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Sutherland R, Peacock A, Crawford S, Holly C, Gava P, Dicka J, Manu G, Byrne J. Information acquisition and dissemination among a sample of people who inject drugs in Australia. Drug Alcohol Rev 2024; 43:1104-1111. [PMID: 37952935 DOI: 10.1111/dar.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 09/13/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION This paper examines the acquisition and dissemination of harm reduction information among people who inject drugs, as well as preferred sources of information. METHODS Data were obtained from 862 people who inject drugs, recruited from Australian capital cities for the 2021 Illicit Drug Reporting System. Multivariable regression analyses were performed to assess potential factors associated with knowledge sharing. RESULTS Almost two-fifths (37%) reported that they had received information about how to keep themselves safe when using drugs within the past 6 months. Reporting on their last occasion of receiving information, participants stated that it was commonly about injecting practices (56%), overdose prevention (26%) and injection-related injuries (22%), and was mostly received from an alcohol and other drug worker (54%), followed by other health professional (24%) and social network (18%). Among those who reported receiving information, 50% shared this information with other people, predominantly with their social network: no factors were found to be significantly associated with sharing information. The majority reported that peer workers and/or people with lived experience would be the first person they would talk to for information about a range of topics (e.g., injecting/harm reduction practices, overdose prevention). DISCUSSION AND CONCLUSIONS Two in five participants had recently obtained information about how to keep themselves safe while using drugs, with half sharing this information with their social network. Peer workers were the preferred source of information, suggesting that the peer educator workforce should be expanded to embrace the capacities and expertise of people who inject drugs.
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Affiliation(s)
- Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | | | | | - Peta Gava
- Peer Based Harm Reduction WA, Perth, Australia
| | - Jane Dicka
- Harm Reduction Victoria, Melbourne, Australia
| | - Geoff Manu
- Australian Injecting and Illicit Drug Users League, Canberra, Australia
| | - Jude Byrne
- Australian Injecting and Illicit Drug Users League, Canberra, Australia
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Ezell JM, Pho MT, Ajayi BP, Simek E, Shetty N, Goddard-Eckrich DA, Bluthenthal RN. Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model. Drug Alcohol Rev 2024; 43:1143-1159. [PMID: 38646735 DOI: 10.1111/dar.13832] [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: 08/29/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 04/23/2024]
Abstract
ISSUES To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. APPROACH Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors. KEY FINDINGS Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. IMPLICATIONS There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement. CONCLUSION There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.
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Affiliation(s)
- Jerel M Ezell
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, USA
| | - Babatunde P Ajayi
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
| | - Elinor Simek
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Netra Shetty
- University of California Berkeley, Berkeley, USA
| | | | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Gozdzialski L, Louw R, Kielty C, Margolese A, Poarch E, Sherman M, Cameron F, Gill C, Wallace B, Hore D. Beyond a spec: assessing heterogeneity in the unregulated opioid supply. Harm Reduct J 2024; 21:63. [PMID: 38491435 PMCID: PMC10941387 DOI: 10.1186/s12954-024-00980-5] [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: 01/24/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Drug checking services aim to provide compositional information for the illicit drug supply and are being employed in public health responses to extreme rates of overdose associated with fentanyl within street opioids. The technologies used within these services range from basic qualitative tests, such as immunoassay test strips, to comprehensive quantitative analyses, such as mass spectrometry. In general, there is concern that heterogeneity of a drug mixture adds significant uncertainty when using drug checking results based on a small subsamples. The presence of hot spots of active drug components in this context is often termed the 'chocolate chip cookie effect'. Establishing the limitations of the service are essential for interpretation of the results. METHODS This study assesses the consequence of drug heterogeneity and sampling of consumer level opioid purchased in Victoria, British Columbia ( n = 21 , 50-100 mg each) on quantitative fentanyl results determined from testing with paper spray mass spectrometry. RESULTS Using descriptive statistics, such as relative standard deviation and interquartile range, the results demonstrate varied distributions of fentanyl concentrations within a single drug batch. However, the presence of hot spots, defined as outliers, were relatively rare. CONCLUSIONS This study found that the variability in fentanyl concentration from drug heterogeneity and sampling is greater than that attributed to the analytical technique. On a practical level, this provides data to help guide communication of limitations of drug checking services, supporting the aim of trust and transparency between services and people who use drugs. However, if drug checking services continue to be restricted from fully engaging with the reality of manufacturing, buying, selling, mixing and dosing practices, the accuracy, usefulness, and impact will always be limited.
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Affiliation(s)
- Lea Gozdzialski
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Rebecca Louw
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Collin Kielty
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Ava Margolese
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Eric Poarch
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Miriam Sherman
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | | | - Chris Gill
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
- Applied Environmental Research Laboratories (AERL), Department of Chemistry, Vancouver Island University, Nanaimo, V9R 5S5, Canada
- Department of Chemistry, Simon Fraser University, Burnaby, V5A 1S6, Canada
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, 98195, USA
| | - Bruce Wallace
- School of Social Work, University of Victoria, Victoria, V8W 2Y2, Canada
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada
| | - Dennis Hore
- Department of Chemistry, University of Victoria, Victoria, V8W 2Y2, Canada.
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, V8N 5M8, Canada.
- Department of Computer Science, University of Victoria, Victoria, V8W 3P6, Canada.
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Greer A, Xavier J, Loewen OK, Kinniburgh B, Crabtree A. Awareness and knowledge of drug decriminalization among people who use drugs in British Columbia: a multi-method pre-implementation study. BMC Public Health 2024; 24:407. [PMID: 38331771 PMCID: PMC10851533 DOI: 10.1186/s12889-024-17845-y] [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: 10/18/2023] [Accepted: 01/22/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND In January 2023, British Columbia implemented a three-year exemption to Controlled Drugs and Substances Act, as granted by the federal government of Canada, to decriminalize the personal possession of small amounts of certain illegal drugs. This decriminalization policy, the first in Canada, was announced in response to the overdose emergency in British Columbia as a public health intervention that could help curb overdose deaths by reducing the impact of criminalization and increasing access to health and social services through stigma reduction. METHODS The current multi-method study examines people who use drugs' awareness and knowledge of British Columbia's decriminalization model through cross-sectional quantitative surveys and qualitative interviews among people who use drugs from September-November 2022, immediately prior to the implementation of decriminalization. RESULTS Quantitative findings show that two-thirds (63%) of people who use drugs were aware of the policy, but substantial knowledge gaps existed about the legal protections afforded (threshold amount, substances included, drug trafficking, confiscation). The qualitative findings suggest that people who use drugs misunderstood the details of the provincial decriminalization model and often conflated it with regulation. Results suggest that information sharing about decriminalization were minimal pre-implementation, highlighting areas for knowledge dissemination about people who use drugs' rights under this policy. CONCLUSIONS Given that decriminalization in British Columbia is a new and landmark reform, and that the success of decriminalization and its benefits may be undermined by poor awareness and knowledge of it, efforts to share information, increase understanding, and empower the community, may be required to promote its implementation and benefits for the community.
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Affiliation(s)
- Alissa Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada.
| | - Jessica Xavier
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada
- British Columbia Center for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Olivia K Loewen
- Public Health Agency of Canada, Sinclair Centre Federal Building, 218-757 Hastings St. West, Vancouver, BC, V6C 1A1, Canada
| | - Brooke Kinniburgh
- British Columbia Center for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Alexis Crabtree
- British Columbia Center for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
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Turnock L, Gibbs N, Cox L, Piatkowski T. Big business: The private sector market for image and performance enhancing drug harm reduction in the UK. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104254. [PMID: 37950942 DOI: 10.1016/j.drugpo.2023.104254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/21/2023] [Accepted: 10/29/2023] [Indexed: 11/13/2023]
Abstract
This article draws on three mutually independent ethnographic studies to explore the private sector market for image and performance enhancing drug (IPED) harm reduction in the UK, specifically examining (1) steroid accessory supplements; (2) blood testing services; and (3) bloodletting services. After contextualising the work with a discussion of IPED use and harm reduction and the substantial growth of the global health and fitness industry, each private sector provision is critically interrogated with the following questions in mind: what is the role and utility of these services compared to public sector provision? Why has the private sector begun to deliver IPED harm reduction products and services in the UK? And how does this provision relate to the health and fitness industry more broadly? The paper concludes with some reflections about the future direction of IPED harm reduction, the importance of community-led services, and the need to think innovatively if we are to best protect users' health and wellbeing.
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Affiliation(s)
- Luke Turnock
- School of Social and Political Sciences, University of Lincoln, UK
| | - Nick Gibbs
- Department of Social Sciences, Northumbria University, UK.
| | - Luke Cox
- Faculty of Movement & Rehabilitation Sciences, KU Leuven, Belgium
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Syrjanen R, Schumann JL, Lyons T, McKinnon G, Hodgson SE, Abouchedid R, Gerostamoulos D, Koutsogiannis Z, Fitzgerald J, Greene SL. A risk-based approach to community illicit drug toxicosurveillance: operationalisation of the Emerging Drugs Network of Australia - Victoria (EDNAV) project. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104251. [PMID: 37952318 DOI: 10.1016/j.drugpo.2023.104251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/22/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The Emerging Drugs Network of Australia - Victoria (EDNAV) project is a newly established toxicosurveillance network that collates clinical and toxicological data from patients presenting to emergency departments with illicit drug related toxicity in a centralised clinical registry. Data are obtained from a network of sixteen public hospital emergency departments across Victoria, Australia (13 metropolitan and three regional). Comprehensive toxicological analysis of a purposive sample of 22 patients is conducted each week, with reporting of results to key alcohol and other drug stakeholders. This paper describes the overarching framework and risk-based approach developed within Victoria to assess drug intelligence from EDNAV toxicosurveillance. METHODS Risk management principles from other spheres of public health surveillance and healthcare clinical governance have been adapted to the EDNAV framework with the aim of facilitating a consistent and evidence-based approach to assessing weekly drug intelligence. The EDNAV Risk Register was reviewed over the first two years of EDNAV project operation (September 2020 - August 2022), with examples of eight risk assessments detailed to demonstrate the process from signal detection to public health intervention. RESULTS A total of 1112 patient presentations were documented in the EDNAV Clinical Registry, with 95 signals of concern entered into the EDNAV Risk Register over the two-year study period. The eight examples examined in further detail included suspected drug adulteration (novel opioid adulterated heroin, para-methoxymethamphetamine adulterated 3,4-methylenedioxymethamphetamine (MDMA)), drug substitution (25B-NBOH sold as lysergic acid diethylamide, five benzodiazepine-type new psychoactive substances in a single tablet, protonitazene sold as ketamine), new drug detection (N,N-dimethylpentylone), contamination (unreported acetylfentanyl) and a fatality subsequent to MDMA use. A total of four public Drug Alerts were issued over this period. CONCLUSIONS Continued toxicosurveillance efforts are paramount to characterising the changing landscape of illicit drug use. This work demonstrates a functional model for risk assessment of illicit drug toxicosurveillance, underpinned by analytical confirmation and evidence-based decision-making.
