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Curtin KD, Thomson M, Hyshka E, Colman I, Wild TC, Belon AP, Nykiforuk CIJ. Assessing support for substance use policies among the general public and policy influencers in two Canadian provinces. Subst Abuse Treat Prev Policy 2024; 19:40. [PMID: 39232782 PMCID: PMC11373234 DOI: 10.1186/s13011-024-00622-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 08/20/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Examining support for substance use policies, including those for harm reduction, among the general public and policy influencers is a fundamental step to map the current policy landscape and leverage policy opportunities. Yet, this is a knowledge gap in Canada. Our paper identifies the level of support for substance use policies in two provinces in Canada and describes how the level of support is associated with intrusiveness and sociodemographic variables. METHODS Data came from the 2019 Chronic Disease Prevention Survey. The representative sample included members of the general public (Alberta n = 1648, Manitoba n = 1770) as well as policy influencers (Alberta n = 204, Manitoba n = 98). We measured the level of support for 22 public policies concerning substance use through a 4-point Likert-scale. The Nuffield Council on Bioethics Intervention Ladder framework was applied to assess intrusiveness. We used cumulative link models to run ordinal regressions for identification of explanatory sociodemographic variables. RESULTS Overall, there was generally strong support for the policies assessed. The general public in Manitoba was significantly more supportive of policies than its Alberta counterpart. Some differences were found between provinces and samples. For certain substance use policies, there was stronger support among women than men and among those with higher education than those with less education. CONCLUSIONS The results highlight areas where efforts are needed to increase support from both policy influencers and general public for adoption, implementation, and scaling of substance use policies. Socio-demographic variables related to support for substance use policies may be useful in informing strategies such as knowledge mobilization to advance the policy landscape in Western Canada.
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Affiliation(s)
- Kimberley D Curtin
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8303-112 St NW - Room 7-80, Edmonton, AB, T6G 2T4, Canada
| | - Mathew Thomson
- Clinical Epidemiology Department, Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 ECHA, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cr - Room 308C, Ottawa, ON, K1G 5Z3, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, 3-300 ECHA, 11405- 87 Ave, Ave, Edmonton, AB, 11405-87, T6G 1C9, Canada
| | - Ana Paula Belon
- Centre for Healthy Communities, School of Public Health, University of Alberta, 3-300 ECHA, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Candace I J Nykiforuk
- School of Public Health, University of Alberta, 3-300 ECHA, 11405- 87 Ave, Ave, Edmonton, AB, 11405-87, T6G 1C9, Canada.
- Centre for Healthy Communities, School of Public Health, University of Alberta, 3-300 ECHA, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada.
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Lloyd Z, Colledge-Frisby S, Taylor N, Livingston M, Jauncey M, Roxburgh A. Changes in Australians' attitudes towards supervised injecting facilities. Drug Alcohol Rev 2024. [PMID: 39222486 DOI: 10.1111/dar.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Supervised injecting facilities (SIF) have been shown to reduce negative outcomes experienced by people who inject drugs. They are often subject to intense public and media scrutiny. This article aimed to explore population attitudes to SIFs and how these changed over time in Australia. METHODS Data were drawn from the National Drug Strategy Household Survey, a national sample collecting data on illicit drug use and attitudes towards drug policy among Australians (2001-2019). Ordinal logistic regression assessed sociodemographic characteristics associated with different attitudes to SIFs and binary logistic regression assessed trends over time and by jurisdiction. RESULTS In 2019, 54% of respondents (95% CI 52.9, 55.1) supported SIFs, 27.5% (95% CI 26.6, 28.4) opposed and 18.4% (95% CI 17.7, 19.2) were ambivalent. Support for SIFs correlated with having a university degree (OR 1.75; 95% CI 1.58, 1.94), non-heterosexual identity (OR 1.81, 95% CI 1.51, 2.17) and recent illicit drug use (OR = 1.74, 95% CI 1.55, 1.94). Male respondents or those living in socioeconomically disadvantaged areas had lower odds of supporting SIFs (OR 0.92, 95% CI 0.85, 1.00; OR 0.64-0.80, respectively). Between 2001 and 2019, support for SIFs increased modestly by 3.3%, those who 'don't know' by 7.4%, whereas opposition decreased by 11.7%. Between 2001 and 2019, support for SIFs increased in NSW and Queensland, whereas opposition decreased in all jurisdictions. DISCUSSION AND CONCLUSIONS Opposition to SIFs declined over the past 20 years, but a substantial proportion of respondents are ambivalent or 'don't know enough to say'. Plain language information about SIFs and their potential benefits, targeted to those who are ambivalent/'don't know' may further increase public support.
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Affiliation(s)
| | - Samantha Colledge-Frisby
- Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Nicholas Taylor
- Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Michael Livingston
- Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Marianne Jauncey
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Amanda Roxburgh
- Burnet Institute, Melbourne, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Schaefer M, Panagiotoglou D. Evaluating the effects of supervised consumption sites on housing prices in Montreal, Canada using interrupted time series and hedonic price models. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100242. [PMID: 38948426 PMCID: PMC11214419 DOI: 10.1016/j.dadr.2024.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 07/02/2024]
Abstract
Background In 2017, three brick and mortar supervised consumption sites (SCS) opened in Montreal, Canada. Opponents argued the sites would attract people who use drugs and reduce local real estate prices. Methods We used interrupted time series and hedonic price models to evaluate the effects of Montreal's SCS on local real estate prices. We linked the Quebec Professional Association of Real Estate Brokers' housing sales data provided by Centris Inc. with census tract data and gentrification scores. Homes sold within 200 m of the SCS locations between 1 January 2014 and 31 December 2021 were included. We adjusted for internal (e.g., number of bed/bathrooms, unit size) and external attributes (e.g., neighbourhood demographics), and included a spatio-temporal lag to account for correlation between sales. For sensitivity analysis we used site-specific dummy variables to better account for unmeasured neighbourhood differences, and repeated analyses using 500 m and 1000 m radii. Results We observed a price shock after the opening of the first two SCS in June 2017 (level effect: -10.5%, 95% CI: -19.1%, -1.1%) but prices rose faster month-to-month (trend effect: 1.1%, 95% CI: 0.7%, 1.6%) after implementation. Following the implementation of the third site in November 2017 there was no immediate impact (level effect: 2.4%, 95% CI: -10.4%, 17.0%) but once more prices roses faster (0.9%, 95% CI: 0.4%, 1.5%) thereafter. When we replaced neighbourhood attributes with a site-specific dummy variable, we observed the same pattern. Sales' prices dropped (level effect: -9.6%, 95% CI: -15.0%, -3.8%) but rose faster month-to-month (trend effect: 0.9%, 95% CI: 0.6%, 1.2%) following June 2017's SCS implementations, with no level effect (4.9%, 95% CI: -7.3%, 18.6%) and a positive trend (0.9%, 95% CI: 0.5%, 1.3%) after November 2017's SCS opening. In most 500 m and 1000 m radii models, there were no immediate shocks following SCS opening, however, positive trend effects persisted in all models. Conclusion Our models suggest homes sold near SCS may experience a price shock immediately post-implementation, with evidence of market recovery in the months that follow.
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Affiliation(s)
- Maximilian Schaefer
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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Whiteside B, Dunn M. Voices represented and voices silenced: Represented voices in the media coverage of the implementation of a supervised injecting facility. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104213. [PMID: 37776603 DOI: 10.1016/j.drugpo.2023.104213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Victoria's first medically supervised injecting room (MSIR) has remained controversial despite mounting evidence in support of the facility. The opposition to a policy idea is subject to a myriad of factors including the media. Favouring the opinions of various actors, the media are a fundamental element of the narrative formation process. In this article, we examine the voices represented and voice silenced in print news media and the possible effects of such reporting. METHODS A quantitative content and qualitative thematic analysis of Victorian print media (n=645) focusing on the implementation and continued operation of North Richmond Community Health's medically supervised injecting room was conducted. RESULTS The representations of the MSIR were debated by three predominant actors - politicians, public, and residents. Politicians largely relied on the 'saving lives' rhetoric when supporting the facility. In addition, competing representations of 'public amenity' were presented by both advocates and proponents of the MSIR. We found the voices of people who inject drugs were inadequately represented within the data. Instead, overdose statistics were featured as were discursive descriptions of people who inject drugs such as 'addicts', 'junkies', and 'druggies'. CONCLUSION Despite people who inject drugs being the population the MSIR is designed to benefit, their experiences and voices were lacking, highlighting social power structures, denying the silenced power, and obstructing social change. Overdose rates were consistently presented as numbers, negating personal experiences and lacking meaningful debate. Further, negative discourse referring to people who inject drugs may have implications regarding internalised and externalised stigma and drug policy.
