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Lloyd Z, Colledge-Frisby S, Taylor N, Livingston M, Jauncey M, Roxburgh A. Changes in Australians' attitudes towards supervised injecting facilities. Drug Alcohol Rev 2024. [PMID: 39222486 DOI: 10.1111/dar.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Supervised injecting facilities (SIF) have been shown to reduce negative outcomes experienced by people who inject drugs. They are often subject to intense public and media scrutiny. This article aimed to explore population attitudes to SIFs and how these changed over time in Australia. METHODS Data were drawn from the National Drug Strategy Household Survey, a national sample collecting data on illicit drug use and attitudes towards drug policy among Australians (2001-2019). Ordinal logistic regression assessed sociodemographic characteristics associated with different attitudes to SIFs and binary logistic regression assessed trends over time and by jurisdiction. RESULTS In 2019, 54% of respondents (95% CI 52.9, 55.1) supported SIFs, 27.5% (95% CI 26.6, 28.4) opposed and 18.4% (95% CI 17.7, 19.2) were ambivalent. Support for SIFs correlated with having a university degree (OR 1.75; 95% CI 1.58, 1.94), non-heterosexual identity (OR 1.81, 95% CI 1.51, 2.17) and recent illicit drug use (OR = 1.74, 95% CI 1.55, 1.94). Male respondents or those living in socioeconomically disadvantaged areas had lower odds of supporting SIFs (OR 0.92, 95% CI 0.85, 1.00; OR 0.64-0.80, respectively). Between 2001 and 2019, support for SIFs increased modestly by 3.3%, those who 'don't know' by 7.4%, whereas opposition decreased by 11.7%. Between 2001 and 2019, support for SIFs increased in NSW and Queensland, whereas opposition decreased in all jurisdictions. DISCUSSION AND CONCLUSIONS Opposition to SIFs declined over the past 20 years, but a substantial proportion of respondents are ambivalent or 'don't know enough to say'. Plain language information about SIFs and their potential benefits, targeted to those who are ambivalent/'don't know' may further increase public support.
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Affiliation(s)
| | - Samantha Colledge-Frisby
- Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Nicholas Taylor
- Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Michael Livingston
- Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Marianne Jauncey
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Amanda Roxburgh
- Burnet Institute, Melbourne, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Byrne CJ, Sani F, Flynn T, Malaguti A. 'It was like coming back from the clouds': a qualitative analysis of the lived experience of overdose consequent to drug use among a cohort of people who use drugs in Scotland. Harm Reduct J 2024; 21:112. [PMID: 38849877 PMCID: PMC11157918 DOI: 10.1186/s12954-024-01033-7] [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: 01/08/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Globally, non-fatal overdose (NFOD) rates consequent to drug use, typically opioids, continue increasing at a startling rate. Existing quantitative research has revealed myriad factors and characteristics linked to experiencing NFOD, but it is critically important to explore the lived context underlying these associations. In this qualitative study, we sought to understand the experiences of NFOD among people who use drugs in a Scottish region in order to: enhance public policy responses; inform potential intervention development to mitigate risk; and contribute to the literature documenting the lived experience of NFOD. METHODS From June to July 2021, two peer researchers conducted face-to-face semi-structured interviews with people who use drugs who had experienced recent NFOD attending harm reduction services in Tayside, Scotland. These were transcribed verbatim and evaluated using thematic analysis with an inductive approach which had an experiential and essentialist orientation. RESULTS Twenty people were interviewed across two sites. Of those, 15 (75%) were male and mean age was 38.2 (7.7) years. All had experienced at least one NFOD in the prior six months, and all reported polydrug use. Five themes were identified, within which 12 subthemes were situated. The themes were: social context; personal risk-taking triggers; planned and impulsive consumption; risk perception; and overdose reversal. The results spoke to the environmental, behavioural, cognitive, economic, and marketplace, factors which influence the context of NFOD in the region. CONCLUSIONS A complex interplay of behavioural, psychological, and situational factors were found to impact the likelihood of experiencing NFOD. Structural inequities which policy professionals and civic leaders should seek to remedy were identified, while service providers may seek to reconfigure healthcare provision for people who use drugs to account for the interpersonal, psychological, and social factors identified, which appear to precipitate NFOD. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK.
