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 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.

The “Drugs-Crime Nexus”

2018 ◽  
Author(s):  
Dominique de Andrade
Keyword(s):  
At Risk ◽  
Drug Use ◽  
Harm Reduction ◽  
Good Evidence ◽  
People Who Use Drugs ◽  
Correctional Institutions ◽  
Reduction Strategies ◽  
At Risk Populations ◽  
Prison Populations ◽  
The Impact

The prioritization of imprisonment as a response to drug use in many countries has led to growing prison populations, with little impact on drug use, drug-related harm, or drug-related crime. There is increased international debate around how to best manage and respond to at-risk populations, with good evidence to suggest that embracing harm reduction strategies in the community and in prison can lead to reduced rates of imprisonment, infectious disease, and other preventable harms. Despite this, evidence-based treatment and harm reduction programs have largely failed to penetrate the walls of correctional institutions in most countries. This chapter provides an overview of major drug groups and explores the impact of drug policy on international imprisonment rates, and the diversity of responses to people who use drugs in the community and prison. The potential for corrections to play a significant therapeutic role in addressing the urgent treatment and harm reduction needs of at-risk, drug-using populations in prison and during their transition back to the community is highlighted.

scholarly journals Hoots and harm reduction: a qualitative study identifying gaps in overdose prevention among women who smoke drugs

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Geoff Bardwell ◽  
Tamar Austin ◽  
Lisa Maher ◽  
Jade Boyd
Keyword(s):  
Harm Reduction ◽  
Illicit Drugs ◽  
Structural Violence ◽  
Structured Interviews ◽  
Overdose Prevention ◽  
Polysubstance Use ◽  
Reduction Strategies ◽  
Prevention Interventions ◽  
Negative Health Outcomes ◽  
Mixed Gender

Abstract Background Smoking or inhaling illicit drugs can lead to a variety of negative health outcomes, including overdose. However, most overdose prevention interventions, such as supervised consumption services (SCS), prohibit inhalation. In addition, women are underrepresented at SCS and are disproportionately impacted by socio-structural violence. This study examines women’s experiences smoking illicit drugs during an overdose epidemic, including their utilization of a women-only supervised inhalation site. Methods Qualitative research methods included on-site ethnographic observation and semi-structured interviews with 32 participants purposively recruited from the women-only site. Data were coded and analyzed using NVivo 12 and thematic analysis was informed by gendered and socio-structural understandings of violence. Results Participants had preferences for smoking drugs and these were shaped by their limited income, inability to inject, and perceptions of overdose risk. Participants expressed the need for services that attend to women’s specific experiences of gendered, race-based, and structural violence faced within and outside mixed-gender social service settings. Results indicate a need for sanctioned spaces that recognize polysubstance use and drug smoking, accommodated by the women-only SCS. The smoking environment further fostered a sociability where participants could engage in perceived harm reduction through sharing drugs with other women/those in need and were able to respond in the event of an overdose. Conclusions Findings demonstrate the ways in which gendered social and structural environments shape women’s daily experiences using drugs and the need for culturally appropriate interventions that recognize diverse modes of consumption while attending to overdose and violence. Women-only smoking spaces can provide temporary reprieve from some socio-structural harms and build collective capacity to practice harm reduction strategies, including overdose prevention. Women-specific SCS with attention to polysubstance use are needed as well as continued efforts to address the socio-structural harms experienced by women who smoke illicit drugs.

scholarly journals Substance use Treatment and Harm Reduction Services for Migrants and Refugees in the COVID-19 Pandemic: Findings from a Global Survey

2020 ◽  
Author(s):  
Cornelis De Jong ◽  
Ali Farhoudian ◽  
Mehrnoosh Vahidi ◽  
Mohsen Ebrahimi ◽  
Hamed Ekhtiari ◽  
...  
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Substance Use Disorders ◽  
Mental Health Problems ◽  
World Health ◽  
Substance Use Treatment ◽  
Second Phase ◽  
Addiction Medicine ◽  
Global Survey ◽  
The Impact

Abstract Migrants and refugees are considered vulnerable to mental health problems and substance use disorders; and may be particularly affected by service disruptions associated with the COVID-19 pandemic The International Society of Addiction Medicine (ISAM) ran a multi-phased global survey among clinicians and health professional that are actively working in the field of addiction medicine to investigate the impact of the COVID-19 pandemic on substance use and related services. In March 2020, the first month after the announcement of the pandemic by the World Health Organization, 177 informants from 77 countries took part in the global survey, and only 12.9% of them reported their countries’ substance use treatment and harm reduction services for the migrants and refugees with substance use disorders continued as usual. In May 2020, 11.7% of respondents of the second phase reported that the services for refugees and migrants improved in comparison to March 2020; 11.7% reported that these services in their country discontinued. Results suggest that refugee and migrants access to treatment and harm reduction services has been reduced as a result of COVID-19. It can be concluded that it is crucial to improve the visibility of migrants’ needs and exploit appropriate interventions for those with substance use disorders.