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Affiliation(s)
- Rebekka Syrjanen
- Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia
| | - Jennifer L Schumann
- Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Victorian Institute of Forensic Medicine, Toxicology Department, Southbank, Victoria, Australia; Monash University, Monash Addiction Research Centre, Frankston, Victoria, Australia
| | - Tom Lyons
- The Department of Health, Alcohol and Other Drugs Strategy Team, Victorian State Government, Melbourne, Victoria, Australia
| | - Ginny McKinnon
- The Department of Health, Alcohol and Other Drugs Strategy Team, Victorian State Government, Melbourne, Victoria, Australia
| | - Sarah E Hodgson
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia
| | - Rachelle Abouchedid
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Bendigo Health, Emergency Department, Bendigo Hospital, Bendigo, Victoria, Australia
| | - Dimitri Gerostamoulos
- Monash University, Department of Forensic Medicine, Southbank, Victoria, Australia; Victorian Institute of Forensic Medicine, Toxicology Department, Southbank, Victoria, Australia
| | - Zeff Koutsogiannis
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia
| | - John Fitzgerald
- The University of Melbourne, Melbourne School of Population and Global Health, Parkville, Victoria, Australia
| | - Shaun L Greene
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Melbourne Medical School, Department of Critical Care, Parkville, Victoria, Australia.
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Perri M, Khorasheh T, Poon DEO, Kaminski N, LeBlanc S, Mizon L, Smoke A, Strike C, Leece P. A rapid review of current engagement strategies with people who use drugs in monitoring and reporting on substance use-related harms. Harm Reduct J 2023; 20:169. [PMID: 37964286 PMCID: PMC10648706 DOI: 10.1186/s12954-023-00902-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The Canadian drug supply has significantly increased in toxicity over the past few years, resulting in the worsening of the overdose crisis. A key initiative implemented during this crisis has been data monitoring and reporting of substance use-related harms (SRH). This literature review aims to: (1) identify strategies used for the meaningful engagement of people who use drugs (PWUD) in local, provincial, and national SRH data system planning, reporting, and action and (2) describe data monitoring and reporting strategies and common indicators of SRH within those systems. METHODS We searched three academic and five gray literature databases for relevant literature published between 2012 and 2022. Team members who identify as PWUD and a librarian at Public Health Ontario developed search strings collaboratively. Two reviewers screened all search results and applied the eligibility criteria. We used Microsoft Excel for data management. RESULTS Twenty-two articles met our eligibility criteria (peer-reviewed n = 10 and gray literature reports n = 12); most used qualitative methods and focused on the Canadian context (n = 20). There were few examples of PWUD engaged as authors of reports on SRH monitoring. Among information systems involving PWUD, we found two main strategies: (1) community-based strategies (e.g., word of mouth, through drug sellers, and through satellite workers) and (2) public health-based data monitoring and communication strategies (e.g., communicating drug quality and alerts to PWUD). Substance use-related mortality, hospitalizations, and emergency department visits were the indicators most commonly used in systems of SRH reporting that engaged PWUD. CONCLUSION This review demonstrates limited engagement of PWUD and silos of activity in existing SRH data monitoring and reporting strategies. Future work is needed to better engage PWUD in these processes in an equitable manner. Building SRH monitoring systems in partnership with PWUD may increase the potential impact of these systems to reduce harms in the community.
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Affiliation(s)
- Melissa Perri
- Dalla Lana School of Public Health, University of Toronto, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Triti Khorasheh
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada
| | - David Edward-Ooi Poon
- Dalla Lana School of Public Health, University of Toronto, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Nat Kaminski
- Ontario Network of People Who Use Drugs, ON, Canada
| | - Sean LeBlanc
- Ontario Network of People Who Use Drugs, ON, Canada
| | | | - Ashley Smoke
- Ontario Network of People Who Use Drugs, ON, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Pamela Leece
- Dalla Lana School of Public Health, University of Toronto, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada.
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
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Borge TC, Muller AE. Overdosevarslingssystemer – en kartleggingsoversikt med maskinlæring. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:443-462. [PMID: 37969899 PMCID: PMC10634385 DOI: 10.1177/14550725221143180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/18/2022] [Indexed: 11/17/2023] Open
Abstract
Bakgrunn: Helsedirektoratet ønsker å vurdere muligheten for å etablere et nasjonalt overdosevarslingssystem (OVS) for å kunne varsle brukere om økt overdosefare. OVS som system forstås her som et sett med sammenhengende elementer som fungerer som en helhet, der hensikten er tidlig oppdagelse av økt overdoserisiko kombinert med rask varsling til de som står i fare for overdoser. Metode: Vi utførte en kartleggingsoversikt over forskning om varslingssystemer for økt overdosefare. Mål 1 var å kartlegge eksisterende forskning om effekten av et OVS (antall brukere nådd, antall overdoser, varslingshurtighet). Mål 2 var å kartlegge eksisterende forskning som kunne belyse brukeres erfaringer med slike systemer. Resultater: Vi brukte flere maskinlæringsfunksjoner for å identifisere og vurdere totalt 4102 referanser fra litteratursøk gjennomført i mars/april 2022, hvorav 11 studier oppfylte inklusjonskriteriene. Effekt av OVS på antall overdoser var ikke mulig å skille fra eksisterende overdoseforebyggende tiltak. OVS’er varslet skadereduksjonsgrupper eller erfaringskonsulenter så tidlig som fire timer etter innmeldt/oppdaget fare. Antall brukere varslet ble i stor grad ikke rapportert, antageligvis fordi data om dette ikke ble innsamlet. Fra syv kvalitative studier ble mønstre i hovedfunn sett på tvers, som omhandlet preferanser for språkbruk og innhold, hvor varslinger burde komme fra, og prinsippene bak dem. Konklusjon: Vi identifiserte lite empirisk forskning om eksisterende OVS’er, særlig relatert til effekt av slike systemer. Uten tilstrekkelig forskningsgrunnlag om effekt må vi være forsiktige med å trekke konklusjoner om hvilke typer OVS’er som bør og ikke bør innføres i Norge. Opprettelse av et OVS trenger ikke nødvendigvis innebære etablering av en ny infrastruktur, men heller være snakk om at to godt utviklede, eksisterende systemer – systemer for overvåking og skadereduksjonstiltak – kan kobles sammen.
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Mathias S, Burns D, Hambidge T, McCullough BJ, Hopley CJ, Douce D, Sage A, Sears P. Assessment of atmospheric solids analysis probe as a tool for the rapid determination of drug purity. Drug Test Anal 2023. [PMID: 37621075 DOI: 10.1002/dta.3568] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023]
Abstract
The ability to determine the purity (% controlled compound) of drug-of-abuse samples is necessary for public health and law enforcement. Here, we describe the assessment of atmospheric solids analysis probe (ASAP) for the rapid determination of drug purity for a set of formulated pharmaceuticals, chosen due to their availability, uncontrolled status and consistency. Paracetamol and loratadine were used as models of high and low purity compounds being ~90% and ~10% active ingredient, respectively. Individual tablets were ground up and diluted in an internal standard solution. The resulting samples were analysed by ASAP coupled to a Waters QDa mass spectrometer followed by confirmatory testing by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The inclusion of a non-matched internal standard (quinine) improved linearity and repeatability of drug analysis by ASAP-MS. Levels of drug purity using formulated pharmaceutical tablets were found to be highly comparable with results produced by the 'gold standard' LC-MS/MS technique. Rapid determination of drug purity is therefore possible with ASAP-MS for highly concentrated samples with minimal sample preparation. It may be possible to use this deployable system to determine drug purity outside of a laboratory setting.
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Affiliation(s)
- Simone Mathias
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford, UK
| | - Daniel Burns
- National Measurement Laboratory, LGC, Teddington, UK
| | | | - Bryan J McCullough
- National Measurement Laboratory, LGC, Teddington, UK
- Waters Corporation, Wilmslow, UK
| | | | | | | | - Patrick Sears
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford, UK
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Ali F, Kaura A, Russell C, Bonn M, Bruneau J, Dasgupta N, Imtiaz S, Martel-Laferrière V, Rehm J, Shahin R, Elton-Marshall T. Identifying barriers and facilitators to COVID-19 vaccination uptake among People Who Use Drugs in Canada: a National Qualitative Study. Harm Reduct J 2023; 20:99. [PMID: 37516836 PMCID: PMC10387201 DOI: 10.1186/s12954-023-00826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, and disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making. METHODS Between March and October 2022, semi-structured interviews with PWUD across Canada were conducted. Fully vaccinated (2 or more doses) and partially or unvaccinated (1 dose or less) participants were recruited from a convenience sample to participate in telephone interviews to discuss facilitators, barriers, and concerns about receiving COVID-19 vaccines and subsequent boosters, and ways to address concerns. A total of 78 PWUD participated in the study, with 50 participants being fully vaccinated and 28 participants partially or unvaccinated. Using thematic analysis, interviews were coded based on the capability, opportunity, and motivation-behavior (COM-B) framework. RESULTS Many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust toward government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD. CONCLUSION PWLLE should be supported to design tailored information to reduce barriers and address mistrust. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.
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Affiliation(s)
- Farihah Ali
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada.
