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Fleming T, Boyd J, Gagnon M, Kerr T, McNeil R. Using drugs alone in single room occupancy housing: Understanding environmental drivers of overdose risk. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104444. [PMID: 38754243 DOI: 10.1016/j.drugpo.2024.104444] [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: 02/06/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Across North America most overdose deaths occur in housing, largely due to individuals using drugs alone. In cities, fatalities are disproportionately concentrated in low-income housing, including single room occupancy (SRO) housing. While research has highlighted how SROs operate as risk environments for various poor outcomes, there has been little attention to specific drug use practices (i.e., using alone) associated with overdose vulnerability in these spaces. This study explores how environmental contexts of SROs shape overdose risks, with specific attention to practices of using drugs alone. METHODS In-depth semi-structured interviews were conducted with 30 people who use drugs (PWUD) living in Vancouver SROs. Interviews covered topics such as social-structural environments of housing, drug use practices, and housing-based harm reduction. Thematic analysis drew on the intersectional risk environment framework. RESULTS Narratives positioned SROs as extensions of public space, with similar expectations of risks and behaviours as in public spaces. For some participants, using alone in their room was characterized as a practice in claiming privacy within the context of a public existence. Participants highlighted how certain features of SRO's social-structural environments were routinely leveraged against them (e.g., security cameras, staff surveillance), suggesting using alone as a tactic to minimize risks of hyper-surveillance and punitive policies. Further, participants discussed using alone as "safer," describing how this practice mitigated place-based risks of social-structural harms (e.g., violence, criminalization) in ways that eclipsed overdose risk. CONCLUSION Using drugs alone may be understood as a spatial negotiation of vulnerability to diverse harms produced by environmental contexts of SROs. Interventions accounting for broader contextual factors (e.g., improvements housing quality/quantity, providing a safer supply of drugs) that render using alone as instrumental to survival, and that reduce the implicit threat of punishment from intensive surveillance and control practices are critical to reduce vulnerability to overdose and other harms.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Marilou Gagnon
- School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA; Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA.
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Lorvick J, Hemberg J, George MJ, Piontak J, Comfort ML. Understanding polysubstance use at the daily and event levels: protocol for a mixed-methods qualitative and ecological momentary assessment study in a community-based sample of people who use illicit drugs in Oakland, California, USA. BMJ Open 2023; 13:e075380. [PMID: 37699625 PMCID: PMC10503366 DOI: 10.1136/bmjopen-2023-075380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Polysubstance use is extremely common among people who use illicit opioids in the USA. It is associated with poor substance use treatment outcomes, infectious disease risk and alarming rates of drug overdose. Nearly all extant literature examines polysubstance use over broad time frames, such as 30 days or 6 months. However, both substance use and overdose risk are episodic. To build a stronger understanding of polysubstance use and overdose risk, we need to expand the knowledge base to include daily-level and event-level data that examine how substances are used together, in which combinations and in which contexts. The study described in this protocol will use qualitative and ecological momentary assessment (EMA) methods to examine polysubstance use and overdose risk on a daily and event level. METHODS AND ANALYSIS This is a mixed-methods observational study with three phases. The first phase is formative, consisting of qualitative interviews with people who use multiple substances (N=20), to inform the development of items for the EMA component. The second phase is EMA data collection with people who use multiple substances (N=120), three times daily for 28 days. The third phase consists of mixed-methods inquiries with a subset of participants (N=20), using participant-level EMA data and qualitative techniques to build a nuanced understanding of the motivations and contexts of polysubstance use in everyday life. Analytical induction methods will be used to interpret qualitative data. Hierarchical linear modelling methods will be used to analyse EMA data. ETHICS AND DISSEMINATION This research has been reviewed and approved by the Institutional Review Board at RTI International (#MOD00001782 for EMA procedures and #MOD00001241 for qualitative procedures). Participants engage in an informed consent procedure for each component of the study. Data will be managed and shared per the National Institutes of Health extramural data sharing policy.
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Affiliation(s)
- Jennifer Lorvick
- Community Health and Implementation Research Program, RTI International, Berkeley, California, USA
| | - Jordana Hemberg
- Community Health and Implementation Research Program, RTI International, Berkeley, California, USA
| | - Madeleine J George
- Health of Populations Program, RTI International, Research Triangle Park, North Carolina, USA
| | - Joy Piontak
- Health of Populations Program, RTI International, Research Triangle Park, North Carolina, USA
| | - Megan L Comfort
- Transformative Research Unit for Equity, RTI International, Berkeley, CA, USA
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Boeri M, Pereira E, Minkova A, Marcato K, Martinez E, Woodall D. Green Hope: Perspectives on Cannabis from People who Use Opioids. SOCIOLOGICAL INQUIRY 2021; 91:668-695. [PMID: 34538961 PMCID: PMC8446945 DOI: 10.1111/soin.12359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
While states are implementing policies to legalize cannabis for medical or recreational purposes, it remains a Schedule 1 controlled substance with no medical uses according to US federal law. The perception of cannabis depends on social and cultural norms that impact political institutions involved in implementing policy. Because of negative social constructions, such as the "gateway hypothesis," legalization of cannabis has been slow and contentious. Recent studies suggest that cannabis can help combat the opioid epidemic. This paper fills a gap in our understanding of how cannabis is viewed by people who are actively misusing opioids and not in treatment. Using ethnographic methods to recruit participants living in a state that legalized cannabis and a state where cannabis was illegal, survey and interview data were analyzed informed by a social constructionist lens. Findings from their "insider perspective" suggest that for some people struggling with problematic opioid use, cannabis can be beneficial.
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4
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Dalpoas SE, Shermock KM. Practical utility of mixed methods research in pharmacy practice. Am J Health Syst Pharm 2021; 78:2033-2039. [PMID: 34077491 DOI: 10.1093/ajhp/zxab232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Our aim was to review key methodological concepts and provide a practical guide to employing mixed methods research to enhance pharmacy practice research. SUMMARY Mixed methods research provides multiple organized analytic perspectives to thoroughly investigate complex social and scientific problems in a methodologically rigorous manner. This research design incorporates collection and analysis of both qualitative and quantitative data components to create a thorough understanding of a complex question. The 5 most commonly identified reasons for conducting mixed methods research include triangulation, complementarity, development, initiation, and expansion of results. For research questions that benefit from mixed methods research, we review how to structure the study, including timing, sequencing, and prioritization of methods. Illustrative examples from the literature highlight the utility of this methodology for clinical and operational pharmacy research questions. CONCLUSION Mixed methods designs can enhance pharmacy research inquiry, provide a means to understand complicated issues, and uncover optimal interventions.
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Affiliation(s)
- Stacy Elder Dalpoas
- Department of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Kenneth M Shermock
- Center for Medication Quality and Outcomes, The Johns Hopkins Health System, Baltimore, MD, USA
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5
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Walters SM, Kral AH, Lamb S, Goldshear JL, Wenger L, Bluthenthal RN. Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California. J Urban Health 2021; 98:70-82. [PMID: 33409836 PMCID: PMC7873178 DOI: 10.1007/s11524-020-00494-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Men who inject drugs (MWID) and engage in transactional sex (i.e., receive money or drugs in exchange for sex) are vulnerable to HIV and violence. However, MWID who engage in transactional sex have been less studied than women. We examine factors associated with transactional sex among MWID in Los Angeles and San Francisco and whether transactional sex is associated with violent victimization. MWID were recruited using targeted sampling methods in 2011-2013 and completed surveys that covered demographics, drug use, HIV risk, violence, transactional sex, and other items. Multivariable logistic regression was used to (1) determine factors independently associated with transactional sex and (2) determine if transactional sex was independently associated with violence victimization in the last 6 months among MWID. An interaction term between income source and sexual identity was included in the transactional sex model. Of the 572 male PWID in the sample, 47 (8%) reported transactional sex in the past 6 months. Self-reported HIV infection was 7% for MWID who did not report transactional sex, 17% for MWID who reported transactional sex, and 24% for MWID who reported transactional sex and reported gay or bisexual identity. In multivariable analysis, transactional sex was positively associated with gay or bisexual identity (GB without illegal income adjusted odds ratio [AOR] = 5.16; 95% confidence interval [CI] = 1.86-14.27; GB with illegal income AOR = 13.55, CI = 4.57-40.13), coerced sex in the last 12 months (AOR = 11.66, CI = 1.94-70.12), and violent victimization in the last 12 months (AOR = 2.31, CI = 1.13-4.75). Transactional sex was negatively associated with heroin injection (last 30 days) (AOR = 0.37; 95% CI = 0.18-0.78). Transactional sex was independently associated with violent victimization in the last 12 months (AOR = 2.04; 95% CI = 1.00-4.14) while controlling for confounders. MWID who engaged in transactional sex are at elevated risk for HIV and multiple forms of violent victimization. Interventions focused on this at-risk subpopulation are urgently needed and should include access to substance use disorder treatment, victimization services, and harm reduction services across the HIV care continuum.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | | | - Shona Lamb
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jesse L Goldshear
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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6
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[Public policies for people who use drugs: Strategies for the elimination of stigma and the promotion of human rights]. Salud Colect 2021; 17:e3041. [PMID: 33822543 DOI: 10.18294/sc.2021.3041] [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] [Received: 07/31/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
This paper aims to provide theoretically informed practical proposals for the improvement of current drug policies, which are based on a biological model of disease and the criminalization of people who use drugs. First, we present alternatives to a biologically-oriented scientific conception centered around neuroscientific postulates, which support the idea that the etiology of addiction materializes in the brain, in favor of models based on the social sciences where context plays a relevant role in the description and management approaches regarding different uses of psychoactive substances. Second, epistemological models and proposals are offered from a practical perspective to sustain or implement policies and programs in accordance with a more sustainable approach based on the elimination of stigma and the promotion of political participation of people who use drugs. In short, drug policies based on human rights.