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Affiliation(s)
- Bianca Whiteside
- School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Australia; Institute for Health Transformation, Faculty of Health, Deakin University, Australia.
| | - Matthew Dunn
- School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Australia; Institute for Health Transformation, Faculty of Health, Deakin University, Australia
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Morris H, Bwala H, Wesley J, Hyshka E. Public support for safer supply programs: analysis of a cross-sectional survey of Canadians in two provinces. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:484-492. [PMID: 36689127 PMCID: PMC9869824 DOI: 10.17269/s41997-022-00736-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Canada's ongoing drug poisoning crisis has contributed to unprecedented rates of morbidity and mortality. Health Canada has funded safer supply pilot programs to help connect people who use drugs to pharmaceutical grade medications that reduce their reliance on a toxic drug supply. However, most provinces, including Alberta and Saskatchewan, have not endorsed these initiatives. We explored public support for safer supply programs in these two Canadian provinces and identified predictors of support for this policy option. METHODS Cross-sectional data were examined from an online panel survey that included measures assessing views on policy responses to substance use and addiction. A total of 1602 adults were recruited during March 2021. We used descriptive statistics to characterize support for safer supply programs in Alberta and Saskatchewan and multinominal logistic regression analysis to examine predictors of public support for safer supply. RESULTS The majority of respondents (AB: 63.5% and SK: 56.3%) supported safer supply programs that replace illegal street drugs with pharmaceutical alternatives for those unable to stop using. Predicted probabilities show a greater probability of support for safer supply among those with higher education and those leaning left on the political spectrum. CONCLUSION A majority of Canadians from Alberta and Saskatchewan supported provincial government efforts to expand safer supply, suggesting a lack of public support is not the main barrier to implementation. Efforts at mobilizing this public opinion are needed to scale up and facilitate evaluation of this drug poisoning response.
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Affiliation(s)
- Heather Morris
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Hauwa Bwala
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Jared Wesley
- Faculty of Arts-Political Science Department, University of Alberta, Edmonton, AB, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Effects of media representations of drug related deaths on public stigma and support for harm reduction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103909. [PMID: 36399962 DOI: 10.1016/j.drugpo.2022.103909] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Drug related deaths (DRD) are at historically high levels in the United Kingdom (UK), but some approaches that have the potential to reduce risk of mortality remain controversial. Public support makes an important contribution to drug policy development but there are high levels of public stigma towards people who use drugs (PWUD), and this is partly shaped by media representations. We investigated whether depiction of the characteristics of decedents represented in news articles about DRD was associated with differences in stigmatising attitudes and support for harm reduction policy. METHODS We undertook a cross-sectional online study with a randomised design, conducted with a nationally representative sample (UK). Participants (N = 1280) were randomly presented with one of eight simulated news stories that reported on a DRD that differed with respect to drug (ecstasy or heroin), and the gender (male or female) and age (younger or older) of the decedent. Data were analysed using MANOVA. RESULTS Data were obtained for 1248 participants (51.0% female; mean age 45.7±15.4). Stigma was higher towards depictions of male, older, and heroin deaths (all p < .001). Harm reduction support was higher in those participants seeing older compared to younger subjects (p = .035), and the older ecstasy decedent compared to younger decedent (p = .029). CONCLUSION Presentation of some types of DRD are associated with higher public stigma towards the decedent than others. Those groups developing agenda-setting activities designed to reduce stigma or foster public support for harm reduction policies should consider the different ways in which audiences may respond to the depiction and framing of DRD in news media.
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Filteau MR, Green B, Kim F, McBride KA. 'It's the same thing as giving them CPR training': rural first responders' perspectives on naloxone. Harm Reduct J 2022; 19:111. [PMID: 36192736 PMCID: PMC9531424 DOI: 10.1186/s12954-022-00688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
The Substance Abuse and Mental Health Services Administration's (SAMHSA) Harm Reduction grant program expanded access to several harm reduction strategies to mitigate opioid overdose fatalities, including expanding access to naloxone. Interviews with first responders in a frontier and remote (FAR) state were conducted to understand their job responsibilities in relation to overdose response and prevention and their perceptions of training laypersons to administer naloxone. This study includes 22 interviews with law enforcement, EMS and/or fire personnel, and members of harm reduction-focused community organizations. The study finds widespread support for increasing access to naloxone and training laypersons in naloxone administration throughout Montana, due to rural first responders' inability to meet the needs of residents and an overall lack of resources to address addiction and the effects of fentanyl. Participants from harm reduction-focused community organizations convey support for training lay persons, but also illuminate that real and perceived cultural opposition to harm reduction strategies could reduce the likelihood that laypeople enroll in naloxone training. This study adds to the literature because it focuses on first responders in a FAR area that would benefit from layperson naloxone education and administration training due to its geographic expansiveness and the area's overall lack of access to medications for opioid use disorder or other treatment services. Expanding harm reduction approaches, like increasing access and training laypersons to administer naloxone, might be FAR residents' best chance for surviving an opioid overdose.
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Affiliation(s)
| | | | - Frances Kim
- JG Research and Evaluation, Bozeman, MT, USA
| | - Ki-Ai McBride
- Montana Department of Health and Human Services, Behavioral Health and Disabilities Disorders Division, Helena, MT, USA
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Berrigan P, Zucchelli E. Public preferences for safe consumption sites for opioid use: A discrete choice experiment. Drug Alcohol Depend 2022; 238:109578. [PMID: 35933890 DOI: 10.1016/j.drugalcdep.2022.109578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Safe consumption sites provide people who use drugs with medical supervision and sterile paraphernalia for drug use. Although the presence of sites in neighborhoods can be controversial, few studies have assessed the preferences of individuals for attributes of safe consumption sites. METHODS A discrete choice experiment was conducted to assess public preferences for safe consumption sites. Logit and mixed logit models were used to analyze data. Participants were recruited from Conjointly.com using a sample of the general population in Canada. The sample included adults only, was split approximately evenly by gender, and reflects census data for household income and geographic area. Attributes included: cost of the site to the healthcare system; effectiveness of the site in reducing overdose death; financial compensation to residents if a site opens in their neighborhood; if the site is located in the respondent's neighborhood; and if the site reduces improperly discarded needles. RESULTS The sample consisted of 203 respondents. Respondents had negative preferences for sites that increased cost to the healthcare system. Conversely, they had positive preferences for sites that would reduce fatal overdoses, that could reduce improperly discarded needles, and sites that provided compensation to those impacted by the establishment of sites. CONCLUSIONS Findings suggest that there exist a set of attributes that influence respondents' preferences for safe consumption sites. By considering these attributes when designing sites and developing messaging for sites, decision-makers may develop sites that are potentially less controversial.
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Affiliation(s)
- Patrick Berrigan
- Faculty of Health and Medicine, Division of Health Research, Lancaster University, 46 Bardsea, Bailrigg, Lancaster LA1 4YG, United Kingdom.
| | - Eugenio Zucchelli
- Faculty of Health and Medicine, Division of Health Research, Lancaster University, 46 Bardsea, Bailrigg, Lancaster LA1 4YG, United Kingdom; Madrid Institute for Advanced Study, Casa de Velázquez, Ciudad Universitaria, C/ de Paul Guinard, 3E - 28040 Madrid, Spain; Department of Economic Analysis, Universidad Autónoma de Madrid, C/ Francisco Tomás y Valiente 5, 28049 Madrid, Spain; IZA Institute of Labor Economics. Forschungsinstitut zur Zukunft der Arbeit GmbH (IZA), Schaumburg-Lippe-Straße 5-9, 53113 Bonn, Germany.
