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Rudzinski K, Xavier J, Guta A, Chan Carusone S, King K, Phillips JC, Switzer S, O'Leary B, Baltzer Turje R, Harrison S, de Prinse K, Simons J, Strike C. Feasibility, acceptability, concerns, and challenges of implementing supervised injection services at a specialty HIV hospital in Toronto, Canada: perspectives of people living with HIV. BMC Public Health 2021; 21:1482. [PMID: 34325681 PMCID: PMC8323264 DOI: 10.1186/s12889-021-11507-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance use significantly impacts health and healthcare of people living with HIV/AIDS (PLHIV), especially their ability to remain in hospital following admission. Supervised injection services (SIS) reduce overdoses and drug-related harms, but are not often provided within hospitals/outpatient programs. Leading us to question, what are PLHIV's perceptions of hospital-based SIS? METHODS This mixed-methods study explored feasibility and acceptability of implementing SIS at Casey House, a Toronto-based specialty HIV hospital, from the perspective of its in/outpatient clients. We conducted a survey, examining clients' (n = 92) demand for, and acceptability of, hospital-based SIS. Following this, we hosted two focus groups (n = 14) and one-on-one interviews (n = 8) with clients which explored benefits/drawbacks of in-hospital SIS, wherein participants experienced guided tours of a demonstration SIS space and/or presentations of evidence about impacts of SIS. Data were analysed using descriptive statistics and thematic analysis. RESULTS Among survey participants, 76.1% (n = 70) identified as cis-male and over half (n = 49;54.4%) had been a hospital client for 2 years or less. Nearly half (48.8%) knew about clients injecting in/near Casey House, while 23.6% witnessed it. Survey participants were more supportive of SIS for inpatients (76.1%) than for outpatients (68.5%); most (74.7%) reported SIS implementation would not impact their level of service use at Casey House, while some predicted coming more often (16.1%) and others less often (9.2%). Most focus group/interview participants, believed SIS would enhance safety by reducing health harms (e.g. overdose), increasing transparency between clients and clinicians about substance use, and helping retain clients in care. Debate arose about who (e.g., in/outpatients vs. non-clients) should have access to hospital-based SIS and how implementation may shift organizational priorities/resources away from services not specific to drug use. CONCLUSIONS Our data showed widespread support of, and need for, hospital-based SIS among client stakeholders; however, attempts to reduce negative impacts on non-drug using clients need to be considered in the balance of implementation plans. Given the increased risks of morbidity and mortality for PLHIV who inject drugs as well as the problems in retaining them in care in a hospital setting, SIS is a key component of improving care for this marginalized group.
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Affiliation(s)
- Katherine Rudzinski
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.
| | - Jessica Xavier
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, Canada
| | - Soo Chan Carusone
- Casey House, 119 Isabella St, Toronto, ON, M4Y 1P2, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, 1280 Main Street West 2C Area, Hamilton, ON, L8S 4K, Canada
| | - Kenneth King
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - J Craig Phillips
- Faculty of Health Sciences, University of Ottawa, 190 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Sarah Switzer
- Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, ON, M5S 1V6, Canada
| | - Bill O'Leary
- Casey House, 119 Isabella St, Toronto, ON, M4Y 1P2, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada
| | | | - Scott Harrison
- Providence Health Care - St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | | | - Joanne Simons
- Casey House, 119 Isabella St, Toronto, ON, M4Y 1P2, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
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Taylor J, Ober AJ, Kilmer B, Caulkins JP, Iguchi MY. Community perspectives on supervised consumption sites: Insights from four U.S. counties deeply affected by opioids. J Subst Abuse Treat 2021; 131:108397. [PMID: 34098293 DOI: 10.1016/j.jsat.2021.108397] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND To address the overdose crisis in the United States, expert groups have been nearly unanimous in calls for increasing access to evidence-based treatment and overdose reversal drugs. In some places there have also been calls for implementing supervised consumption sites (SCSs). Some cities-primarily in coastal urban areas-have explored the feasibility and acceptability of introducing them. However, the perspectives of community stakeholders from more inland and rural areas that have also been hard hit by opioids are largely missing from the literature. METHODS To examine community attitudes about implementing SCSs for people who use opioids (PWUO) in areas with acute opioid problems, the research team conducted in-depth interviews and focus groups in four counties: Ashtabula and Cuyahoga Counties in Ohio, and Carroll and Hillsborough Counties in New Hampshire, two states with high rates of opioid overdose. Participants were policy, treatment, and criminal justice professionals, frontline harm reduction and service providers, and PWUO. RESULTS Key informants noted benefits to SCSs, but also perceived potential drawbacks such as that they may enable opioid use, and potential practical barriers, including lack of desire among PWUO to travel to an SCS after purchasing opioids and fear of arrest. Key informants generally believed their communities likely would not currently accept SCSs due to cultural, resource, and practical barriers. They viewed publication of evidence on SCSs and community education as essential for fostering acceptance. CONCLUSIONS Despite cultural and other barriers, implementation of SCSs may be more feasible in urban communities with existing (and perhaps more long-standing) harm reduction programs, greater treatment resources, and adequate transportation, particularly if there is strong evidence to support them.
