scholarly journals A qualitative study on overdose response in the era of COVID-19 and beyond: how to spot someone so they never have to use alone

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Melissa Perri ◽  
Natalie Kaminski ◽  
Matthew Bonn ◽  
Gillian Kolla ◽  
Adrian Guta ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Emergency Services ◽  
Community Support ◽  
People Who Use Drugs ◽  
Sexually Transmitted ◽  
Prevention Services ◽  
Rural Settings ◽  
Structured Audio ◽  
Research Assistants

Abstract Background Spotting is an informal practice among people who use drugs (PWUD) where they witness other people using drugs and respond if an overdose occurs. During COVID-19 restrictions, remote spotting (e.g., using a telephone, video call, and/or a social media app) emerged to address physical distancing requirements and reduced access to harm reduction and/or sexually transmitted blood borne infection (STBBI’s) prevention services. We explored spotting implementation issues from the perspectives of spotters and spottees. Methods Research assistants with lived/living expertise of drug use used personal networks and word of mouth to recruit PWUD from Ontario and Nova Scotia who provided or used informal spotting. All participants completed a semi-structured, audio-recorded telephone interview about spotting service design, benefits, challenges, and recommendations. Recordings were transcribed and thematic analysis was used. Results We interviewed 20 individuals between 08/2020–11/2020 who were involved in informal spotting. Spotting was provided on various platforms (e.g., telephone, video calls, and through texts) and locations (e.g. home, car), offered connection and community support, and addressed barriers to the use of supervised consumption sites (e.g., location, stigma, confidentiality, safety, availability, COVID-19 related closures). Spotting calls often began with setting an overdose response plan (i.e., when and who to call). Many participants noted that, due to the criminalization of drug use and fear of arrest, they preferred that roommates/friends/family members be called instead of emergency services in case of an overdose. Both spotters and spottees raised concerns about the timeliness of overdose response, particularly in remote and rural settings. Conclusion Spotting is a novel addition to, but not replacement for, existing harm reduction services. To optimize overdose/COVID-19/STBBI’s prevention services, additional supports (e.g., changes to Good Samaritan Laws) are needed. The criminalization of drug use may limit uptake of formal spotting services.

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 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.

Harm Reduction Services in Ottawa: The Culture of Drug Use

2020 ◽  
Vol 34 (2) ◽  
pp. 188-202
Author(s):  
Marlene Haines ◽  
Patrick O'Byrne
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Physical Environment ◽  
Best Practice ◽  
Cultural Norms ◽  
People Who Use Drugs ◽  
Access To Services ◽  
Policy Changes ◽  
Best Practice Guidelines ◽  
Depth Interviews

Between January 2016 and June 2019, there were over 13,900 apparent opioid-related deaths in Canada, solidifying the need for appropriate and effective services for people who use drugs (PWUD). Within government initiatives and policies, PWUD are often inappropriately considered a homogeneous group of individuals, with implementation of services nationally often being guided by these governmental bodies without meaningful consultation and collaboration with PWUD. However, recent harm reduction research and best practice guidelines have emphasized the importance of tailoring services to local drug scenes. Despite this, very little research on the cultural norms of PWUD exists in the literature. In an attempt to explore the local culture of drug use in Ottawa, a literature review ultimately uncovered very few articles on this topic. However, by expanding the search beyond Ottawa and using a social determinants of health framework, the factors of culture, income and social status, physical environment, and access to services were revealed as unique experiences for PWUD. Further, through four in-depth interviews with current harm reduction providers in Ottawa, the themes of (1) uncertainty and concerns surrounding the overdose crisis; (2) lack of flexibility in resources and access issues; and (3) diversity in the culture of drug use in Ottawa were explored. Recommendations surrounding partnering with PWUD, policy changes, and a safer supply were subsequently discussed. These findings helped to validate the reality of the unique drug-use culture in Ottawa, and the requirement for harm reduction services to be adapted to the local needs of PWUD.