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada.
| | - Ashima Kaura
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Cayley Russell
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, QC, H2X 0A9, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Boul, Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Nabarun Dasgupta
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sameer Imtiaz
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- Department of Psychiatry, Dalla Lana School of Public Health, & Institute of Medical Science (IMS), Toronto, Canada
- 1 King's College Circle, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada
- Institut Für Klinische Psychologie Und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | | | - Tara Elton-Marshall
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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11
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Brien R, Volpe I, Grigg J, Lyons T, Hughes C, McKinnon G, Tzanetis S, Crawford S, Eade A, Lee N, Barratt MJ. Co-designing drug alerts for health and community workers for an emerging early warning system in Victoria, Australia. Harm Reduct J 2023; 20:30. [PMID: 36894933 PMCID: PMC9995746 DOI: 10.1186/s12954-023-00761-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Alerts about changes in unregulated drug markets may be useful for supporting health and community workers to anticipate, prevent, and respond to unexpected adverse drug events. This study aimed to establish factors influencing the successful design and implementation of drug alerts for use in clinical and community service settings in Victoria, Australia. METHODS An iterative mixed methods design was used to co-produce drug alert prototypes with practitioners and managers working across various alcohol and other drug services and emergency medicine settings. A quantitative needs-analysis survey (n = 184) informed five qualitative co-design workshops (n = 31). Alert prototypes were drafted based on findings and tested for utility and acceptability. Applicable constructs from the Consolidated Framework for Implementation Research helped to conceptualise factors that impact successful alert system design. RESULTS Timely and reliable alerts about unexpected drug market changes were important to nearly all workers (98%) yet many reported insufficient access to this kind of information (64%). Workers considered themselves 'conduits' for information-sharing and valued alerts for increasing exposure to drug market intelligence; facilitating communication about potential threats and trends; and improving capacity for effective responding to drug-related harm. Alerts should be 'shareable' across a range of clinical and community settings and audiences. To maximise engagement and impact, alerts must command attention, be easily recognisable, be available on multiple platforms (electronic and printable formats) in varying levels of detail, and be disseminated via appropriate notification mechanisms to meet the needs of diverse stakeholder groups. Three drug alert prototypes (SMS prompt, summary flyer, and a detailed poster) were endorsed by workers as useful for supporting their work responding to unexpected drug-related harms. DISCUSSION Alerts informed by coordinated early warning networks that offer close to real-time detection of unexpected substances can provide rapid, evidence-based drug market intelligence to inform preventive and responsive action to drug-related harm. The success of alert systems requires adequate planning and resourcing to support design, implementation, and evaluation, which includes consultation with all relevant audiences to understand how to maximise engagement with information, recommendations, and advice. Our findings about factors impacting successful alert design have utility to inform the development of local early warning systems.
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Affiliation(s)
- Rita Brien
- Turning Point, Eastern Health Statewide Services, Richmond, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Isabelle Volpe
- Social and Global Studies Centre, RMIT University, Melbourne, Australia.,Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Jasmin Grigg
- Turning Point, Eastern Health Statewide Services, Richmond, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Tom Lyons
- Department of Health, State Government of Victoria, Melbourne, Australia
| | - Caitlin Hughes
- Law and Commerce, Flinders University, Adelaide, Australia.,National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Ginny McKinnon
- Department of Health, State Government of Victoria, Melbourne, Australia
| | - Stephanie Tzanetis
- Harm Reduction Victoria (DanceWize), Melbourne, Australia.,CanTEST - Directions Health Services, Canberra, Australia
| | - Sione Crawford
- Harm Reduction Victoria (DanceWize), Melbourne, Australia
| | - Alan Eade
- Safer Care Victoria, Melbourne, Australia.,Department of Paramedicine, Monash University, Melbourne, Australia
| | - Nicole Lee
- 360Edge, Melbourne, Australia.,National Drug Research Institute, Curtin University, Perth, Australia
| | - Monica J Barratt
- Social and Global Studies Centre, RMIT University, Melbourne, Australia. .,National Drug and Alcohol Research Centre, UNSW, Sydney, Australia. .,Digital Ethnography Research Centre, RMIT University, Melbourne, Australia.
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12
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Volpe I, Brien R, Grigg J, Tzanetis S, Crawford S, Lyons T, Lee N, McKinnon G, Hughes C, Eade A, Barratt MJ. 'We don't live in a harm reduction world, we live in a prohibition world': tensions arising in the design of drug alerts. Harm Reduct J 2023; 20:3. [PMID: 36624508 PMCID: PMC9829230 DOI: 10.1186/s12954-022-00716-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/22/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Drug alerts designed for health and community workforces have potential to avert acute harms associated with unpredictable illicit drug markets, by preparing workers to respond to unusual drug-related events, and distribute information to service users. However, the design of such alerts is complicated by diverse needs of individuals, and broader socio-political contexts. Here, we discuss the tensions that arose in the process of co-designing drug alert templates with health and community workers. METHODS We conducted five in-depth digital co-design workshops with 31 workers employed in alcohol and other drug and urgent care settings. Our approach to analysis was informed by Iterative Categorisation and reflexive thematic analysis methods. RESULTS We identified five key tensions. First, there is a need to provide comprehensive information to meet the information needs of a diverse group of workers with varying knowledge levels, while also designing alerts to be clear, concise, and relevant to the work of individuals. Second, it is important that alerts do not create 'information overload'; however, it is also important that information should be available to those who want it. Third, alert design and dissemination must be perceived to be credible, to avoid 'alert scepticism'; however, credibility is challenging to develop in a broader context of criminalisation, stigmatisation, and sensationalism. Fourth, alerts must be carefully designed to achieve 'intended effects' and avoid unintended effects, while acknowledging that it is impossible to control all potential effects. Finally, while alerts may be intended for an audience of health and community workers, people who use drugs are the end-users and must be kept front of mind in the design process. CONCLUSIONS The co-design process revealed complexities in designing drug alerts, particularly in the context of stigmatised illicit drug use, workforce diversity, and dissemination strategies. This study has highlighted the value of developing these important risk communication tools with their target audiences to ensure that they are relevant, useful, and impactful. The findings have informed the development of our drug alert prototypes and provide local context to complement existing best-practice risk-communications literature.
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Affiliation(s)
- Isabelle Volpe
- grid.1017.70000 0001 2163 3550Social and Global Studies Centre, RMIT University, Melbourne, Australia ,grid.1005.40000 0004 4902 0432Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Rita Brien
- grid.414366.20000 0004 0379 3501Turning Point, Eastern Health Statewide Services, Richmond, Australia ,grid.1002.30000 0004 1936 7857Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Jasmin Grigg
- grid.414366.20000 0004 0379 3501Turning Point, Eastern Health Statewide Services, Richmond, Australia ,grid.1002.30000 0004 1936 7857Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | | | - Sione Crawford
- Harm Reduction Victoria (DanceWize), North Melbourne, Australia
| | - Tom Lyons
- Department of Health, Victoria State Government, Melbourne, Australia
| | - Nicole Lee
- 360Edge, Melbourne, Australia ,grid.1032.00000 0004 0375 4078National Drug Research Institute, Curtin University, Perth, Australia
| | - Ginny McKinnon
- Department of Health, Victoria State Government, Melbourne, Australia
| | - Caitlin Hughes
- grid.1014.40000 0004 0367 2697Law and Commerce, Flinders University, Adelaide, Australia ,grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Alan Eade
- Safer Care Victoria, Melbourne, Australia ,grid.1002.30000 0004 1936 7857Department of Paramedicine, Monash University, Melbourne, Australia
| | - Monica J. Barratt
- grid.1017.70000 0001 2163 3550Social and Global Studies Centre, RMIT University, Melbourne, Australia ,grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, UNSW, Sydney, Australia ,grid.1017.70000 0001 2163 3550Digital Ethnography Research Centre, RMIT University, Melbourne, Australia
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13
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Masese LN, Ludwig-Barron NT, Mbogo L, Guthrie BL, Musyoki H, Bukusi D, Sinkele W, Gitau E, Farquhar C, Monroe-Wise A. Occupational roles and risks of community-embedded peer educators providing HIV, hepatitis C and harm reduction services to persons who inject drugs in Nairobi, Kenya. PLoS One 2022; 17:e0278210. [PMID: 36454881 PMCID: PMC9714845 DOI: 10.1371/journal.pone.0278210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Kenya, harm reduction organizations have adopted evidence-based peer educator (PE) programs, where former people who inject drugs (PWID) serve as community health liaisons to engage PWID in HIV, HCV and harm reduction services. While PEs play an integral role in healthcare delivery, little data exists on their roles, risks and experiences working with PWID, which may be used to inform local harm reduction policy. METHODS PE's from two harm reduction sites in Nairobi were randomly and purposively selected to participate in semi-structured in-depth interviews. Thematic analysis was conducted to characterize the expected versus actual roles that PEs employ while serving PWID, personal motivation and/or challenges and occupational health risks. Data was analyzed using Atlas.ti software. RESULTS Twenty PEs participated in the study. On average, PEs were 37 years of age, with 3 years of service. Female representation was 30%. Expected responsibilities included locating clients, establishing rapport, educating and escorting clients to addiction care facilities. Additional roles included attending to clients outside of work hours, escorting clients to medical appointments and facilitating patient-provider discussions. Occupational health risks included harassment by police and drug dealers, needle sticks, and close proximity to drug use environments that could prompt drug relapse. Despite these challenges and risks, PEs are motivated by their personal experiences of overcoming addiction with help from harm reduction programs. CONCLUSIONS/RECOMMENDATIONS PEs play a vital role in HIV, HCV and harm reduction service delivery in Kenya, often exceeding their job descriptions by offering additional support to PWID. Recommendations include (1) advocating for PEs to provide patient navigation services, (2) promoting the use of post-exposure prophylaxis (PEP), (3) providing occupational mental health services to prevent drug relapse, and (4) collaborating with law enforcement to address harassment, with the ultimate goal of reducing HIV and HCV incidence among PWID.
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Affiliation(s)
- Linnet N. Masese
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Natasha T. Ludwig-Barron
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Brandon L. Guthrie
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | | | - William Sinkele
- Support for Addiction Prevention and Treatment in Africa, Nairobi, Kenya
| | - Esther Gitau
- Support for Addiction Prevention and Treatment in Africa, Nairobi, Kenya
| | - Carey Farquhar
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Aliza Monroe-Wise
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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14
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Ackermann E, Kievit B, Xavier J, Barbic S, Ferguson M, Greer A, Loyal J, Mamdani Z, Palis H, Pauly B, Slaunwhite A, Buxton JA. Awareness and knowledge of the Good Samaritan Drug Overdose Act among people at risk of witnessing an overdose in British Columbia, Canada: a multi-methods cross sectional study. Subst Abuse Treat Prev Policy 2022; 17:42. [PMID: 35614474 PMCID: PMC9131579 DOI: 10.1186/s13011-022-00472-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Bystanders to drug overdoses often avoid or delay calling 9–1-1 and cite fear of police involvement as a main reason. In 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted by the Canadian government to provide people present at an overdose with legal protection from charges for simple drug possession, and conditions stemming from simple possession. Few studies have taken a multi-methods approach to evaluating the GSDOA. We used quantitative surveys and qualitative interviews to explore awareness, understanding, and perceptions of the GSDOA in people at risk of witnessing an overdose. Methods Quantitative cross-sectional surveys and qualitative telephone interviews were conducted with adults and youth at risk of witnessing an overdose across British Columbia. Cross-sectional survey participants were recruited at 19 Take Home Naloxone sites and online through Foundry. Multivariable logistic regression models were constructed hierarchically to determine factors associated with GSDOA awareness. Telephone interview participants were recruited by research assistants with lived/living experience of substance use. Deductive and inductive thematic analyses were conducted to identify major themes. Results Overall, 52.7% (n = 296) of the quantitative study sample (N = 453) reported being aware of the GSDOA. In multivariable analysis, cellphone possession (adjusted odds ratio [AOR] = 2.19; 95% confidence interval [CI] 1.36, 3.54) and having recently witnessed an opioid overdose (AOR = 2.34; 95% CI 1.45, 3.80) were positively associated with GSDOA awareness. Young adults (25 – 34 years) were more likely to be aware of the Act (AOR = 2.10; 95% CI 1.11, 3.98) compared to youth (16–24 years). Qualitative interviews (N = 42) revealed that many overestimated the protections offered by the GSDOA. To increase awareness and knowledge of the Act among youth, participants recommended adding the GSDOA to school curricula and using social media. Word of mouth was suggested to reach adults. Conclusion Both awareness and knowledge of the GSDOA remain low in BC, with many overestimating the protections the Act offers. Dissemination efforts should be led by people with lived/living experience and should target those with limited awareness and understanding of the Act as misunderstandings can erode trust in law enforcement and harm reduction policy. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-022-00472-4.
