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 New psychoactive substances in Eurasia: a qualitative study of people who use drugs and harm reduction services in six countries

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Eliza Kurcevič ◽  
Rick Lines
Keyword(s):  
Harm Reduction ◽  
Lived Experience ◽  
Service Providers ◽  
Synthetic Cannabinoids ◽  
New Psychoactive Substances ◽  
Prior History ◽  
People Who Use Drugs ◽  
Psychoactive Substances ◽  
Structured Interviews ◽  
Drug Policies

Abstract Background This study examines the use of new psychoactive substances (NPS) and the harm reduction response in six Eurasian countries: Belarus, Moldova, Serbia, Kazakhstan, Kyrgyzstan, and Georgia. The aim is to identify current patterns of NPS use and related harms in each country through recording the perspectives and lived experience of people who use drugs and people who provide harm reduction services in order to inform the harm reduction response. Methodology The study involved desk-based research and semi-structured interviews/focus groups with 124 people who use drugs and 55 health and harm reduction service providers across the six countries. Results People who use drugs in all countries were aware of NPS, primarily synthetic cathinones and synthetic cannabinoids. NPS users generally reflected two groups: those with no prior history of illicit drug use (typically younger people) and those who used NPS on an occasional or regular basis due to the lack of availability of their preferred drug (primarily opiates). In many cases, these respondents reported they would not use NPS if traditional opiates were available. Common factors for choosing NPS included cost and accessibility. Respondents in most countries described NPS markets that use the DarkNet and social media for communication, secretive methods of payment and hidden collection points. A recurring theme was the role of punitive drug policies in driving NPS use and related harms. Respondents in all countries agreed that current harm reduction services were important but needed to be enhanced and expanded in the context of NPS. Conclusions The study identified patterns and drivers of NPS use, risk behaviours and drug-related harms. It identified gaps in the current harm reduction response, particularly the needs of non-injectors and overdose response, as well as the harmful effects of punitive drug policies. These findings may inform and improve current harm reduction services to meet the needs of people who use NPS.

scholarly journals Service providers’ use of harm reduction approaches in working with older adults experiencing abuse: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Donna Goodridge ◽  
Kerstin Stieber Roger ◽  
Christine A. Walsh ◽  
Elliot PausJenssen ◽  
Marina Cewick ◽  
...  
Keyword(s):  
Older Adults ◽  
Harm Reduction ◽  
Professional Practice ◽  
Service Provision ◽  
Service Providers ◽  
Qualitative Interviews ◽  
Risk Environment ◽  
Intervention Process ◽  
Process Enactment ◽  
Humanistic Approach

Abstract Background Although abuse experienced by older adults is common and expected to increase, disclosure, reporting and interventions to prevent or mitigate abuse remain sub-optimal. Incorporating principles of harm reduction into service provision has been advocated as a strategy that may improve outcomes for this population. This paper explores whether and how these principles of harm reduction were employed by professionals who provide services to older adults experiencing abuse. Methods Thematic analysis of qualitative interviews with 23 professionals providing services to older adults experiencing abuse across three Western provinces of Canada was conducted. Key principles of harm reduction (humanism, incrementalism, individualism, pragmatism, autonomy, and accountability without termination) were used as a framework for organizing the themes. Results Our analysis illustrated a clear congruence between each of the six harm reduction principles and the approaches reflected in the narratives of professionals who provided services to this population, although these were not explicitly articulated as harm reduction by participants. Each of the harm reduction principles was evident in service providers’ description of their professional practice with abused older adults, although some principles were emphasized differentially at different phases of the disclosure and intervention process. Enactment of a humanistic approach formed the basis of the therapeutic client-provider relationships with abused older adults, with incremental, individual, and pragmatic principles also apparent in the discourse of participants. While respect for the older adult’s autonomy figured prominently in the data, concerns about the welfare of the older adults with questionable capacity were expressed when they did not engage with services or chose to return to a high-risk environment. Accountability without termination of the client-provider relationship was reflected in continuation of support regardless of the decisions made by the older adult experiencing abuse. Conclusions Harm reduction approaches are evident in service providers’ accounts of working with older adults experiencing abuse. While further refinement of the operational definitions of harm reduction principles specific to their application with older adults is still required, this harm reduction framework aligns well with both the ethical imperatives and the practical realities of supporting older adults experiencing abuse.

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.