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The importance of PEOPLE who use drugs within drug policy reform debates: Findings from the UK Drug Policy Voices online survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103711. [DOI: 10.1016/j.drugpo.2022.103711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/16/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022]
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Panagiotoglou D. Evaluating the population-level effects of overdose prevention sites and supervised consumption sites in British Columbia, Canada: Controlled interrupted time series. PLoS One 2022; 17:e0265665. [PMID: 35316284 PMCID: PMC8939833 DOI: 10.1371/journal.pone.0265665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND On 14 April 2016, British Columbia's Provincial Medical Health Officer declared the overdose crisis a public health emergency, sanctioning the implementation of new overdose prevention sites (OPS) and supervised consumption sites (SCS) across the province. METHODS We used the BC Centre for Disease Control's Provincial Overdose Cohort of all overdose events between 1 January 2015 and 31 December 2017 to evaluate the population-level effects of OPSs and SCSs on acute health service use and mortality. We matched local health areas (LHA) that implemented any site with propensity score matched controls and conducted controlled interrupted time series analysis. RESULTS During the study period, twenty-five OPSs and SCSs opened across fourteen of British Columbia's 89 LHAs. Results from analysis of LHAs with matched controls (i.e. excluding Vancouver DTES) were mixed. Significant declines in reported overdose events, paramedic attendance, and emergency department visits were observed. However, there were no changes to trends in monthly hospitalization or mortality rates. Extensive sensitivity analyses found these results persisted. CONCLUSIONS We found OPSs and SCSs reduce opioid-related paramedic attendance and emergency department visit rates but no evidence that they reduce local hospitalization or mortality rates.
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Affiliation(s)
- Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Tran V, Reid SE, Roxburgh A, Day CA. Assessing Drug Consumption Rooms and Longer Term (5 Year) Impacts on Community and Clients. Risk Manag Healthc Policy 2021; 14:4639-4647. [PMID: 34815725 PMCID: PMC8604650 DOI: 10.2147/rmhp.s244720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Drug consumption rooms (DCRs) and supervised injecting facilities (SIFs) provide a safe environment in which people who inject drugs (PWIDs) can inject under hygienic and supervised conditions. Numerous reviews have documented the benefits of these facilities; however, there is a lack of clarity surrounding their long-term effects. PURPOSE To conduct, with a systematic approach, a literature review, of published peer-reviewed literature assessing the long-term impacts of DCRs/SIFs. METHODS A systematic search of the PubMed and Embase database was performed using the keywords: ("SUPERVISED" OR "SAFE*") AND ("CONSUMPTION" OR "INJECT*" OR "SHOOTING") AND ("FACILITY*" OR "ROOM*" OR "GALLERY*" OR "CENTRE*" OR "CENTER*" OR "SITE*"). Included studies were original articles reporting outcomes for five or more years and addressed at least one of the following client or community outcomes; (i) drug-related harms; (ii) access to substance use treatment and other health services; (iii) impact on local PWID population; (iv) impact on public drug use, drug-related crime and violence; and (v) local community attitudes to DCRs. RESULTS Four publications met our inclusion criteria, addressing four of the five outcomes. Long-term data suggested that while the health of PWID naturally declined over time, DCRs/SIFs helped reduce injecting-related harms. The studies showed that DCRs/SIFs facilitate drug treatment, access to health services and cessation of drug injecting. Local residents and business owners reported less public drug use and public syringe disposal following the opening of a DCR/SIF. CONCLUSION Long-term evidence on DCRs/SIFs is consistent with established short-term research demonstrating the benefits of these facilities. A relative paucity of studies was identified, with most evidence originating from Sydney and Vancouver. The overall body of evidence would be improved by future studies following outcomes over longer periods and being undertaken in a variety of jurisdictions and models of DCRs/SIFs.
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Affiliation(s)
- Vincent Tran
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon E Reid
- Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Amanda Roxburgh
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
- National Drug and Alcohol Research Centre, UNSW, Randwick, New South Wales, Australia
- Monash Addiction Research Centre, Monash University, Clayton, Victoria, Australia
| | - Carolyn A Day
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, New South Wales, Australia
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Murphy J, Russell B. Police Officers' addiction frameworks and policy attitudes. Addict Behav 2021; 122:107007. [PMID: 34146796 DOI: 10.1016/j.addbeh.2021.107007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/08/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023]
Abstract
Police officers have frequent encounters with people who use drugs, either by making an arrest for a drug-related offense or responding to a drug overdose call. Yet, little is known about how police officers view drug addiction - as a disease, a moral failure, or something else - and how their frameworks for conceptualizing addiction impact their attitudes toward drug policies, including the use of naloxone. This research examined police officers' adherence to a moralistic addiction framework in relation to their support for treatment-oriented drug policies. Officers (N = 618) were surveyed about their beliefs on drug policy and the extent to which drug addiction was a product of one's morals or related to social or biological reasons. Results found that approximately 22% of the variance in drug policy attitudes could be explained by addiction frameworks and control variables. Officers who embraced a biological perspective of addiction were more supportive of policies that expanded treatment, including access to naloxone, and less punitive sanctions. Those with stronger moralistic views were less supportive of expanding treatment initiatives and endorsed expanding punitive sanctions. Officer age and education was positively related with expanding treatment and naloxone use while exposure to overdoses was negatively related to policy support. These results demonstrate that officers' frameworks about drug addiction play an important role in drug policy attitudes and, by extension, how they might interact with people who use drugs.
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Churchill E, Shankardass K, Perrella AM, Lofters A, Quiñonez C, Brooks L, Wilson D, Kirst M. Effectiveness of Narrative Messaging Styles about the Social Determinants of Health and Health Inequities in Ontario, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10881. [PMID: 34682626 PMCID: PMC8535318 DOI: 10.3390/ijerph182010881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 02/02/2023]
Abstract
Health inequities are systemic, avoidable, and unjust differences in health between populations. These differences are often determined by social and structural factors, such as income and social status, employment and working conditions, or race/racism, which are referred to as the social determinants of health (SDOH). According to public opinion, health is considered to be largely determined by the choices and behaviours of individuals. However, evidence suggests that social and structural factors are the key determinants of health. There is likely a lack of public understanding of the role that social and structural factors play in determining health and producing health inequities. Public opinion and priorities can drive governmental action, so the aim of this work was to determine the most impactful way to increase knowledge and awareness about the social determinants of health (SDOH) and health inequities in the province of Ontario, Canada. A study to test the effectiveness of four different messaging styles about health inequities and the SDOH was conducted with a sample of 805 adult residents of Ontario. Findings show that messages highlighting the challenges faced by those experiencing the negative effects of the SDOH, while still acknowledging individual responsibility for health, were the most effective for eliciting an empathetic response from Ontarians. These findings can be used to inform public awareness campaigns focused on changing the current public narrative about the SDOH toward a more empathetic response, with the goal of increasing political will to enact policies to address health inequities in Ontario.
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Affiliation(s)
- Emily Churchill
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada; (E.C.); (K.S.)
| | - Ketan Shankardass
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada; (E.C.); (K.S.)
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
| | - Andrea M.L. Perrella
- Department of Political Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada;
| | - Aisha Lofters
- Women’s College Hospital, Toronto, ON M5S 1B2, Canada;
| | - Carlos Quiñonez
- Faculty of Dentistry, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Louise Brooks
- Wellington-Dufferin-Guelph Public Health, Guelph, ON N1G 0E1, Canada;
| | - Dana Wilson
- Public Health Sudbury & Districts, Sudbury, ON P3E 3A3, Canada;
| | - Maritt Kirst
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada; (E.C.); (K.S.)