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15
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Masterton W, Falzon D, Burton G, Carver H, Wallace B, Aston EV, Sumnall H, Measham F, Gittins R, Craik V, Schofield J, Little S, Parkes T. A Realist Review of How Community-Based Drug Checking Services Could Be Designed and Implemented to Promote Engagement of People Who Use Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191911960. [PMID: 36231262 PMCID: PMC9564958 DOI: 10.3390/ijerph191911960] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 05/06/2023]
Abstract
With rising numbers of drug-related deaths in the UK and globally, exploration of interventions that seek to reduce drug-related harm is essential. Drug checking services (DCS) allow people to submit drug samples for chemical analysis and receive feedback about the sample, as well as harm reduction advice. The use of DCS is often linked to festival and/or nightlife settings and to so-called 'recreational' drug use, but research has also shown the potential of community-based DCS as an intervention serving more varied demographics of people who use drugs, including more marginalised individuals and those experiencing drug dependence. Whilst there is a growing evidence base on the effectiveness of drug checking as a harm reduction intervention, there is still limited evidence of the underlying mechanisms and processes within DCS which may aid implementation and subsequent engagement of people who use drugs. This presents a challenge to understanding why engagement differs across types of DCS, and how best to develop and deliver services across different contexts and for different populations. To explore the contexts and mechanisms which impact engagement in community-based DCS, a realist review was undertaken to synthesise the international evidence for the delivery and implementation of DCS. There were 133 sources included in the review. From these sources the underlying contexts, mechanisms, and outcomes relating to DCS implementation and engagement were developed and refined into seven programme theories. The findings of this review are theoretically novel and hold practical relevance for the design of DCS, with implications for optimisation, tailoring, and implementing services to reach individuals in different settings.
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Affiliation(s)
- Wendy Masterton
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
- Correspondence:
| | - Danilo Falzon
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Gillian Burton
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Hannah Carver
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Bruce Wallace
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Elizabeth V. Aston
- School of Applied Sciences, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool L2 2QP, UK
| | - Fiona Measham
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool L69 7ZR, UK
- The Loop, Unclassified Community Interest Company, Manchester M13 9PL, UK
| | | | | | - Joe Schofield
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
| | - Simon Little
- Kinbank Social Research Consultancy, Tayport DD6 9AP, UK
| | - Tessa Parkes
- Salvation Army Centre for Addictions Services and Research, University of Stirling, Stirling FK9 4LA, UK
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16
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Drug checking use and interest among people who inject drugs in Toronto, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103781. [DOI: 10.1016/j.drugpo.2022.103781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/02/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
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17
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Jozaghi E. The overdose epidemic: a study protocol to determine whether people who use drugs can influence or shape public opinion via mass media. HEALTH & JUSTICE 2022; 10:22. [PMID: 35870016 PMCID: PMC9307426 DOI: 10.1186/s40352-022-00189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND We are currently witnessing an ongoing drug overdose death epidemic in many nations linked to the distribution of illegally manufactured potent synthetic opioids. While many health policy makers and researchers have focused on the root causes and possible solutions to the current crisis, there has been little focus on the power of advocacy and community action by people who use drugs (PWUDs). Specifically, there has been no research on the role of PWUDs in engaging and influencing mass media opinion. METHODS By relying on one of the longest and largest peer-run drug user advocacy groups in the world, the Vancouver Area Network of Drug Users (VANDU), newspaper articles, television reports, and magazines that VANDU or its members have been directly involved in will be identified via two data bases (the Canadian Newsstream & Google News). The news articles and videos related to the health of PWUDs and issues affecting PWUDs from 1997 to the end of 2020 will be analyzed qualitatively using Nvivo software. DISCUSSION As our communities are entering another phase of the drug overdose epidemic, acknowledging and partnering with PWUDs could play an integral part in advancing the goals of harm reduction, treatment, and human rights.
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Affiliation(s)
- Ehsan Jozaghi
- UBC Faculty of Dentistry, Nobel Biocare Oral Health Centre, 2151 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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18
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Brener L, Horwitz R, Rance J, Gray R, Poeder F, Bryant J. Establishing the impact of consumer participation in alcohol and other drug treatment settings in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1183-e1193. [PMID: 34328677 DOI: 10.1111/hsc.13525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/28/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
It is generally recognised that engaging consumers to participate in policy making, programming, and practice is fundamental to effective alcohol and other drug (AOD) treatment, however, literature continues to document challenges and barriers to its implementation in AOD settings. This study reports on an evaluation of the Consumer Participation Project implemented in key non-government AOD services in Australia. Data collection consisted of an online survey of 86 staff members at the five participating AOD services and 27 consumer interviews. The survey examined staff attitudes towards and beliefs about consumer participation, perceived current levels of consumer participation and service changes as a result of the consumer participation project. The qualitative arm explored consumer's prior knowledge and current experiences of consumer participation. Staff who took part in the consumer participation training offered as part of the project were more likely to believe that service changes could encourage greater consumer participation rather than any barriers associated with consumer circumstances. Additionally, while services offered low-level involvement consumer activities, there were fewer examples of mid- and high-level activities being conducted at the different services. Consumers discussed the significance of being actively involved in their AOD treatment service while stressing the importance of proper training and support for those engaging in consumer participation. This research highlights the benefits of consumer participation in AOD treatment and suggests that most consumer participation activities undertaken at present are "low" level involvement concerned with providing and receiving information from consumers. Importantly, however, our study did demonstrate some support for "high" level involvement activities and service providers being open to doing more to encourage consumer participation.
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Affiliation(s)
- Loren Brener
- University of New South Wales, Sydney, Australia
| | | | - Jake Rance
- University of New South Wales, Sydney, Australia
| | - Rebecca Gray
- University of New South Wales, Sydney, Australia
| | - Fiona Poeder
- Network of Alcohol and other Drugs Agencies, Woolloomooloo, NSW, Australia
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Parkes T, Matheson C, Carver H, Foster R, Budd J, Liddell D, Wallace J, Pauly B, Fotopoulou M, Burley A, Anderson I, Price T, Schofield J, MacLennan G. Assessing the feasibility, acceptability and accessibility of a peer-delivered intervention to reduce harm and improve the well-being of people who experience homelessness with problem substance use: the SHARPS study. Harm Reduct J 2022; 19:10. [PMID: 35120539 PMCID: PMC8815224 DOI: 10.1186/s12954-021-00582-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 12/07/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that the development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing. METHODS The study used mixed methods to assess the feasibility, acceptability and accessibility of a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning, for people experiencing homelessness and problem substance use. Four Peer Navigators were employed to support individuals (n = 68 total, intervention participants). They were based in outreach services and hostels in Scotland and England. Qualitative interviews were conducted with intervention participants, Peer Navigators and staff in services, and observations were conducted in all settings. Quantitative outcomes relating to participants' substance use, physical and mental health, and quality of the Peer Navigator relationship, were measured via a 'holistic health check' with six questionnaires completed at two time-points. RESULTS The intervention was found to be acceptable to, and feasible and accessible for, participants, Peer Navigators, and service staff. Participants reported improvements to service engagement, and feeling more equipped to access services independently. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling trusting, authentic, and meaningful relationships to be developed. Some challenges were experienced in relation to the 'fit' of the intervention within some settings. Among participants there were reductions in drug use and risky injecting practices. There were increases in the number of participants receiving opioid substitution therapy. Overall, the intervention was positively received, with collective recognition that the intervention was unique and highly valuable. While most of the measures chosen for the holistic health check were found to be suitable for this population, they should be streamlined to avoid duplication and participant burden. CONCLUSIONS The study established that a peer-delivered, relational harm reduction intervention is acceptable to, and feasible and accessible for, people experiencing homelessness and problem substance use. While the study was not outcomes-focused, participants did experience a range of positive outcomes. A full randomised controlled trial is now required to assess intervention effectiveness. TRIAL REGISTRATION Study registered with ISRCTN: 15900054.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK.
- Faculty of Social Sciences, University of Stirling, Stirling, UK.
| | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - John Budd
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | - Bernie Pauly
- The Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Maria Fotopoulou
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Tracey Price
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Joe Schofield
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
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Parkes T, Matheson C, Carver H, Foster R, Budd J, Liddell D, Wallace J, Pauly B, Fotopoulou M, Burley A, Anderson I, MacLennan G. A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study. Health Technol Assess 2022; 26:1-128. [PMID: 35212621 PMCID: PMC8899911 DOI: 10.3310/wvvl4786] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing. This study tested the feasibility and acceptability of a peer-delivered intervention, through 'Peer Navigators', to support people who are homeless with problem substance use to address a range of health and social issues. OBJECTIVES The study objectives were to design and implement a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning for people experiencing homelessness and problem substance use, and to conduct a concurrent process evaluation to inform a future randomised controlled trial. DESIGN A mixed-methods feasibility study with concurrent process evaluation was conducted, involving qualitative interviews [staff interviews (one time point), n = 12; Peer Navigator interviews (three or four time points), n = 15; intervention participant interviews: first time point, n = 24, and second time point, n = 10], observations and quantitative outcome measures. SETTING The intervention was delivered in three outreach services for people who are homeless in Scotland, and three Salvation Army hostels in England; there were two standard care settings: an outreach service in Scotland and a hostel in England. PARTICIPANTS Participants were people experiencing homelessness and problem substance use (n = 68) (intervention). INTERVENTION This was a peer-delivered, relational intervention drawing on principles of psychologically informed environments, with Peer Navigators providing practical and emotional support. MAIN OUTCOME MEASURES Outcomes relating to participants' substance use, participants' physical and mental health needs, and the quality of Peer Navigator relationships were measured via a 'holistic health check', with six questionnaires completed at two time points: a specially created sociodemographic, health and housing status questionnaire; the Patient Health Questionnaire-9 items plus the Generalised Anxiety Disorder-7; the Maudsley Addiction Profile; the Substance Use Recovery Evaluator; the RAND Corporation Short Form survey-36 items; and the Consultation and Relational Empathy Measure. RESULTS The Supporting Harm Reduction through Peer Support (SHARPS) study was found to be acceptable to, and feasible for, intervention participants, staff and Peer Navigators. Among participants, there was reduced drug use and an increase in the number of prescriptions for opioid substitution therapy. There were reductions in risky injecting practice and risky sexual behaviour. Participants reported improvements to service engagement and felt more equipped to access services on their own. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling the development of trusting, authentic and meaningful relationships. The relationship with the Peer Navigator was measured as excellent at baseline and follow-up. Some challenges were experienced in relation to the 'fit' of the intervention within some settings and will inform future studies. LIMITATIONS Some participants did not complete the outcome measures, or did not complete both sets, meaning that we do not have baseline and/or follow-up data for all. The standard care data sample sizes make comparison between settings limited. CONCLUSIONS A randomised controlled trial is recommended to assess the effectiveness of the Peer Navigator intervention. FUTURE WORK A definitive cluster randomised controlled trial should particularly consider setting selection, outcomes and quantitative data collection instruments. TRIAL REGISTRATION This trial is registered as ISRCTN15900054. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - John Budd
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | - Bernie Pauly
- The Canadian Institute for Substance Use Research, University of Victoria, Greater Victoria, BC, Canada
| | - Maria Fotopoulou
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Adam Burley
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
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Dasgupta N, Figgatt MC. Invited Commentary: Drug Checking for Novel Insights Into the Unregulated Drug Supply. Am J Epidemiol 2022; 191:248-252. [PMID: 34528056 PMCID: PMC8824693 DOI: 10.1093/aje/kwab233] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022] Open
Abstract
Tobias et al. (Am J Epidemiol. 2022;191 (2):241–247) present a novel analysis of time trends in fentanyl concentrations in the unregulated drug supply in British Columbia, Canada. The preexisting knowledge about unregulated drugs had come from law-enforcement seizures and postmortem toxicology. As both of these data sources are subject to selection bias, large-scale drug-checking programs are poised to be a crucial component of the public health response to the unrelenting increase in overdose in North America. As programs expand, we offer 2 guiding principles. First, the primary purpose of these programs is to deliver timely results to people who use drugs to mitigate health risks. Second, innovation is needed to go beyond criminal justice paradigms in laboratory analysis for a more nuanced understanding of health concerns. We provide examples of the role adulterants play in our understanding of drug harms. We also describe the applications and limitations of common laboratory assays, with implications for epidemiologic surveillance. While the research and direct service teams in British Columbia have taken groundbreaking steps, there is still a need to establish best practices for communicating results to sample donors in an approachable yet nonalarmist tone.
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Affiliation(s)
- Nabarun Dasgupta
- Correspondence to Dr. Nabarun Dasgupta, University of North Carolina Injury Prevention Research Center, 725 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27514 (e-mail: )
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Wallace B, van Roode T, Pagan F, Hore D, Pauly B. The potential impacts of community drug checking within the overdose crisis: qualitative study exploring the perspective of prospective service users. BMC Public Health 2021; 21:1156. [PMID: 34134698 PMCID: PMC8207696 DOI: 10.1186/s12889-021-11243-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background As drug checking becomes more integrated within public health responses to the overdose crisis, and potentially more institutionalized, there is value in critically questioning the impacts of drug checking as a harm reduction response. Methods As part of a pilot project to implement community drug checking in Victoria, BC, Canada, in-depth interviews (N = 27) were held with people who use or have used substances, family or friends of people who use substances, and/or people who make or distribute substances. Critical harm reduction and social justice perspectives and a socioecological model guided our analysis to understand the potential role of drug checking within the overdose crisis, from the perspective of prospective service users. Results Participants provided insight into who might benefit from community drug checking and potential benefits. They indicated drug checking addresses a “shared need” that could benefit people who use substances, people who care for people who use substances, and people who sell substances. Using a socioecological model, we identified four overarching themes corresponding to benefits at each level: “drug checking to improve health and wellbeing of people who use substances”, “drug checking to increase quality control in an unregulated market”, “drug checking to create healthier environments”, and “drug checking to mediate policies around substance use”. Conclusions Drug checking requires a universal approach to meet the needs of diverse populations who use substances, and must not be focused on abstinence based outcomes. As a harm reduction response, community drug checking has potential impacts beyond the individual level. These include increasing power and accountability within the illicit drug market, improving the health of communities, supporting safer supply initiatives and regulation of substances, and mitigating harms of criminalization. Evaluation of drug checking should consider potential impacts that extend beyond individual behaviour change and recognize lived realities and structural conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11243-4.
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Affiliation(s)
- Bruce Wallace
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada. .,School of Social Work, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada.
| | - Thea van Roode
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
| | - Flora Pagan
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
| | - Dennis Hore
- Department of Chemistry, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada.,Department of Computer Science, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada.,School of Nursing, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, Canada
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23
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Gunn CM, Maschke A, Harris M, Schoenberger SF, Sampath S, Walley AY, Bagley SM. Age-based preferences for risk communication in the fentanyl era: 'A lot of people keep seeing other people die and that's not enough for them'. Addiction 2021; 116:1495-1504. [PMID: 33119196 PMCID: PMC8081736 DOI: 10.1111/add.15305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/01/2020] [Accepted: 10/16/2020] [Indexed: 02/03/2023]
Abstract
AIMS To explore how people who use fentanyl and health-care providers engaged in and responded to overdose risk communication interactions, and how these engagements and responses might vary by age. DESIGN A single-site qualitative in-depth interview study. SETTING Boston, MA, United States. PARTICIPANTS The sample included 21 people (10 women, 11 men) who were either 18-25 or 35+, English-speaking, and reported illicit fentanyl use in the last year and 10 health-care providers who worked directly with people who use fentanyl (PWUF) in clinical and community settings. MEASUREMENTS Open-ended, flexible interview questions guided by a risk communication framework were used in all interviews. Codes used for thematic analysis included deductive codes related to the risk communication framework and inductive, emergent codes from interview content. FINDINGS We identified potential age-based differences in perceptions of fentanyl overdose, including that younger participants appeared to display more perceptions of an immunity to fentanyl's lethality, while older people seemed to express a stronger aversion to fentanyl due to its heightened risk of fatal overdose, shorter effects and potential for long-term health consequences. Providers perceived greater challenges relaying risk information to young PWUF and believed them to be less open to risk communication. Compassionate harm reduction communication was preferred by all participants and perceived to be delivered most effectively by community health workers and peers. PWUF and providers identified structural barriers that limited compassionate harm reduction, including misalignment of available treatment with preferred options and clinical structures that impeded the delivery of risk communication messages. CONCLUSIONS Among people who engage in illicit fentanyl use, fentanyl-related risk communication experiences and preferences may vary by age, but some foundational elements including compassionate, trust-building approaches seem to be preferred across the age spectrum. Structural barriers in the clinical setting such as provider-prescribing power and infrequent encounters may impede the providers' ability to provide compassionate harm reduction communication.
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Affiliation(s)
- Christine M Gunn
- Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, Boston, MA, USA
| | - Ariel Maschke
- Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, Boston, MA, USA
| | - Miriam Harris
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Samantha F Schoenberger
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Alexander Y Walley
- Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Grayken Center for Addiction, Boston University School of Medicine, Boston, MA, USA
| | - Sarah M Bagley
- Department of Medicine, Section of General Internal Medicine, Department of Pediatrics, Division of General Pediatrics, Boston University School of Medicine, Boston, MA, USA
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24
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Harris MTH, Bagley SM, Maschke A, Schoenberger SF, Sampath S, Walley AY, Gunn CM. Competing risks of women and men who use fentanyl: "The number one thing I worry about would be my safety and number two would be overdose". J Subst Abuse Treat 2021; 125:108313. [PMID: 34016300 PMCID: PMC8140193 DOI: 10.1016/j.jsat.2021.108313] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/16/2020] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Standard public health approaches to risk communication do not address the gendered dynamics of drug use. The aim of this study was to explore perceptions of fentanyl-related risks among women and men to inform future risk communication approaches. METHODS We conducted a qualitative study, purposively sampling English-speaking women and men, aged 18-25 or 35+ years, with past 12-month illicitly manufactured fentanyl use. In-depth individual interviews explored experiences of women and men related to overdose and fentanyl use. We conducted a grounded content analysis examining specific codes related to overdose and other health or social risks attributed to drug use. Using a constant comparison technique, we explored commonalities and differences in themes between women and men. RESULTS The study enrolled twenty-one participants, 10 women and 11 men. All participants had personal overdose experiences. Both women and men described overdosing as a "chronic" condition and expressed de-sensitization to the risk of overdose. Women and men described other risks around health, safety, and state services that often superseded their fear of overdose. Women feared physical and sexual violence and prioritized caring for children and maintaining relations with child protective services, while men feared violence arising from obtaining and using street drugs and incarceration. Only women reported that fear of violence prevented their utilization of harm reduction services. CONCLUSIONS Experiences with overdose and risk communication among people who use fentanyl-containing opioids varied by gender. The development of gender-responsive programs that address targeted concerns may be an avenue to enhance engagement with harm reduction and treatment services and create safe spaces for women not currently accessing available services.
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Affiliation(s)
- Miriam T H Harris
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America; Clinical Addiction Research and Education Unit, Grayken Center for Addiction, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America.
| | - Sarah M Bagley
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America; Clinical Addiction Research and Education Unit, Grayken Center for Addiction, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America; Boston University School of Medicine, Department of Pediatrics, Division of General Academic Pediatrics, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America.
| | - Ariel Maschke
- Boston University School of Medicine, Department of Medicine, Section of General Internal Medicine, Women's Health Unit, 801 Massachusetts Ave, First Floor, Boston, MA 02118, United States of America.
| | - Samantha F Schoenberger
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America.
| | - Spoorthi Sampath
- Boston University School of Medicine, Department of Medicine, Section of General Internal Medicine, Women's Health Unit, 801 Massachusetts Ave, First Floor, Boston, MA 02118, United States of America.
| | - Alexander Y Walley
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America; Clinical Addiction Research and Education Unit, Grayken Center for Addiction, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, United States of America.
| | - Christine M Gunn
- Boston University School of Medicine, Department of Medicine, Section of General Internal Medicine, Women's Health Unit, 801 Massachusetts Ave, First Floor, Boston, MA 02118, United States of America; Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany Street, Boston, MA 02118, United States of America.