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Lopez AM, Dhatt Z, Howe M, Al-Nassir M, Billing A, Artigiani E, Wish ED. Co-use of methamphetamine and opioids among people in treatment in Oregon: A qualitative examination of interrelated structural, community, and individual-level factors. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 91:103098. [PMID: 33476863 DOI: 10.1016/j.drugpo.2020.103098] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/21/2020] [Accepted: 12/28/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rates of methamphetamine use and methamphetamine-related deaths have increased steadily in the United States in recent years. Methamphetamine is increasingly present in opioid-related deaths. An initial study of de-identified urine specimens (n = 102) collected at a drug treatment program between 2017 and 2018 indicated that 61% of specimens contained methamphetamine; of the specimens containing methamphetamine, people were, on average, five years younger than those who tested negative for methamphetamine; and non-fentanyl opioids were more than three times as common in methamphetamine positive specimens. The National Drug Early Warning System (NDEWS) Coordinating Center initiated a HotSpot Study to assess whether there was an emerging dynamic in the area, or if enhanced data collection could give insights into the co-use of methamphetamine and opioids. METHODS A qualitative study, grounded in principles of rapid ethnographic assessment and a social science/anthropological framework was conducted and used methodological complementarity to contextualize results from the initial urinalysis study. Targeted sampling was conducted at two treatment sites. Program staff and patients were recruited to participate in focus groups and semi-structured interviews to assess structural, community, and individual-level factors impacting methamphetamine and opioid co-use. RESULTS Within our broader framework of structural, community, and individual-level factors intersecting co-use, our data yielded three sub-themes: 1) the circulation of stigma regarding methamphetamine use was consistently described by both patients and staff and this intersected structural changes in treatment policy and suggested compounded stigma; 2) community-level factors and temporality were important for understanding patterns of methamphetamine use and for further interpreting the initial urinalysis; 3) patient rationales regarding the co-use of methamphetamine and opioids included strategies to mitigate the harms of heroin, as well as to detox or titrate the effects of heroin. CONCLUSION AND IMPLICATIONS Using an ethnographically-oriented and social science/anthropological approach and methodological complementarity to contextualize the prior urinalysis study demonstrates how behavioral variables cannot be abstracted from larger socio-structural and community contexts which impact people's decision-making process regarding co-use of methamphetamine and opioids. Further, by grounding our analysis in the meaning-centered and experiential narratives of people who use drugs, our research demonstrates the importance of considering the expertise of people who co-use opioids and methamphetamine as central for informing future sustainable program planning to address co-use that also accounts for the interrelationship between structural, community, and individual-level factors.
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Affiliation(s)
- Andrea M Lopez
- Department of Anthropology, University of Maryland, 1111Woods Hall, 4302 Chapel Lane, College Park, MD 20742, USA.
| | - Zena Dhatt
- Department of Anthropology, University of Maryland, 1111Woods Hall, 4302 Chapel Lane, College Park, MD 20742, USA
| | - Mary Howe
- Homeless Youth Alliance, PO Box 170427, San Francisco, CA 94117, USA
| | - Marwa Al-Nassir
- Center for Substance Abuse Research, University of Maryland, College Park, USA
| | - Amy Billing
- Center for Substance Abuse Research, University of Maryland, College Park, USA
| | - Eleanor Artigiani
- Center for Substance Abuse Research, University of Maryland, College Park, USA
| | - Eric D Wish
- Center for Substance Abuse Research, University of Maryland, College Park, USA
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8
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Fleming T, Valleriani J, Ng C, Maher L, Small W, McNeil R. Acceptability of a hypothetical preventative HIV vaccine among people who use drugs in Vancouver, Canada. BMC Public Health 2020; 20:1081. [PMID: 32646390 PMCID: PMC7350753 DOI: 10.1186/s12889-020-09202-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/02/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND As research on HIV vaccines continues to advance, studies exploring the feasibility of this intervention are necessary to inform uptake and dissemination strategies with key populations, including people who use drugs (PWUD). METHODS We conducted 25 in-depth qualitative interviews examining HIV vaccine acceptability among PWUD in Vancouver, Canada. Participants were recruited from an ongoing prospective cohort of HIV-negative PWUD. Data were coded using NVivo, and analyzed thematically. RESULTS Acceptability was framed by practical considerations such as cost and side effects, and was influenced by broader trust of government bodies and health care professionals. While an HIV vaccine was perceived as an important prevention tool, willingness to be vaccinated was low. Results suggest that future vaccine implementation must consider how to minimize the burden an HIV vaccine may place on PWUD. Centering the role of health care providers in information dissemination and delivery may assist with uptake. CONCLUSIONS Our findings suggest improvements in care and improved patient-provider relationships would increase the acceptability of a potential HIV vaccine among this population.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Interdisciplinary Graduate Studies Program, University of British Columbia, Vancouver, BC, Canada
| | - Jenna Valleriani
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,National Institute for Cannabis Health and Education, Toronto, ON, Canada
| | - Cara Ng
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Lisa Maher
- The Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,The Burnet Institute, Melbourne, VIC, Australia
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, BC, Canada. .,Department of Medicine, Yale School of Medicine, New Haven, CT, USA. .,Program in Addiction Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, USA.
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Maghsoudi N, McDonald K, Stefan C, Beriault DR, Mason K, Barnaby L, Altenberg J, MacDonald RD, Caldwell J, Nisenbaum R, Leece P, Watson TM, Tupper KW, Kufner L, Scheim AI, Werb D. Evaluating networked drug checking services in Toronto, Ontario: study protocol and rationale. Harm Reduct J 2020; 17:9. [PMID: 32204713 PMCID: PMC7092475 DOI: 10.1186/s12954-019-0336-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/06/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The increasing incidence of fatal opioid overdose is a public health crisis in Canada. Given growing consensus that this crisis is related to the presence of highly potent opioid adulterants (e.g., fentanyl) in the unregulated drug supply, drug checking services (DCS) have emerged as part of a comprehensive approach to overdose prevention. In Canada's largest city, Toronto, a network of DCS launched in 2019 to prevent overdose and overdose-related risk behaviors. This network employs mass spectrometry technologies, with intake sites co-located with supervised consumption services (SCS) at three frontline harm reduction agencies. The protocol and rationale for assessing the impact of this multi-site DCS network in Toronto is described herein. The aims of this study are to (1) evaluate the impact of DCS access on changes in and factors influencing overdose and related risk behaviors, (2) investigate the perceived capacity of DCS to prevent overdose, and (3) identify composition (qualitative and quantitative) trends in Toronto's unregulated drug supply. METHODS We will use a parallel-mixed-methods design with complementary data sources (including data from chemical analysis of drug samples, quantitative intake and post-test surveys, SCS, coroners, paramedic services, and qualitative interviews), followed by a meta-inference process wherein results from analyses are synthesized. RESULTS Whereas most DCS globally target "recreational drug users," in Toronto, this networked DCS will primarily target marginalized people who use drugs accessing frontline services, many of whom use drugs regularly and by injection. This evolution in the application of DCS poses important questions that have not yet been explored, including optimal service delivery models and technologies, as well as unique barriers for this population. Increasing information on the unregulated drug supply may modify the risk environment for this population of people who use drugs. CONCLUSIONS This study addresses evidence gaps on the emerging continuum of overdose prevention responses and will generate critical evidence on a novel approach to reducing the ongoing high incidence of drug-related morbidity and mortality in Canada and elsewhere.