| | - Fabio Sani
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Scrymgeour Building, Dundee, UK
| | | | - Amy Malaguti
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Scrymgeour Building, Dundee, UK
- Tayside Drug and Alcohol Recovery Psychology Service, NHS Tayside, Dundee, UK
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3
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Guise A, Harris M, McCusker M, McNeil R, Werb D. Stigma is stopping an evidence based response to drug overdose deaths in the UK. BMJ 2023; 382:e074934. [PMID: 37558236 DOI: 10.1136/bmj-2023-074934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
| | | | | | - Ryan McNeil
- University of Yale, New Haven, Connecticut, USA
| | - Dan Werb
- University of Toronto. Toronto, Canada
- University of California San Diego, San Diego, USA
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Carver H, Falzon D, Masterton W, Wallace B, Aston EV, Measham F, Hunter C, Sumnall H, Gittins R, Raeburn F, Craik V, Priyadarshi S, Rothney L, Weir K, Parkes T. 'It's not going to be a one size fits all': a qualitative exploration of the potential utility of three drug checking service models in Scotland. Harm Reduct J 2023; 20:94. [PMID: 37501057 PMCID: PMC10373262 DOI: 10.1186/s12954-023-00830-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Scotland currently has the highest rates of drug-related deaths in Europe, so drug checking services are being explored due to their potential role in reducing these deaths and related harms. Drug checking services allow individuals to submit presumed psychoactive drug samples for analysis, and then receive individualised feedback and counselling. This paper explores participants' views on the advantages and challenges of three hypothetical service models, to inform future service delivery in Scotland. METHODS Semi-structured interviews were conducted with 43 people: 27 professional stakeholders, 11 people with experience of drug use, and five family members across three cities. Vignettes were used to provide short descriptions of three hypothetical service models during the interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis. RESULTS Participants identified advantages and challenges for each of the three potential service models. The third sector (not-for-profit) model was favoured overall by participants, and the NHS substance use treatment service was the least popular. Participants also noted that multiple drug checking sites within one city, along with outreach models would be advantageous, to meet the diverse needs of different groups of people who use drugs. CONCLUSIONS Drug checking services need to be tailored to local context and needs, with a range of service models being possible, in order to meet the needs of a heterogeneous group of people who use drugs. Addressing issues around stigma, accessibility, and concerns about the potential impact of accessing drug checking on access to and outcomes of drug treatment, are essential for successful service delivery.
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Affiliation(s)
- Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Danilo Falzon
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Wendy Masterton
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, 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
| | - 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
| | - Carole Hunter
- Alcohol and Drug Services, NHS Greater Glasgow and Clyde, Glasgow, G51 1DP, UK
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, L2 2QP, UK
| | | | - Fiona Raeburn
- NHS Grampian, Royal Cornhill Hospital, Cornhill Road, Aberdeen, AB25 2ZH, UK
| | | | - Saket Priyadarshi
- Alcohol and Drug Services, NHS Greater Glasgow and Clyde, Glasgow, G51 1DP, UK
| | - Laura Rothney
- NHS Grampian, Royal Cornhill Hospital, Cornhill Road, Aberdeen, AB25 2ZH, UK
| | | | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
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Ondocsin J, Ciccarone D, Moran L, Outram S, Werb D, Thomas L, Arnold EA. Insights from Drug Checking Programs: Practicing Bootstrap Public Health Whilst Tailoring to Local Drug User Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5999. [PMID: 37297603 PMCID: PMC10252652 DOI: 10.3390/ijerph20115999] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
The year 2021 was the most deadly year for overdose deaths in the USA and Canada. The stress and social isolation stemming from the COVID-19 pandemic coupled with a flood of fentanyl into local drug markets created conditions in which people who use drugs were more susceptible to accidental overdose. Within territorial, state, and local policy communities, there have been longstanding efforts to reduce morbidity and mortality within this population; however, the current overdose crisis clearly indicates an urgent need for additional, easily accessible, and innovative services. Street-based drug testing programs allow individuals to learn the composition of their substances prior to use, averting unintended overdoses while also creating low threshold opportunities for individuals to connect to other harm reduction services, including substance use treatment programs. We sought to capture perspectives from service providers to document best practices around fielding community-based drug testing programs, including optimizing their position within a constellation of other harm reduction services to best serve local communities. We conducted 11 in-depth interviews from June to November 2022 via Zoom with harm reduction service providers to explore barriers and facilitators around the implementation of drug checking programs, the potential for integration with other health promotion services, and best practices for sustaining these programs, taking the local community and policy landscape into account. Interviews lasted 45-60 min and were recorded and transcribed. Thematic analysis was used to reduce the data, and transcripts were discussed by a team of trained analysts. Several key themes emerged from our interviews: (1) the instability of drug markets amid an inconsistent and dangerous drug supply; (2) implementing drug checking services in dynamic environments in response to the rapidly changing needs of local communities; (3) training and ongoing capacity building needed to create sustainable programs; and (4) the potential for integrating drug checking programs into other services. There are opportunities for this service to make a difference in overdose deaths as the contours of the drug market itself have changed over time, but a number of challenges remain to implement them effectively and sustain the service over time. Drug checking itself represents a paradox within the larger policy context, putting the sustainability of these programs at risk and challenging the potential to scale these programs as the overdose epidemic worsens.