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25
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Exploring care of hospital inpatients with substance involvement. Soc Sci Med 2021; 281:114071. [PMID: 34102423 DOI: 10.1016/j.socscimed.2021.114071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/06/2021] [Accepted: 05/19/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This article presents demographic and care factors related to persons who are substance-involved and require inpatient administration of intravenous antibiotics. PURPOSE This study was conducted to explore healthcare responses to support substance-involved inpatients, through exploration of documented client outcomes, healthcare provider accounts, and representation of clients through documentation. METHOD(S) A patient-oriented research team undertook this multiple methods, exploratory study. A health record review included people admitted to a complex continuing care hospital, within a 2-year period, for long-term antibiotic treatment and concurrent illicit substance use. Correlations were examined between whether or not clients were discharged against medical advice (AMA) in comparison to demographic, medical, and care-related factors. Qualitative analysis of narrative health record data was undertaken. Semi-structured interviews of healthcare providers and decision makers were conducted. RESULTS Twenty-five people met recruitment criteria for health record review; three people were admitted twice, resulting in 28 admissions. Interviews with seven healthcare providers and decision makers uncovered themes of client autonomy, professional liability, client responsibility, the "right" service, and burnout, hopelessness, and helplessness. CONCLUSION Recommended strategies to effectively respond to substance use among clients admitted for general medical concerns are: i) support inpatients with complex health needs, including substance use, ii) ensure substance use and addiction services are integrated into all inpatient practice areas, iii) support effective harm reduction practices for hospital-admitted clients, and iv) develop robust policies and protocols to support healthcare providers and inpatients.
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26
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Seaman A, Leichtling G, Stack E, Gray M, Pope J, Larsen JE, Leahy JM, Gelberg L, Korthuis PT. Harm Reduction and Adaptations Among PWUD in Rural Oregon During COVID-19. AIDS Behav 2021; 25:1331-1339. [PMID: 33471243 PMCID: PMC7816753 DOI: 10.1007/s10461-020-03141-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
Coronavirus Disease 2019 (COVID-19) may influence HIV/HCV transmission risk behaviors in rural communities. We conducted semi-structured qualitative interviews with people who use drugs (PWUD) in five rural Oregon counties and asked about COVID-19 impact on substance use and harm reduction practices and their advice for improving public health responses. Participants (n = 36) reported using only methamphetamine (52.8%), only heroin (16.7%), or both (30.6%); 75% of participants reported recent injection. Three thematic categories emerged: SSP adaptations and accessibility, PWUD harm reduction practices, and policy suggestions. Participants noted the importance of SSPs to COVID-19 prevention and wellbeing, though some experienced increased barriers, leading to increased risky injection practices. Participants suggested need-based rather than one-for-one exchange, increasing syringe delivery services, encouraging secondary exchange by PWUD, and peers as trusted voices for information exchange. Rapid implementation of policy and practice changes are urgently required to improve SSP access, reinforce safer use, and prevent HIV/HCV and COVID-19 transmission.
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Affiliation(s)
- Andrew Seaman
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code - L475, Portland, 97239-3098, OR, USA.
| | | | | | | | | | - Jessica E Larsen
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code - L475, Portland, 97239-3098, OR, USA
| | - Judith M Leahy
- Oregon Health Authority, Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Salem, OR, USA
| | - Lillian Gelberg
- Oregon Health Authority, Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Salem, OR, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, USA
| | - P Todd Korthuis
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code - L475, Portland, 97239-3098, OR, USA
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Goodyear T, Mniszak C, Jenkins E, Fast D, Knight R. "Am I gonna get in trouble for acknowledging my will to be safe?": Identifying the experiences of young sexual minority men and substance use in the context of an opioid overdose crisis. Harm Reduct J 2020; 17:23. [PMID: 32228646 PMCID: PMC7106659 DOI: 10.1186/s12954-020-00365-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/13/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND North America and other parts of the globe are in the midst of a public health emergency related to opioid overdoses and a highly contaminated illicit drug supply. Unfortunately, there is a substantial gap in our understandings about how this crisis affects key populations not conventionally identified within overdose-related surveillance data. This gap is particularly pronounced for gay, bisexual, and other men who have sex with men (sexual minority men)-a population that experiences substance use-related inequities across adolescence and young adulthood. METHODS We draw on in-depth semi-structured interviews conducted in 2018 with a diverse sample (N = 50) of sexual minority men ages 15-30 who use substances and live in Vancouver, Canada, to identify how patterns and contexts of substance use are occurring in the context of the opioid overdose crisis. RESULTS Our analysis revealed three themes: awareness, perceptions, and experiences of risk; strategies to mitigate risk; and barriers to safer substance use. First, participants described how they are deeply impacted by the contaminated illicit drug supply, and how there is growing apprehension that fatal and non-fatal overdose risk is high and rising. Second, participants described how procuring substances from "trustworthy" drug suppliers and other harm reduction strategies (e.g., drug checking technologies, Naloxone kits, not using alone) could reduce overdose risk. Third, participants described how interpersonal, service-related, and socio-structural barriers (e.g., drug criminalization and the lack of a regulated drug supply) limit opportunities for safer substance use. CONCLUSIONS Equity-oriented policies and programming that can facilitate opportunities for safer substance use among young sexual minority men are critically needed, including community- and peer-led initiatives, access to low-barrier harm reduction services within commonly frequented social spaces (e.g., Pride, night clubs, bathhouses), nonjudgmental and inclusive substance use-related health services, the decriminalization of drug use, and the provision of a safe drug supply.
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Affiliation(s)
- Trevor Goodyear
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- School of Nursing, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Caroline Mniszak
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, Vancouver, Canada.
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Tsang VWL, Papamihali K, Crabtree A, Buxton JA. Acceptability of technological solutions for overdose monitoring: Perspectives of people who use drugs. Subst Abus 2019; 42:284-293. [PMID: 31657675 DOI: 10.1080/08897077.2019.1680479] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Rising overdose deaths are a devastating problem across the United States and Canada. Despite the availability of observed consumption sites in British Columbia (BC), data suggest people who use drugs (PWUD) alone in private residences are most at risk of overdose death. These individuals may not use consumption sites due to fear of stigmatization, lack of privacy, or personal preference. It is this population that would benefit from overdose monitoring alternatives. METHODS This 2018 study employed two sources of data. (1) A provincial harm reduction distribution site client survey administered at 27 sites across BC asked about cell phone possession and functionality. (2) Structured interviews with PWUD in Vancouver gathered perspectives regarding monitoring devices and alerting systems. Results: The client survey was administered to 486 individuals. Among 443 respondents, 48% (n = 212) owned a cellphone and 68% (n = 115) of individuals with a cellphone with access to internet (n = 168) would use an application to mitigate opioid-related overdose deaths. Thirty qualitative interviews were performed; thematic analysis of the responses identified three major themes - safety, public versus private drug use, and technological monitoring and function. The relevance of technological devices was affected by the inconsistent availability of cellphones, concerns about anonymity, as well as personal comfort while using drugs. Conclusions: Technological applications may not be suitable for clients with transient lifestyles, no permanent home, and lack of consistent access to a mobile device. Thorough needs assessments, considerations of lifestyle limitations, and understanding perceptions around cellphone and overdose monitoring can increase the potential that devices will be used.Highlights45% (n = 219) of client survey respondents owned a cellphoneOut of cellphone owners, 59% (n = 102) of client survey respondents had access to internetOf 168 with internet access, 68% willing to use any applications for overdose responseApplications not suitable for transient lifestyles, no permanent home, and lack of consistent access to cellphone.
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Affiliation(s)
- V W L Tsang
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - K Papamihali
- BC Centre for Disease Control, Vancouver, Canada
| | - A Crabtree
- BC Centre for Disease Control, Vancouver, Canada
| | - J A Buxton
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Centre for Disease Control, Vancouver, Canada
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Palamar JJ, Acosta P, Sutherland R, Shedlin MG, Barratt MJ. Adulterants and altruism: A qualitative investigation of "drug checkers" in North America. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:160-169. [PMID: 31610451 DOI: 10.1016/j.drugpo.2019.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND "Drug checking" has become a common harm reduction method used to test illicit substances, such as ecstasy, for purity and/or the presence of adulterants. Formal drug-checking services have been operating for decades, and the use of personal reagent test kits appears to be relatively common; however, little attention has been devoted to understanding the role and broader experiences of 'drug-checkers' (i.e., people who test their own and/or other people's substances). As such, it remains unknown who is engaging in this practice, their motivations for drug-checking, and what barriers they may experience. We addressed this research gap by interviewing people who check drugs about their experiences, with a goal of better understanding drug checking practices. METHODS We conducted in-depth interviews with 32 adults in North America who reported testing drugs. Coding was conducted in an inductive manner and thematic analysis was used to identify relevant themes. RESULTS Over half (56.2%) of our sample was affiliated with a drug checking organization. Among non-affiliated checkers (43.8%), the majority (57.1%) tested for friends, 21.4% tested only for themselves, and 21.4% were people who sold drugs and tested for their clients. Motivations were driven largely by altruism, described by checkers as wanting to protect their peers from exposure to adulterants. People interviewed who sold drugs were altruistic in the same manner. Barriers to checking-particularly at nightclubs and festivals-included perceived illegality of test kits and denied approval to test drugs at venues, although many checkers circumvented this barrier by checking drugs without such approval. CONCLUSIONS Drug checkers in North America seek to educate people who use drugs about the risk of exposure to unexpected substance types, but they face various barriers. Policy change could help ensure that these potentially life-saving services can be provided without fear of fines and/or criminal prosecution.
