1
|
Brener L, Cama E, Broady T, Harrod ME, Holly C, Caruana T, Beadman K, Treloar C. Experiences of stigma and subsequent reduced access to health care among women who inject drugs. Drug Alcohol Rev 2024; 43:1071-1079. [PMID: 38271084 DOI: 10.1111/dar.13806] [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: 11/23/2022] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Research into stigma and injecting drug use has typically involved predominantly male participants, with limited research about the unique experience of women who inject drugs. METHODS This study used survey methods to assess reduced access to health care due to stigma among a sample of women who inject drugs. Women (n = 232) completed a survey as part of a broader national study of people who inject drugs. RESULTS Only 46 (19.9%) women reported that they had not experienced any injecting drug use-related stigma in the past year and most commonly noted 'sometimes' experiencing injecting-related stigma (36.8%) with more than 75% of women reporting that health workers had treated them negatively because of their injecting drug use. Most women undertook strategies to prevent experiencing stigma, such as not disclosing drug use to a health worker (81.3%), not attending follow-up appointments (76.7%) and delaying accessing health care (76.8%). Women with lower levels of personal wellbeing, who had experienced poorer treatment by health workers, had engaged in greater past month injecting, were employed and identified as lesbian, gay, bisexual, transgender or queer (LGBTQ) reported more reduced access to health care. DISCUSSION AND CONCLUSIONS Stigma has concerning health care implications for women who inject drugs and this research highlights the importance of understanding the impact of stigma in impeding health care access. Public health interventions should focus on addressing the systemic factors that reduce health care access for women who inject and take account of the impact of stigma in diminishing the quality and accessibility of health care for this group.
Collapse
Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Timothy Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Theresa Caruana
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| |
Collapse
|
2
|
Dunham K, Hill K, Kazal H, Butner JL, Hull I, Sue K, Li L, Doneski K, Dinges B, Rife-Pennington T, Kung S, Thakarar K. In Support of Overdose Prevention Centers: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education and Research in Substance Use and Addiction). SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:328-336. [PMID: 38747578 DOI: 10.1177/29767342241252590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Given increasing rates of fatal overdoses in the United States and the rapidly changing drug supply, overdose prevention centers (OPCs; also known as safe consumption sites) have been identified as a vital, evidence-based strategy that provide people who use drugs (PWUD) the opportunity to use drugs safely and receive immediate, life-saving overdose support from trained personnel. In addition to providing a safe, supervised space to use drugs, OPCs can house further essential harm reduction drop-in services such as sterile supplies, social services, and medical care. There are established national and international data demonstrating the lifesaving services provided by OPCs, inspiring a groundswell of advocacy efforts to expand these programs in the United States. Thus, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) endorses OPCs, in addition to other harm reduction strategies that protect PWUD. Ultimately, it is imperative to increase access to OPCs across the United States and support key policy changes at the local, state, and federal levels that would facilitate urgent expansion.
Collapse
Affiliation(s)
- Katherine Dunham
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katherine Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Hannah Kazal
- Division of Addiction Medicine, Department of Family Medicine, Maine Medical Center, Portland, ME, USA
| | - Jenna L Butner
- Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Ilana Hull
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kimberly Sue
- Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Li Li
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin Doneski
- Harm Reduction Program/Needle Exchange, Portland Public Health, Portland, ME, USA
| | - Beth Dinges
- Pharmacy Service, Veteran Affairs Illiana Healthcare System, Danville, IL, USA
| | - Tessa Rife-Pennington
- Pharmacy Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- School of Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Sunny Kung
- Mass General Brigham Community Physicians, Haverhill, MA, USA
| | - Kinna Thakarar
- Center for Interdisciplinary Population and Health Research/Maine, Portland, ME, USA
- Department of Medicine, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
- Maine Medical Partners Adult Infectious Diseases, South Portland, ME, USA
| |
Collapse
|
3
|
Dertadian GC, Askew R. Towards a social harm approach in drug policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104425. [PMID: 38615484 DOI: 10.1016/j.drugpo.2024.104425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
In this paper, we explore how the social harm approach can be adapted within drug policy scholarship. Since the mid-2000s, a group of critical criminologists have moved beyond the concept of crime and criminology, towards the study of social harm. This turn proceeds decades of research that highlights the inequities within the criminal legal system, the formation of laws that protect the privileged and punish the disadvantaged, and the systemic challenge of the effectiveness of retribution and punishment at addressing harm in the community. The purpose of this paper is to first identify parallels between the social harm approach and critical drug scholarship, and second to advocate for the adoption of a social harm lens in drug policy scholarship. In the paper, we draw out the similarities between social harm and drug policy literatures, as well as outline what the study of social harm can bring to an analysis of drug policy. This includes a discussion on the ontology of drug crime, the myth of drug crime and the ineffective use of the crime control system in response to drug use. The paper then discusses how these conversations in critical criminology and critical drugs scholarship can be brought together to inform future drug policy research. This reflection details the link between social harm and the impingement of human flourishing, explores the role of decolonizing drug policy, advocates for the centralization of lived experience within the research process and outlines how this might align with harm reduction approaches. We conclude by arguing that the social harm approach challenges the idea that neutrality is the goal in drug policy and explicitly seeks to expand new avenues in activist research and social justice approaches to policymaking.
Collapse
Affiliation(s)
| | - Rebecca Askew
- Manchester Metropolitan University: Department of Sociology and Criminology; Visiting Fellow, Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney
| |
Collapse
|
4
|
Anwar I, Faye A, Pereira Gonçalves J, Briand Madrid L, Maradan G, Lalanne L, Jauffret-Roustide M, Auriacombe M, Roux P. Gender and Drug Use Discrimination Among People Who Inject Drugs: An Intersectional Approach Using the COSINUS Cohort. Int J Womens Health 2024; 16:451-462. [PMID: 38495429 PMCID: PMC10944247 DOI: 10.2147/ijwh.s448147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/25/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Injection drug use is strongly associated with stigmatization by loved ones, healthcare providers, and society in general. This stigmatization can have negative consequences on the health of people who inject drugs (PWID) and limit their access to care. Women who inject drugs face greater stigma than men because of gendered social norms and the intersectional effect between gender and drug use identities. For this analysis, we aimed to study discrimination - which is closely linked to stigmatization - experienced by PWID, considering the intersectionality between drug use discrimination and gender discrimination in the French context. Methods We used data from the COSINUS cohort study, conducted between June 2016 and May 2019 in four French cities. We selected 427 of the 665 PWID who regularly injected drugs enrolled in COSINUS, at three months of follow-up, and performed multivariable logistic regression to identify factors associated with self-reported drug use discrimination. Results Women comprised 20.6% of the study sample. Sixty-nine percent of the participants declared drug use discrimination and 15% gender discrimination. In the multivariable regression analysis, PWID who had hurried injection out of fear of being seen were almost twice as likely to have experienced drug use discrimination (OR [95% CI]: 1.77 [1.15, 2.74], p = 0.010). Likewise, women experiencing gender discrimination were almost three times as likely to have experienced drug use discrimination (OR [95% CI]: 2.84 [1.07,7.56], p=0.037). Conclusion Women who inject drugs experienced gender and drug use intersectional discrimination. This could be a reason for the low attendance rates of women in healthcare settings. In addition, discrimination negatively impacted injection drug use practices (eg, hurried injection), particularly for people with unstable housing who injected in public spaces. We recommend introducing adapted services in healthcare facilities for women who inject drugs, and creating a favorable social and physical environment for all PWID in order to improve their health and access to care.