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MacQuarrie AL, Brunelle C. Emerging Attitudes Regarding Decriminalization: Predictors of Pro-Drug Decriminalization Attitudes in Canada. JOURNAL OF DRUG ISSUES 2021. [DOI: 10.1177/00220426211050030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Canada and the United States have recently evaluated the decriminalization of drugs as multiple provinces and states put motions forward to consider drug decriminalization legislation. The influence of factors such as demographics, substance use, perceived substance use risk, and personality have not been widely studied in predicting attitudes toward drug decriminalization. A total of 504 participants were drawn from university ( n = 269, 53.37%) and community samples ( n = 235, 46.63%) through online social media groups and posts (i.e., Facebook, Twitter, Reddit, etc). Analyses indicated that male gender, single or non-married relationship status, living outside of Atlantic Canada, higher problematic alcohol use scores, lower Extraversion, higher Open-mindedness, and lower perceived risk of using substances emerged as significant predictors of support for drug decriminalization. These findings have important implications as public attitudes toward a substance influence drug policy.
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Affiliation(s)
- Amy L. MacQuarrie
- Department of Psychology, University of New Brunswick Saint John Campus, Saint John, NB, Canada
| | - Caroline Brunelle
- Department of Psychology, University of New Brunswick Saint John Campus, Saint John, NB, Canada
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15
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Rudzinski K, Xavier J, Guta A, Chan Carusone S, King K, Phillips JC, Switzer S, O'Leary B, Baltzer Turje R, Harrison S, de Prinse K, Simons J, Strike C. Feasibility, acceptability, concerns, and challenges of implementing supervised injection services at a specialty HIV hospital in Toronto, Canada: perspectives of people living with HIV. BMC Public Health 2021; 21:1482. [PMID: 34325681 PMCID: PMC8323264 DOI: 10.1186/s12889-021-11507-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance use significantly impacts health and healthcare of people living with HIV/AIDS (PLHIV), especially their ability to remain in hospital following admission. Supervised injection services (SIS) reduce overdoses and drug-related harms, but are not often provided within hospitals/outpatient programs. Leading us to question, what are PLHIV's perceptions of hospital-based SIS? METHODS This mixed-methods study explored feasibility and acceptability of implementing SIS at Casey House, a Toronto-based specialty HIV hospital, from the perspective of its in/outpatient clients. We conducted a survey, examining clients' (n = 92) demand for, and acceptability of, hospital-based SIS. Following this, we hosted two focus groups (n = 14) and one-on-one interviews (n = 8) with clients which explored benefits/drawbacks of in-hospital SIS, wherein participants experienced guided tours of a demonstration SIS space and/or presentations of evidence about impacts of SIS. Data were analysed using descriptive statistics and thematic analysis. RESULTS Among survey participants, 76.1% (n = 70) identified as cis-male and over half (n = 49;54.4%) had been a hospital client for 2 years or less. Nearly half (48.8%) knew about clients injecting in/near Casey House, while 23.6% witnessed it. Survey participants were more supportive of SIS for inpatients (76.1%) than for outpatients (68.5%); most (74.7%) reported SIS implementation would not impact their level of service use at Casey House, while some predicted coming more often (16.1%) and others less often (9.2%). Most focus group/interview participants, believed SIS would enhance safety by reducing health harms (e.g. overdose), increasing transparency between clients and clinicians about substance use, and helping retain clients in care. Debate arose about who (e.g., in/outpatients vs. non-clients) should have access to hospital-based SIS and how implementation may shift organizational priorities/resources away from services not specific to drug use. CONCLUSIONS Our data showed widespread support of, and need for, hospital-based SIS among client stakeholders; however, attempts to reduce negative impacts on non-drug using clients need to be considered in the balance of implementation plans. Given the increased risks of morbidity and mortality for PLHIV who inject drugs as well as the problems in retaining them in care in a hospital setting, SIS is a key component of improving care for this marginalized group.
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Affiliation(s)
- Katherine Rudzinski
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.
| | - Jessica Xavier
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, Canada
| | - Soo Chan Carusone
- Casey House, 119 Isabella St, Toronto, ON, M4Y 1P2, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main Street West 2C Area, Hamilton, ON, L8S 4K, Canada
| | - Kenneth King
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - J Craig Phillips
- Faculty of Health Sciences, University of Ottawa, 190 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Sarah Switzer
- Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, ON, M5S 1V6, Canada
| | - Bill O'Leary
- Casey House, 119 Isabella St, Toronto, ON, M4Y 1P2, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada
| | | | - Scott Harrison
- Providence Health Care - St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | | | - Joanne Simons
- Casey House, 119 Isabella St, Toronto, ON, M4Y 1P2, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
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16
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Wild TC, Koziel J, Anderson-Baron J, Asbridge M, Belle-Isle L, Dell C, Elliott R, Hathaway A, MacPherson D, McBride K, Pauly B, Strike C, Galovan A, Hyshka E. Public support for harm reduction: A population survey of Canadian adults. PLoS One 2021; 16:e0251860. [PMID: 34010338 PMCID: PMC8133460 DOI: 10.1371/journal.pone.0251860] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/05/2021] [Indexed: 11/19/2022] Open
Abstract
We described public views toward harm reduction among Canadian adults and tested a social exposure model predicting support for these contentious services, drawing on theories in the morality policy, intergroup relations, addiction, and media communication literatures. A quota sample of 4645 adults (18+ years), randomly drawn from an online research panel and stratified to match age and sex distributions of adults within and across Canadian provinces, was recruited in June 2018. Participants completed survey items assessing support for harm reduction for people who use drugs (PWUD) and for seven harm reduction interventions. Additional items assessed exposure to media coverage on harm reduction, and scales assessing stigma toward PWUD (α = .72), personal familiarity with PWUD (α = .84), and disease model beliefs about addiction (α = .79). Most (64%) Canadians supported harm reduction (provincial estimates = 60% - 73%). Five of seven interventions received majority support, including: outreach (79%), naloxone (72%), drug checking (70%), needle distribution (60%) and supervised drug consumption (55%). Low-threshold opioid agonist treatment and safe inhalation interventions received less support (49% and 44%). Our social exposure model, adjusted for respondent sex, household income, political views, and education, exhibited good fit and accounted for 17% of variance in public support for harm reduction. Personal familiarity with PWUD and disease model beliefs about addiction were directly associated with support (βs = .07 and -0.10, respectively), and indirectly influenced public support via stigmatized attitudes toward PWUD (βs = 0.01 and -0.01, respectively). Strategies to increase support for harm reduction could problematize certain disease model beliefs (e.g., "There are only two possibilities for an alcoholic or drug addict-permanent abstinence or death") and creating opportunities to reduce social distance between PWUD, the public, and policy makers.
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Affiliation(s)
- T. Cameron Wild
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jakob Koziel
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | | | - Mark Asbridge
- Department of Community Health and Epidemiology, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lynne Belle-Isle
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Colleen Dell
- Department of Sociology, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Andrew Hathaway
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
| | | | | | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adam Galovan
- Department of Human Ecology, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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17
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Thakarar K, Nenninger K, Agmas W. Harm Reduction Services to Prevent and Treat Infectious Diseases in People Who Use Drugs. Infect Dis Clin North Am 2021; 34:605-620. [PMID: 32782104 DOI: 10.1016/j.idc.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article reviews the principles of harm reduction, evidence-based harm reduction strategies such as syringe service programs and supervised injection facilities, and provides approaches to integrating a harm reduction approach into clinical practice. As providers strive to increase capacity to treat underlying substance use disorder, we must also recognize that some people may continue to use drugs. In this setting, providers can still deliver nonjudgmental, individualized care, and advocate for the health and safety of people who inject drugs.
