽  
Age Of Consent

Abstract Background: Young people under 30 represent the majority of people who use drugs in the Kathmandu Valley, Nepal. Young people who use drugs (YPWUD) may have particular needs and require different service and policy responses when compared to their older peers. This research examines the strengths and limitations of currently available policies and services; their effectiveness in meeting the needs of YPWUD and identifies gaps and opportunities for their improvement.Methodology: Semi-structured interviews (n=9) with key stakeholders and one focus group (n=5) discussion with YPWUD were conducted. Results were analyzed using the Rhodes Risk Environment framework which considers the ‘physical’, ‘social’, ‘economic’ and ‘policy’ level factors shaping risk at ‘micro’, ‘meso’ and ‘macro’ levels.Results: Drug use patterns among YPWUD in the Kathmandu Valley, Nepal are changing. Several trends have been identified including increased use of methamphetamine, diverted pharmaceuticals and ‘Southasian-Cocktail’ (a mixture of buprenorphine, benzodiazepine and antihistamines); use at the border regions and a move away from drug dealing ‘hotspots’ to online drug purchasing. YPWUD and service providers report a range of barriers to accessing services including stigma and discrimination; a lack of local services; a lack of knowledge of existing services; age of consent legislation and opening hours which may conflict with commitments such as school and college. YPWUD report a range of human rights violations including involuntary treatment, arbitrary detention, forced labour and public body searches. Service providers and policymakers report precarious international donor funding of services through HIV prevention programs with little to no youth-specific services for YPWUD.Conclusion: The findings of this study highlight the importance of youth-friendly harm reduction services that are relevant and responsive to the unique needs and experiences of YPWUD. These services should address current trends including the use of new substances (for example, methamphetamine and ‘Southasian Cocktail’) in diverse environments (including at the border regions and online). The perspectives of YPWUD are vital while developing and implementing harm reduction programs to ensure that the programs are effective, efficient and based on the diverse needs of YPWUD.

scholarly journals “Drugs are a taboo”: a qualitative and retrospective study on the role of education and harm reduction strategies associated with the use of psychoactive substances under the age of 18

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Gabriela Almeida Pinto da Silva ◽  
Catarina Pinto Pereira ◽  
Marta Sofia de Sousa Pinto
Keyword(s):  
Retrospective Study ◽  
Young People ◽  
Drug Use ◽  
Harm Reduction ◽  
School Environment ◽  
Psychoactive Substances ◽  
Structured Interviews ◽  
Policy And Practice ◽  
Online Questionnaire ◽  
Lack Of Information

Abstract Background The use of psychoactive substances frequently starts at a younger age than adulthood. Considering the perspective of young people, this retrospective study tried to provide them with a role in identifying their own needs regarding drug use and interventions focused on it; the obstacles in accessing both general health and harm reduction services; the changes needed for a more effective, congruent and empowering response to the use of psychoactive substances before the age of 18. Methods The study was divided into two parts having both parts a qualitative focus. In the first part of the study, an online questionnaire was sent to all harm reduction teams and two focus groups were carried out with eight harm reduction professionals and six people who use(d) drugs. The second part used an online questionnaire applied to 143 participants aged between the age of 18 and 25 complemented by two semi-structured interviews. Results The need for education about psychoactive substances, namely in the educational context; the lack of information about available services; and the need for confidentiality were the most mentioned issues by the young people. Also, the informal network played a significant role in the participants relationship with psychoactive substances. Conclusions The lack of information was the most highlighted obstacle. Also, there is a confluence of various vulnerabilities such as being under 18, using drugs and the different social situations that they live in. To improve policy and practice regarding drug use among young people, harm reduction interventions must be scaled-up as well as intentionally driven to empower youth to deal with. School environment was chosen by participants as one of the elected environments to implement harm reduction services.