Collapse
Affiliation(s)
- Ilhame Anwar
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Aissatou Faye
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Jessica Pereira Gonçalves
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Laélia Briand Madrid
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Gwenaëlle Maradan
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Laurence Lalanne
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, 67000, France
- Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, 67000, France
| | - Marie Jauffret-Roustide
- CERMES3 (Inserm U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris, France
- British Columbia Center on Substance Use, Vancouver, Canada
- Baldy Center on Law and Social Policy, Buffalo University, New York, NY, USA
| | - Marc Auriacombe
- Univ. Bordeaux, Bordeaux, France
- Addiction Team (Laboratoire de psychiatrie)/SANPSY, CNRS USR 3413, Bordeaux, France
- Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Perrine Roux
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| |
Collapse
|
5
|
Beaugard CA, Khudairi F, Yesufu O, Farina A, Laks J. "I don't think of it as a shelter. I say I'm going home": a qualitative evaluation of a low-threshold shelter for women who use drugs. Harm Reduct J 2024; 21:44. [PMID: 38374063 PMCID: PMC10877776 DOI: 10.1186/s12954-024-00930-1] [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: 09/29/2023] [Accepted: 01/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In 2021-2022, encampments in a downtown Boston neighborhood reached record heights, increasing the visibility of drug use and homelessness in the city. In response, the city planned a "sweep" (i.e., eradication of encampments) and requested support from social services and medical providers to pilot low-threshold shelters. Low-threshold shelters reduce barriers to staying in traditional congregate shelters with more flexible regulations, longer-term bed assignments, and secured storage for contraband (e.g., drugs, weapons) instead of forced disposal. One homeless service provider opened a harm reduction-focused shelter for women who use drugs. This report describes the low-threshold shelter design and program evaluation. METHODS This program evaluation had two primary aims: (1) to examine guests' beliefs about shelter policies and practices; and (2) to understand the staff's experiences working in a low-threshold model. We conducted semi-structured qualitative interviews with 16 guests and 12 staff members during the summer 2022. Interviews were thematically analyzed. RESULTS Guests expressed overwhelming approval for the shelter's policies, which they stated supported their autonomy, dignity, and safety. They emphasized the staff's willingness to build relationships, thus demonstrating true commitment to the guests. Guests highlighted the value of daytime access to the shelter, as it granted them autonomy over their time, reduced their substance use, and helped them build relationships with staff and other guests. The co-directors and staff designed the shelter quickly and without US models for reference; they turned to international literature, local harm reduction health care providers, and women living in encampments for guidance on the shelter policies. The staff were passionate and committed to the health and stability of the guests. Most staff found value in the low-threshold model, though some were challenged by it, believing it enabled drug use and did not require the guests to "get better." CONCLUSIONS This evaluation indicates the value of low-threshold, harm reduction shelters as alternatives to traditional models. While these shelters do not mitigate the need for overarching housing reform, they are important measures to meet the needs of women experiencing unsheltered homelessness who face intersectional oppression.
Collapse
Affiliation(s)
- Corinne A Beaugard
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA, 02215, USA.
- , 801 Massachusetts Avenue, Crosstown Building 4th Floor, Suite 400, Boston, MA, 02180, USA.
| | - Fay Khudairi
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Oluwatoyin Yesufu
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
| | - Andrea Farina
- St. Francis House, 39 Boylston St, Boston, MA, 02116, USA
| | - Jordana Laks
- Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA
- Chobanian and Avedisian School of Medicine, Department of Internal Medicine, Boston University, 801 Massachusetts Ave 6th Floor, Boston, MA, 02119, USA
| |
Collapse
|
6
|
Harris MTH, Laks J, Hurstak E, Jain JP, Lambert AM, Maschke AD, Bagley SM, Farley J, Coffin PO, McMahan VM, Barrett C, Walley AY, Gunn CM. "If you're strung out and female, they will take advantage of you": A qualitative study exploring drug use and substance use service experiences among women in Boston and San Francisco. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209190. [PMID: 37866442 PMCID: PMC11040599 DOI: 10.1016/j.josat.2023.209190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/12/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Significant disparities in substance use severity and treatment persist among women who use drugs compared to men. Thus, we explored how identifying as a woman was related to drug use and treatment experiences. METHODS The study recruited participants for a qualitative interview study in Boston and San Francisco from January-November 2020. Self-identified women, age ≥ 18 years, with nonprescribed opioid use in the past 14 days were eligible for inclusion. The study team developed deductive codes based on intersectionality theory and inductive codes generated from transcript review, and identified themes using grounded content analysis. RESULTS The study enrolled thirty-six participants. The median age was 46; 58 % were White, 16 % were Black, 14 % were Hispanic, and 39 % were unstably housed. Other drug use was common with 81 % reporting benzodiazepine, 50 % cocaine, and 31 % meth/amphetamine use respectively. We found that gender (i.e., identifying as a woman) intersected with drug use and sex work practices and exacerbated experiences of marginalization. Violence was ubiquitous in drug use environments. Some women reported experiences of gender-based violence in substance use service settings that perpetuated cycles of trauma and reinforced barriers to care. Substance use services that were women-led, safe, and responsive to women's needs were valued and sought after. CONCLUSION Women reported a cycle of trauma and drug use exacerbated by oppression in substance use services settings. In addition to increasing access to gender-responsive care, our study highlights the need for greater research and examination of practices within substance use service settings that may be contributing to gender-based violence.
Collapse
Affiliation(s)
- Miriam T H Harris
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Jordana Laks
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Emily Hurstak
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Jennifer P Jain
- School of Nursing and Department of Community Health Systems at the University of California, San Francisco, CA 94143, USA.
| | - Audrey M Lambert
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Ariel D Maschke
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA.
| | - John Farley
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Phillip O Coffin
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Vanessa M McMahan
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Cynthia Barrett
- San Francisco Department of Public Health, 101 Grove St, San Francisco, CA 94102, USA; Department of Medicine, University of California, 533 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA 02118, USA.
| |
Collapse
|
7
|
Moreheart S, Shannon K, Krüsi A, McDermid J, Ettinger E, Braschel M, Goldenberg SM. Negative changes in illicit drug supply during COVID-19: Associations with use of overdose prevention and health services among women sex workers who use drugs (2020-2021). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104212. [PMID: 37797570 PMCID: PMC10798550 DOI: 10.1016/j.drugpo.2023.104212] [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: 11/30/2022] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Women sex workers are a highly criminalized population who are over-represented amongst people who use drugs (PWUD) and face gaps in overdose prevention and harm reduction services. British Columbia, Canada continues to face a pronounced drug poisoning crisis of the illicit drug supply, which has intensified during the COVID-19 pandemic. Our objective was to examine the prevalence and structural correlates of experiencing negative changes in illicit drug supply (e.g., availability, quality, cost, or access to drugs) amongst women sex workers who use drugs during the first year of the COVID-19 pandemic. METHODS Cross-sectional questionnaire data were drawn from a prospective, community-based cohort of women sex workers in Vancouver (AESHA) from April 2020 to 2021. Bivariate and multivariable logistic regression was used to investigate structural correlates of negative changes in drug supply during COVID-19 among sex workers who use drugs. RESULTS Among 179 sex workers who use drugs, 68.2% reported experiencing negative changes to drug supply during COVID-19, 54.2% recently accessed overdose prevention sites, and 44.7% reported experiencing recent healthcare barriers. In multivariable analysis adjusted for injection drug use, women who reported negative changes in illicit drug supply had higher odds of experiencing recent healthcare barriers (AOR 2.28, 95%CI 1.12-4.62); those recently accessing overdose prevention sites (AOR 1.75, 95%CI 0.86-3.54) faced marginally higher odds also. CONCLUSIONS Over two-thirds of participants experienced negative changes to illicit drug supply during the first year of the COVID-19 pandemic. The association between experiencing negative changes in the illicit drug supply and accessing overdose prevention services highlights the agency of women in taking measures to address overdose-related risks. Highly criminalized women who experience structural barriers to direct services are also vulnerable to fluctuations in the illicit drug supply. Attenuating health consequences requires interventions tailored to sex workers' needs.