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Affiliation(s)
- Kinna Thakarar
- Infectious Disease and Addiction Medicine, Maine Medical Center/Tufts University School of Medicine, 50 Foden Road, South Portland, ME 04106, USA.
| | - Katherine Nenninger
- Preventive Medicine, Maine Medical Center/Tufts University School of Medicine, 22 Bramhall Street, Portland, ME 04102, USA
| | - Wollelaw Agmas
- Infectious Disease, Maine Medical Center/Tufts University School of Medicine, 22 Bramhall Street, Portland, ME 04102, USA
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18
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Munoz Sastre MT, Kpanake L, Mullet E. French People's positions on supervised injection facilities for drug users. Subst Abuse Treat Prev Policy 2020; 15:79. [PMID: 33054832 PMCID: PMC7557075 DOI: 10.1186/s13011-020-00321-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Supervised injection facilities have been set-up in many countries to curb the health risks associated with unsafe injection practices. These facilities have, however, been met with vocal opposition, notably in France. As harm reduction policies can only succeed to the extent that people agree with them, this study mapped French people's opinions regarding the setting-up of these facilities. METHOD A sample of 318 adults--among them health professionals--were presented with 48 vignettes depicting plans to create a supervised injection facility in their town. Each vignette contained three pieces of information: (a) the type of substance that would be injected in the facility (amphetamines only, amphetamines and cocaine only, or amphetamines, cocaine and heroin), (b) the type of staff who would be working in the facility (physicians and nurses, specially trained former drug users, specially trained current drug users, or trained volunteers recruited by the municipality), and (c) the staff members' mission (to be present and observe only, technical counselling about safe injection, counselling about safe injection and hygiene, or counselling and encouragement to follow a detoxification program). RESULTS Through cluster analysis, three qualitatively different positions were found: Not very acceptable (20%), Depends on staff and mission (49%), and Always acceptable (31%). These positions were associated with demographic characteristics--namely gender, age and political orientation. CONCLUSION French people's positions regarding supervised injection facilities were extremely diverse. One type of facility would, however, be accepted by a large majority of people: supervised injection facilities run by health professionals whose mission would be, in addition to technical and hygienic counselling, to encourage patrons to enter detoxification or rehabilitation programs.
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Affiliation(s)
- Maria Teresa Munoz Sastre
- CERPPS, Maison de la recherche, Federal University of Toulouse, 5 allées Antonio Machado, 31058 Toulouse cedex 9, France
| | - Lonzozou Kpanake
- University of Québec – TELUQ, 5800, rue Saint-Denis, Bureau 1105, Montréal (Québec), Montréal, H2S 3L5 Canada
| | - Etienne Mullet
- Institute of Advanced Studies (EPHE), 17 bis, rue Quefes, Plaisance du Touch, 31830 Paris, France
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19
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Sumnall HR, Atkinson AM, Trayner KMA, Gage SH, McAuley A. Effects of messaging on public support for drug consumption rooms in scotland, UK. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102855. [PMID: 32693322 DOI: 10.1016/j.drugpo.2020.102855] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is evidence to suggest that medically supervised drug consumption rooms (DCRs) may form part of responses to reduce drug-related harm. Although DCRs have been established globally, they are perceived by some to be a controversial approach in the UK, and Government has repeatedly rejected proposals to establish one in Glasgow, Scotland. As public support is an important component of policy development and enactment, we sought to investigate the effects of different types of message framing on public support for DCR. METHODS We undertook a cross-sectional online study with a randomised design, conducted with a nationally representative sample. Participants were randomised to one of six message conditions comprising combinations of four components. All conditions included i) a basic description of a DCR, and conditions included combinations of ii) factual information; iii) pre-emptive refutation of common public concerns about DCR; and/or iv) a sympathetic narrative describing a mother whose son died from a heroin overdose. After reading each message, participants completed a bespoke measure assessing support for DCR. Data were analysed using ANCOVA. RESULTS Complete data were obtained from 1591 participants (50.3% Female; mean age 44.9 ± 16.1 years). Compared to reading a basic description of DCR alone, there was greater support for DCR in participants receiving the refutation (p < .001); sympathetic + factual (p < .05); and sympathetic + factual + refutation (p < .001) message conditions. Presenting factual or sympathetic messages alone were not associated with increased support. CONCLUSION Our findings suggest that public support for DCRs is not improved through communication of factual statements outlining potential benefits of the intervention alone. Advocates seeking to foster public support, and thus influence policy making, should also consider communication campaigns that address common concerns that the public might have about DCRs, and present the intervention in relation to potential benefits that they hold for people indirectly affected by drug-related harm.
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Affiliation(s)
- H R Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, UK.
| | - A M Atkinson
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - K M A Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
| | - S H Gage
- Psychological Sciences, University of Liverpool, UK
| | - A McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
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20
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Russell C, Imtiaz S, Ali F, Elton-Marshall T, Rehm J. 'Small communities, large oversight': The impact of recent legislative changes concerning supervised consumption services on small communities in Ontario, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102822. [PMID: 32563756 DOI: 10.1016/j.drugpo.2020.102822] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/10/2023]
Abstract
The opioid epidemic continues to exert a large toll on public health across Canada, with the province of Ontario specifically experiencing exceptionally high opioid-related hospitalizations and overdoses in 2019. As a key evidence-based public health intervention to reduce these harms, over the past few years supervised consumption services (SCS), including temporary and flexible unsanctioned models, have been implemented in select cities across the province. However, in March 2019, the newly elected Ontario provincial government replaced SCS regulations with a 'streamlined' model that introduced additional bureaucratic and administrative requirements for application approval and funding, while placing a cap on the number of sites allowed. Only a select few sites were approved, despite the ability of numerous cities across the province to demonstrate a need for SCS in their community. Importantly, many small communities throughout Ontario have been experiencing opioid-related harms at rates which far outpace those of larger cities. Several of these communities have been actively working towards securing SCS sites, but have been unable to do so as they do not have the resources to meet stringent application requirements. These regulatory changes therefore hinder the feasibility of small communities to implement necessary and life-saving SCS, which will affect lives. This is a major oversight.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, Ontario, Canada, M5S 2S1.
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, Ontario, Canada, M5S 2S1
| | - Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, Ontario, Canada, M5S 2S1
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, Ontario, Canada, M5S 2S1; Dalla School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, Canada, M5T 3M7; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, Ontario, Canada, M6A 5C1
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, Ontario, Canada, M5S 2S1; Dalla School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, Canada, M5T 3M7; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College St., Toronto, Ontario, Canada, M5T 1R8; Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada, M5S 1A8; Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada, M5S 1A8; Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19с1, Moscow, Russian Federation 119146
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21
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Roth AM, Kral AH, Mitchell A, Mukherjee R, Davidson P, Lankenau SE. Overdose Prevention Site Acceptability among Residents and Businesses Surrounding a Proposed Site in Philadelphia, USA. J Urban Health 2019; 96:341-352. [PMID: 31168733 PMCID: PMC6565835 DOI: 10.1007/s11524-019-00364-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Overdose prevention sites (OPS) are places where people use previously obtained drugs under the supervision of a health professional. They have been proposed in six United States (US) cities, including Philadelphia, to help reduce opioid-related overdose deaths and public injection. Philadelphia has the highest overdose rate among large cities in the US, which has led a local community-based organization to plan the implementation of OPS. Kensington, a neighborhood with the highest drug mortality overdose rates in the city, is a likely site for the proposed OPS. Given the dearth of research systematically assessing public opinion towards OPS prior to implementation, we enrolled 360 residents and 79 business owners/staff in the Kensington neighborhood in a cross-sectional acceptability study. Face-to-face surveys assessed participant characteristics, experiences with drug-related social problems, and OPS acceptability. Using descriptive statistics, we estimated factors associated with favorability towards opening an OPS in the Kensington neighborhood. Ninety percent of residents were in favor of an OPS opening in Kensington. Support was significantly higher among unstably housed individuals and persons who currently use opioids. In the business sample, 63% of owners/staff were in favor of opening an OPS in Kensington. A greater proportion of Asian/Pacific Islanders, Hispanic/Latinx respondents, and non-Hispanic/Latinx Black respondents were in favor of an OPS opening in Kensington compared with white respondents (p < 0.04). While details about implementation are still being considered, results indicate general acceptability among Kensington residents and businesses for an OPS, especially if it can deliver benefits that curb drug-related social problems. Should an OPS be implemented in Philadelphia, it would be important to monitor changes in drug-related social problems and acceptability post implementation.