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>

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

2020 ◽  
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 ◽  
Advantages And Disadvantages ◽  
Services Delivery ◽  
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. Recently several harm reduction 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 4 semi-structured interviews with the NGO staff and 301 cases of web outreach work with PWUD comprised the dataset. The process of web outreach, service provision to PWUD, and PWUD’s needs were thematically analyzed. Results Three stages of the process of web outreach work were determined: clients initiating communication, NGO workers addressing clients’ needs, and NGO workers receiving clients’ feedback. Communication proceeded either in group chat or in direct messages. Challenges in addressing clients’ needs happened when clients turned for help in nighttime, 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. PWUD’s needs 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 recruiting new clients (including hard-to-reach PWUD that avoid attending brick-and-mortar facilities). It indicates that harm reduction organizations should consider incorporating online harm reduction services into their activities. However, more research is needed to explore relative advantages and disadvantages of online harm reduction services delivery.

scholarly journals Research led by people who use drugs: centering the expertise of lived experience

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zach R. Salazar ◽  
Louise Vincent ◽  
Mary C. Figgatt ◽  
Michael K. Gilbert ◽  
Nabarun Dasgupta
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Critical Role ◽  
Drug Market ◽  
Research Process ◽  
Medical Community ◽  
People Who Use Drugs ◽  
Main Body ◽  
Research Collaborations ◽  
History Of

Abstract Background Research collaborations between people who use drugs (PWUD) and researchers are largely underutilized, despite the long history of successful, community-led harm reduction interventions and growing health disparities experienced by PWUD. PWUD play a critical role in identifying emerging issues in the drug market, as well as associated health behaviors and outcomes. As such, PWUD are well positioned to meaningfully participate in all aspects of the research process, including population of research questions, conceptualization of study design, and contextualization of findings. Main body We argue PWUD embody unparalleled and current insight to drug use behaviors, including understanding of novel synthetic drug bodies and the dynamics at play in the drug market; they also hold intimate and trusting relationships with other PWUD. This perfectly situates PWUD to collaborate with researchers in investigation of drug use behaviors and development of harm reduction interventions. While PWUD have a history of mistrust with the medical community, community-led harm reduction organizations have earned their trust and are uniquely poised to facilitate research projects. We offer the North Carolina Survivors Union as one such example, having successfully conducted a number of projects with reputable research institutions. We also detail the fallacy of meaningful engagement posed by traditional mechanisms of capturing community voice. As a counter, we detail the framework developed and implemented by the union in hopes it may serve as guidance for other community-led organizations. We also situate research as a mechanism to diversify the job opportunities available to PWUD and offer a real-time example of the integration of these principles into public policy and direct service provision. Conclusion In order to effectively mitigate the risks posed by the fluid and volatile drug market, research collaborations must empower PWUD to play meaningful roles in the entirety of the research process. Historically, the most effective harm reduction interventions have been born of the innovation and heart possessed by PWUD; during the current overdose crisis, there is no reason to believe they will not continue to be.

scholarly journals Harm Reduction and Moral Desert in the Context of Drug Policy

2020 ◽  
Vol 28 (4) ◽  
pp. 362-371
Author(s):  
Lindsey Brooke Porter
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Drug Policy ◽  
Health And Safety ◽  
People Who Use Drugs ◽  
Moral Desert ◽  
Problematic Drug ◽  
To Come ◽  
State Of Affairs ◽  
The Right

AbstractThe target of my discussion is intuitions lay people have about justice in the context of drug policy—intuitions that take on a more or less moral-desert-based shape. I argue that even if we think desert is the right measure of how we ought to treat people, we ought still be in favour of Harm Reduction measures for people who use drugs. Harm Reduction measures are controversial with members of the public, and much of the opposition seems to come from something like an appeal to a desert conception of justice—the notion that a just state of affairs is one in which everybody gets what they deserve, no more, no less. A recent study, for example, found that ‘moral outrage’ predicts a preference for prevalence reduction (criminal sanction, etc.) over Harm Reduction. The thinking seems to be that, since drug use is wrong, letting people who use drugs suffer and/or die as a consequence of their use is just. Aiding their health and safety, while perhaps compassionate, is unjust. I argue that there is a bad desert fit between using drugs and suffering avoidable harm even if using drugs is morally wrong. Many of the possible harms of drug use are socially/policy driven, and much problematic drug use is context dependent, not cleanly attributable to the decisions of the person who uses drugs. This means that even if drug use is wrong, people who use drugs deserve Harm Reduction policies, at minimum.

scholarly journals High burden of Self-reported Sexually Transmitted Infections among Key Populations in Mozambique: The Urgent Need for an Integrated Surveillance System

2020 ◽  
Author(s):  
Makini A.S. Boothe ◽  
Charlotte Comé ◽  
Cynthia Semá Baltazar ◽  
Noela Chicuecue ◽  
Jessica Seleme ◽  
...  
Keyword(s):  
Risk Factors ◽  
Drug Use ◽  
Sex Work ◽  
Surveillance System ◽  
Self Report ◽  
Key Populations ◽  
Risk Behaviours ◽  
High Burden ◽  
Sexually Transmitted ◽  
Prevention Services