Collapse
Affiliation(s)
- Sarah Moreheart
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jennifer McDermid
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Emma Ettinger
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shira Miriam Goldenberg
- Centre for Gender and Sexual Health Equity, UBC Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, United States.
| |
Collapse
|
8
|
Mayer S, Boyd J, Fairbairn N, Chapman J, Brohman I, Jenkins E, McNeil R. Women's experiences in injectable opioid agonist treatment programs in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104054. [PMID: 37192557 PMCID: PMC10330495 DOI: 10.1016/j.drugpo.2023.104054] [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: 01/19/2023] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) has recently been expanded in some geographical contexts in Canada as part of a response to the escalating overdose crisis. Complex gendered dynamics, including power differentials, violence, and social norms, shape the overdose crisis and drug treatment programs which can adversely impact women's experiences. This qualitative study examines how social (e.g., gender, income, housing) and structural factors (e.g., program policies) impact women's experiences of iOAT. METHODS Qualitative interviews were completed with 16 women enrolled in four iOAT programs in Vancouver, Canada. Approximately 50 hours of ethnographic observations were conducted. Interview transcripts and ethnographic fieldnotes were analyzed using a critical feminist lens by applying the concepts of embodiment, relationality, and social control to understand women's engagement and self-reported treatment outcomes. RESULTS Initial iOAT engagement was a relational process, including initiating treatment with a partner and engaging with iOAT to (re)build personal relationships. Relationships with iOAT providers, including flexibility and support with medication administration, were important to women, providing an affirming embodied experience and a greater sense of agency. However, program operations (e.g., mandated daily attendance, program crowding) incompatible with women's needs (e.g., employment) could undermine these positive experiences. Women's reported outcomes highlight a tension between achieving more agency and the constraints of intensive and stigmatized treatment. CONCLUSION This study highlights how iOAT is both a source of care and control for women from a relational and embodied perspective. Findings underscore the need for gender-attentive and flexible drug treatment services to meet the varied needs of women and the importance of providing relational care for women accessing iOAT.
Collapse
Affiliation(s)
- Samara Mayer
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 170-6371 Crescent Road, Vancouver, BC V6T 1Z2, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street. Vancouver, BC V6Z 1Y6, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street. Vancouver, BC V6Z 1Y6, Canada
| | - Jules Chapman
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada
| | - Isabella Brohman
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall. Vancouver, BC V6T 2B5, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street. Vancouver, BC V6Z 1Y6, Canada; Internal Medicine, Yale School of Medicine, New Haven, 06510, United States; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, 06510, United States; Department of Anthropology, Yale University, New Haven, 06510, United States.
| |
Collapse
|
9
|
Savic M, Barnett A, Pienaar K, Carter A, Warren N, Sandral E, Manning V, Lubman DI. Staying with the silence: Silence as affording care in online alcohol and other drug counselling. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104030. [PMID: 37148620 DOI: 10.1016/j.drugpo.2023.104030] [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: 07/28/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 05/08/2023]
Abstract
As the name 'talk therapy' suggests, a key aim of alcohol and other drug counselling, psychotherapy and other talk therapies is to discuss issues, concerns and feelings with a health professional. Implicit here is the therapeutic value of talking through issues with a trained professional. But as with all interactions, therapeutic encounters involve silences and pauses as key aspects of the communicative process. Despite their ubiquity in the therapeutic encounter, research tends to either dismiss silences as inconsequential or as having undesirable effects, such as generating awkwardness or even disengagement from treatment. Drawing on Latour's (2002) concept of 'affordance' and a qualitative study of an Australian alcohol and other drug counselling service, we explore the varied functions of silences in online text-based counselling sessions. For clients, these include the role of silence in affording opportunities to engage in other everyday practices, such as socialising, caregiving or working - practices that can generate comfort and reduce distress, which in turn may support the therapeutic encounter. Similarly, for counsellors, temporal silences provide opportunities to confer with other counsellors and provide tailored care. However, protracted silences can raise concerns about the safety and wellbeing of clients who do not respond promptly or who exit encounters unexpectedly. Similarly, the sudden cessation of online care encounters (often associated with technical difficulties) can leave clients feeling frustrated and confused. In tracking these diverse affordances of silence, we draw attention to its generative potential in care encounters. We conclude by exploring the implications of our analysis for conceptions of care that underpin alcohol and other drug treatment.
Collapse
Affiliation(s)
- Michael Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC.
| | - Anthony Barnett
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC
| | - Kiran Pienaar
- Deakin University, Sociology, School of Humanities and Social Sciences, VIC; Monash University, Sociology, School of Political and Social Sciences, Clayton, VIC
| | - Adrian Carter
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne
| | - Narelle Warren
- School of Social Sciences, Faculty of Arts, Monash University, VIC
| | - Emma Sandral
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC
| |
Collapse
|
10
|
Austin T, Lavalley J, Parusel S, Collins AB, Olding M, Boyd J. Women who use drugs: engagement in practices of harm reduction care. Harm Reduct J 2023; 20:49. [PMID: 37055805 PMCID: PMC10100181 DOI: 10.1186/s12954-023-00775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Harm reduction services that employ or are operated by people who use drugs are an effective means of mitigating overdose risks and other drug-related harms. However, stereotypes portraying people who use criminalized drugs as incapable caregivers persist. This is especially true for women who use drugs, and to a greater extent racialized women, who are characterized as having diverged from traditional ideals of womanhood as a result of drug-user stigma and the intersections of gender- and class-based and racist stereotypes. In an effort to identify and understand how women who use drugs practise care through harm reduction, we explored the experiences of women accessing a low-threshold supervised consumption site exclusively for women (transgender and non-binary inclusive) in Vancouver, Canada. METHODS Data were drawn from research conducted from May 2017 to June 2018 exploring women's experiences accessing the supervised consumption site during an overdose crisis. Data included forty-five semistructured interviews with women recruited from the site, analysed thematically to explore practices of care through harm reduction. FINDINGS Participants reported engaging in both formal and informal care. Acts of care included interventions that both aligned with and deviated from conventional understandings of care practices, including overdose reversal and education, overdose supervision/care, and assisted injection. CONCLUSION The boundary between formal and informal harm reduction care is fluid. Women who use drugs engage in harm reduction across these borders with acts of care that align with or fill the gaps in current harm reduction services in order to meet the needs of drug-using communities, challenging negative stereotypes of women who use drugs. However, these caregiving practices can increase risks to care providers' physical, mental, and emotional health and wellness. Increased financial, social, and institutional supports, including safer supply, assisted injection, and community resources, are needed to better support women as they continue to engage in harm reduction care.
Collapse
Affiliation(s)
- Tamar Austin
- Birth Place Lab, UBC Midwifery, Faculty of Medicine, University Boulevard, Vancouver, BC, 3302-5950, Canada
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Lavalley
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Sylvia Parusel
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Michelle Olding
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Burrard Street, Vancouver, BC, 608-1081, Canada.
| |
Collapse
|
11
|
Harris MT, Goldenberg S, Cui Z, Fairbairn N, Milloy MJS, Hayashi K, Samet JH, Walley AY, Nolan S. Association of sex work and social-structural factors with non-fatal overdose among women who use drugs in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103950. [PMID: 36640591 PMCID: PMC9974922 DOI: 10.1016/j.drugpo.2022.103950] [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: 08/28/2022] [Revised: 11/24/2022] [Accepted: 12/24/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Women who use drugs (WWUD) and engage in sex work experience disproportionate sex- and drug-related harms, such as HIV, however comparatively little is known about their overdose risk. Therefore, we examined the association between sex work and overdose and secondarily explored the association of social-structural factors, such as policing and gendered violence, with overdose. METHODS Data were derived from two community cohort studies based in Vancouver, Canada between 2005 to 2018. We used logistic regression with GEE to examine the associations between a) sex work and nonfatal overdose and b) social-structural and individual variables with overdose among WWUD who engaged in sex work during the study. Sex work, overdose, and other variables were time-updated, captured every six months. RESULTS Among 857 WWUD included, 56% engaged in sex work during the study. Forty-three percent of WWUD engaged in sex work had at least one overdose compared to 26% of WWUD who did not. Sex work was not significantly associated with an increased odds of overdose (AOR = 1.14, 95% CI: 0.93-1.40). In the exploratory analysis amongst 476 WWUD engaged in sex work, social-structural variables associated with overdose in the multivariable model included exposure to: punitive policing (OR = 1.97, 95% CI: 1.30-2.96) and physical or sexual violence (OR = 2.55, 95% CI: 1.88-3.46). CONCLUSIONS WWUD engaged in sex work had an increased overdose burden that may be driven by social-structural factors rather than sex work itself. Interventions that address policing and gendered violence represent potential targets for effective overdose prevention.