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Affiliation(s)
- Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA.
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, San Francisco, CA, USA
| | - Allison Mitchell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
| | - Rohit Mukherjee
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
| | - Peter Davidson
- Department of Medicine, University of California, San Diego, CA, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
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Belackova V, Salmon AM, Day CA, Ritter A, Shanahan M, Hedrich D, Kerr T, Jauncey M. Drug consumption rooms: A systematic review of evaluation methodologies. Drug Alcohol Rev 2019; 38:406-422. [PMID: 30938025 DOI: 10.1111/dar.12919] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 01/27/2023]
Abstract
ISSUES Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies. APPROACH Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF 'exposure' were recorded. KEY FINDINGS Two hundred and nineteen eligible peer-reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty-six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on blood-borne diseases, overdose deaths and costs. Papers using individual-level data included four prospective cohorts (n = 28), cross-sectional surveys (n = 7) and service records (n = 5). Individual-level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service 'exposure'. IMPLICATIONS Research around DCRs/SIFs has used ecological, modelling, cross-sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self-reported proportion of injections at SIFs or a stepped-wedge or a cluster trial comparing localities. CONCLUSIONS Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted.
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Affiliation(s)
| | - Allison M Salmon
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Carolyn A Day
- Central Clinical School, Addiction Medicine, University of Sydney, Royal Prince Albert Hospital, Sydney, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, UNSW Sydney, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Calabrese C, Bell RA. Opposition to Nonprescription Naloxone Access: Measurement and Psychosocial Predictors. Subst Use Misuse 2019; 54:1853-1861. [PMID: 31131707 DOI: 10.1080/10826084.2019.1618331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Access of naloxone has been increased in recent years, yet opposition to unrestricted availability persists. Objectives: To validate a measure of opposition to the policy of nonprescription naloxone and foster a better understanding of the characteristics of individuals who oppose such a policy. Methods: Respondents from a crowdsource platform (N = 621) responded to an instrument developed to assess opposition to nonprescription naloxone. Construct validity was assessed by examining the relationship of the opposition scale with measures of social distance, belief in a just world, right wing authoritarianism, social dominance orientation (SDO), perceptions of the degree of threat to the nation presented by opioid users, past exposure to opioid misuse, and conservative political ideology. Results: A 9-item measure of opposition emerged (α=.96). Opposition to nonprescription naloxone was generally associated with construct validation variables as expected. In a regression analysis that adjusted for demographic characteristics, opposition was most strongly related to authoritarianism, the perception that opioid users present a threat to our nation, the belief that we live in a just world, social dominance orientation, greater perceived social distance between self and opioid users, and past experiences with users. Opposition scores differentiated those who supported versus opposed specific policies regarding naloxone access and were particularly high among Republicans. Most respondents did not oppose policies on nonprescription naloxone access. Conclusions/Importance: The instrument developed provides a reliable and valid tool that enables future investigations into understanding and overcoming the psychological, social, and political foundations of opposition to expanded naloxone access.
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Affiliation(s)
- Christopher Calabrese
- a Department of Communication , University of California, Davis , Davis , California , USA
| | - Robert A Bell
- a Department of Communication , University of California, Davis , Davis , California , USA.,b Department of Public Health Sciences , University of California, Davis , Davis , California , USA
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24
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Arguments supporting and opposing legalization of safe consumption sites in the U.S. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 63:18-22. [DOI: 10.1016/j.drugpo.2018.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 09/05/2018] [Accepted: 10/31/2018] [Indexed: 01/05/2023]
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Jauffret-Roustide M, Cailbault I. Drug consumption rooms: Comparing times, spaces and actors in issues of social acceptability in French public debate. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 56:208-217. [PMID: 29754895 DOI: 10.1016/j.drugpo.2018.04.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND In October 2016, the first French drug consumption room (DCR) opened in Paris. We propose to examine the process through which this issue has been framed as a matter of public concern, after being ignored for almost 20 years. Our analysis of the controversy on DCRs investigates how public conversations on harm reduction evolve according to the time period (from the 1990s to the present), scale of discourse (local vs. national), and involved actors (politicians, professionals, local residents, and drug users). METHODOLOGY Our methodology includes analyses of media content: we reviewed 1735 articles published between 1990 and 2017. Our theoretical approach is in line with the sociology "des épreuves" derived from pragmatic sociology and controversy analysis. This approach goes beyond interactionism by attempting to place situations back into broader sociological realities. We also pay special attention to governance, a political lens that focuses on local aspects of negotiations and on the implication of a variety of actors. RESULTS While the current debate on DCRs in France draws on constraints and resources already present in the harm reduction debate of the 1980s, it also repositions itself by avoiding moral argumentation and featuring less confrontation in the professional sphere. Today, we can see that the center of this tense debate has shifted from the professional sphere to the political and residential spheres. Most often, residents advance concerns that are not directly related to drug users themselves, but that derive from their apprehension of living in a displaced and stranded neighborhood. The public conversation leaves little room for drug users, even though they are the primary stakeholders of harm reduction and play a crucial role in DCR advocacy. CONCLUSION Our work reveals that the controversy about DCR is the product of complex interactions between different kinds of actors harm reduction professionals, political actors at the local and national levels, local residents, and drug users. Comparing different instances of public debate reveals the specific limitations and potentials for change in French drug policy.
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Affiliation(s)
- Marie Jauffret-Roustide
- Cermes 3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), 45 rue des Saint Pères, Paris, France.
| | - Isabelle Cailbault
- Cermes 3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), 45 rue des Saint Pères, Paris, France; Qalister, Boulogne, France
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Bardwell G, Scheim A, Mitra S, Kerr T. Assessing support for supervised injection services among community stakeholders in London, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 48:27-33. [DOI: 10.1016/j.drugpo.2017.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/18/2017] [Accepted: 05/02/2017] [Indexed: 11/26/2022]
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Kulesza M, Matsuda M, Ramirez JJ, Werntz AJ, Teachman BA, Lindgren KP. Towards greater understanding of addiction stigma: Intersectionality with race/ethnicity and gender. Drug Alcohol Depend 2016; 169:85-91. [PMID: 27792911 PMCID: PMC6040658 DOI: 10.1016/j.drugalcdep.2016.10.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/20/2016] [Accepted: 10/14/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND In spite of the significant burden associated with substance use disorders, especially among persons who inject drugs (PWIDs), most affected individuals do not engage with any type of formal or informal treatment. Addiction stigma, which is represented by negative social attitudes toward individuals who use alcohol and/or other drugs, is one of the barriers to care that is poorly understood. The current study: a) assessed implicit (indirect and difficult to consciously control) and explicit (consciously controlled) beliefs about PWIDs among visitors to a public web site; and b) experimentally investigated the effects of ethnicity/race and gender on those implicit and explicit beliefs. METHODS N=899 predominantly White (70%) and women (62%) were randomly assigned to one of six target PWIDs conditions: gender (man/woman) x race/ethnicity (White, Black, Latino/a). Participants completed an Implicit Association Test and explicit assessment of addiction stigma. RESULTS Participants implicitly associated PWIDs (especially Latino/a vs. White PWIDs) with deserving punishment as opposed to help (p=0.003, d=0.31), indicating presence of addiction stigma-related implicit beliefs. However, this bias was not evident on the explicit measure (p=0.89). Gender did not predict differential implicit or explicit addiction stigma (p=0.18). CONCLUSIONS Contrary to explicit egalitarian views towards PWIDs, participants' implicit beliefs were more in line with addiction stigma. If replicated and clearer ties to behavior are established, results suggest the potential importance of identifying conditions under which implicit bias might influence behavior (even despite explicit egalitarian views) and increase the likelihood of discrimination towards PWIDs.