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Affiliation(s)
- Joseph J Palamar
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, Room 1752, New York, NY 10016, USA; Center for Drug Use and HIV/HCV Research, NYU College of Global Public Health, New York, NY, USA.
| | - Patricia Acosta
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, Room 1752, New York, NY 10016, USA
| | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Michele G Shedlin
- Center for Drug Use and HIV/HCV Research, NYU College of Global Public Health, New York, NY, USA
| | - Monica J Barratt
- Social and Global Studies Centre, RMIT University, Melbourne, Australia; National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Bardwell G, Boyd J, Arredondo J, McNeil R, Kerr T. Trusting the source: The potential role of drug dealers in reducing drug-related harms via drug checking. Drug Alcohol Depend 2019; 198:1-6. [PMID: 30856370 PMCID: PMC6467706 DOI: 10.1016/j.drugalcdep.2019.01.035] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Drug checking technologies (DCTs) have been implemented as a response to the ongoing opioid overdose epidemic. We examined the level of trust people who use drugs (PWUD) have in their drug dealers as well as their perspectives on the potential for drug dealers to use DCTs to provide knowledge of drug contents to their customers. METHODS We conducted one-to-one qualitative semi-structured interviews with 20 PWUD in Vancouver, Canada's Downtown Eastside. Participants were purposively recruited from ongoing cohort studies of PWUD and were required to currently be using stimulants and/or opioids. RESULTS Most participants discussed having a high level of trust for their drug dealers based on length of relationships, drug supply consistencies, and communication. Given this, participants did not identify drug checking as a priority. However, participants discussed a lower level of trust when buying drugs from an unfamiliar source. Participants also discussed how DCTs would provide knowledge to drug dealers about drug contents and how communicating test results to customers could be a risk reduction measure. Participants described privacy concerns that drug dealers might experience as well as the lack of concern that some drug dealers have about their drug supply. CONCLUSIONS Future drug checking programming should consider ways to engage drug dealers to test their supplies and develop communication strategies to more accurately inform PWUD of drug contents and avert risks associated with using them. Additionally, drug policies that address the effects of criminalization should be considered to lessen potential barriers to DCT use by drug dealers.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Jade Boyd
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Jaime Arredondo
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Ryan McNeil
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Thomas Kerr
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
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Parkes T, Matheson C, Carver H, Budd J, Liddell D, Wallace J, Pauly B, Fotopoulou M, Burley A, Anderson I, MacLennan G, Foster R. Supporting Harm Reduction through Peer Support (SHARPS): testing the feasibility and acceptability of a peer-delivered, relational intervention for people with problem substance use who are homeless, to improve health outcomes, quality of life and social functioning and reduce harms: study protocol. Pilot Feasibility Stud 2019; 5:64. [PMID: 31164989 PMCID: PMC6489271 DOI: 10.1186/s40814-019-0447-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/09/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While people who are homeless often experience poor mental and physical health and problem substance use, getting access to appropriate services can be challenging. The development of trusting relationships with non-judgemental staff can facilitate initial and sustained engagement with health and wider support services. Peer-delivered approaches seem to have particular promise, but there is limited evidence regarding peer interventions that are both acceptable to, and effective for, people who are homeless and using drugs and/or alcohol. In the proposed study, we will develop and test the use of a peer-to-peer relational intervention with people experiencing homelessness. Drawing on the concept of psychologically informed environments, it will focus on building trusting and supportive relationships and providing practical elements of support such as access to primary care, treatment and housing options. METHODS A mixed-method feasibility study with concurrent process evaluation will be conducted to explore the feasibility and acceptability of a peer-delivered, relational intervention for people with problem substance use who are homeless. Peer Navigators will be based in homelessness outreach and residential services in Scotland and England. Peer Navigators will work with a small number of participants for up to 12 months providing both practical and emotional support. The sample size for the intervention is 60. Those receiving the intervention must be currently homeless or at risk of homelessness, over the age of 18 years and self-report alcohol/drug problems. A holistic health check will be conducted in the first few months of the intervention and repeated towards the end. Health checks will be conducted by a researcher in the service where the Peer Navigator is based. Semi-structured qualitative interviews with intervention participants and staff in both intervention and standard care settings, and all Peer Navigators, will be conducted to explore their experiences with the intervention. Non-participant observation will be conducted in intervention and standard care sites to document similarities and differences between care pathways. DISCUSSION The SHARPS study will provide evidence regarding whether a peer-delivered harm reduction intervention is feasible and acceptable to people experiencing homelessness and problem substance use in order to develop a definitive trial. TRIAL REGISTRATION SRCTN registry ISRCTN15900054, protocol version 1.3, March 12, 2018.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - John Budd
- Edinburgh Access Practice, NHS Lothian, 22-24 Spittal Street, Edinburgh, EH3 9DU UK
| | - Dave Liddell
- Scottish Drugs Forum, 91 Mitchell Street, Glasgow, G1 3LN UK
| | - Jason Wallace
- Scottish Drugs Forum, 91 Mitchell Street, Glasgow, G1 3LN UK
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, Technology Enterprise Facility, University of Victoria, Room 273, Victoria, British Columbia V8P 5C2 Canada
| | - Maria Fotopoulou
- Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Adam Burley
- The Access Point, 17/23 Leith Street, Edinburgh, EH1 3AT UK
| | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
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Greer AM, Amlani A, Burmeister C, Scott A, Newman C, Lampkin H, Pauly B, Buxton JA. Peer engagement barriers and enablers: insights from people who use drugs in British Columbia, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:227-235. [PMID: 30610564 PMCID: PMC6964581 DOI: 10.17269/s41997-018-0167-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/14/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Globally, engaging people who have used drugs, or peers, in decision-making has been increasingly touted as a best practice approach to developing priorities, programs, and policies. Peer engagement ensures decisions are relevant, appropriate, and effective to the affected community. However, ensuring that inclusion is accessible and equitable for those involved remains a challenge. In this study, we examined the perspectives of people who use or have used illicit drugs (PWUD) on peer engagement in health and harm reduction settings across British Columbia (BC), Canada. METHODS The Peer Engagement and Evaluation Project used a participatory approach to conducting 13 peer-facilitated focus groups (n = 83) across BC. Focus group data were coded and analyzed with five peer research assistants. Themes about the nature of peer engagement were generated. From this analysis, peer engagement barriers and enablers were identified. RESULTS Barriers to peer engagement included individual, geographical, systemic, and social factors. Issues related to stigma, confidentiality, and mistrust were intensely discussed among participants. Being "outed" in one's community was a barrier to engagement, particularly in rural areas. Participants voiced that compensation, setting, and the right people help facilitate and motivate engagement. Peer networks are an essential ingredient to engagement by promoting support and advocacy. CONCLUSION PWUD are important stakeholders in decisions that affect them. This cross-jurisdictional study investigated how PWUD have experienced engagement efforts in BC, identifying several factors that influence participation. Meaningful engagement can be facilitated by attention to communication, relationships, personal capacity, and compassion between peers and other professionals.
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Affiliation(s)
- Alissa M Greer
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
- Interdisciplinary Graduate Studies Program, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
- SPPH, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.
- Technology Enterprise Facility, Canadian Institute for Substance Use Research, 2300 Mackenzie Avenue, Victoria, BC, V8P 5C2, Canada.
| | - Ashraf Amlani
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Charlene Burmeister
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Alex Scott
- Providence Health, 3080 Prince Edward St, Vancouver, BC, V5T 3N4, Canada
| | - Cheri Newman
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Hugh Lampkin
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | - Bernie Pauly
- Technology Enterprise Facility, Canadian Institute for Substance Use Research, 2300 Mackenzie Avenue, Victoria, BC, V8P 5C2, Canada
| | - Jane A Buxton
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- SPPH, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
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Fernández-Calderón F, Díaz-Batanero C, Barratt MJ, Palamar JJ. Harm reduction strategies related to dosing and their relation to harms among festival attendees who use multiple drugs. Drug Alcohol Rev 2019; 38:57-67. [PMID: 30302851 PMCID: PMC6338512 DOI: 10.1111/dar.12868] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 09/10/2018] [Accepted: 09/17/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND AIMS Polysubstance users are a high-risk population for negative health-related consequences. Although some studies have described harm reduction strategies adopted by polysubstance users, studies have not examined their effectiveness in minimising health-related consequences. We aimed to identify dosing-related harm reduction strategies in a sample of polysubstance-using dance festival attendees, and explore the relationship between harm reduction strategies and self-reported adverse health consequences. DESIGN AND METHODS Data were examined for 1226 past-year dance festival attendees who self-identified as past-year multiple drug users. We conducted bivariable and multivariable analyses to explore relationships between six dosing-related harm reduction strategies and 13 self-reported adverse consequences. RESULTS Self-reported use of dosing-related harm reduction strategies was prevalent, mainly avoidance of mixing depressants (69.2%) and setting limits on quantity (62.2%). Frequent users of harm reduction strategies reported experiencing fewer adverse health consequences (P values < 0.05). Those who reportedly set limits on quantity were at decreased odds of experiencing a bad mood after drug use, sexual difficulties while under drug influence, injuries or fractures while under drug influence, and involvement in fights or being attacked while under drug influence (P values < 0.05). Moreover, those who report frequently avoid mixing depressants were at decreased odds of experiencing headache, loss of consciousness, drop in blood pressure, injuries of fractures, and fights or attacks (P values < 0.05). DISCUSSION AND CONCLUSIONS Adoption of dosing-related harm reduction strategies appears to be associated with less drug-related harm among polysubstance-using festival attendees. Findings may inform organisations and policymakers in the designing of harm reduction interventions with this population.
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Affiliation(s)
- Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Carmen Díaz-Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Monica J Barratt
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Australia
| | - Joseph J Palamar
- Department of Population Health, New York University Langone Medical Center, New York, USA
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Waye KM, Yedinak JL, Koziol J, Marshall BDL. Action-focused, plain language communication for overdose prevention: A qualitative analysis of Rhode Island's overdose surveillance and information dashboard. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 62:86-93. [PMID: 30384027 DOI: 10.1016/j.drugpo.2018.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/10/2018] [Accepted: 08/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In 2015, the state of Rhode Island reported the fifth highest drug overdose mortality rate in the United States. In response to this crisis, Rhode Island created a statewide, publicly accessible drug surveillance and information system, www.PreventOverdoseRI.org (PORI). Alongside near real-time overdose surveillance data, PORI provides plain language materials and resources regarding overdose prevention, recognition and response. We sought to determine how people who use drugs (PWUD) perceive and utilize overdose prevention material, and to evaluate PORI's action-based, plain language content. METHODS We conducted 21 semi-structured qualitative interviews with PWUD from February-June 2017 in the state of Rhode Island. Data were audio-recorded, transcribed, coded in NVivo (Version 11), and key themes were developed. RESULTS Participants viewed online health promotion and harm reduction materials as a useful approach for overdose prevention. Information displayed as accessible, action-driven statements was seen as most desirable for learning and dissemination. After viewing overdose prevention material, participants reported feeling better prepared for responding to an accidental overdose and motivated to share the infographics and website to other people either at risk for or likely to witness an overdose. CONCLUSION Action-focused, plain language approaches for overdose prevention materials can be of particular use for public health campaigns addressing opioid overdose crises. Overdose prevention health campaigns should incorporate evidence-based testing to ensure that outreach material is grounded in plain language techniques.