Collapse
Affiliation(s)
- Miriam Th Harris
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA, 02118, USA.
| | - Shira Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA; Centre for Gender and Sexual Health Equity, St Paul's Hospital, 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada
| | - Zishan Cui
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
| | - M-J S Milloy
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kanna Hayashi
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Jeffrey H Samet
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA, 02118, USA
| | - Alexander Y Walley
- Grayken Center for Addiction, Boston Medical Center, One Boston Medical Center Place, Boston, MA, 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave, Boston, MA, 02118, USA
| | - Seonaid Nolan
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, BC, V6Z 2A9, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada
| |
Collapse
|
12
|
Ivsins A, Warnock A, Small W, Strike C, Kerr T, Bardwell G. A scoping review of qualitative research on barriers and facilitators to the use of supervised consumption services. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103910. [PMID: 36436364 DOI: 10.1016/j.drugpo.2022.103910] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
A substantial body of evidence demonstrates that supervised consumption services (SCS) mitigate a variety of drug-related harms, including decreasing overdose deaths, infectious disease transmission, and connecting people who use drugs (PWUD) to various health and social services. Research on SCS has predominantly been quantitative, though qualitative research on these services has increased substantially over the last decade. Qualitative methods provide a framework for developing a richer and more nuanced understanding of meanings and contexts associated with drug use, health service implementation, and experience. We present findings from a scoping review of qualitative studies on experiences of PWUD with SCS published between 1997 and 2022. In total, forty-two papers were included in this analysis. Four primary themes emerged from our analysis: 1) Influence of SCS on health and wellbeing among PWUD, 2) the physical environment of SCS can be both a facilitator and barrier to use, 3) social resources can shape and reshape the context within which PWUD benefit from SCS, and 4) various intersecting forces at play both support and harm PWUD in relation to their experiences with SCS. We discuss the primary facilitators and barriers of SCS use and conclude with suggestions to inform future qualitative research, SCS implementation, and PWUD-centered approaches to drug policy.
Collapse
Affiliation(s)
- Andrew Ivsins
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - Ashley Warnock
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Psychiatry, University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Will Small
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Thomas Kerr
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Geoff Bardwell
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| |
Collapse
|
13
|
Allan J, Cameron J, Bruno J. A Systematic Review of Recreational Nitrous Oxide Use: Implications for Policy, Service Delivery and Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11567. [PMID: 36141850 PMCID: PMC9517250 DOI: 10.3390/ijerph191811567] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nitrous oxide (N2O) is a dissociative anaesthetic that is sometimes used recreationally. The prevalence of N2O use is difficult to quantify but appears to be increasing. Research on N2O harms and application of harm reduction strategies are limited. The aim of this mixed method systematic review was to collate and synthesise the disparate body of research on recreational nitrous oxide use to inform harm reduction approaches tailored for young people. METHODS To identify publications reporting the recreational use of N2O, a search of public health, psychology and social science databases was conducted. Databases included PubMed, CIHNAL, PsycINFO, Scopus and Web of Science. Grey literature and Google advanced search were also used. Due to limited published literature on the recreational use of N2O, no limit was placed on publication date or study type. A thematic synthesis extracted descriptive and analytical themes from the selected studies. Quality appraisal was conducted using the CASP Tool for Qualitative studies and the Joanna Briggs Institute case report assessment tool. RESULTS The search retrieved 407 reports. Thirty-four were included in the final analysis, including sixteen case reports. The included studies were primarily concerned with raising awareness of the apparently increasing use and subsequently increasing harms of recreational N2O use. There was limited reference to policy or legislative responses in any published studies, no suggestions for harm reduction strategies or application of service level responses. In general, individuals lack awareness of N2O-related harms. CONCLUSION The review found three key areas that deserve further consideration including: (1) policy, (2) service delivery, and (3) harm associated with N2O use. We recommend a top-down (policy) and bottom-up (services delivery/services users) approach to harm reduction for N2O use which also includes further consultation and research with both groups. Future research could explore young people's experience of N2O use including benefits and problems to inform contextually relevant harm reduction strategies.
Collapse
Affiliation(s)
- Julaine Allan
- School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
| | - Jacqui Cameron
- School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia
- Department of Social Work, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Juliana Bruno
- School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia
| |
Collapse
|
14
|
COVID-19 and the opportunity for gender-responsive virtual and remote substance use treatment and harm reduction services. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103815. [PMID: 35969920 PMCID: PMC9359504 DOI: 10.1016/j.drugpo.2022.103815] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 11/21/2022]
Abstract
The COVID-19 pandemic has increased the uptake of virtual and remote service delivery in the substance use field, which was previously uncommon. This swift uptake of virtual services provides an opportunity to improve service design to meet the diverse needs of women and gender-diverse people. Such services have the potential to better meet the needs of women and gender-diverse people by allowing for increased choice, control, and autonomy, enabling empowerment, facilitating greater considerations of power relations, violence, childcare responsibilities, and fostering greater inclusion of trans and non-binary people. This commentary aims to identify how virtual and remote delivery of substance use treatment and harm reduction services can be gender-responsive. We highlight the role gender transformative services play in meeting the unique needs of women and gender-diverse people who use drugs both during and after the COVID-19 pandemic. By using the unique window of opportunity COVID-19 has created to develop and deliver gender-transformative programs, we can help address the detrimental gaps in service accessibility and effectiveness that have persistently been experienced by women and gender-diverse people who use drugs.
Collapse
|
15
|
Goodman-Meza D, Arredondo J, Slim S, Angulo L, Gonzalez-Nieto P, Loera A, Shoptaw S, Cambou MC, Pitpitan EV. Behavior change after fentanyl testing at a safe consumption space for women in Northern Mexico: A pilot study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103745. [PMID: 35636071 PMCID: PMC9924820 DOI: 10.1016/j.drugpo.2022.103745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/29/2022] [Accepted: 05/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fentanyl has led to an increased number of overdose deaths in North America. Testing substances for fentanyl may be a harm reduction strategy to prevent overdose. Little is known about behavior change after fentanyl testing and the attitudes around fentanyl knowledge and testing along the US-Mexico border in the context of a safe consumption site. METHODS This was a pilot quantitative and qualitative study with 30 women who use drugs at an unsanctioned safe consumption site in Mexicali, Mexico. Women participated in a quantitative survey, a semi-structured interview, and fentanyl testing of substances. Injection behavior was observed after fentanyl testing results were provided. Qualitative data were collected to explore the meanings participants attributed to fentanyl and fentanyl testing. RESULTS Half of the substances tested positive for fentanyl (n=15, 50%), and all of them were in samples of black tar heroin. Among those participants who tested positive for fentanyl, 7 (47%) subsequently used less of the intended substance, 1 did not use the intended substance, and 7 (47%) did not change their behavior (i.e., used as originally intended). In qualitative interviews, a predominant theme was a description of fentanyl as dangerous and deadly and fentanyl testing as being helpful for modifying drug use behaviors. However, participants recognized that there could be no change in behavior following a positive fentanyl test in the context of not being able to find substances free of fentanyl. CONCLUSION We observed mixed results related to behavior change after women's intended substance for use tested positive for fentanyl. Fentanyl testing was acceptable to women, but behavior change was hampered by the inability to find substances free of fentanyl. Further research is needed to maximize the potential of fentanyl testing as a harm reduction tool especially in the context of a changing drug supply.