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Affiliation(s)
- N Maghsoudi
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street Toronto, Ontario, M5B 1 W8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - K McDonald
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street Toronto, Ontario, M5B 1 W8, Canada
| | - C Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - D R Beriault
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - K Mason
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | - L Barnaby
- Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - J Altenberg
- South Riverdale Community Health Centre, Toronto, Ontario, Canada
| | - R D MacDonald
- Toronto Paramedic Services, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J Caldwell
- Toronto Public Health, Toronto, Ontario, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions and Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - P Leece
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - T M Watson
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - K W Tupper
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - L Kufner
- Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - A I Scheim
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street Toronto, Ontario, M5B 1 W8, Canada
- Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - D Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street Toronto, Ontario, M5B 1 W8, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA.
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Zhao JK, Kral AH, Wenger LD, Bluthenthal RN. Characteristics Associated with Nonmedical Methadone Use among People Who Inject Drugs in California. Subst Use Misuse 2020; 55:377-386. [PMID: 31608746 PMCID: PMC7002277 DOI: 10.1080/10826084.2019.1673420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Illicit, nonmedical use of opioid agonist medications such as methadone is an ongoing concern. Yet, few studies have examined nonmedical use of methadone by people who inject drugs (PWID). Objectives: This study describes the prevalence of nonmedical methadone use in a community sample of PWID and examines factors associated with recent use of nonmedical methadone. Methods: A cross-sectional sample of PWID (N = 777) was recruited using targeted sampling and interviewed in California (2011-2013). Descriptive, bivariate, and multivariate logistic regression analyses were used to determine characteristics associated with nonmedical methadone use in the last 30 days. To determine if nonmedical methadone use was associated with overdose in the last 6 months, a separate multivariate analysis was conducted. Results: Among PWID sampled, 21% reported nonmedical methadone use in the last 30 days. In multivariate logistic regression analysis, nonmedical methadone use was associated with recent methadone maintenance treatment (adjusted odds ratio [AOR] = 2.86; 95% confidence interval [CI] = 1.90, 4.30), recent nonmedical buprenorphine use (AOR = 3.12; 95% CI = 1.31, 7.47), higher injection frequency (referent <30 injections; 30-89 injections AOR = 1.89; 95% CI = 1.19, 3.02; 90-plus injections AOR = 2.43; 95% CI = 1.53, 3.87), schizophrenia diagnosis (AOR = 2.36; 95% CI = 1.36, 4.10), recent non-injection opioid prescription use (AOR = 2.97; 95% CI = 1.99, 4.43), and recent injection opioid prescription misuse (AOR = 2.13; 95% CI = 1.27, 3.59). Nonmedical methadone use was found not to be associated with nonfatal overdose (AOR = 0.77; 95% CI = 0.38, 1.56). Conclusion: Nonmedical methadone use identifies a vulnerable subpopulation among PWID, is not associated with elevated nonfatal overdose risk, and evidences a need to expand methadone treatment availability.
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Affiliation(s)
- Johnathan K Zhao
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alex H Kral
- RTI International, San Francisco, California, USA
| | | | - Ricky N Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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11
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Friedman J, Karandinos G, Hart LK, Castrillo FM, Graetz N, Bourgois P. Structural vulnerability to narcotics-driven firearm violence: An ethnographic and epidemiological study of Philadelphia's Puerto Rican inner-city. PLoS One 2019; 14:e0225376. [PMID: 31751394 PMCID: PMC6872141 DOI: 10.1371/journal.pone.0225376] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/02/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The United States is experiencing a continuing crisis of gun violence, and economically marginalized and racially segregated inner-city areas are among the most affected. To decrease this violence, public health interventions must engage with the complex social factors and structural drivers-especially with regard to the clandestine sale of narcotics-that have turned the neighborhood streets of specific vulnerable subgroups into concrete killing fields. Here we present a mixed-methods ethnographic and epidemiological assessment of narcotics-driven firearm violence in Philadelphia's impoverished, majority Puerto Rican neighborhoods. METHODS Using an exploratory sequential study design, we formulated hypotheses about ethnic/racial vulnerability to violence, based on half a dozen years of intensive participant-observation ethnographic fieldwork. We subsequently tested them statistically, by combining geo-referenced incidents of narcotics- and firearm-related crime from the Philadelphia police department with census information representing race and poverty levels. We explored the racialized relationships between poverty, narcotics, and violence, melding ethnography, graphing, and Poisson regression. FINDINGS Even controlling for poverty levels, impoverished majority-Puerto Rican areas in Philadelphia are exposed to significantly higher levels of gun violence than majority-white or black neighborhoods. Our mixed methods data suggest that this reflects the unique social position of these neighborhoods as a racial meeting ground in deeply segregated Philadelphia, which has converted them into a retail endpoint for the sale of astronomical levels of narcotics. IMPLICATIONS We document racial/ethnic and economic disparities in exposure to firearm violence and contextualize them ethnographically in the lived experience of community members. The exceptionally concentrated and high-volume retail narcotics trade, and the violence it generates in Philadelphia's poor Puerto Rican neighborhoods, reflect unique structural vulnerability and cultural factors. For most young people in these areas, the narcotics economy is the most readily accessible form of employment and social mobility. The performance of violence is an implicit part of survival in these lucrative, illegal narcotics markets, as well as in the overcrowded jails and prisons through which entry-level sellers cycle chronically. To address the structural drivers of violence, an inner-city Marshall Plan is needed that should include well-funded formal employment programs, gun control, re-training police officers to curb the routinization of brutality, reform of criminal justice to prioritize rehabilitation over punishment, and decriminalization of narcotics possession and low-level sales.
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Affiliation(s)
- Joseph Friedman
- Center for Social Medicine and Humanities, University of California, Los Angeles, CA, United States of America
- * E-mail: (PB); (JF)
| | | | - Laurie Kain Hart
- Department of Anthropology, University of California, Los Angeles, CA, United States of America
| | | | - Nicholas Graetz
- Department of Demography, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, University of California, Los Angeles, CA, United States of America
- * E-mail: (PB); (JF)
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12
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Kataja K, Törrönen J, Hakkarainen P, Koivula P, Tigerstedt C, Hautala S. Combining Alcohol with Benzodiazepines or Psychostimulants. Metaphoric Meanings and the Concept of Control in the Online Talk of Polydrug Use. J Psychoactive Drugs 2019; 51:473-481. [PMID: 31547794 DOI: 10.1080/02791072.2019.1669845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The co-administration of different substances is a widespread practice in the context of hard drug use. Among others, alcohol combined with certain substances produces potentially dangerous interactions. This article explores how people who combine alcohol with benzodiazepines or psychostimulants perceive these practices and how they share their perceptions in Finnish and Swedish online discussions. This is carried out by analyzing discussants' use of metaphoric expressions. We found that the metaphors given to the use of these substance combinations reflect their pharmacological characteristics. Through that, the metaphors and meanings were different depending on the substance alcohol was combined with. Moreover, we found that, in the realities the metaphors create, the control of use was differently conceptualized. The different aspects of control could be divided into three categories that, however, were not related to any specific substances but overarched all metaphors: 1) controlling pharmacological risks, 2) controlling social appearance and 3) ignoring control. As our findings bring out, often the actual health dangers and risks of the studied substance combinations were bypassed, and the control was rather understood either as a form of socially appropriate behavior or wholly ignored.
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Affiliation(s)
- Kati Kataja
- Faculty of Social Sciences, University of Lapland, Rovaniemi, Finland
| | - Jukka Törrönen
- Department of Public Health Sciences, University of Stockholm, Stockholm, Sweden
| | - Pekka Hakkarainen
- The Alcohol, Drugs, and Addictions Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Petteri Koivula
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Christoffer Tigerstedt
- The Alcohol, Drugs, and Addictions Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Sanna Hautala
- Faculty of Social Sciences, University of Lapland, Rovaniemi, Finland
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13
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Steinberg J, Kral AH, Sumstine S, Wenger LD, D’Anna L, Bluthenthal RN. Gang Involvement and Drug Use Histories Among People Who Inject Drugs in California: A Retrospective Analysis. JOURNAL OF DRUG ISSUES 2019. [DOI: 10.1177/0022042619853295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined whether gang membership history was associated with earlier age of first drug use, first drug injection, and shorter time to injection (TTI) drug use among people who inject drugs (PWID). PWID ( N = 438) were interviewed in California (2011-2013). Surveys addressed demographics, current/former drug use practices, gang membership, and parental drug use. Multivariate analyses were conducted to identify whether gang membership history was associated with age at first drug use, first injection drug use, and TTI. Gang membership was reported by 23% of sample. Gang membership history was associated with earlier ages of first drug use (–1.35 years; 95% confidence interval [CI]= [−0.50, −2.20]), age at first injection (–1.89 years; 95% CI = [0.00, −3.78]), but not TTI. Gang involvement facilitates drug use including earlier age of first injection drug use.