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>

Marginalised young people’s healthcare journeys: Professionals’ perspectives

2018 ◽  
Vol 77 (6) ◽  
pp. 692-704 ◽  
Author(s):  
Fiona Robards ◽  
Melissa Kang ◽  
Kate Tolley ◽  
Catherine Hawke ◽  
Lena Sanci ◽  
...  
Keyword(s):  
Young People ◽  
Health System ◽  
Access To Health Care ◽  
System Analysis ◽  
Service Providers ◽  
Cross Sectional Study ◽  
Models Of Care ◽  
Sampling Frame ◽  
Structured Interviews ◽  
Cross Sectional

Introduction: The pursuit of social justice includes a commitment to health equity for marginalised young people. Health professionals are central to marginalised young people’s engagement and access to health care and their navigation of health systems. They are also uniquely positioned to shed insight into structures and inefficiencies within the health system, including the role of technology, and to advocate for system change. Methods: This qualitative cross-sectional study employed in-depth semi-structured interviews with 22 health service managers and experienced clinicians to better understand service providers’ perspectives. The sampling frame comprised professionals from different sectors and levels of the health system. Analysis used Grounded Theory methods. Results: Three major themes were identified in the data: (1) intersectionalities – understanding the complexity of multiple disadvantage; (2) health system fragmentation – leading to inefficiencies, inertia and advocacy; and (3) services needing to be ‘turned on their head’ – rethinking service delivery and models of care. Conclusion: A better understanding of marginalised young people’s healthcare experiences, including the complexities of multiple disadvantage, and how this contributes to health inequalities could lead to more welcoming and respectful services. Services can reconceptualise their roles by reaching out to young people, both physically and online, to make the navigation of the health system easier. Marginalised young people’s healthcare journeys can be supported by advocates that help them navigate the health system.

scholarly journals Principles of Harm Reduction for Young People Who Use Drugs

PEDIATRICS ◽  
2021 ◽  
Vol 147 (Supplement 2) ◽  
pp. S240-S248
Author(s):  
Simeon D. Kimmel ◽  
Jessie M. Gaeta ◽  
Scott E. Hadland ◽  
Eliza Hallett ◽  
Brandon D.L. Marshall
Keyword(s):  
Young People ◽  
Harm Reduction ◽  
People Who Use Drugs

scholarly journals Anti-Oppressive Practice in Harm Reduction

2021 ◽  
Author(s):  
Travis Cross
Keyword(s):  
Harm Reduction ◽  
Justice System ◽  
Personal Responsibility ◽  
Research Question ◽  
Work Practice ◽  
Social Work Practice ◽  
People Who Use Drugs ◽  
Structured Interviews ◽  
Peer Engagement

This study interrogates the current neoliberal harm reduction model and examines antioppressive practice within harm reduction through the following research question: how do harm reduction workers in Toronto address structural processes of oppression through their work? Three harm reduction workers participated in one-on-one, semi-structured interviews for this study, and were asked to discuss their understandings and experiences with harm reduction and anti-oppression. Through a phenomenological analysis of participant responses, three themes were developed: participants conceptualize harm reduction beyond personal substance use; facilitate peer engagement and mobilization; and challenge incarceration, policing, and surveillance. These findings indicate that research participants engage in multiple forms of politicized practice that collectively challenge the neoliberal tenet of personal responsibility within harm reduction, as well as the role of the criminal justice system in the lives of people who use drugs. This study concludes with implications for social work practice and research.

scholarly journals Learning to Leave and to Return: Mobility, Place, and Sense of Belonging amongst Young People Growing up in Border and Rural Regions of Mainland Portugal

2021 ◽  
Vol 13 (16) ◽  
pp. 9432
Author(s):  
Sofia Marques da Silva ◽  
Ana Milheiro Silva ◽  
Pablo Cortés-González ◽  
Rūta Brazienė
Keyword(s):  
Young People ◽  
Sense Of Belonging ◽  
Further Education ◽  
Growing Up ◽  
Structured Interviews ◽  
Border Regions ◽  
Mainland Portugal ◽  
12Th Grade ◽  
Decisions To Leave ◽  
Outward Migration

This article examines how mobility is incorporated into the lives of young people growing up in rural border regions of continental Portugal. It also explores how municipalities are dealing with the contemporary imperative of mobility and its consequences. Young people from these regions are affected by decisions to leave to continue studying in higher education, or to find a job. Combined, these lead to an outward migration trend and thus loss of human capital. This paper is based on a multi-method research project carried out in the border regions and involves young people and other stakeholders from 38 municipalities. The data were selected from a questionnaire completed by young people (9th–12th grade; n = 3968), 38 semi-structured interviews with local policymakers, 50 biographical interviews, and 5 focus groups with young people. Results indicate that although most young people aspire to further education and do not fear leaving their region, they nonetheless tend to integrate the necessity to be mobile into their biographies. Hence, they do not associate it with displacement or as being tantamount to abandoning their region, and to which some of them want to return. We consider that in parallel with learning to leave local sentiments, policies, and actions are emerging towards coalescing a trend of learning to stay and returning. We propose an interpretation of this tendency as indicative of new understandings around these peripheral territories and which are shaped by young people’s experience of reconciling a sense of belonging to place and any associated mobilities.

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.

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