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Affiliation(s)
- Jirka Taylor
- Drug Policy Research Center, RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States of America.
| | - Allison J Ober
- Drug Policy Research Center, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, United States of America
| | - Beau Kilmer
- Drug Policy Research Center, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, United States of America
| | - Jonathan P Caulkins
- Carnegie Mellon University Heinz College, 5000 Forbes Avenue, Pittsburgh, PA 15213, United States of America
| | - Martin Y Iguchi
- Drug Policy Research Center, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, United States of America
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Lange BCL, Bach-Mortensen AM. A systematic review of stakeholder perceptions of supervised injection facilities. Drug Alcohol Depend 2019; 197:299-314. [PMID: 30875651 DOI: 10.1016/j.drugalcdep.2019.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/17/2019] [Accepted: 02/07/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Supervised injection facilities (SIFs) have been developed to address the public health burden associated with substance use. While these facilities have been associated with a number of positive outcomes, stakeholder opinion (the opinions of those potentially affected by these facilities) is likely to influence their future development. This systematic review aims to answer the question, "how do stakeholders perceive SIFs?" MATERIALS AND METHODS Articles were located through nine academic databases, by searching for grey literature, by contacting health departments in countries where SIFs have been implemented, by searching articles that cited included articles, and by searching the reference lists of included articles. Two reviewers screened all articles. Data was double-extracted and quality appraised. All extracted perceptions were analyzed by two coders. RESULTS Forty-seven articles were synthesized. Key themes included (1) benefits of SIFs, such as the increased safety of people who use drugs (PWUD) and the education that was provided at these facilities; (2) concerns regarding SIFs, such as the location of these facilities and existing rules and regulations; and (3) suggestions for SIFs, such as changing restrictions and regulations. Perceptions often fluctuated between stakeholders with first-hand experience of SIFs (e.g. staff and PWUD) and stakeholders not involved in the operation of SIFs (e.g. the general public). CONCLUSION The findings of this review illustrate how perceptions vary and align across different types of SIFs. Going forward, it will be important to draw on these insights to facilitate a more informed discussion on the implementation and continuation of these facilities.
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Affiliation(s)
- Brittany C L Lange
- University of Oxford, Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, UK.
| | - Anders Malthe Bach-Mortensen
- University of Oxford, Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, UK
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Cleirec G, Fortias M, Bloch V, Clergue-Duval V, Bellivier F, Dusouchet T, Debaulieu C, Vorspan F. Opinion of health professionals and drug users before the forthcoming opening of the first drug consumption room in Paris: a quantitative cross-sectional study. Harm Reduct J 2018; 15:53. [PMID: 30359272 PMCID: PMC6202864 DOI: 10.1186/s12954-018-0260-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/17/2018] [Indexed: 12/16/2022] Open
Abstract
Background On the brink of the opening of the first French drug consumption room in Paris, the general opinion of the local involved health care professionals and drug users was not known. The objective of this study was to determine their expectations and to search for influencing factors. Method We carried out a quantitative cross-sectional study. A multiple choice questionnaire was proposed to the surrounding willing general practitioners (GPs) and pharmacists, to the emergency doctors of Lariboisière hospital, and to the professionals of the harm reduction facilities and their drug users (PWUD). For each question, there was a choice between seven answers, from “− 3” (very negative impact) to “+ 3” (very positive impact). The influence of the characteristics of each group on its mean answers was explored by Mann-Whitney, Kruskal-Wallis, and Spearman’s tests. Results The median expectations among the groups of responding GPs (N = 62), other health care professionals (N = 82), and PWUD (N = 57) were mainly positive. They thought that the drug consumption room (DCR) would improve the health of PWUD, reduce their at-risk behaviors, would not increase drug use or drug dealing in the neighborhood, and would reduce nuisance in the public space. Only the group of GPs expressed that the DCR could decrease the quietness of the neighborhood, and only the group of PWUD had higher expectations that the DCR would decrease the number of arrests and the number of violent behavior. GPs’ expectations were significantly better in terms of health improvement of PWUD and reducing their precariousness if they had a previous experience in addiction medicine (Mann-Whitney, p = 0.004 and p = 0.019), with a longer practice (Spearman’s rho, p = 0.021 and p = 0.009), and if they were currently prescribing opioid substitution treatments (Mann-Whitney, p = 0.030 and p = 0.002). Among non-GPs, those who were working in addiction medicine centers had significantly better expectations than pharmacists, and the professionals of the local emergency department had intermediate expectations. Conclusions Health care professionals and drug users had a positive opinion of the to-be-created Parisian drug consumption room. Experience in addiction medicine influenced positively health professionals’ expectations.
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Affiliation(s)
- Grégoire Cleirec
- Service de médecine addictologique, Hôpital René Muret, APHP, Sevran, France
| | - Maeva Fortias
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France
| | - Vanessa Bloch
- Inserm Umrs1144 Variabilité de Réponse aux Psychotropes, Paris, France
| | - Virgile Clergue-Duval
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France.,Faculté de Médecine, Université Paris Diderot, Paris, France.,Inserm Umrs1144 Variabilité de Réponse aux Psychotropes, Paris, France
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France.,Faculté de Médecine, Université Paris Diderot, Paris, France.,Inserm Umrs1144 Variabilité de Réponse aux Psychotropes, Paris, France
| | | | | | - Florence Vorspan
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, APHP, Paris, France. .,Faculté de Médecine, Université Paris Diderot, Paris, France. .,Inserm Umrs1144 Variabilité de Réponse aux Psychotropes, Paris, France.
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