Class, Lifestyle and Substance Use among Adolescents: A Bourdieusian Perspective

Young ◽  
2018 ◽  
Vol 27 (2) ◽  
pp. 140-163
Author(s):  
Jan Skrobanek ◽  
Verena Kuglstatter
Keyword(s):  
Substance Use ◽  
Young People ◽  
Economic Capital ◽  
Adolescent Substance Use ◽  
Adolescent Substance ◽  
Capital Endowment ◽  
Starting Point ◽  
Lifestyle Practices ◽  
The Impact ◽  
Specific Capital

Against the backdrop of the continuing controversy regarding the interlinkage between social class, lifestyle and substance use of young people, the article reports the findings of an effort to assess the impact of adolescents’ cultural and economic capital and lifestyle practices on substance use. Drawing on Bourdieu’s work on class, lifestyle and practice, young people’s substance use can be seen as the product of class-specific capital endowment and related highbrow or lowbrow lifestyles. However, research seeking to explain adolescent substance use so far has eschewed a stringent empirical attempt to examine the impact of capital and lifestyle in relation to the use of different substances. Taking this desideratum as a starting point, our research indicates that although effects of cultural and economic capital are present, the type of lifestyle is more important for understanding and explaining substance use by young people.

All Women Are Welcome: Reducing Barriers to Women's Shelters With Harm Reduction

Partner Abuse ◽  
2019 ◽  
Vol 10 (4) ◽  
pp. 409-428
Author(s):  
Angela Hovey ◽  
Susan Scott
Keyword(s):  
Domestic Violence ◽  
Substance Use ◽  
Service Delivery ◽  
Harm Reduction ◽  
Violence Against Women ◽  
Health And Safety ◽  
Service Delivery Model ◽  
Reduction Strategies ◽  
Positive Experiences ◽  
Minimal Research

Women who experience domestic violence are more likely to use or become dependent on substances. Their health and safety are at greater risk when Violence Against Women (VAW) shelters have policies prohibiting admission if noticeably impaired. Harm reduction strategies can help reduce harms caused by substance use. Minimal research was found about impacts of integrating harm reduction in VAW shelters. We examined women's experiences with a harm reduction service delivery model at a Canadian rural VAW shelter. Interviews were conducted with 25 former residents to explore their experiences. Most women preferred to have harm reduction implemented, although most women also wanted changes made to harm reduction practices. These recommended changes would enhance positive experiences and feelings of safety for all women, thereby achieving the goal of all women welcome. Overall, our findings support the integration of harm reduction in VAW shelters that balances harm reduction philosophy and practices with the individualized needs of traumatized women and safety of children.

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 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>

Is cleanliness next to abstinence? The effect of cleanliness priming on attitudes towards harm reduction strategies for people with substance use disorders

2020 ◽  
Author(s):  
Tiana Ciccarelli ◽  
Molly Soberman ◽  
Taylor Leshuk ◽  
Hannah Cole ◽  
Farhana Afreen ◽  
...  
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Substance Use Disorders ◽  
Reduction Strategies

scholarly journals 788. Outcomes of Multidisciplinary Care Conferences for Patients with Substance Use Disorders Requiring Prolonged Antimicrobial Therapy for Severe Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S349-S349
Author(s):  
Sara J Gore ◽  
Luke Strnad ◽  
Honora Englander ◽  
Jessica Gregg ◽  
Monica Sikka ◽  
...  
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Substance Use Disorders ◽  
Antimicrobial Therapy ◽  
Patient Preferences ◽  
Treatment Plan ◽  
Definitive Treatment ◽  
Care Plans ◽  
Hospital Days ◽  
The Impact

Abstract Background Infectious complications in people with substance use disorders (SUD) are rising, and while outpatient parenteral antimicrobial therapy (OPAT) is widely used in the general population, OPAT failure rates in SUD are high. Due to perceived PICC risks and OPAT safety, serious infections in people with SUD at our institution often resulted in hospitalization for the duration of treatment. Prolonged inpatient treatment is difficult to tolerate and increases healthcare costs. Our OPAT and addiction medicine teams initiated multidisciplinary discharge planning conferences (OPTIONS-DC) for inpatients with SUD requiring prolonged antimicrobials. The goal was to prioritize patient preferences regarding OPAT setting while incorporating harm-reduction principles. The goal of this study is to assess the impact and outcomes of the OPTIONS-DC. Methods We prospectively recorded comprehensive notes at OPTIONS-DC and retrospectively performed chart review for conferences held from February 2018 to March 2019.We performed a content analysis of OPTIONS-DC notes and patient records to identify ways that OPTIONS-DC modified care plans and prioritized patient preferences. Results Thirty-one conferences were held during the study period. Twenty-eight patients reported substance use within 90 days, 24 used intravenous substances, 12 were homeless, 24 had a mental health diagnosis, and 20 started medication-assisted treatment during hospitalization (Table 1). For 16 patients the conference altered the definitive treatment plan to align with patient preferences while emphasizing safety, and 13 of those were changed to an outpatient setting. A total of 10 patients had a decreased length of stay, with a total of 238 hospital days saved overall. OPAT was planned at discharge for 15 patients, 11 of whom completed their OPAT course. Overall, 21/31 (68%) completed their recommended antimicrobial course and 3 were lost to follow-up. Conclusion A multidisciplinary conference that prioritizes patient preferences and uses harm reduction strategies to optimize infection treatment plans is feasible and effective. The OPTIONS-DC model has potential to expand treatment options for infections in SUD, reduce hospital days, and may serve as an example for other institutions. Disclosures All authors: No reported disclosures.

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