scholarly journals A Sin or a Health Issue? : Morality Policy Framing and the State of Harm Reduction in East-Central Europe

Intersections ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. 97-115
Author(s):  
Iga Jeziorska
Keyword(s):  
Harm Reduction ◽  
Drug Policy ◽  
Selection Procedure ◽  
Needle Exchange ◽  
The State ◽  
Policy Outcomes ◽  
Morality Policy ◽  
East Central Europe ◽  
Policy Framing ◽  
Exchange Programmes

Aims. There are significant differences in harm reduction services availability and performance in various countries. The paper examines the state of one of the harm reduction interventions – needle exchange services – through the lenses of morality policy, attempting to establish possible relationships between policy framing and policy outcomes. Method. The research uses an explorative design with cross-country comparison. The unit of analysis is drug policy in a country, and the geographical scope includes Czechia, Hungary, Poland and Slovakia, following the maximum variation case selection procedure. Countries’ drug strategies are analysed to identify the policy frames and data on needle exchange programmes are used to assess the state of harm reduction. Results. The analysis identified health and social drug policy framing in Czechia and Slovakia, morality frame in Hungary and no frame in Poland. The availability of availability and coverage of needle exchange programmes is the highest in Czechia, followed by Slovakia, Hungary and Poland. Conclusions. The Hungarian case confirms the relationship between morality framing and poor policy outcomes, while the Czech case between health framing and effective policy. Further research is needed to establish the function of morality framing as necessary and/or sufficient condition for unsatisfactory policy outcomes.

scholarly journals Could 30 years of political controversy on needle exchange programmes in Sweden contribute to scaling-up harm reduction services in the world?

2020 ◽  
pp. 145507252096501
Author(s):  
Niklas Karlsson ◽  
Torsten Berglund ◽  
Anna Mia Ekström ◽  
Anders Hammarberg ◽  
Tuukka Tammi
Keyword(s):  
Harm Reduction ◽  
Drug Policy ◽  
Grey Literature ◽  
Scale Up ◽  
Valuable Insight ◽  
Control Drug ◽  
Policy Domain ◽  
The World ◽  
Key Events ◽  
Exchange Programmes

Aims: To end the hepatitis and AIDS epidemics in the world by 2030, countries are encouraged to scale-up harm reduction services and target people who inject drugs (PWID). Blood-borne viruses (BBV) among PWID spread via unsterile injection equipment sharing and to combat this, many countries have introduced needle and syringe exchange programmes (NEP), though not without controversy. Sweden’s long, complicated harm reduction policy transition has been deviant compared to the Nordic countries. After launch in 1986, no NEP were started in Sweden for 23 years, the reasons for which are analysed in this study. Methods: Policy documents, grey literature and research mainly published in 2000–2017 were collected and analysed using a hierarchical framework, to understand how continuous build-up of evidence, decisions and key events, over time influenced NEP development. Results: Sweden’s first NEP opened in a repressive-control drug policy era with a drug-free society goal. Despite high prevalence of BBV among PWID with recurring outbreaks, growing research and key-actor support including a NEP law, no NEP were launched. Political disagreements, fluctuating actor-coalitions, questioning of research, and a municipality veto against NEP, played critical roles. With an individual-centred perspective being brought into the drug policy domain, the manifestation of a dual drug and health policy track, a revised NEP law in 2017 and removal of the veto, Sweden would see fast expansion of new NEP. Conclusions: Lessons from the Swedish case could provide valuable insight for countries about to scale-up harm reduction services including how to circumvent costly time- and resource-intensive obstacles and processes involving ideological and individual moral dimensions.

Harm reduction and needle exchange programmes

The Lancet ◽  
1998 ◽  
Vol 351 (9118) ◽  
pp. 1819 ◽  
Author(s):  
Sandra S Bennett
Keyword(s):  
Harm Reduction ◽  
Needle Exchange ◽  
Exchange Programmes

Women Who Inject Drugs (WWID): Stigma, Gender and Barriers to Needle Exchange Programmes (NEPs)

2021 ◽  
pp. 009145092110352
Author(s):  
Kirsten Gibson ◽  
Fiona Hutton
Keyword(s):  
Harm Reduction ◽  
Drug Users ◽  
Qualitative Interviews ◽  
Significant Proportion ◽  
Needle Exchange ◽  
Pharmacy Staff ◽  
Women's Voices ◽  
The Social ◽  
Women Who Inject Drugs ◽  
Exchange Programmes

Global evidence suggests that experiences of access to Needle Exchange services are gendered and that women who inject drugs (WWID) access needle exchange services differently to men. Despite being a significant proportion of injecting drug users, women’s voices and experiences have often been silenced in studies around harm reduction service provision, hampering the development of harm reduction services for WWID. This article highlights the experiences of four women and one trans man who have previously injected drugs, in accessing needle exchange programmes (NEPs) in a New Zealand context. Semi-structured qualitative interviews were carried out with five participants and thematic analysis of the interviews produced three core themes: how stigma permeates WWIDs’ lives; barriers in accessing needle exchange services; and how experiences within a drugs context are gendered. Stigma was an overwhelming issue affecting WWID which also acted as a barrier to their access of NEPs. The WWID in our study in terms of Goffman’s original theorizing were “doubly discredited” as well as “precariously discreditable” due to their gender and injection drug using status. The participants keenly felt their stigmatized status through interactions with pharmacy-based needle exchange staff, perceiving that pharmacy staff viewed them as more contaminated than their male counterparts. Gendered relationships were also noted in injection practices, although initiation for this group of WWID was done by intimate partners as well as friends, dispelling the stereotype of WWID as passive victims. Some participants also learnt to self-inject which gave them a sense of empowerment and freedom as they did not have to rely on others to help them. The social structures that support stigmatizing tropes about WWID need to be addressed as well as more local interventions to prevent stigma in NEPs, alongside women focused services.

Harm reduction and needle exchange programmes

The Lancet ◽  
1998 ◽  
Vol 351 (9118) ◽  
pp. 1819-1820 ◽  
Author(s):  
Ricky N Bluthenthal ◽  
Alex H Kral ◽  
Jennifer Lorvick ◽  
Elizabeth A Erringer ◽  
Brian R Edlin
Keyword(s):  
Harm Reduction ◽  
Needle Exchange ◽  
Exchange Programmes

Harm reduction and needle exchange programmes

The Lancet ◽  
1998 ◽  
Vol 351 (9118) ◽  
pp. 1819 ◽  
Author(s):  
Alan R Lifson
Keyword(s):  
Harm Reduction ◽  
Needle Exchange ◽  
Exchange Programmes

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.

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