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Affiliation(s)
- Katherine M Waye
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA
| | - Jennifer Koziol
- Rhode Island Department of Health, 3 Capitol Hill, Providence, RI, 02908 USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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Laing MK, Tupper KW, Fairbairn N. Drug checking as a potential strategic overdose response in the fentanyl era. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 62:59-66. [PMID: 30359874 DOI: 10.1016/j.drugpo.2018.10.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/26/2022]
Abstract
Adulteration of illicit drug supplies with synthetic opioids such as fentanyl has contributed to a dramatic rise in overdose morbidity and mortality in North America. One promising response to this crisis is the implementation of "drug checking" services. Drug checking encompasses a range of interventions used to assess the constituents of illicit drug samples, such as colour-spot testing, gas or liquid chromatography, and various methods of spectroscopy. Testing may be performed on-site at events or harm reduction service locales, performed independently by consumers, or sent to a centralized lab for analysis. This information may then serve to inform individual decision-making, enhance harm reduction efforts and strengthen public health surveillance and response strategies to prevent harms associated with illicit drug use. Historical examples of drug checking services that emerged with the 1990s synthetic "party drug" movement in Europe provide a theoretical and practical basis for the adaptation of these services for use in context of the current opioid overdose crisis. Potential harm reduction benefits of drug checking for synthetic opioid adulterants include individuals being more likely to use drugs more safely or to dispose of drugs found to contain harmful adulterants. Public health benefits of drug checking may also include negative feedback on the illicit drug supply with decreased availability or consumption of drugs from sources adulterated with synthetic opioids following public health warning campaigns. As part of the response to the current synthetic opioid epidemic in BC, pilot efforts are being undertaken in Vancouver to determine the feasibility and effectiveness of drug checking as an overdose response strategy. Models of drug checking service delivery and comparison of differing technologies, including unique challenges and potential solutions related to access to these services, legal obstacles, and sensitivity and specificity of testing technologies, are explored, alongside suggestions for future research and directions.
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Affiliation(s)
- Matthew K Laing
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Kenneth W Tupper
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
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Trayner KMA, Weir A, McAuley A, Godbole G, Amar C, Grant K, Penrice G, Roy K. A pragmatic harm reduction approach to manage a large outbreak of wound botulism in people who inject drugs, Scotland 2015. Harm Reduct J 2018; 15:36. [PMID: 29996865 PMCID: PMC6042261 DOI: 10.1186/s12954-018-0243-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/05/2018] [Indexed: 11/12/2022] Open
Abstract
Background People who inject drugs (PWID) are at an increased risk of wound botulism, a potentially fatal acute paralytic illness. During the first 6 months of 2015, a large outbreak of wound botulism was confirmed among PWID in Scotland, which resulted in the largest outbreak in Europe to date. Methods A multidisciplinary Incident Management Team (IMT) was convened to conduct an outbreak investigation, which consisted of enhanced surveillance of cases in order to characterise risk factors and identify potential sources of infection. Results Between the 24th of December 2014 and the 30th of May 2015, a total of 40 cases were reported across six regions in Scotland. The majority of the cases were male, over 30 and residents in Glasgow. All epidemiological evidence suggested a contaminated batch of heroin or cutting agent as the source of the outbreak. There are significant challenges associated with managing an outbreak among PWID, given their vulnerability and complex addiction needs. Thus, a pragmatic harm reduction approach was adopted which focused on reducing the risk of infection for those who continued to inject and limited consequences for those who got infected. Conclusions The management of this outbreak highlighted the importance and need for pragmatic harm reduction interventions which support the addiction needs of PWID during an outbreak of spore-forming bacteria. Given the scale of this outbreak, the experimental learning gained during this and similar outbreaks involving spore-forming bacteria in the UK was collated into national guidance to improve the management and investigation of future outbreaks among PWID.
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Affiliation(s)
- Kirsten M A Trayner
- Health Protection Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland. .,Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland.
| | - Amanda Weir
- Health Protection Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland
| | - Andrew McAuley
- Health Protection Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland.,Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland
| | - Gauri Godbole
- Gastrointestinal Bacteria Reference Unit (GBRU), National Infection Service, Public Health England, London, England
| | - Corinne Amar
- Gastrointestinal Bacteria Reference Unit (GBRU), National Infection Service, Public Health England, London, England
| | - Kathie Grant
- Gastrointestinal Bacteria Reference Unit (GBRU), National Infection Service, Public Health England, London, England
| | - Gillian Penrice
- Public Health Protection Unit, Gartnavel Royal Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | - Kirsty Roy
- Health Protection Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland
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Dunleavy K, Munro A, Roy K, Hutchinson S, Palmateer N, Knox T, Goldberg D, Hope V, Campbell J, Hamilton E, Liddell D, Penrice G, Taylor A. Spore forming bacteria infections and people who inject drugs: Implications for harm reduction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 53:45-54. [DOI: 10.1016/j.drugpo.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/17/2017] [Accepted: 12/05/2017] [Indexed: 11/28/2022]
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Abstract
This paper is the thirty-eighth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2015 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Henning A. Challenges to promoting health for amateur athletes through anti-doping policy. DRUGS-EDUCATION PREVENTION AND POLICY 2016; 24:306-313. [PMID: 28736489 DOI: 10.1080/09687637.2016.1208732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Anti-doping regulations are intended, at least in part, to promote the health of athletes. While most anti-doping efforts target elite and professional competitors, there have been recent moves by sport governing bodies to expand anti-doping testing to include amateur athletes. Drawing on previous critiques of anti-doping policies and illustrating cases, this article outlines five of the challenges to health promotion of applying the current detect and ban model to the amateur level of sport. I argue that the current approach is not effective and, in some ways, may undermine the goal of health promotion at the amateur level. In order to address these challenges, I propose alternative, health-centred strategies that focus on athlete empowerment and choice through critical awareness of a variety of substances, associated risks and rewards, and the role of expertise in decision-making.
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Affiliation(s)
- April Henning
- Behavioral Sciences Training, National Development and Research Institutes, New York, NY, USA
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Greer AM, Luchenski SA, Amlani AA, Lacroix K, Burmeister C, Buxton JA. Peer engagement in harm reduction strategies and services: a critical case study and evaluation framework from British Columbia, Canada. BMC Public Health 2016; 16:452. [PMID: 27229314 PMCID: PMC4882818 DOI: 10.1186/s12889-016-3136-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/14/2016] [Indexed: 11/22/2022] Open
Abstract
Background Engaging people with drug use experience, or ‘peers,’ in decision-making helps to ensure harm reduction services reflect current need. There is little published on the implementation, evaluation, and effectiveness of meaningful peer engagement. This paper aims to describe and evaluate peer engagement in British Columbia from 2010–2014. Methods A process evaluation framework specific to peer engagement was developed and used to assess progress made, lessons learned, and future opportunities under four domains: supportive environment, equitable participation, capacity building and empowerment, and improved programming and policy. The evaluation was conducted by reviewing primary and secondary qualitative data including focus groups, formal documents, and meeting minutes. Results Peer engagement was an iterative process that increased and improved over time as a consequence of reflexive learning. Practical ways to develop trust, redress power imbalances, and improve relationships were crosscutting themes. Lack of support, coordination, and building on existing capacity were factors that could undermine peer engagement. Peers involved across the province reviewed and provided feedback on these results. Conclusion Recommendations from this evaluation can be applied to other peer engagement initiatives in decision-making settings to improve relationships between peers and professionals and to ensure programs and policies are relevant and equitable.
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Affiliation(s)
- Alissa M Greer
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia, V5Z 4R4, Canada. .,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Serena A Luchenski
- The Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom
| | - Ashraf A Amlani
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia, V5Z 4R4, Canada
| | - Katie Lacroix
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia, V5Z 4R4, Canada.,Society of Living Illicit Drug Users, 857 Caledonia Street, Victoria, British Columbia, V8T 1E6, Canada
| | - Charlene Burmeister
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia, V5Z 4R4, Canada
| | - Jane A Buxton
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, British Columbia, V5Z 4R4, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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Syvertsen JL, Ohaga S, Agot K, Dimova M, Guise A, Rhodes T, Wagner KD. An ethnographic exploration of drug markets in Kisumu, Kenya. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 30:82-90. [PMID: 26838470 DOI: 10.1016/j.drugpo.2016.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/15/2015] [Accepted: 01/03/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Illegal drug markets are shaped by multiple forces, including local actors and broader economic, political, social, and criminal justice systems that intertwine to impact health and social wellbeing. Ethnographic analyses that interrogate multiple dimensions of drug markets may offer both applied and theoretical insights into drug use, particularly in developing nations where new markets and local patterns of use traditionally have not been well understood. This paper explores the emergent drug market in Kisumu, western Kenya, where our research team recently documented evidence of injection drug use. METHODS Our exploratory study of injection drug use was conducted in Kisumu from 2013 to 2014. We draw on 151 surveys, 29 in-depth interviews, and 8 months of ethnographic fieldwork to describe the drug market from the perspective of injectors, focusing on their perceptions of the market and reports of drug use therein. RESULTS Injectors described a dynamic market in which the availability of drugs and proliferation of injection drug use have taken on growing importance in Kisumu. In addition to reports of white and brown forms of heroin and concerns about drug adulteration in the market, we unexpectedly documented widespread perceptions of cocaine availability and injection in Kisumu. Examining price data and socio-pharmacological experiences of cocaine injection left us with unconfirmed evidence of its existence, but opened further possibilities about how the chaos of new drug markets and diffusion of injection-related beliefs and practices may lend insight into the sociopolitical context of western Kenya. CONCLUSIONS We suggest a need for expanded drug surveillance, education and programming responsive to local conditions, and further ethnographic inquiry into the social meanings of emergent drug markets in Kenya and across sub-Saharan Africa.
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Affiliation(s)
- Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Ave., Columbus, OH 43210-1106, USA.
| | - Spala Ohaga
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya
| | - Margarita Dimova
- Department of Politics and International Studies, SOAS, Thornhaugh Street, Russell Square, London, England WC1H 0XG, United Kingdom
| | - Andy Guise
- Division of Global Public Health, University of California, San Diego, Central Research Services Facility (CRSF), La Jolla, CA 92093-0507, USA; London School of Hygiene & Tropical Medicine, Keppel Street, London, England WC1E 7HT, United Kingdom
| | - Tim Rhodes
- London School of Hygiene & Tropical Medicine, Keppel Street, London, England WC1E 7HT, United Kingdom
| | - Karla D Wagner
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. MS 0274, Reno, NV 89557, USA
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Markwick N, McNeil R, Anderson S, Small W, Kerr T. Communicating risk in the context of methadone formulation changes: A qualitative study of overdose warning posters in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:178-81. [PMID: 26644025 DOI: 10.1016/j.drugpo.2015.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 10/27/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Nicole Markwick
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6T 1Z1, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z9, Canada
| | - Ryan McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6T 1Z1, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Solanna Anderson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6T 1Z1, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6T 1Z1, 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 V6T 1Z1, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
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