Facilitators, barriers and lessons learnt from the first state-wide naloxone distribution conducted in West Virginia

2020 ◽  
pp. injuryprev-2020-043666
Author(s):  
Toni Marie Rudisill ◽  
Alexandria J Ashraf ◽  
Herbert I Linn ◽  
Sheena Sayres ◽  
James E Jeffries ◽  
...  
Keyword(s):  
West Virginia ◽  
Large Scale ◽  
Qualitative Content Analysis ◽  
Opioid Overdose ◽  
Collaborative Partnerships ◽  
Fire Departments ◽  
Structured Interviews ◽  
Programme Implementation ◽  
External Stakeholders ◽  
The Impact

BackgroundOverdose education and naloxone distribution programmes are known to reduce opioid-related deaths. A state-wide naloxone distribution effort of 8250 rescue kits was undertaken by government, community and university partners in West Virginia in 2016–2017. The purpose of this study was to discern the barriers, facilitators and lesson learnt from implementing this endeavour in a rural state with the highest opioid overdose fatality rate in the US.MethodsStructured interviews (n=26) were conducted among both internal and external stakeholders. Those who participated were >18 years of age and were the lead representative from agencies that either received naloxone (ie, external stakeholders) or helped implement the distribution (ie, internal stakeholders). The interviews followed standardised scripts and lasted approximately 40 min. Sessions were audio-recorded and transcribed. Qualitative content analysis was performed by two researchers to determine themes surrounding facilitators or barriers to programme implementation.ResultsThe primary facilitators reported by stakeholders included collaborative partnerships, ease of participating in the programme, being established in prevention efforts, demand for naloxone and the need for personal protection from overdose. The primary barriers identified by stakeholders included bureaucracy/policy/procedures of their organisation or agency, stigma, logistical or planning issues, problems with reporting, lack of communication post distribution and sustainability. Numerous lessons were learnt.ConclusionsBased on the implementation of the programme in 87 organisations, including law enforcement and fire departments, the impact of facilitators outweighed that of barriers. These findings may inform others planning to conduct a similar, large-scale project.

scholarly journals Drug use, homelessness and health: responding to the opioid overdose crisis with housing and harm reduction services

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Katrina Milaney ◽  
Jenna Passi ◽  
Lisa Zaretsky ◽  
Tong Liu ◽  
Claire M. O’Gorman ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Housing Instability ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Chi Square ◽  
Increased Risk ◽  
Reported Data ◽  
Structural Inequities ◽  
Hospital Use

Abstract Background Canada is in the midst of an opioid overdose crisis and Alberta has one of the highest opioid use rates across the country. Populations made vulnerable through structural inequities who also use opioids, such as those who are unstably housed, are at an increased risk of experiencing harms associated with opioid use. The main purpose of this study was to explore if there was an association between unstable housing and hospital use for people who use opioids. Methods Analysis utilized self-reported data from the Alberta Health and Drug Use Survey which surveyed 813 Albertans in three cities. Hospital use was modeled using a logistic regression with our primary variable of interest being housing unstable status. Chi square tests were conducted between hospital use and variables associated with demographics, characteristics of drug use, health characteristics, and experiences of receiving services to establish model inclusion. Results Results revealed a significant association between housing instability and hospital use with unstably housed individuals twice as likely torequire hospital care. Conclusions Results highlight the importance of concurrently addressing housing instability alongside the provision of harm reduction services such as safe supply and supervised consumption sites. These findings have significant implications for policy and policymakers during the opioid overdose epidemic, and provide a foundation for future areas of research.

scholarly journals An ethnographic study of opioid use disorder in rural Maine: The problem of pain

2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Weronika Grabowska ◽  
Selma Holden ◽  
Peter M Wayne ◽  
Karen Kilgore
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Opioid Use Disorder ◽  
Ethnographic Study ◽  
Community Leaders ◽  
Medical Setting ◽  
Opioid Overdose ◽  
Care Providers ◽  
Opioid Use ◽  
Structured Interviews

This qualitative study was conducted to more fully understand health care providers and community leaders’ perceptions of the opioid crisis in rural Maine. In 2017, Maine continued to have one of the highest opioid overdose death rates in the country, more than double the national average. I (first author) visited eight treatment centers in Maine providing support and treatment to people recovering form Opioid Use Disorder (OUD), shadowing health care providers. I also attended OUD-related meetings held with community leaders. I conducted a total of 33 semi-structured interviews with health care providers, community leaders, and NGOs in the state of Maine. Three themes emerged integrating observations with semi-structured interviews: i) Impact of emergence of new extended release opioids, their prescription patterns, and culture around them; ii) Subjectivity of pain and importance of understanding psychic injury in OUD treatment; iii) Socio-political context and perception of OUD in Maine. Our society’s perception of pain has deep historical and cultural sources that influence the way that pain has been perceived and treated in the medical setting. Resources beyond the medical environment are needed to address pain adequately.

Sign in / Sign up

Export Citation Format

Share Document