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Navigating social norms of injection initiation assistance during an overdose crisis: A qualitative study of the perspectives of people who inject drugs (PWID) in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 69:24-33. [PMID: 31029914 DOI: 10.1016/j.drugpo.2019.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/27/2019] [Accepted: 04/13/2019] [Indexed: 01/24/2023]
Abstract
Despite the proliferation of fentanyl and fentanyl-adulterated opioids in North America, the impacts of this drug market change on injection initiation processes have not been examined. With the aim of informing structural interventions to address injection initiation and related harms, we explore how people who inject drugs (PWID) in Vancouver, Canada understand and navigate social norms of initiating others into injecting within the context of an overdose crisis. In-depth qualitative interviews were conducted with 19 PWID who reported helping someone inject for the first time. Participants were recruited from two cohort studies of PWID. Participants articulated moral dilemmas about assisting others with injecting. While participants described a 'moral code' prohibiting assisting injection-naïve individuals, this code was not the sole consideration shaping social action around injection initiation. Rather, PWID exercised agency about whether and how to assist novice injectors within the context of constraining and enabling social norms around practicing interpersonal responsibility. Changes to the drug market heightened feelings of moral culpability and criminal liability among PWID who assisted others into injection, given that injecting heightened initiates' risk of overdose. These concerns operated in tension with the aim of protecting novice injectors from harms associated with an increasingly potent and unpredictable drug supply by providing them with injection assistance, education and supervision. Our analysis of how PWID practice interpersonal responsibility helps conceptualise how 'moral codes' prohibiting initiation assistance are managed and negotiated amidst structural vulnerability. Structural interventions reducing the vulnerability of novice injectors should be prioritized, including the implementation of supervised injection sites allowing for assisted injection, Good Samaritan laws, and policy changes conducive to a safer drug supply.
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15
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Castillo EG, Chung B, Bromley E, Kataoka SH, Braslow JT, Essock SM, Young AS, Greenberg JM, Miranda J, Dixon LB, Wells KB. Community, Public Policy, and Recovery from Mental Illness: Emerging Research and Initiatives. Harv Rev Psychiatry 2019; 26:70-81. [PMID: 29381527 PMCID: PMC5843494 DOI: 10.1097/hrp.0000000000000178] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This commentary examines the roles that communities and public policies play in the definition and processes of recovery for adults with mental illness. Policy, clinical, and consumer definitions of recovery are reviewed, which highlight the importance of communities and policies for recovery. This commentary then presents a framework for the relationships between community-level factors, policies, and downstream mental health outcomes, focusing on macroeconomic, housing, and health care policies; adverse exposures such as crime victimization; and neighborhood characteristics such as social capital. Initiatives that address community contexts to improve mental health outcomes are currently under way. Common characteristics of such initiatives and select examples are discussed. This commentary concludes with a discussion of providers', consumers', and other stakeholders' roles in shaping policy reform and community change to facilitate recovery.
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Affiliation(s)
- Enrico G Castillo
- From the Center for Health Services and Society (Drs. Chung, Bromley, Kataoka, Young, Miranda, and Wells), Center for Social Medicine and Humanities (Drs. Braslow and Castillo), Division of Child and Adolescent Psychiatry (Dr. Kataoka), Department of Psychiatry and Biobehavioral Sciences (Dr. Greenberg), David Geffen School of Medicine, and School of Public Health (Drs. Miranda and Wells), University of California, Los Angeles; Los Angeles County Department of Mental Health (Dr. Castillo); RAND Corporation (Drs. Chung and Wells); Los Angeles Biomedical Research Institute (Dr. Chung); Healthy African American Families II (Dr. Chung); Health Services Research & Development Center of Innovation (Dr. Young), Desert Pacific MIRECC Health Services Unit (Drs. Bromley and Greenberg), VA Greater Los Angeles Healthcare System; Division of Behavioral Health Services and Policy Research, Department of Psychiatry, Columbia University College of Physicians and Surgeons (Drs. Essock and Dixon); New York State Psychiatric Institute (Drs. Essock and Dixon)
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16
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Lamb S, Kral AH, Dominguez-Gonzalez K, Wenger LD, Bluthenthal RN. Peer-to-peer injection: Demographic, drug use, and injection-related risk factors. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 61:44-51. [PMID: 30388569 DOI: 10.1016/j.drugpo.2018.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Peer-to-peer injection (either providing or receiving an injection to/from a person who injects drugs [PWID]) is common (19%-50%) among PWID. Most studies of peer-to-peer injection have focused on receiving injection assistance, with fewer examining providing injection assistance and none considering characteristics of PWID who do both. We examined characteristics of PWID by peer-to-peer injection categories (receiving, providing, both, and neither) and determined if these behaviors were associated with receptive and distributive syringe sharing. METHODS Los Angeles and San Francisco PWID (N = 777) were recruited using targeted sampling methods and interviewed during 2011-2013. Multinomial logistic regression was used to determine characteristics associated with peer-to-peer injection categories and logistic regression was used to examine if peer-to-peer categories were independently associated with distributive and receptive syringe sharing. RESULTS Recent peer-to-peer injection was reported by 42% of PWID (18% provider; 14% recipient; 10% both). In multinomial regression analysis, PWID reporting any peer-to-peer injection were more likely to inject with others than those who did neither. Injection providers and those who did both were associated with more frequent injection, illegal income source, and methamphetamine injection while injection recipients were associated with fewer years of injection. Injection providers were younger, had more years of injecting, and were more likely to inject heroin than PWID who did neither. In multivariate analyses, we found that providers and PWID who did both were significantly more likely to report receptive and distributive syringe sharing than PWID who did neither. CONCLUSION Peer-to-peer injection is associated with HIV/HCV risk. Current prevention strategies may not sufficiently address these behaviors. Modification of existing interventions and development of new interventions to better respond to peer-to-peer injection is urgently needed.
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Affiliation(s)
- Shona Lamb
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, United States
| | - Alex H Kral
- Behavioral and Urban Health Program, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, United States
| | - Karina Dominguez-Gonzalez
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N Soto St, 3rd floor, Los Angeles, CA 90033, United States
| | - Lynn D Wenger
- Behavioral and Urban Health Program, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, United States
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N Soto St, 3rd floor, Los Angeles, CA 90033, United States.