Collapse
Affiliation(s)
- David Goodman-Meza
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Jaime Arredondo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México; School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Said Slim
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Lourdes Angulo
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Pablo Gonzalez-Nieto
- Integración Social Verter, A.C., Calle José Azueta 230, Primera, 21100 Mexicali, B.C., México
| | - Alejandra Loera
- Centro de Investigación y Docencia Económicas (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, 20313 Aguascalientes, Ags., México
| | - Steve Shoptaw
- Centro de Investigación y Docencia Económicas (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, 20313 Aguascalientes, Ags., México; Department of Family Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Mary C Cambou
- Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Eileen V Pitpitan
- School of Social Work, San Diego State University, Hepner Hall room 119 5500 Campanile Drive, San Diego, CA, 92182, USA
| |
Collapse
|
16
|
Milaney K, Haines-Saah R, Farkas B, Egunsola O, Mastikhina L, Brown S, Lorenzetti D, Hansen B, McBrien K, Rittenbach K, Hill L, O'Gorman C, Doig C, Cabaj J, Stokvis C, Clement F. A scoping review of opioid harm reduction interventions for equity-deserving populations. LANCET REGIONAL HEALTH. AMERICAS 2022; 12:100271. [PMID: 36776426 PMCID: PMC9904129 DOI: 10.1016/j.lana.2022.100271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Morbidity and mortality associated with opioid use has become a North American crisis. Harm reduction is an evidence-based approach to substance use. Targeted harm reduction strategies that consider the needs of specific populations are required. The objective of this scoping review was to document the range of opioid harm reduction interventions across equity-deserving populations including racialized groups, Indigenous peoples, LGBTQIA2S+, people with disabilities, and women. Methods Ten databases were searched from inception to July 5th, 2021. Terms for harm reduction and opioid use formed the central concepts of the search. We included studies that: (1) assessed the development, implementation, and/or evaluation of harm reduction interventions for opioid use, and (2) reported health-related outcomes or presented perspectives that directly related to experiences receiving or administering harm reduction interventions, (3) were completed within an equity-deserving population and (4) were completed in New Zealand, Australia, Canada or the US. A knowledge map was developed a-priori based on literature outlining different types of harm reduction interventions and supplemented by the expertise of the research team. Findings 12,958 citations were identified and screened, with 1373 reviewed in full-text screening. Of these, 15 studies were included in the final dataset. The most common harm reduction program was opioid agonist treatment (OAT) (n = 11, 73%). The remaining four studies included: overdose prevention; drug testing equipment; and outreach, peer support, and educational programs for safer use. Nine studies focused on women, primarily pregnant/post-partum women, three focused on Indigenous peoples, and three studies included racialized groups. No studies were identified that provided any information on persons with a disability or members of the LGBTQIA2S+ population. Interpretation The scant opioid specific harm reduction literature on equity-deserving populations to date has primarily focused on OAT programs and is focused primarily on women. There is a need for more targeted research to address the diverse social experiences of people who use drugs and the spectrum of harm reduction interventions that are needed. There is also a need to acknowledge the history of harm reduction as a drug-user activist movement aimed at challenging bio-medical paradigms of drug use. Further, there is a need to recognize that academic research may be contributing to health inequity by not prioritizing research with this lens. Funding This research was funded by the Canadian Institutes of Health Research.
Collapse
Affiliation(s)
- Katrina Milaney
- University of Calgary, Calgary, Alberta, Canada,Corresponding author.
| | | | | | | | | | - Sage Brown
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | - Leslie Hill
- Community Partners, Calgary, Alberta, Canada
| | | | | | | | | | | |
Collapse
|
17
|
Davidson PJ, Wenger LD, Lambdin BH, Kral AH. Establishment and Enforcement of Operational Rules at an Unsanctioned Safe Drug Consumption Site in the United States, 2014-2020. Am J Public Health 2022; 112:S166-S172. [PMID: 35349308 PMCID: PMC8965194 DOI: 10.2105/ajph.2022.306714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To examine how operational rules are established and enforced at an unsanctioned safe consumption site (SCS) operating in the United States. Methods. We conducted 44 qualitative interviews with people who use drugs, staff members, and volunteers at an unsanctioned SCS and analyzed them using an inductive thematic approach. Results. Rule-making processes were largely driven by concerns raised by service users rather than driven by external pressures, and iterated rapidly in response to changing needs. The unsanctioned nature of the site produced an environment where bottom-up rule-making was critical to generating a shared sense of ownership of the site and where enforcement was necessarily fluid. Conclusions. Removing external restrictions on operational rules for SCSs results in a flexible set of rules that are highly responsive to the social and public health needs of people who use drugs. Legislation and regulations of SCSs should aim to place as few hard limits on operating conditions as possible to maximize involvement of and responsiveness to people who use drugs. (Am J Public Health. 2022;112(S2):S166-S172. https://doi.org/10.2105/AJPH.2022.306714).
Collapse
Affiliation(s)
- Peter J Davidson
- Peter J. Davidson is with the Division of Infectious Disease & Global Public Health, Department of Medicine, University of California, San Diego. Lynn D. Wendger, Barrot H. Lambdin, and Alex H. Kral are with the Community Health Research Division, RTI International, Berkeley CA
| | - Lynn D Wenger
- Peter J. Davidson is with the Division of Infectious Disease & Global Public Health, Department of Medicine, University of California, San Diego. Lynn D. Wendger, Barrot H. Lambdin, and Alex H. Kral are with the Community Health Research Division, RTI International, Berkeley CA
| | - Barrot H Lambdin
- Peter J. Davidson is with the Division of Infectious Disease & Global Public Health, Department of Medicine, University of California, San Diego. Lynn D. Wendger, Barrot H. Lambdin, and Alex H. Kral are with the Community Health Research Division, RTI International, Berkeley CA
| | - Alex H Kral
- Peter J. Davidson is with the Division of Infectious Disease & Global Public Health, Department of Medicine, University of California, San Diego. Lynn D. Wendger, Barrot H. Lambdin, and Alex H. Kral are with the Community Health Research Division, RTI International, Berkeley CA
| |
Collapse
|
18
|
Boyd J, Maher L, Austin T, Lavalley J, Kerr T, McNeil R. Mothers Who Use Drugs: Closing the Gaps in Harm Reduction Response Amidst the Dual Epidemics of Overdose and Violence in a Canadian Urban Setting. Am J Public Health 2022; 112:S191-S198. [PMID: 35349325 PMCID: PMC8965171 DOI: 10.2105/ajph.2022.306776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To identify key gaps in overdose prevention interventions for mothers who use drugs and the paradoxical impact of institutional practices that can increase overdose risk in the context of punitive drug policies and a toxic drug supply. Methods. Semistructured interviews were conducted with 40 women accessing 2 women-only, low-barrier supervised consumption sites in Greater Vancouver, British Columbia, Canada, between 2017 and 2019. Our analysis drew on intersectional understandings of structural, everyday, and symbolic violence. Results. Participants' substance use and overdose risk (e.g., injecting alone) was shaped by fear of institutional and partner scrutiny and loss (or feared loss) of child custody or reunification. Findings indicate that punitive policies and institutional practices that frame women who use drugs as unfit parents continue to negatively shape the lives of women, most significantly among Indigenous participants. Conclusions. Nonpunitive policies, including access to safe, nontoxic drug supplies, are critical first steps to decreasing women's overdose risk alongside gender-specific and culturally informed harm-reduction responses, including community-based, peer-led initiatives to maintain parent-child relationships. (Am J Public Health. 2022;112(S2):S191-S198. https://doi.org/10.2105/AJPH.2022.306776).
Collapse
Affiliation(s)
- Jade Boyd
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Lisa Maher
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Tamar Austin
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Jennifer Lavalley
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Thomas Kerr
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
| | - Ryan McNeil
- Jade Boyd and Thomas Kerr are with the Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Lisa Maher is with the Kirby Institute for Infection and Immunity, Faculty of Medicine, University of New South Wales, Sydney, Australia. Tamar Austin and Jennifer Lavalley are with the British Columbia Centre on Substance Use (BCCSU), Vancouver. Ryan McNeil is with the Program in Addiction Medicine and General Internal Medicine, Yale School of Medicine, New Haven, CT. Ryan McNeil is also a Guest Editor of this supplement issue
| |
Collapse
|
19
|
Kennedy MC, Hayashi K, Milloy MJ, Compton M, Kerr T. Health impacts of a scale-up of supervised injection services in a Canadian setting: an interrupted time series analysis. Addiction 2022; 117:986-997. [PMID: 34854162 PMCID: PMC8904318 DOI: 10.1111/add.15717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS In response to a dramatic rise in overdose deaths due to injection drug use, there was a rapid scale-up of low-threshold supervised injection services (SIS), termed 'overdose prevention sites' (OPS), in Vancouver, Canada in December 2016. We measured the potential impact of this intervention on SIS use and related health outcomes among people who inject drugs (PWID). DESIGN Segmented regression analyses of interrupted time series data from two community-recruited prospective cohorts of PWID from January 2015 to November 2018 were used to measure the impact of the OPS scale-up on changes in SIS use, public injection, syringe sharing and addiction treatment participation, controlling for pre-existing secular trends. SETTING Vancouver, Canada. PARTICIPANTS Of 745 PWID, 292 (39.7%) were women, 441 (59.6%) self-reported white ancestry and the median age was 47 years (interquartile range = 38, 53) at baseline. MEASUREMENTS Immediate (i.e. step level) and gradual (i.e. slope) changes in the monthly proportion of participants who self-reported past 6-month SIS use, public injection, syringe sharing and participation in any form of addiction treatment. FINDINGS Post OPS expansion, the monthly prevalence of SIS use immediately increased by an estimated 6.4% [95% confidence interval (CI) = 1.7, 11.2] and subsequently further increased by an estimated 0.7% (95% CI = 0.3, 1.1) per month. The monthly prevalence of addiction treatment participation immediately increased by an estimated 4.5% (95% CI = 0.5, 8.5) following the OPS expansion, while public injection and syringe sharing were estimated to immediately decrease by 5.5% (95% CI = 0.9, 10.0) and 2.5% (95% CI = 0.5, 4.6), respectively. Findings were inconclusive as to whether or not an association was present between the intervention and subsequent gradual changes in public injection, syringe sharing and addiction treatment participation. CONCLUSIONS Scaling-up overdose prevention sites in Vancouver, Canada in December 2016 was associated with immediate and continued gradual increases in supervised injection service engagement and immediate increases in related health benefits.