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Affiliation(s)
| | - Mauri Matsuda
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Jason J Ramirez
- University of Washington, Department of Psychiatry, 1100 NE 45th Street, Seattle, WA, 98105, USA.
| | - Alexandra J Werntz
- University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA.
| | - Bethany A Teachman
- University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA.
| | - Kristen P Lindgren
- University of Washington, Department of Psychiatry, 1100 NE 45th Street, Seattle, WA, 98105, USA.
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Oudshoorn A, Kirkwood K. The geographic scope of opiate substitution therapy in an urban area in Canada. DRUGS-EDUCATION PREVENTION AND POLICY 2016. [DOI: 10.1080/09687637.2016.1216947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Abram Oudshoorn
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Ken Kirkwood
- Faculty of Health Sciences, Western University, London, ON, Canada
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Strike C, Rotondi NK, Watson TM, Kolla G, Bayoumi AM. Public opinions about supervised smoking facilities for crack cocaine and other stimulants. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:8. [PMID: 26860540 PMCID: PMC4748465 DOI: 10.1186/s13011-016-0052-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/03/2016] [Indexed: 11/11/2022]
Abstract
Background The purpose of this study was to estimate awareness and opinions about supervised smoking facilities (SSFs) for smoking crack cocaine and other stimulants and make comparisons with awareness and opinions about supervised injection facilities (SIFs) in Ontario, Canada. Methods We used data from a 2009 telephone survey of a representative adult sample. The survey asked about awareness of, and level of support for, the implementation of SSFs and SIFs. Data were analysed using statistical models for complex survey data, which account for stratified sampling and incorporate sampling weights. Results A total of 1035 participated in the survey. Significantly fewer had knowledge about SSFs (17.9 %) than about SIFs (57.6 %). Fewer strongly agreed with implementation of SSFs (19.6 %) than SIFs (28.3 %). Just over half (51.1 %) of participants somewhat agreed or disagreed, 15.7 % strongly agreed, and 10.6 % strongly disagreed with implementing both SSFs and SIFs. Conclusions Members of the public in Ontario had little knowledge of SSFs compared to SIFs. Recent federal government changes in Canada may provide the leadership environment necessary to ensure that innovative, evidence-based harm reduction programs such as SSFs are developed and implemented.
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Affiliation(s)
- Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada.
| | - Nooshin Khobzi Rotondi
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Canada.
| | - Tara Marie Watson
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada.
| | - Gillian Kolla
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada.
| | - Ahmed M Bayoumi
- Centre for Research on Innercity Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Canada. .,Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Canada. .,Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Canada. .,Division of General Internal Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Canada.
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Kulesza M, Teachman BA, Werntz AJ, Gasser ML, Lindgren KP. Correlates of public support toward federal funding for harm reduction strategies. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:25. [PMID: 26122408 PMCID: PMC4490612 DOI: 10.1186/s13011-015-0022-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/26/2015] [Indexed: 12/31/2022]
Abstract
Background Historically, US federal policy has not supported harm reduction interventions, such as safe injection facilities (SIFs) and needle and syringe programs (NSPs), which can reduce the burden associated with injection drug use. Given recent increases in abuse of both legal and illegal opioids, there has been a renewed debate about effective ways to address this problem. The current study (1) assessed participants’ support for SIFs and NSPs, and (2) evaluated several demographic factors (e.g., age, gender, race, education, political ideology, and religiosity) and individual differences in stigmatizing beliefs about people who inject drugs (PWID) that might relate to support for these interventions. Methods U.S. adults (N = 899) completed a web-based study that assessed self-reported support for NSPs and SIFs, and stigma about PWID. Results The majority of participants were at least somewhat supportive of both NSPs and SIFs. Regression analyses indicated greater support for NSPs and SIFs was predicted by more liberal political ideology, more agreement that PWID deserve help rather than punishment, older age, and male gender. Also, participants who endorsed lower stigma about PWID were more supportive of NSPs and SIFs. Race, religiosity, and education did not predict support for NSPs and SIFs. Conclusions Most participants tended to report support for harm reduction strategies. Age, political ideology, and individual differences in stigmatizing beliefs about PWID were significantly associated with support. Given the potential malleability of stigmatizing beliefs, efforts that seek to shift stigma about PWID could have important implications for public policy towards harm reduction strategies for PWID.
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Affiliation(s)
- Magdalena Kulesza
- Department of Psychiatry, University of Washington, 1100 NE 45th Street, Seattle, WA, 98105, USA. .,RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA.
| | - Bethany A Teachman
- University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA.
| | - Alexandra J Werntz
- University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA.
| | - Melissa L Gasser
- Department of Psychiatry, University of Washington, 1100 NE 45th Street, Seattle, WA, 98105, USA.
| | - Kristen P Lindgren
- Department of Psychiatry, University of Washington, 1100 NE 45th Street, Seattle, WA, 98105, USA.
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Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend 2014; 145:48-68. [PMID: 25456324 DOI: 10.1016/j.drugalcdep.2014.10.012] [Citation(s) in RCA: 319] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Supervised injection services (SISs) have been developed to promote safer drug injection practices, enhance health-related behaviors among people who inject drugs (PWID), and connect PWID with external health and social services. Nevertheless, SISs have also been accused of fostering drug use and drug trafficking. AIMS To systematically collect and synthesize the currently available evidence regarding SIS-induced benefits and harm. METHODS A systematic review was performed via the PubMed, Web of Science, and ScienceDirect databases using the keyword algorithm [("supervised" or "safer") and ("injection" or "injecting" or "shooting" or "consumption") and ("facility" or "facilities" or "room" or "gallery" or "centre" or "site")]. RESULTS Seventy-five relevant articles were found. All studies converged to find that SISs were efficacious in attracting the most marginalized PWID, promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency. SISs were not found to increase drug injecting, drug trafficking or crime in the surrounding environments. SISs were found to be associated with reduced levels of public drug injections and dropped syringes. Of the articles, 85% originated from Vancouver or Sydney. CONCLUSION SISs have largely fulfilled their initial objectives without enhancing drug use or drug trafficking. Almost all of the studies found in this review were performed in Canada or Australia, whereas the majority of SISs are located in Europe. The implementation of new SISs in places with high rates of injection drug use and associated harms appears to be supported by evidence.
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Affiliation(s)
- Chloé Potier
- Department of Addiction Medicine, CHRU de Lille, Univ Lille Nord de France, F-59037 Lille, France; University of Lille 2, Faculty of Medicine, F-59045 Lille, France.
| | - Vincent Laprévote
- CHU Nancy, Maison des Addictions, Nancy F-54000, France; CHU Nancy, Centre d'Investigation Clinique CIC-INSERM 9501, Nancy F-54000, France
| | - Françoise Dubois-Arber
- Institute of Social and Preventive Medicine, University Hospital Center and University of Lausanne, Chemin de la Corniche 10, 1010 Lausanne, Switzerland
| | - Olivier Cottencin
- Department of Addiction Medicine, CHRU de Lille, Univ Lille Nord de France, F-59037 Lille, France; University of Lille 2, Faculty of Medicine, F-59045 Lille, France
| | - Benjamin Rolland
- Department of Addiction Medicine, CHRU de Lille, Univ Lille Nord de France, F-59037 Lille, France; University of Lille 2, Faculty of Medicine, F-59045 Lille, France
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Stigmatizing harm reduction through language: a case study into the use of "addict" and opposition to supervised injection sites in Canada. J Addict Nurs 2014; 24:102-7. [PMID: 24621488 DOI: 10.1097/jan.0b013e3182929466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Stigma continues to be the largest barrier for accessing treatment among people experiencing drug addiction. The dominant portrayals that exist about people who use drugs are often damaging and act to dehumanize the group as a whole. When left unchallenged, stereotypes can act as truthful depictions and facilitate the resistance against harm reduction services that are based on a human rights model. The use of labels is one way stigma is perpetuated by eliciting the label's stereotyped narratives onto an individual or group. Within harm reduction discourse, the word "addict" can have detrimental effects on how the public perceives people experiencing addiction and their deservingness of pragmatic services. This article aims to draw attention to the inattention we give "addict" in language and explain how its routine use in society acts to perpetuate addiction stigma. Using the example of supervised injection site opposition in Canada, the use of "addict" is used as a way to understand how stigma through language works to impede the expansion of harm reduction initiatives.