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Bardwell G, Anderson S, Richardson L, Bird L, Lampkin H, Small W, McNeil R. The perspectives of structurally vulnerable people who use drugs on volunteer stipends and work experiences provided through a drug user organization: Opportunities and limitations. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:40-46. [PMID: 29501928 PMCID: PMC7046180 DOI: 10.1016/j.drugpo.2018.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/02/2017] [Accepted: 02/12/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND While drug user organizations (DUO) have received public health attention as a means to potentially reduce the harms associated with drug use, there is a lack of research on the compensation and structural forces that promote or inhibit participation in DUO. Against the backdrop of structural vulnerability experienced by people who use drugs (PWUD), we examined the impact of monetary 'volunteer stipends' provided through a DUO and explore their role in providing low-threshold employment opportunities and shaping participation in DUO. METHODS Participants were purposively sampled to reflect a range of perspectives and experiences volunteering at Vancouver Area Network of Drug Users (VANDU) and receiving stipends. Semi-structured qualitative interviews were conducted with 23 members of VANDU. Interview transcripts were coded in Atlas.ti 7 for key a priori themes and emergent categories from the data and analyzed thematically. RESULTS Stipends provided participants with symbolic and material recognition of the time, effort, and expertise they contribute to the organization, and functioned to facilitate ongoing participation. Payments that rewarded, skills, labour and drug-related knowledge reduced participant's perception of stigma against PWUD. Paid work in VANDU further provided participants with non-material benefits commonly attributed to regular employment, including social connections and a sense of purpose. Participants also identified the low level of pay as a limitation of VANDU's paid participation program. The daily demands of survival (accessing shelter, food, and drugs) posed more complex structural vulnerabilities to participate in VANDU, as small stipends were not sufficient to address these needs. CONCLUSION Low threshold employment opportunities within DUO may provide significant individual and public health benefits. However, these benefits are constrained by the small size of stipends. Therefore, to ensure better inclusion of PWUD, our findings recommend the development and expansion of equitable, accessible, well-paying employment programs for PWUD.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Solanna Anderson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Sociology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Lorna Bird
- Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | - Hugh Lampkin
- Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | - Will Small
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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18
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Boyd J, Fast D, Hobbins M, McNeil R, Small W. Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study. Harm Reduct J 2017; 14:31. [PMID: 28583136 PMCID: PMC5460503 DOI: 10.1186/s12954-017-0159-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/24/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Injection drug use is associated with HIV and hepatitis C transmission, overdose, and other preventable harms. These harms are heightened for structurally vulnerable injection drug-using populations, as their social conditions pose barriers to safer injecting. Previous research on injection cessation has largely focused on adult drug-using populations. Little qualitative work has examined the social, structural, and environmental factors that shape periods of injection cessation among youth and young adults. Such research is essential to understanding how we can best reduce harms among this vulnerable population as they move in and out of periods of injection cessation. METHODS We conducted 22 semi-structured, qualitative interviews with street-involved young people who use drugs (SY), focused on characterizing their transitions into periods of injection cessation and perceived barriers to injection cessation. Adopting an ethno-epidemiological approach, participants who had experienced at least 6 months of injection cessation were purposively recruited from an ongoing prospective cohort study of SY in Vancouver, Canada to participate in qualitative interviews. Qualitative interview findings were triangulated with the findings of a longitudinal program of ethnographic research with SY in this setting. This ethno-epidemiological approach allowed for a more robust exploration of contextual factors surrounding drug use patterns than would be possible through traditional epidemiological methods alone. RESULTS Findings indicate that periods of injection cessation were influenced by access to harm reduction-informed youth-focused services, transitions in route of administration (e.g., from injecting methamphetamine to the smoking of methamphetamine), and the provision of housing and social supports (e.g., from friends, family, and care providers). Conversely, participants indicated that inadequate social supports and, for some, abstinence-focused treatment methods (e.g., 12-step programs), impeded efforts to cease injecting. CONCLUSIONS To reduce harms, it is imperative to reorient attention toward the social, structural, and spatial contexts that surround injection drug use and shape periods of injection cessation for SY. There is an urgent need for more comprehensive youth-focused services for those engaged in injection drug use, and further study of innovative means of engaging youth.
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Affiliation(s)
- Jade Boyd
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Megan Hobbins
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, V5A 1S6, BC, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Will Small
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, V5A 1S6, BC, Canada.
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Bluthenthal RN, Wenger L, Chu D, Bourgois P, Kral AH. Drug use generations and patterns of injection drug use: Birth cohort differences among people who inject drugs in Los Angeles and San Francisco, California. Drug Alcohol Depend 2017; 175:210-218. [PMID: 28448905 PMCID: PMC5494991 DOI: 10.1016/j.drugalcdep.2017.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/24/2017] [Accepted: 04/05/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES A robust literature documents generational trends in drug use. We examined the implications of changing national drug use patterns on drug injection histories of diverse people who inject drugs (PWID). METHODS Drug use histories were collected from 776 active PWID in 2011-13. Using descriptive statistics, we examine drug use initiation by year and birth cohort (BC) differences in drug first injected. A multivariate linear regression model of time to injection initiation ([TTII] (year of first injection minus year of first illicit drug use) was developed to explore BC differences. RESULTS The first drug injected by BC changed in tandem with national drug use trends with heroin declining from 77% for the pre-1960's BC to 58% for the 1960's BC before increasing to 71% for the 1990's BC. Multivariate linear regression modeling found that shorter TTII was associated with the 1980's/1990's BC (-3.50 years; 95% Confidence Interval [CI]=-0.79, -6.21) as compared to the 1970's BC. Longer TTII was associated with being female (1.65 years; 95% CI=0.40, 2.90), African American (1.69 years; 95% CI=0.43, 2.95), any substance use treatment prior to injection (4.22 years; 95% CI=2.65, 5.79), and prior non-injection use of drug that was first injected (3.29 years; 95% CI=2.19, 4.40). CONCLUSION National drug trends appear to influence injection drug use patterns. The prescription opiate drug era is associated with shorter TTII. Culturally competent, demographically and generationally-targeted prevention strategies to combat transitions to drug injection are needed to prevent or shorten upstream increases in risky drug use practices on a national level.
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Affiliation(s)
- Ricky N. Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90033, USA
| | - Lynn Wenger
- Behavioral and Urban Health Program, RTI International, 351 California St., San Francisco, CA 94104, USA
| | - Daniel Chu
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90033, USA
| | - Philippe Bourgois
- Department of Psychiatry and Biobehavioral Sciences, UCLA Center for Social Medicine and the Humanities, Semel Institute, 760 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Alex H. Kral
- Behavioral and Urban Health Program, RTI International, 351 California St., San Francisco, CA 94104, USA
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McNeil R, Kerr T, Coleman B, Maher L, Milloy MJ, Small W. Antiretroviral Therapy Interruption Among HIV Postive People Who Use Drugs in a Setting with a Community-Wide HIV Treatment-as-Prevention Initiative. AIDS Behav 2017; 21:402-409. [PMID: 27351192 DOI: 10.1007/s10461-016-1470-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
HIV Treatment as Prevention (TasP) initiatives promote antiretroviral therapy (ART) access and optimal adherence (≥95 %) to produce viral suppression among people living with HIV (PLHIV) and prevent the onward transmission of HIV. ART treatment interruptions are common among PLHIV who use drugs and undermine the effectiveness of TasP. Semi-structured interviews were conducted with 39 PLHIV who use drugs who had experienced treatment ART interruptions in a setting with a community-wide TasP initiative (Vancouver, Canada) to examine influences on these outcomes. While study participants attributed ART interruptions to "treatment fatigue," our analysis revealed individual, social, and structural influences on these events, including: (1) prior adverse ART-related experiences among those with long-term treatment histories; (2) experiences of social isolation; and, (3) breakdowns in the continuity of HIV care following disruptive events (e.g., eviction, incarceration). Findings reconceptualise 'treatment fatigue' by focusing attention on its underlying mechanisms, while demonstrating the need for comprehensive structural reforms and targeted interventions to optimize TasP among drug-using PLHIV.
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Affiliation(s)
- Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada.
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bill Coleman
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada
| | - Lisa Maher
- Kirby Institute of Infection and Immunity, UNSW Australia, Sydney, Australia
| | - M J Milloy
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Will Small
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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21
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Werb D, Garfein R, Kerr T, Davidson P, Roux P, Jauffret-Roustide M, Auriacombe M, Small W, Strathdee SA. A socio-structural approach to preventing injection drug use initiation: rationale for the PRIMER study. Harm Reduct J 2016; 13:25. [PMID: 27629248 PMCID: PMC5024479 DOI: 10.1186/s12954-016-0114-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/01/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Injection drug use remains a primary driver of HIV and HCV-related harms globally. However, there is a gap in efforts to prevent individuals from transitioning into injecting. People who inject drugs (PWID) play a key role in the transition of others into injecting, and while behavioral interventions have been developed to address this phenomenon, socio-structural approaches remain unexplored. To that end, we hypothesize that certain interventions designed to reduce injecting-related risk behaviors may also reduce the risk that PWID expose and introduce others into injecting. Identifying the preventive potential of existing interventions will inform broader efforts to prevent injecting and related harms. METHODS The Preventing Injecting by Modifying Existing Responses (PRIMER) study is a multi-country mixed methods study with an aim to investigate whether specific interventions (e.g., opioid substitution therapy, supervised injection facilities, stable housing, incarceration environments) and related factors (e.g., public injecting and gender) influence the likelihood that PWID initiate others into injecting. This study will (1) investigate the PWID participation in injection initiation; (2) identify factors influencing the risk that PWID expose others to or facilitate injection initiation; (3) describe drug scene roles that increase the risk of PWID facilitating injection initiation; and (4) evaluate the impact of structural, social, or biomedical interventions on the risk that PWID facilitate injection initiation. It does so by pooling observational data from cohort studies of PWID in six cities: Vancouver, Canada; San Diego, USA; Tijuana, Mexico; Paris, Marseille, and Bordeaux, France. RESULTS Team members are conducting a prospective, multi-site study of PWID (n = 3050) in North America and France that includes quantitative and qualitative data collection through four separate cohort studies of PWID (San Diego, STAHR II; Tijuana, El Cuete IV; Vancouver, V-DUS; Bordeaux, Marseille, Paris and Strasbourg, COSINUS). CONCLUSIONS PRIMER is the largest study of injection initiation to date and the first to investigate structural approaches to preventing injection drug use initiation. Findings have the potential to inform the development and scale up of new and existing interventions to prevent transitions into injecting. TRIAL REGISTRATION Preventing Injecting by Modifying Existing Responses (PRIMER), NIDA DP2-DA040256-01 .