Collapse
Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | | | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| |
Collapse
|
20
|
Meyers-Pantele SA, Jain S, Sun X, Marks C, DeBeck K, Hayashi K, Strathdee SA, Werb D. Gender and the first-time provision of injection initiation assistance among people who inject drugs across two distinct North American contexts: Tijuana, Mexico and Vancouver, Canada. Drug Alcohol Rev 2022; 41:686-696. [PMID: 34636100 PMCID: PMC8930605 DOI: 10.1111/dar.13390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Injection drug use initiation is commonly facilitated by other people who inject drugs (PWID). We investigated how the gender of PWID influences their risk of providing initiation assistance to others across two distinct geo-cultural settings. METHODS Data were drawn from two prospective cohorts in Tijuana, Mexico and Vancouver, Canada which conducted semi-annual interviews within the PReventing Injecting by Modifying Existing Responses (PRIMER) study. Participants consisted of PWID who had reported never providing injection initiation assistance at baseline. We then conducted site-specific discrete-time survival analyses assessing the relationship between gender and other relevant covariates (e.g. age and past 6-month sex work) on the risk of the first reported instance of providing initiation assistance. RESULTS Of 1988 PWID (Tijuana: n = 596; Vancouver: n = 1392), 256 (43%) and 511 (36.7%) participants were women, and 42 (1.7%) and 78 (1.6%) reported recent injection initiation assistance across a median of three and two follow-up visits, respectively. Women had a lower risk of providing injection initiation assistance for the first time in Tijuana (adjusted hazard ratio = 0.52, 95% confidence interval 0.27-0.99), but not in Vancouver. Gendered pathways, like sex work, were associated with providing initiation assistance for the first time in Vancouver (adjusted hazard ratio = 1.97, 95% confidence interval 1.08-3.61). DISCUSSION AND CONCLUSIONS Women in Tijuana, but not Vancouver, were less likely to provide first-time initiation assistance among PWID. These results can inform gender- and site-specific prevention efforts aimed at reducing transitions into drug injecting across geographic contexts.
Collapse
Affiliation(s)
- Stephanie A. Meyers-Pantele
- Department of Psychology, San Diego State University, San Diego, USA,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, USA
| | - Charles Marks
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA,School of Public Health, University of Nevada, Reno, USA
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, USA,Centre on Drug Policy Evaluation, St. Michael’s Hospital, Toronto, Canada
| |
Collapse
|
21
|
Research With Women Who Use Drugs: Applying a Trauma-informed Framework. J Addict Med 2022; 16:627-629. [PMID: 35678457 PMCID: PMC9970160 DOI: 10.1097/adm.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Women who use drugs (WWUD) experience high rates of trauma. The complex impacts of trauma can act as a barrier to accessing substance use and harm reduction services, and to participation and representation within substance use research. Trauma-informed practice is an evidence-based approach for improved clinical care among WWUD, the principles of which can be applied to substance use research. Many researchers are integrating trauma-informed approaches across research settings, yet these principles are often not referenced specifically within publications, and there is a lack of comprehensive guidance regarding integration of trauma-informed methods across different research designs and methodologies. This commentary describes and discusses the merits of applying the 4 principles of trauma-informed practice - trauma awareness, safety and trustworthiness, choice collaboration and connection, and strengths-based and skills building - to promote safety and inclusion of WWUD in substance use research.
Collapse
|
22
|
Collins AB, McNeil R, Czechaczek S, Boyd J. " That's what I'm supposed to do at work": Gendered labor, self-care, and overdose risk among women who use drugs in Vancouver, Canada. CRITICAL PUBLIC HEALTH 2022; 32:382-391. [PMID: 35812810 PMCID: PMC9268005 DOI: 10.1080/09581596.2020.1844151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Through rapid ethnography undertaken in Vancouver, Canada's Downtown Eastside - one of Canada's overdose epicenters - this article examines how gendered expectations of labor shape overdose risk for structurally vulnerable women and gender diverse people who use drugs. Drawing on two participant narratives, we explore how structural, symbolic, and everyday violence frame the lives of women and gender diverse people who use drugs in ways that drive their overdose risk as they balance self-care with caretaking, paid work, and basic survival. This article underscores the need for structural reform of peer overdose response work and funding for gender-attentive harm reduction and ancillary supports to better mitigate overdose risk for these populations.
Collapse
Affiliation(s)
- Alexandra B. Collins
- School of Public Health, Brown University, 121 S Main Street, Providence, RI 02903, United States
| | - Ryan McNeil
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, United States, General Internal Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, United States
| | - Sandra Czechaczek
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC V6Z 2A9, Canada, Department of Medicine, University of British Columbia, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| |
Collapse
|
23
|
Olding M, Cook A, Austin T, Boyd J. "They went down that road, and they get it": A qualitative study of peer support worker roles within perinatal substance use programs. J Subst Abuse Treat 2021; 132:108578. [PMID: 34373170 DOI: 10.1016/j.jsat.2021.108578] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Perinatal substance use programs employ multidisciplinary teams to support women who use drugs through pregnancies and parenting, with some programs expanding to include peer support workers with lived experience of parenting and substance use. Research has shown peer support to enhance care in substance use treatment; however, little research exists that examines this model of support within perinatal substance use programs. We explore the current and potential role of peer support workers within perinatal substance use programs, from the perspectives of mothers accessing these programs. METHODS We conducted focus groups with 20 mothers enrolled in three perinatal substance use programs serving the greater Vancouver area, including two community-based programs that employed peer workers and an acute care maternity ward that did not. We recorded focus groups, had them professionally transcribed, and analyzed them thematically. RESULTS Participants characterized peer support workers as extending and complementing informal care practices already occurring within programs, including mother-to-mother support with breastfeeding, childcare, and system navigation. Integrating peer workers shifted care relations and practices in ways that participants found beneficial. Participants emphasized how support workers with similar social locations and life experiences-beyond just their substance use-helped to foster trust and safety for mothers in the program. Indigenous mothers discussed the importance of having Indigenous support workers whose practice is grounded in their cultures and experiences under colonization. Participants ascribed an aspirational status to peer support workers, conveying that it was motivational to see other mothers working in the program, and described the role as a means of maintaining connection and community. However, some expressed concerns about managing professional-personal boundaries and being emotionally "triggered" by the work. CONCLUSION This study evidences benefits of employing peer support workers within perinatal substance use programs, while also indicating the need for organizational processes to ensure that peer staff are integrated equitably and supported adequately.
Collapse
Affiliation(s)
- Michelle Olding
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Ainslie Cook
- BC Women's Hospital + Health Centre, Vancouver, BC, Canada
| | - Tamar Austin
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
24
|
Barnhart KJ, Dodge B, Sayegh MA, Herbenick D, Reece M. Shared injection experiences: Interpersonal involvement in injection drug practices among women. Subst Abus 2021; 42:912-918. [PMID: 33798019 DOI: 10.1080/08897077.2021.1903650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many women who inject drugs are aware of the associated risks, however social influences play a part in their behavioral decisions. Incorporation of others in drug use behaviors may be common practice among women who use drugs. The aim of this study was to gain an in-depth understanding of women's injection drug use experiences with a focus on interpersonal involvement. Methods: Venue-based recruitment was conducted in collaboration with a harm reduction program. A group of 30 women, ages 18 and older, who reported injecting drugs within the past 30 days took part in a demographic survey and semi-structured interview to gain an understanding of their injection practices. In vivo coding and thematic analysis were conducted. Results: Three main themes that relate to incorporating others into injection drug behaviors surfaced, including: (1) injection practices described as we and not I, (2) partnered purchase and drug preparation, and (3) assisted injection. This group of women most often incorporated sexual and/or romantic partners (same and other-gender), friends, or family members into their injection drug use behaviors. Some women described a lack of ability to inject themselves and require assistance every time they use. Women also reported helping other women during drug use behaviors. Conclusions: Our primary themes indicate that a variety of relationship partners are important conceptual links in theoretical frameworks explaining drug use behaviors among women. Findings suggest same gender assistance during drug use behaviors, including injection, that may reduce harm. The interpersonal nature of injection drug use among women may indicate the expansion of treatment options designed for couples or other relationship partners, such as family, together.