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Affiliation(s)
- Jeff Ondocsin
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Daniel Ciccarone
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Lissa Moran
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Simon Outram
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Dan Werb
- Centre on Drug Policy Evaluation, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
- Division of Infectious Diseases & Global Public Health, UC San Diego School of Medicine, University of California, San Diego, CA 92093, USA
| | - Laura Thomas
- San Francisco AIDS Foundation, San Francisco, CA 94103, USA
| | - Emily A. Arnold
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94143, USA
- Family & Community Medicine, Department of Medicine, University of California, San Francisco, CA 94143, USA
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Miller NM, Campbell C, Shorter GW. Barriers and facilitators of naloxone and safe injection facility interventions to reduce opioid drug-related deaths: A qualitative analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104049. [PMID: 37247475 DOI: 10.1016/j.drugpo.2023.104049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Opioid drug-related deaths continue to be a significant public health concern in the Republic of Ireland (ROI) and Northern Ireland (NI). While both regions have implemented naloxone to reduce drug related deaths, there remains a gap in the implementation of a supervised injection facility (SIF). This study aimed to identify barriers and facilitators to implementing naloxone and a SIF to reduce opioid drug-related deaths in ROI and NI. METHODS Semi-structured interviews (n=23) were conducted in ROI and NI with experts by experience (n=8), staff from low threshold services (n=9), and individuals involved in policy making (n= 6). Data were analyzed using coding reliability Thematic Analysis and were informed by the Risk Environmental Framework. RESULTS The findings illustrated that stigma within the media, health centers, and the community was a significant barrier to naloxone distribution and SIF implementation. Policing and community intimidation were reported to hinder naloxone carriage in both the ROI and NI, while threats of paramilitary violence towards people who use drugs were unique to NI. Municipal government delays and policy maker apathy were reported to hinder SIF implementation in the ROI. Participants suggested peer-to-peer naloxone delivery and amending legislation to facilitate non-prescription naloxone would increase naloxone uptake. Participants recommended using webinars, Town Halls, and a Citizens' Assembly as tools to advocate for SIF implementation. CONCLUSION Local and regional stigma reduction campaigns are needed in conjunction with policy changes to advance naloxone and a SIF. Tailoring stigma campaigns to incorporate the lived experience of people who use drugs, their family members, and the general community can aid in educating the public and change negative perceptions. This study highlights the need for ongoing efforts to reduce stigma and increase accessibility to evidence-based interventions to address opioid drug-related deaths in the ROI, NI, and internationally.