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Affiliation(s)
- Daniel Werb
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA. .,Division of Global Public Health, University of California School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA.
| | - Richard Garfein
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA
| | - Thomas Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Peter Davidson
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA
| | - Perrine Roux
- INSERM, UMR_S 912, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), F-13385, Marseille, France
| | - Marie Jauffret-Roustide
- Inserm U988/CNRS UMR 8211, Ecole des Hautes Etudes en Sciences Sociales, Université de Paris Descartes, Paris, France
| | - Marc Auriacombe
- SANSPY/CNRS USR 3413, Université de Bordeaux, Bordeaux, France
| | - Will Small
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA
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Small W, Milloy MJ, McNeil R, Maher L, Kerr T. Plasma HIV-1 RNA viral load rebound among people who inject drugs receiving antiretroviral therapy (ART) in a Canadian setting: an ethno-epidemiological study. AIDS Res Ther 2016; 13:26. [PMID: 27462360 PMCID: PMC4960678 DOI: 10.1186/s12981-016-0108-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/10/2016] [Indexed: 12/26/2022] Open
Abstract
Background People who inject drugs (PWID) living with HIV often experience sub-optimal antiretroviral therapy (ART) treatment outcomes, including HIV plasma viral load (PVL) rebound. While previous studies have identified risk factors for PVL rebound among PWID, no study has examined the perspectives of PWID who have experienced PVL rebound episodes. We conducted an ethno-epidemiological study to investigate the circumstances surrounding the emergence of rebound episodes among PWID in Vancouver, BC, Canada. Methods Comprehensive clinical records linked to a community-based prospective observational cohort of HIV-positive drug users were used to identify PWID who had recently experienced viral rebound. In-depth qualitative interviews with 16 male and 11 female participants explored participant perspectives regarding the emergence of viral rebound. A timeline depicting each participant’s HIV viral load and adherence to ART was used to elicit discussion of circumstances surrounding viral rebound. Findings Viral rebound episodes were shaped by interplay between various individual, social, and environmental factors that disrupted routines facilitating adherence. Structural-environmental influences resulting in non-adherence included housing transitions, changes in drug use patterns and intense drug scene involvement, and inadequate care for co-morbid health conditions. Social-environmental influences on ART adherence included poor interactions between care providers and patients producing non-adherence, and understandings of HIV treatment that fostered intentional treatment discontinuation. Conclusions This study describes key pathways which led to rebound episodes among PWID receiving ART and illustrates how environmental forces may increase vulnerability for non-adherence leading to treatment failure. Our findings have potential to help inform interventions and supports that address social-structural forces that foster non-adherence among PWID.
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Ciccarone D, Bourgois P. Injecting drugs in tight spaces: HIV, cocaine and collinearity in the Downtown Eastside, Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 33:36-43. [PMID: 27117187 PMCID: PMC4947565 DOI: 10.1016/j.drugpo.2016.02.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 02/16/2016] [Accepted: 02/20/2016] [Indexed: 11/26/2022]
Abstract
This commentary revisits the political turmoil and scientific controversy over epidemiological study findings linking high HIV seroincidence to syringe exchange attendance in Vancouver in the mid-1990s. The association was mobilized polemically by US politicians and hard-line drug warriors to attack needle exchange policies and funding. In turn, program restrictions limiting access to syringes at the Vancouver exchange may have interfaced with a complex conjunction of historical, geographic, political economic and cultural forces and physiological vulnerabilities to create an extraordinary HIV risk environment: (1) ghettoization of services for indigent populations in a rapidly gentrifying, post-industrial city; (2) rural-urban migration of vulnerable populations subject to historical colonization and current patterns of racism; and (3) the flooding of North America with inexpensive powder cocaine and heroin, and the popularity of crack. In fact, we will never know with certainty the precise cause for the extreme seroincidence rates in Vancouver in the early to mid-1990s. The tendency for modern social epidemiology to decontextualize research subjects and assign excessive importance to discrete, "magic bullet" variables resulted in a counterproductive scientific and political debate in the late 1990s that has obfuscated potentially useful practical lessons for organizing the logistics of harm reduction services - especially syringe exchange - to better serve the needs of vulnerable populations and to mitigate the effects of political-economically imposed HIV risk environments. We would benefit from humbly acknowledging the limits of public health science and learn to recognize the unintended consequences of well-intentioned interventions rather than sweep embarrassing histories under the rug.
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Affiliation(s)
- Daniel Ciccarone
- Family and Community Medicine, UCSF 500 Parnassus Avenue, MU-3E, Box 0900, San Francisco, CA 94143-0900, United States.
| | - Philippe Bourgois
- Psychiatry, Center for Social Medicine, UCLA, 760 Westwood Plaza, B7-435, Los Angeles, CA 90025, United States
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Hesse-Biber S. Doing Interdisciplinary Mixed Methods Health Care Research: Working the Boundaries, Tensions, and Synergistic Potential of Team-Based Research. QUALITATIVE HEALTH RESEARCH 2016; 26:649-58. [PMID: 26984708 DOI: 10.1177/1049732316634304] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Current trends in health care research point to a shift from disciplinary models to interdisciplinary team-based mixed methods inquiry designs. This keynote address discusses the problems and prospects of creating vibrant mixed methods health care interdisciplinary research teams that can harness their potential synergy that holds the promise of addressing complex health care issues. We examine the range of factors and issues these types of research teams need to consider to facilitate efficient interdisciplinary mixed methods team-based research. It is argued that concepts such as disciplinary comfort zones, a lack of attention to team dynamics, and low levels of reflexivity among interdisciplinary team members can inhibit the effectiveness of a research team. This keynote suggests a set of effective strategies to address the issues that emanate from the new field of research inquiry known as team science as well as lessons learned from tapping into research on organizational dynamics.
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McNeil R, Kerr T, Pauly B, Wood E, Small W. Advancing patient-centered care for structurally vulnerable drug-using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction interventions into hospitals. Addiction 2016; 111:685-94. [PMID: 26498577 PMCID: PMC4801725 DOI: 10.1111/add.13214] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/05/2015] [Accepted: 10/20/2015] [Indexed: 12/30/2022]
Abstract
AIMS To explore the perspectives of structurally vulnerable people who use drugs (PWUD) regarding: (1) the potential integration of harm reduction interventions (e.g. supervised drug consumption services, opioid-assisted treatment) into hospitals; and (2) the implications of these interventions for patient-centered care, hospital outcomes and drug-related risks and harms. DESIGN Semi-structured qualitative interviews. SETTING Vancouver, Canada. PARTICIPANTS Thirty structurally vulnerable PWUD who had been discharged from hospital against medical advice within the past 2 years, and hospitalized multiple times over the past 5 years. MEASUREMENTS Semi-structured interview guide including questions to elicit perspectives on hospital-based harm reduction interventions. FINDINGS Participant accounts highlighted that hospital-based harm reduction interventions would promote patient-centered care by: (1) prioritizing hospital care access and risk reduction over the enforcement of abstinence-based drug policies; (2) increasing responsiveness to subjective health needs (e.g. pain and withdrawal symptoms); and (3) fostering 'culturally safe' care. CONCLUSIONS Hospital-based harm reduction interventions for people who use drugs, such as supervised drug consumption services and opioid-assisted treatment, can potentially improve hospital care retention, promote patient-centered care and reduce adverse health outcomes among people who use drugs.