Collapse
Affiliation(s)
- Kathryn J Barnhart
- Department of Public Health, Grand Valley State University, Grand Rapids, MI, USA
| | - Brian Dodge
- School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - M Aaron Sayegh
- School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Debby Herbenick
- School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| |
Collapse
|
25
|
Mitra S, Lee W, Hayashi K, Boyd J, Milloy M, Dong H, Wood E, Kerr T. A gender comparative analysis of post-traumatic stress disorder among a community-based cohort of people who use drugs in Vancouver, Canada. Addict Behav 2021; 115:106793. [PMID: 33421746 DOI: 10.1016/j.addbeh.2020.106793] [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] [Received: 09/02/2020] [Revised: 11/18/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND While exposure to traumatic events and subsequent post-traumatic stress disorder (PTSD) are common among people who use drugs (PWUD), little is known about gender-based differences associated with PTSD in this population. We explore gender-based differences in factors associated with a probable PTSD diagnosis in a cohort of PWUD from Vancouver, Canada. METHODS Data were collected through the Vancouver Injection Drug Users Study (VIDUS) and the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS), two community-recruited cohorts of PWUD. Participants were administered the PTSD Checklist for DSM-5. Multivariable logistic regression was used to investigate social-structural factors and substance use patterns and behaviours associated with a probable PTSD diagnosis, stratified by self-identified gender. PTSD symptom clusters and brief descriptions of the worst traumatic event experienced were also reported. RESULTS Between December 2016 and December 2018, of 797 eligible participants, 295 (37.0%) identified as women. PTSD was more commonly reported in women compared to men (53.2% vs. 31.5%, p < 0.001). In multivariable analysis involving men, no correlates were associated with PTSD. In multivariable analysis involving women, PTSD was positively associated with exposure to violence (AOR: 3.66; 95%CI: 1.14-11.72), daily stimulant use (AOR: 2.32; 95%CI: 1.32-4.08) and heavy alcohol use (AOR: 3.84; 95%CI: 1.84-8.00), and negatively associated with being in a stable relationship (AOR: 0.46; 95%CI: 0.25-0.84). CONCLUSIONS Gender-based differences in PTSD diagnosis among a cohort of PWUD point to the need to develop gender-focused and trauma-informed health and social services to meet the immediate needs of PWUD living with PTSD.
Collapse
|
26
|
Sa M, C R, Ml M, Lr S, J TM, S J, X S, Rs G, Sa S, K D, K H, R M, Mj M, M O, A G, D W, Ai S. Examining the gender composition of drug injecting initiation events: A mixed methods investigation of three North American contexts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103056. [PMID: 33310638 PMCID: PMC8046711 DOI: 10.1016/j.drugpo.2020.103056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/03/2020] [Accepted: 11/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gender influences the health and social risks faced by individuals initiating drug injecting. Using mixed methods across three settings in North America, we investigated the gender composition of injection initiation events and the gendered risk environments in which they occurred. METHODS The PReventing Injecting by Modifying Existing Responses (PRIMER) study pooled data from three prospective community-recruited cohorts of people who inject drugs (PWID) in San Diego, USA, Vancouver, Canada, and Tijuana, Mexico. A qualitative subsample provided narrative data on their experiences of, and the contexts for, injection initiation events. Guided by Rhodes' risk environment framework, we examined the gender composition of initiation events stratified by city, and analyzed qualitative data using abductive thematic analyses. RESULTS Among 2,622 PWID (Tijuana: n = 531; San Diego: n = 352; Vancouver: n = 1,739), 112 (4.3%) reported providing initiation assistance to injection-naïve individuals in the previous six months. The proportion of gender concordant (e.g., male-male) initiation pairs varied, (χ2 = 10.32, p <0.001) with greater than expected concordance among pairs in Tijuana compared with those in Vancouver or San Diego. Sixty-one interviews provided context for the discrepancy across sites by highlighting the gendered injection initiation risk environments of prison/jail detention in Tijuana, intimate partnerships in San Diego, and overdose risk in Vancouver. CONCLUSIONS These results highlight how gender influences injection initiation events within spatial, social, and economic risk environments, and how this influence varies across settings. These findings can inform interventions to reduce the risk of injection initiation and related harms.
Collapse
Affiliation(s)
- Meyers Sa
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, United States; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Rafful C
- Facultad de Psicología, Universidad Nacional Autónoma de México, University City, Coyoacán, 04510, Mexico City, Mexico
| | - Mittal Ml
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Colonia Chapultepec Alamar C.P. 22540, Tijuana, Baja California, Mexico
| | - Smith Lr
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Tirado-Muñoz J
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Jain S
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Sun X
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Garfein Rs
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Strathdee Sa
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - DeBeck K
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 Canada
| | - Hayashi K
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6 Canada
| | - McNeil R
- School of Medicine, Yale, 333 Cedar Street, New Haven, CT, 06510, United States
| | - Milloy Mj
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9 Canada
| | - Olding M
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9 Canada
| | - Guise A
- Addison House, Guy's Hospital, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Werb D
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada
| | - Scheim Ai
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8 Canada; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, United States.
| |
Collapse
|
27
|
Bardwell G, Austin T, Maher L, Boyd J. Hoots and harm reduction: a qualitative study identifying gaps in overdose prevention among women who smoke drugs. Harm Reduct J 2021; 18:29. [PMID: 33678163 PMCID: PMC7937364 DOI: 10.1186/s12954-021-00479-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/26/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Smoking or inhaling illicit drugs can lead to a variety of negative health outcomes, including overdose. However, most overdose prevention interventions, such as supervised consumption services (SCS), prohibit inhalation. In addition, women are underrepresented at SCS and are disproportionately impacted by socio-structural violence. This study examines women's experiences smoking illicit drugs during an overdose epidemic, including their utilization of a women-only supervised inhalation site. METHODS Qualitative research methods included on-site ethnographic observation and semi-structured interviews with 32 participants purposively recruited from the women-only site. Data were coded and analyzed using NVivo 12 and thematic analysis was informed by gendered and socio-structural understandings of violence. RESULTS Participants had preferences for smoking drugs and these were shaped by their limited income, inability to inject, and perceptions of overdose risk. Participants expressed the need for services that attend to women's specific experiences of gendered, race-based, and structural violence faced within and outside mixed-gender social service settings. Results indicate a need for sanctioned spaces that recognize polysubstance use and drug smoking, accommodated by the women-only SCS. The smoking environment further fostered a sociability where participants could engage in perceived harm reduction through sharing drugs with other women/those in need and were able to respond in the event of an overdose. CONCLUSIONS Findings demonstrate the ways in which gendered social and structural environments shape women's daily experiences using drugs and the need for culturally appropriate interventions that recognize diverse modes of consumption while attending to overdose and violence. Women-only smoking spaces can provide temporary reprieve from some socio-structural harms and build collective capacity to practice harm reduction strategies, including overdose prevention. Women-specific SCS with attention to polysubstance use are needed as well as continued efforts to address the socio-structural harms experienced by women who smoke illicit drugs.