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Affiliation(s)
| | | | - Gillian W Shorter
- Drug and Alcohol Research Network & Centre for Improving Health Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
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Rosen JG, Glick JL, Zhang L, Cooper L, Olatunde PF, Pelaez D, Rouhani S, Sue KL, Park JN. Safety in solitude? Competing risks and drivers of solitary drug use among women who inject drugs and implications for overdose detection. Addiction 2022; 118:847-854. [PMID: 36468191 PMCID: PMC10073256 DOI: 10.1111/add.16103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/11/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Solitary drug use (SDU) can amplify risks of fatal overdose. We examined competing risks and drivers of SDU, as well as harm reduction strategies implemented during SDU episodes, among women who inject drugs (WWID). DESIGN A cross-sectional qualitative study, including telephone and face-to-face in-depth interviews. SETTING Baltimore City, MD, USA. PARTICIPANTS Twenty-seven WWID (mean age = 39 years, 67% white, 74% injected drugs daily) recruited via outreach and street intercept (April-September 2021). MEASUREMENTS Interviews explored the physical (i.e. indoor/private, outdoor/public) and social (i.e. alone, accompanied) risk environments in which drug use occurred. Guided by the principles of emergent design, we used thematic analysis to interrogate textual data, illuminating women's preferences/motivations for SDU and strategies for minimizing overdose risks when using alone. FINDINGS Many participants reported experiences with SDU, despite expressed preferences for accompanied drug use. SDU motivations clustered around three primary drivers: (1) avoiding opioid withdrawal, (2) preferences for privacy when using drugs and (3) safety concerns, including threats of violence. Participants nevertheless acknowledged the dangers of SDU and, at times, took steps to mitigate overdose risk, including naloxone possession, communicating to peers when using alone ('spotting') and using drugs in public spaces. CONCLUSIONS WWID appear to engage frequently in SDU due to constraints of the physical and social environments in which they use drugs. They express a preference for accompanied drug use in most cases and report implementing strategies to mitigate their overdose risk, especially when using drugs alone.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lyra Cooper
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Praise F Olatunde
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Saba Rouhani
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kimberly L Sue
- National Harm Reduction Coalition, New York, New York, USA.,Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Department of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.,Center of Biomedical Research Excellent on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
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8
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Falzon D, Aston EV, Carver H, Masterton W, Wallace B, Sumnall H, Measham F, Fletcher E, Gittins R, Priyadarshi S, Parkes T. Challenges for drug checking services in Scotland: a qualitative exploration of police perceptions. Harm Reduct J 2022; 19:105. [PMID: 36138440 PMCID: PMC9502919 DOI: 10.1186/s12954-022-00686-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background The impact of policing practices on the engagement of people who use drugs (PWUD) with harm reduction services is well evidenced. Although the police have traditionally taken an enforcement role in responding to drug use, it is increasingly clear that they can play an important part in multiagency delivery of harm reduction interventions. Despite this, there have been no studies exploring police officer perceptions of drug checking services (DCS), which provide analytical testing of client drug samples alongside harm reduction support and advice. Methods Semi-structured interviews were conducted with 10 police officers to explore the policing and legal challenges which could be encountered in the delivery of DCS in Scotland. Results Participants expressed general support for DCS and described this support as part of a wider organisational shift towards public health-oriented policing. Participants also discussed different potential approaches to the policing of areas surrounding DCS including: formal limits on police presence around the service and/or stop and search powers in relation to personal possession; the effective decriminalisation of personal possession within a specified boundary around the service; and informal agreements between local divisions and DCS outlining expected policing practices. Any formal limitation on the capacity of police officers to respond to community concerns was viewed as problematic and as having the potential to erode public confidence in policing. Participants also highlighted the potential for frontline officers to utilise discretion in ways which could undermine public health goals. Legislative change, or national strategic guidance from relevant stakeholders, was seen as a means of providing ‘cover’, enabling local divisions to support the operation of drug checking. Conclusions Despite a small sample of participants, this study summarises key challenges to be addressed in the implementation and operation of DCS in Scotland, and more widely. The paper concludes with suggested opportunities to develop approaches to policing that can facilitate rather than impede implementation and operation of these services.
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Affiliation(s)
- Danilo Falzon
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK.