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Affiliation(s)
- Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columba, Canada
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernie Pauly
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
- Centre for Addictions Research of British Columbia, Victoria, British Columbia, Canada
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Will Small
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columba, Canada
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Palinkas LA, Bazzi AR, Syvertsen JL, Ulibarri MD, Hernandez D, Rangel MG, Martinez G, Strathdee SA. Measuring Current Drug Use in Female Sex Workers and Their Noncommercial Male Partners in Mexico: Concordance Between Data Collected From Surveys Versus Semi-Structured Interviews. Subst Use Misuse 2016; 51:23-33. [PMID: 26683591 PMCID: PMC4802973 DOI: 10.3109/10826084.2015.1073326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Self-reports are commonly used to assess prevalence and frequency of drug use, but it is unclear whether qualitative methods like semi-structured interviews are as useful at obtaining such information as quantitative surveys. OBJECTIVES This study compared drug use occurrence and frequency using data collected from quantitative surveys and qualitative interviews. We also examined whether combining data from both sources could result in significant increases in percentages of current users and whether the concordance between the two sets of data was associated with the type of drug use, age, gender and socioeconomic status. METHODS Self- reports of recent marijuana, heroin, crack, cocaine, crystal/methamphetamine, inhalant, and tranquilizer use were collected using both methods from a cohort of Mexican female sex workers and their non-commercial male partners (n = 82). RESULTS Participants were significantly less likely to report marijuana, cocaine and tranquilizer use and frequency of use during the qualitative interviews than during the quantitative surveys. Agreement on frequency of drug use was excellent for crystal/methamphetamine, heroin and inhalant use, and weak for cocaine, tranquilizers and marijuana use. Older participants exhibited significantly higher concordance than younger participants in reports of marijuana and methamphetamine use. Higher monthly income was significantly associated with higher concordance in crack use but lower concordance with marijuana use. CONCLUSIONS Although use of such data can result in an underreporting of drug use, qualitative data can be quantified in certain circumstances to triangulate and confirm the results from quantitative analyses and provide a more comprehensive view of drug use.
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Affiliation(s)
- Lawrence A Palinkas
- a School of Social Work , University of Southern California , Los Angeles , California , USA
| | | | | | - Monica D Ulibarri
- d Psychiatry, University of California , San Diego, La Jolla , California , USA
| | - Daniel Hernandez
- e School of Medicine , University of California , Davis, Sacramento , California , USA
| | | | - Gustavo Martinez
- g Federacion Mexicana de Asociaciones Privadas , Cuidad Juarez , Mexico
| | - Steffanie A Strathdee
- h Division of Global Public Health , University of California , San Diego, La Jolla , California , USA
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Markwick N, McNeil R, Small W, Kerr T. Exploring the Public Health Impacts of Private Security Guards on People Who Use Drugs: a Qualitative Study. J Urban Health 2015; 92:1117-30. [PMID: 26453195 PMCID: PMC4675737 DOI: 10.1007/s11524-015-9992-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Private security guards occupy an increasingly prominent role in the policing of private and public spaces. There are growing concerns regarding security guards' potential to shape violence, discrimination, and adverse health outcomes among vulnerable populations, including people who use drugs (PWUD). This is relevant in Vancouver, Canada, where private security guards have increasingly been employed by private organizations to manage public and private spaces, including those within urban drug scenes. This qualitative study sought to understand interactions between PWUD and private security guards and explore their impacts on health care access, risks, and harms among PWUD. Semi-structured interviews were conducted with 30 PWUD recruited from two ongoing prospective cohort studies. Interviews were transcribed and analyzed using a coding framework comprised of a priori and emergent categories. Study data indicate that participants experience pervasive, discriminatory profiling and surveillance by security guards, which exacerbates existing social marginalization and structural vulnerability, particularly among PWUD of Aboriginal ancestry. Participants reported that security guards restrict PWUD's access to public and private spaces, including pharmacies and hospitals. PWUD also reported that their interactions with security guards often involved interpersonal violence and aggression, experiences that served to increase their vulnerability to subsequent risks and harms. Our findings highlight that private security forces contribute significantly to the everyday violence experienced by PWUD within drug scenes and elsewhere and do so in a manner very similar to that of traditional police forces. These findings point to the urgent need for greater oversight and training of private security guards in order to protect the health and safety of PWUD.
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Affiliation(s)
- Nicole Markwick
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Dyal SR, Kral AH, Dominguez Gonzalez K, Wenger LD, Bluthenthal RN. Consistency of self-reported drug use events in a mixed methods study of people who inject drugs. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:332-8. [PMID: 25970020 DOI: 10.3109/00952990.2015.1037842] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little is known about the consistency of information provided by people who inject drugs (PWID) during quantitative and qualitative interviews in mixed methods studies. OBJECTIVES We illustrate the use of the intraclass correlation coefficient, descriptive statistics, and regression to assess the consistency of information provided during a mixed methods study of PWID living in Los Angeles and San Francisco, California, USA. METHODS Age of first use of heroin, methamphetamine, marijuana, powder cocaine, and crack cocaine and first injection of heroin, methamphetamine, and powder cocaine were collected during an interviewer administered computer-assisted personal interview followed by an in-depth qualitative interview (n = 102). RESULTS Participants were 63% male, racially/ethnically diverse. 80.4% between the ages of 40 and 60 years old, 89% US-born, and 57% homeless. Consistency of self-reported data was adequate for most drug use events. Exact concordance between quantitative and qualitative measures of age of onset ranged from 18.2-50%. Event ordering was consistent across qualitative and quantitative results for 90.2% of participants. Analyses indicated that age of onset for heroin use, heroin injection, and injection of any drug was significantly lower when assessed by qualitative methods as compared to quantitative methods. CONCLUSION While inconsistency will emerge during mixed method studies, confidence in the timing and ordering of major types of events such as drug initiation episodes appear to be warranted.
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Affiliation(s)
- Stephanie R Dyal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California , Los Angeles, CA , USA and
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McNeil R, Kerr T, Anderson S, Maher L, Keewatin C, Milloy MJ, Wood E, Small W. Negotiating structural vulnerability following regulatory changes to a provincial methadone program in Vancouver, Canada: A qualitative study. Soc Sci Med 2015; 133:168-76. [PMID: 25875323 DOI: 10.1016/j.socscimed.2015.04.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While regulatory frameworks governing methadone maintenance therapy (MMT) require highly regimented treatment programs that shape treatment outcomes, little research has examined the effects of regulatory changes to these programs on those receiving treatment, and located their experiences within the wider context of social-structural inequities. In British Columbia (BC), Canada, provincial regulations governing MMT have recently been modified, including: replacing the existing methadone formulation with Methadose(®) (pre-mixed and 10 times more concentrated); prohibiting pharmacy delivery of methadone; and, prohibiting pharmacies incentives for methadone dispensation. We undertook this study to examine the impacts of these changes on a structurally vulnerable population enrolled in MMT in Vancouver, BC. Qualitative interviews were conducted with 34 people enrolled in MMT and recruited from two ongoing observational prospective cohort studies comprised of drug-using individuals in the six-month period in 2014 following these regulatory changes. Interview transcripts were analysed thematically, and by drawing on the concept of 'structural vulnerability'. Findings underscore how these regulatory changes disrupted treatment engagement, producing considerable health and social harms. The introduction of Methadose(®) precipitated increased withdrawal symptoms. The discontinuation of pharmacy delivery services led to interruptions in MMT and co-dispensed HIV medications due to constraints stemming from their structural vulnerability (e.g., poverty, homelessness). Meanwhile, the loss of pharmacy incentives limited access to material supports utilized by participants to overcome barriers to MMT, while diminishing their capacity to assert some degree of agency in negotiating dispensation arrangements with pharmacies. Collectively, these changes functioned to compromise MMT engagement and increased structural vulnerability to harm, including re-initiation of injection drug use and participation in high-risk income-generating strategies. Greater attention to the impacts of social-structural inequities on MMT engagement is needed when modifying MMT programs, especially as other jurisdictions are adopting similar changes. Comprehensive environmental supports should be provided to minimize adverse outcomes during transitional periods.