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Strike C, Jairam JA, Kolla G, Millson P, Shepherd S, Fischer B, Watson TM, Bayoumi AM. Increasing public support for supervised injection facilities in Ontario, Canada. Addiction 2014; 109:946-53. [PMID: 24520984 DOI: 10.1111/add.12506] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 11/05/2013] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Abstract
AIM To determine the level and changes in public opinion between 2003 and 2009 among adult Canadians about implementation of supervised injection facilities (SIFs) in Canada. DESIGN Population-based, telephone survey data collected in 2003 and 2009 were analysed to identify strong, weak, and intermediate support for SIFs. SETTING Ontario, Canada PARTICIPANTS Representative samples of adults aged 18 years and over. MEASUREMENTS Analyses of the agreement with implementation of SIFs in relation to four individual SIF goals and a composite measure. FINDINGS The final sample sizes for 2003 and 2009 were 1212 and 968, respectively. Between 2003 and 2009, there were increases in the proportion of participants who strongly agreed with implementing SIFs to: reduce neighbourhood problems (0.309 versus 0.556, respectively); increase contact of people who use drugs with health and social workers (0.257 versus 0.479, respectively); reduce overdose deaths or infectious disease among people who use drugs (0.269 versus 0.482, respectively); and encourage safer drug injection (0.213 versus 0.310, respectively). Analyses using a composite measure of agreement across goals showed that 0.776 of participants had mixed opinions about SIFs in 2003, compared with only 0.616 in 2009. There was little change among those who strongly disagreed with all SIF goals (0.091 versus 0.113 in 2003 and 2009, respectively). CONCLUSIONS Support for implementation of supervised injection facilities in Ontario, Canada increased between 2003 and 2009, but at both time-points a majority still held mixed opinions.
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Affiliation(s)
- Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Tzemis D, Campbell J, Kuo M, Buxton JA. A cross-sectional study of public attitudes towards safer drug use practices in British Columbia, Canada. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:40. [PMID: 24289280 PMCID: PMC4221987 DOI: 10.1186/1747-597x-8-40] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 11/26/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Harm reduction programs are often vulnerable to political and vocal opposition despite documented evidence of their effectiveness and economic benefit. It is not well understood if opponents to harm reduction represent the general public's attitudes. OBJECTIVE To understand the attitudes of the people of British Columbia (BC) towards various harm reduction strategies and services, and factors associated with support for harm reduction. METHODS A random-digit dialing telephone survey assessing attitudes towards various harm reduction strategies was administered to British Columbians in August 2011 (n = 2000). We compared the level of support for general harm reduction by sex, age, education level, and area of residence (Health Authority region) (χ2). Multivariate logistic regression was used to assess odds of support for harm reduction. RESULTS Overall support for general harm reduction among participants was 76%; needle distribution 72%; needle distribution in one's local community 65%; and safer inhalation equipment distribution 52%. In the multivariate analysis, those with significantly lower odds of supporting harm reduction were male, older, had equal or less than high school education or completed a certificate/diploma program, and resided in the Fraser Health Authority region. The Health Authority region with a municipality that has introduced a bylaw prohibiting the implementation of harm reduction services was found to have 69% support for harm reduction. Another Health Authority region with a municipality that closed a long-standing needle distribution site was found to have over 78% support. CONCLUSION In contrast to some local policies, our results show the British Columbians surveyed in our study support harm reduction. It is unclear whether policy makers are swayed by a vocal minority or block harm reduction activities for other reasons. Tailoring messages towards segments of the public less likely to support harm reduction, as well civic policy-makers and the media, may help to reduce stigma and gain support for harm reduction services designed to protect and improve the health of the individual and the public.
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Affiliation(s)
- Despina Tzemis
- Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
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Supervised consumption rooms: The French Paradox. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:628-30. [DOI: 10.1016/j.drugpo.2013.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/14/2013] [Accepted: 05/10/2013] [Indexed: 11/22/2022]
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Castillo-Carniglia Á, Kaufman JS, Pino P. Alcohol-Attributable Mortality and Years of Potential Life Lost in Chile in 2009. Alcohol Alcohol 2013; 48:729-36. [DOI: 10.1093/alcalc/agt066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Garland TS, Bumphus VW, Knox SA. Exploring General and Specific Attitudes Toward Drug Policies Among College Students. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/0887403410389807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Numerous studies have focused on issues dealing with students’ attitudes toward drug use. Although these studies have examined attitudes toward drug use, there has been little research focusing on drug policy attitudes. Although some research has been conducted on attitudes of students and professionals regarding criminal justice policies, the literature has not directly addressed the perceptions of students regarding specific drug policies in the United States. Using data collected from 294 students enrolled at a southern university, this study examined criminal justice/legal studies majors’ and nonmajors’ perceptions regarding current drug policy and demographic factors influence these perceptions. Findings revealed little variation in overall attitudes among the two study cohorts; however, college major emerged as a significant predictor of more tolerant marijuana attitudes.
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Salmon AM, van Beek I, Amin J, Kaldor J, Maher L. The impact of a supervised injecting facility on ambulance call-outs in Sydney, Australia. Addiction 2010; 105:676-83. [PMID: 20148794 DOI: 10.1111/j.1360-0443.2009.02837.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Supervised injecting facilities (SIFs) are effective in reducing the harms associated with injecting drug use among their clientele, but do SIFs ease the burden on ambulance services of attending to overdoses in the community? This study addresses this question, which is yet to be answered, in the growing body of international evidence supporting SIFs efficacy. DESIGN Ecological study of patterns in ambulance attendances at opioid-related overdoses, before and after the opening of a SIF in Sydney, Australia. SETTING A SIF opened as a pilot in Sydney's 'red light' district with the aim of accommodating a high throughput of injecting drug users (IDUs) for supervised injecting episodes, recovery and the management of overdoses. MEASUREMENTS A total of 20,409 ambulance attendances at opioid-related overdoses before and after the opening of the Sydney SIF. Average monthly ambulance attendances at suspected opioid-related overdoses, before (36 months) and after (60 months) the opening of the Sydney Medically Supervised Injecting Centre (MSIC), in the vicinity of the centre and in the rest of New South Wales (NSW). RESULTS The burden on ambulance services of attending to opioid-related overdoses declined significantly in the vicinity of the Sydney SIF after it opened, compared to the rest of NSW. This effect was greatest during operating hours and in the immediate MSIC area, suggesting that SIFs may be most effective in reducing the impact of opioid-related overdose in their immediate vicinity. CONCLUSIONS By providing environments in which IDUs receive supervised injection and overdose management and education SIF can reduce the demand for ambulance services, thereby freeing them to attend other medical emergencies within the community.
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Affiliation(s)
- Allison M Salmon
- National Centre HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst, NSW, Australia
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Harm reduction for injecting opiate users: an update and implications in China. Acta Pharmacol Sin 2009; 30:513-21. [PMID: 19349966 DOI: 10.1038/aps.2009.30] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The harm associated with high-risk injected opiate use and the threat of the HIV epidemic among injecting drug users has become a worldwide problem. Twenty years ago, in the face of a rapid increase in mortality rates among injecting drug users and the upcoming threat of HIV, the first harm-reduction programs were implemented in the Western world. This paper is a literature review describing four forms of harm reduction currently in use in Europe, North America, and Australia. Each represents a reasonable counterapproach to the threat of increased prevalence of HIV among injecting drug users in transitional and developing countries. The paper attempts to explain the concepts behind the most commonly used types of harm reduction and provides a brief overview of the advantages and disadvantages of each and the reasons for their implementation. The main focus of the review is on the definition and the practical aspects of harm reduction; it includes a brief introduction of Chinese harm-reduction efforts and their implications.
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Kerr T, Kimber J, Rhodes T. Drug use settings: an emerging focus for research and intervention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:1-4. [PMID: 17689337 DOI: 10.1016/j.drugpo.2006.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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