| | - Elizabeth V Aston
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Wendy Masterton
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Bruce Wallace
- School of Social Work, University of Victoria, STN CSC, PO Box 1700, Victoria, BC, Canada
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Fiona Measham
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, UK
| | | | | | | | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
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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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10
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Parkes T, Price T, Foster R, Trayner KMA, Sumnall HR, Livingston W, Perkins A, Cairns B, Dumbrell J, Nicholls J. 'Why would we not want to keep everybody safe?' The views of family members of people who use drugs on the implementation of drug consumption rooms in Scotland. Harm Reduct J 2022; 19:99. [PMID: 36038919 DOI: 10.1186/s12954-022-00679-5.pmid:36038919;pmcid:pmc9421633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/15/2022] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND People who use drugs in Scotland are currently experiencing disproportionately high rates of drug-related deaths. Drug consumption rooms (DCRs) are harm reduction services that offer a safe, hygienic environment where pre-obtained drugs can be consumed under supervision. The aim of this research was to explore family member perspectives on DCR implementation in Scotland in order to inform national policy. METHODS Scotland-based family members of people who were currently or formerly using drugs were invited to take part in semi-structured interviews to share views on DCRs. An inclusive approach to 'family' was taken, and family members were recruited via local and national networks. A convenience sample of 13 family members were recruited and interviews conducted, audio-recorded, transcribed, and analysed thematically using the Structured Framework Technique. RESULTS Family members demonstrated varying levels of understanding regarding the existence, role, and function of DCRs. While some expressed concern that DCRs would not prevent continued drug use, all participants were in favour of DCR implementation due to a belief that DCRs could reduce harm, including saving lives, and facilitate future recovery from drug use. Participants highlighted challenges faced by people who use drugs in accessing treatment/services that could meet their needs. They identified that accessible and welcoming DCRs led by trusting and non-judgemental staff could help to meet unmet needs, including signposting to other services. Family members viewed DCRs as safe environments and highlighted how the existence of DCRs could reduce the constant worry that they had of risk of harm to their loved ones. Finally, family members emphasised the challenge of stigma associated with drug use. They believed that introduction of DCRs would help to reduce stigma and provide a signal that people who use drugs deserve safety and care. CONCLUSIONS Reporting the experience and views of family members makes a novel and valuable contribution to ongoing public debates surrounding DCRs. Their views can be used to inform the implementation of DCRs in Scotland but also relate well to the development of wider responses to drug-related harm and reduction of stigma experienced by people who use drugs in Scotland and beyond.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK.
| | - Tracey Price
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - Kirsten M A Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Harry R Sumnall
- Liverpool John Moores University, Public Health Institute, Liverpool, Scotland, UK
| | - Wulf Livingston
- Faculty of Social Sciences, Glyndwr University, Wrexham, Wales, UK
| | | | - Beth Cairns
- Figure 8 Consultancy Ltd, Dundee, Scotland, UK
| | - Josh Dumbrell
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - James Nicholls
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
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Parkes T, Price T, Foster R, Trayner KMA, Sumnall HR, Livingston W, Perkins A, Cairns B, Dumbrell J, Nicholls J. 'Why would we not want to keep everybody safe?' The views of family members of people who use drugs on the implementation of drug consumption rooms in Scotland. Harm Reduct J 2022; 19:99. [PMID: 36038919 PMCID: PMC9421633 DOI: 10.1186/s12954-022-00679-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People who use drugs in Scotland are currently experiencing disproportionately high rates of drug-related deaths. Drug consumption rooms (DCRs) are harm reduction services that offer a safe, hygienic environment where pre-obtained drugs can be consumed under supervision. The aim of this research was to explore family member perspectives on DCR implementation in Scotland in order to inform national policy. METHODS Scotland-based family members of people who were currently or formerly using drugs were invited to take part in semi-structured interviews to share views on DCRs. An inclusive approach to 'family' was taken, and family members were recruited via local and national networks. A convenience sample of 13 family members were recruited and interviews conducted, audio-recorded, transcribed, and analysed thematically using the Structured Framework Technique. RESULTS Family members demonstrated varying levels of understanding regarding the existence, role, and function of DCRs. While some expressed concern that DCRs would not prevent continued drug use, all participants were in favour of DCR implementation due to a belief that DCRs could reduce harm, including saving lives, and facilitate future recovery from drug use. Participants highlighted challenges faced by people who use drugs in accessing treatment/services that could meet their needs. They identified that accessible and welcoming DCRs led by trusting and non-judgemental staff could help to meet unmet needs, including signposting to other services. Family members viewed DCRs as safe environments and highlighted how the existence of DCRs could reduce the constant worry that they had of risk of harm to their loved ones. Finally, family members emphasised the challenge of stigma associated with drug use. They believed that introduction of DCRs would help to reduce stigma and provide a signal that people who use drugs deserve safety and care. CONCLUSIONS Reporting the experience and views of family members makes a novel and valuable contribution to ongoing public debates surrounding DCRs. Their views can be used to inform the implementation of DCRs in Scotland but also relate well to the development of wider responses to drug-related harm and reduction of stigma experienced by people who use drugs in Scotland and beyond.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK.
| | - Tracey Price
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - Kirsten M A Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Harry R Sumnall
- Liverpool John Moores University, Public Health Institute, Liverpool, Scotland, UK
| | - Wulf Livingston
- Faculty of Social Sciences, Glyndwr University, Wrexham, Wales, UK
| | | | - Beth Cairns
- Figure 8 Consultancy Ltd, Dundee, Scotland, UK
| | - Josh Dumbrell
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK
| | - James Nicholls
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
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