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Affiliation(s)
- Ryan McNeil
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Lisa Maher
- Kirby Institute for Infection & Immunity in Society, UNSW Australia, Sydney, Australia
| | - Chereece Keewatin
- British Columbia Association of People on Methadone, Vancouver, BC, Canada
| | - M J Milloy
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Will Small
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Vandermause R, Barbosa-Leiker C, Fritz R. Research Education: Findings of a Study of Teaching–Learning Research Using Multiple Analytical Perspectives. J Nurs Educ 2014; 53:673-7. [DOI: 10.3928/01484834-20141120-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/21/2014] [Indexed: 11/20/2022]
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Christensen P. Connoisseurship and drunkenness in Tokyo. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:804-9. [PMID: 25037118 DOI: 10.1016/j.drugpo.2014.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/12/2014] [Indexed: 11/24/2022]
Abstract
Although aggregate alcohol consumption in Japan is declining, national data overlook important anomalies and local trends. One is that young adults are drinking in greater volume and frequency than previously observed in the postwar era, while health concerns pertaining to alcohol consumption struggle for national recognition against largely uncritical views of intoxication. This article focuses on the connoisseurship of alcohol among Tokyo's young adults, particularly knowledge and breadth of sampled varieties, an emergent and growing pursuit that encourages drinking and structures drunkenness. Connoisseurship and drunkenness, the article argues, serve as means to assert expertise, sophistication and global competence - a form of cultural capital among young urbanites who increasingly find themselves on the economic and social margins, disconnected from the official institutions of Japanese society. Most of the data presented here were gathered over 14 months of ethnographic fieldwork in Tokyo (interviews, online survey and participant observation), supplemented by ongoing participation in online conversations on the popular social media website www.mixi.jp. Ethnographic attention reveals how alcohol consumption is discussed as a culturally meaningful pursuit illustrative of major societal shifts and challenges confronting Japan.
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Affiliation(s)
- Paul Christensen
- Department of Anthropology, Union College, 807 Union Street, Lamont House 305, Schenectady, NY 12308, USA.
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Wenger LD, Lopez AM, Comfort M, Kral AH. The phenomenon of low-frequency heroin injection among street-based urban poor: drug user strategies and contexts of use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:471-9. [PMID: 24690452 PMCID: PMC4071159 DOI: 10.1016/j.drugpo.2014.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 01/30/2014] [Accepted: 02/25/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dominant public health and medical discourse has relied on a pharmacocentric conception of heroin use-that is, the notion that heroin users inject compulsively to stave off physical and psychological withdrawal. Previous research disputes this claim suggesting that other patterns of heroin use, such as occasional, recreational, or controlled use are possible. In our previous cross-sectional epidemiological research, we identified the phenomenon of low frequency heroin injection (low-FHI), among street-based drug users. The goal of the current study was to qualitatively assess and contextualise this phenomenon over time among a sample of street-based low-FHI. METHODS 29 low-FHI and 25 high frequency heroin injectors (high-FHI) were followed for 2 years, during which they participated in a series of in-depth interviews. Qualitative data were coded using an inductive analysis approach. As similarities and differences between participants were discovered, transcripts were queried for supportive quotations as well as negative cases. RESULTS We found the social context among low-FHI and high-FHI to be similar with the exception of their patterns of heroin use. Thus, we focused this analysis on understanding motivations for and management of low-FHI. Two major categories of low-FHI emerged from the data: maintenance and transitioning low-FHI. Maintenance low-FHI sustained low-FHI over time. Some of these heroin users were circumstantial low-FHI, who maintained low-FHI as a result of their social networks or life events, and others maintained low-FHI purposefully. Transitioning low-FHI did not sustain low use throughout the study. We found that heroin use patterns frequently shift over time and these categories help identify factors impacting drug use within particular moments in an individual's life. CONCLUSIONS Given the various patterns of heroin use that were identified in this study, when working with IDUs, one must assess the specifics of heroin use patterns including drug preferences, desire for substance abuse treatment, as well as basic physical and mental health care needs.
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Affiliation(s)
- Lynn D Wenger
- Urban Health Program, RTI International, San Francisco Regional Office, 351 California St. Suite 500, San Francisco, CA 94104, USA.
| | - Andrea M Lopez
- Urban Health Program, RTI International, San Francisco Regional Office, 351 California St. Suite 500, San Francisco, CA 94104, USA; Department of Anthropology, University of New Mexico, MSC01-1040, Albuquerque, NM 87131, USA; HIV/AIDS Division, University of California, 995 Potrero Avenue, San Francisco, CA 94110, USA
| | - Megan Comfort
- Urban Health Program, RTI International, San Francisco Regional Office, 351 California St. Suite 500, San Francisco, CA 94104, USA; Center for AIDS Prevention Studies, University of California, San Francisco 50 Beale St., San Francisco, CA 94105, USA
| | - Alex H Kral
- Urban Health Program, RTI International, San Francisco Regional Office, 351 California St. Suite 500, San Francisco, CA 94104, USA
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Syvertsen JL, Robertson AM, Strathdee SA, Martinez G, Rangel MG, Wagner KD. Rethinking risk: gender and injection drug-related HIV risk among female sex workers and their non-commercial partners along the Mexico-U.S. border. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:836-44. [PMID: 24641906 DOI: 10.1016/j.drugpo.2014.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/17/2014] [Accepted: 02/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies of injection drug-using couples suggest a gendered performance of risk in which men exert greater control over drug use and render their female partners vulnerable to HIV infection and other negative health outcomes. This study assesses gender roles in injection drug use as practiced among female sex workers and their intimate male partners within a risk environment marked by rapid socioeconomic changes. METHODS We draw on quantitative surveys, semi-structured interviews, and ethnographic fieldwork conducted as part of cohort study of HIV/STI risk among female sex workers and their intimate, non-commercial partners along the Mexico-U.S. border. This study employed descriptive statistics and inductive analyses of transcripts and field notes to examine practices related to drug procurement, syringe sharing, and injection assistance among couples in which both partners reported injecting drugs in the past 6 months. RESULTS Among 156 couples in which both partners injected drugs (n=312), our analyses revealed that women's roles in drug use were active and multidimensional, and both partners' injection risk practices represented embodied forms of cooperation and compassion. Women often earned money to purchase drugs and procured drugs to protect their partners from the police. Sharing drugs and syringes and seeking injection assistance were common among couples due to drug market characteristics (e.g., the use of "black tar" heroin that clogs syringes and damages veins). Both women and men provided and received injection assistance, which was typically framed as caring for the partner in need of help. CONCLUSION Our mixed methods study suggests that in certain risk environments, women are more active participants in injection-related practices than has often been revealed. This participation is shaped by dynamic relationship and structural factors. Our suggestion to consider gendered injection risk as a nuanced and relational process has direct implications for future research and interventions.
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Affiliation(s)
- Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Avenue, Columbus, OH 43210, USA; Division of Global Public Health, Department of Medicine, University of California, San Diego La Jolla, CA 92093-0507, USA
| | - Angela M Robertson
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego La Jolla, CA 92093-0507, USA
| | - Gustavo Martinez
- Federación Mexicana de Asociaciones Privadas, Ciudad Juárez, Chihuahua, Mexico
| | - M Gudelia Rangel
- El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
| | - Karla D Wagner
- Division of Global Public Health, Department of Medicine, University of California, San Diego La Jolla, CA 92093-0507, USA.
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McNeil R, Small W, Wood E, Kerr T. Hospitals as a 'risk environment': an ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs. Soc Sci Med 2014; 105:59-66. [PMID: 24508718 DOI: 10.1016/j.socscimed.2014.01.010] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/15/2013] [Accepted: 01/06/2014] [Indexed: 12/13/2022]
Abstract
People who inject drugs (PWID) experience high levels of HIV/AIDS and hepatitis C (HCV) infection that, together with injection-related complications such as non-fatal overdose and injection-related infections, lead to frequent hospitalizations. However, injection drug-using populations are among those most likely to be discharged from hospital against medical advice, which significantly increases their likelihood of hospital readmission, longer overall hospital stays, and death. In spite of this, little research has been undertaken examining how social-structural forces operating within hospital settings shape the experiences of PWID in receiving care in hospitals and contribute to discharges against medical advice. This ethno-epidemiological study was undertaken in Vancouver, Canada to explore how the social-structural dynamics within hospitals function to produce discharges against medical advice among PWID. In-depth interviews were conducted with thirty PWID recruited from among participants in ongoing observational cohort studies of people who inject drugs who reported that they had been discharged from hospital against medical advice within the previous two years. Data were analyzed thematically, and by drawing on the 'risk environment' framework and concepts of social violence. Our findings illustrate how intersecting social and structural factors led to inadequate pain and withdrawal management, which led to continued drug use in hospital settings. In turn, diverse forms of social control operating to regulate and prevent drug use in hospital settings amplified drug-related risks and increased the likelihood of discharge against medical advice. Given the significant morbidity and health care costs associated with discharge against medical advice among drug-using populations, there is an urgent need to reshape the social-structural contexts of hospital care for PWID by shifting emphasis toward evidence-based pain and drug treatment augmented by harm reduction supports, including supervised drug consumption services.
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Affiliation(s)
- Ryan McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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