Abstract Background: Key populations - men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID) – are at high risk for sexually transmitted infections (STI) given their sexual risk behaviours along with social, legal and structural barriers to prevention, care and treatment services. The purpose of this secondary analysis is to assess the prevalence of self-reported STIs and to describe associated risk factors among participations of the first Biological Behavioural Surveillance (BBS) in Mozambique. Methods: Responses from the first BBS surveys conducted in 2011-2014 were aggregated across survey-cities to produce pooled estimates for each population. Aggregate weighted estimates were computed to analyse self-reported STI prevalence. Unweighted pooled estimates were used in multivariable logistic regression to identify risk factors associated with self-reported STI. Results: The prevalence of self-reported STI was 11.9% (95% CI: 7.8-16.0), 33.6% (95% CI: 29.0-41.3), and 22.0% (95% CI: 17.0-27.0) among MSM, FSW and PWID, respectively. MSM who were circumcised, had HIV, reported drug use, reported receptive anal sex, and non-condom use with their last male partner had greater odds of STI self-report. STI-self report among FSW was associated with living in Beira, being married, employment aside from sex work, physical violence, sexual violence, drug use, access to comprehensive HIV prevention services, non-condom use with last client, and sexual relationship with a non-client romantic partner. Among PWID, risk factors for self-reported STI included living in Nampula/Nacala, access to HIV prevention services, and sex work.Conclusion: The high-burden of STIs among survey participants requires integrated HIV and STI prevention, treatment, and harm reduction services that address overlapping risk behaviours, especially injection drug use and sex work. A robust public health response requires the creation of a national STI surveillance system for better screening and diagnostic procedures within these vulnerable populations.

scholarly journals ‘We Realised We Needed a New Approach’: Government and Law enforcement Perspectives on the Implementation and Future of the Drug Decriminalisation Policy in Vietnam

2020 ◽  
Author(s):  
Hai Thanh Luong ◽  
Luc Trong Hoang ◽  
Toan Quang Le ◽  
Tuan Anh Hoang ◽  
Mai Thanh Vu ◽  
...  
Keyword(s):  
Law Enforcement ◽  
Drug Use ◽  
Harm Reduction ◽  
Drug Policy ◽  
Drug Control ◽  
People Who Use Drugs ◽  
Community Based ◽  
Drug Law ◽  
Drug Law Enforcement ◽  
Law Enforcement Officials

Abstract Background In 2009, Vietnam officially decriminalized drug use through amendments to the criminal law. The amendments specifically outlined that drug use would be seen as an administrative sanction, but not a criminal offence. This legal transition has not been without its implementation challenges and police particularly are have struggled to balance their role between drug law enforcement and decriminalisation. Despite being a health-orientated drug policy amendment, in practice it has meant that police can send suspected drug users to compulsory treatment centres without judicial oversight and people who use drugs continue to face challenges in their interface with law enforcement which can negatively impact access to harm reduction and community-based treatment programs. This paper explores the perspectives of policy makers and law enforcement officials in Vietnam and provides some insights and considerations into how the amended law was implemented and how it could be made more effective in improving both health and safety for all people in Vietnam. Methods To understand government and policing perspective on amended changes to the Criminal Code in 2009 and its subsequent implementation, this mixed methods research combined content analysis of a number of core legislations in terms of drug control policies in Vietnam with perspectives and insights from 14 key informant interviews from people representing a range of relevant Vietnamese Government (n=10) and non-government agencies (n=4). Results While most interviewees recognised that decriminalizing drug use in Vietnam was designed as a a progressive and health-oriented drug policy, many participants acknowledged the ongoing disconnect between the health intent of the policy and the police-led oversight of its implementation in the community. Part of this disconnect was explained by the lack of training and clear protocol that would enhance the police in their ability to contribute to the health intent of the policy rather than continue to view drug use through a drug law enforcement only lens. A current pilot initiative by Hanoi’s People Committee to implement a model of assisted referral for people who use drugs to community-based health, social and legal support may provide an example of how to situate decriminalisation policy within a broader context of harm reduction interventions through the design and trial of clear protocols for how law enforcement agencies can actively engage and support the process of diversion into harm reduction and community-based treatment. Conclusions Since the inception of the amended law there has been very little review and analyses of its implementation progress and its challenges. This is the first study to review and assess the progress of decriminalizing drug use since the policy intervention in 2009 with a specific focus on the perceptions of the policy for Vietnam’s drug control in policing. It discusses insights and considerations from government, law enforcement officials and civil society organisations to develop a deeper understanding of how harm reduction interventions – including decriminalisation – can co-exist within a broader and entrenched drug control strategy in Vietnam.

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