Collapse
Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Tamar Austin
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Lisa Maher
- Faculty of Medicine, Kirby Institute for Infection and Immunity, UNSW Sydney, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| |
Collapse
|
28
|
Bardwell G, Fleming T, McNeil R, Boyd J. Women's multiple uses of an overdose prevention technology to mitigate risks and harms within a supportive housing environment: a qualitative study. BMC WOMENS HEALTH 2021; 21:51. [PMID: 33530987 PMCID: PMC7856712 DOI: 10.1186/s12905-021-01196-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
Background North America is amidst an opioid overdose epidemic. In many settings, particularly Canada, the majority of overdose deaths occur indoors and impact structurally vulnerable people who use drugs alone, making targeted housing-based interventions a priority. Mobile applications have been developed that allow individuals to solicit help to prevent overdose death. We examine the experiences of women residents utilizing an overdose response button technology within a supportive housing environment. Methods In October 2019, we conducted semi-structured qualitative interviews with 14 residents of a women-only supportive housing building in an urban setting where the overdose response button technology was installed. Data was analyzed thematically and framed by theories of structural vulnerability. Results While participants described the utility and disadvantages of the technology for overdose response, most participants, unexpectedly described alternate adoptions of the technology. Participants used the technology for other emergency situations (e.g., gender-based violence), rather than its intended purpose of overdose response. Conclusions Our findings highlight the limitations of current technologies while also demonstrating the clear need for housing-based emergency response interventions that address not just overdose risk but also gender-based violence. These need to be implemented alongside larger strategies to address structural vulnerabilities and provide greater agency to marginalized women who use drugs.
Collapse
Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Taylor Fleming
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Yale School of Medicine, 367 Cedar Street, New Haven, CT, 06510, USA
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| |
Collapse
|
29
|
[Public policies for people who use drugs: Strategies for the elimination of stigma and the promotion of human rights]. Salud Colect 2021; 17:e3041. [PMID: 33822543 DOI: 10.18294/sc.2021.3041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
This paper aims to provide theoretically informed practical proposals for the improvement of current drug policies, which are based on a biological model of disease and the criminalization of people who use drugs. First, we present alternatives to a biologically-oriented scientific conception centered around neuroscientific postulates, which support the idea that the etiology of addiction materializes in the brain, in favor of models based on the social sciences where context plays a relevant role in the description and management approaches regarding different uses of psychoactive substances. Second, epistemological models and proposals are offered from a practical perspective to sustain or implement policies and programs in accordance with a more sustainable approach based on the elimination of stigma and the promotion of political participation of people who use drugs. In short, drug policies based on human rights.
Collapse
|
30
|
Austin T, Boyd J. Having a voice and saving lives: a qualitative survey on employment impacts of people with lived experience of drug use working in harm reduction. Harm Reduct J 2021; 18:1. [PMID: 33407500 PMCID: PMC7789009 DOI: 10.1186/s12954-020-00453-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/07/2020] [Indexed: 11/14/2022] Open
Abstract
Background Ongoing legal and social discrimination, and stigmatization of people with lived experience of drug use (PWLE) continues to contribute to overdose-related deaths in Canada. The involvement of PWLE working in harm reduction services has proven effective in decreasing drug-related harms among PWLE; however, there exist unintended negative impacts. PWLE working in harm reduction services risk overextending themselves beyond employment parameters (e.g., emotional labor) with few systems in place (e.g., employment advocacy) for support. While meaningful participation of PWLE in harm reduction programs is critical to addressing the overdose crisis, their labor in Canada’s overdose response commands further investigation and recognition. This paper examines some of the benefits and negative aspects of working in harm reduction among PWLE. Methods Fifty qualitative surveys were completed by PWLE working in harm reduction services from across Canada at the National 2018 Stimulus conference held in Edmonton, Alberta. The surveys focused on the benefits and negatives of ‘peer’ employment and recommendations for organizational transformation through short answer written sections. Surveys were analyzed thematically using NVivo, informed by critical perspectives on substance use, with attention to key re-occurring themes on employment equity. Results While participants described multiple benefits of working in harm reduction services, such as the valuing of their expertise by fellow ‘peers,’ growing skill sets, countering stigma, and preventing overdose deaths, issues of workplace equity were significantly identified. Stigma, tokenism, workplace discrimination, including power and pay inequities, as well as lack of worker compensation and benefits were identified as key factors persisting in the everyday experiences of participants. Conclusion Continued exposure to stigma, workplace discrimination, and/or power imbalances, combined with the impact of high stakes employment (e.g., dealing with overdose deaths), can have significant consequences for PWLE working in harm reduction, including burn out. Policy recommendations include large-scale structural changes that address inequities of hierarchical ‘peer’ employment for PWLE, including increased leadership roles for diverse PWLE, pay equity and benefits, unionization, as well as more supportive working environments attentive to the intersecting social-structural factors (poverty, criminalization, racism, gendered violence) impacting the everyday lives of PWLE working in harm reduction.
Collapse
Affiliation(s)
| | - Tamar Austin
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| |
Collapse
|
31
|
Värmå Falk M, Strömdahl S, Ekström AM, Kåberg M, Karlsson N, Dahlborn H, Hammarberg A. A qualitative study of facilitators and barriers to participate in a needle exchange program for women who inject drugs. Harm Reduct J 2020; 17:84. [PMID: 33092595 PMCID: PMC7579804 DOI: 10.1186/s12954-020-00425-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women who inject drugs (WWID) show higher levels of injecting risk behaviour compared to men, putting them at risk of contracting HIV and hepatitis C (HCV). Compared to men, WWID are also less present in harm reduction programs such as needle exchange programs (NEP). The aim of this study is to investigate reasons for, and barriers to, participation in NEP among WWID in Sweden, and to identify measures that could be taken to strengthen the program and increase participation among WWID. METHOD In-depth interviews (IDIs) were conducted with 20 WWID who had participated in the Stockholm NEP for at least six months and was over 18 years old. IDIs were audio recorded and transcribed et verbatim. Qualitative content analysis was used to identify themes. RESULTS The need for sterile injection equipment was identified as the main driver to join and remain in the NEP program. Continuous participation in the NEP was further driven by easy access to a multitude of health-related services. The most valued service was the sexual and reproductive health services (SRHR), allowing participants to access contraceptives, cervical cancer screening and sexually transmitted infections testing (STI-testing). NEP staffs' respectful treatment of participants further contributed to program participation. However, participants also expressed a number of concerns around NEP participation, which created barriers to joining. These included losing custody or visitation rights to children, male partner jealousy and violence, unwillingness to spend time in the waiting area and fear of receiving positive HIV/HCV test results. Practical barriers included limited opening hours and travel distance to the NEP. To strengthen the program, most participants requested additional SRHR services. Most participants also proposed some form of "women only" access to the NEP, to strengthen the feeling of the NEP as a safe space. CONCLUSION This study identified factors that may increase uptake of NEP among WWID. Additional SRHR services and "women only" access are recommended to be implemented and evaluated as part of NEP. These findings may inform and improve the current scale-up of NEPs in Sweden to ensure equal access to services.
Collapse
Affiliation(s)
- Malin Värmå Falk
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
| | - Susanne Strömdahl
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Kåberg
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Niklas Karlsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - Helena Dahlborn
- Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
32
|
Barnett A, Savic M, Pienaar K, Carter A, Warren N, Sandral E, Manning V, Lubman DI. Enacting 'more-than-human' care: Clients' and counsellors' views on the multiple affordances of chatbots in alcohol and other drug counselling. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 94:102910. [PMID: 33059955 PMCID: PMC7550115 DOI: 10.1016/j.drugpo.2020.102910] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 01/08/2023]
Abstract
Forms of artificial intelligence (AI), such as chatbots that provide automated online counselling, promise to revolutionise alcohol and other drug treatment. Although the replacement of human counsellors remains a speculative prospect, chatbots for ‘narrow AI’ tasks (e.g., assessment and referral) are increasingly being used to augment clinical practice. Little research has addressed the possibilities for care that chatbots may generate in the future, particularly in the context of alcohol and other drug counselling. To explore these issues, we draw on the concept of technological ‘affordances’ and identify the range of possibilities for care that emerging chatbot interventions may afford and foreclose depending on the contexts in which they are implemented. Our analysis is based on qualitative data from interviews with clients (n=20) and focus group discussions with counsellors (n=8) conducted as part of a larger study of an Australian online alcohol and other drug counselling service. Both clients and counsellors expressed a concern that chatbot interventions lacked a ‘human’ element, which they valued in empathic care encounters. Most clients reported that they would share less information with a chatbot than a human counsellor, and they viewed this as constraining care. However, clients and counsellors suggested that the use of narrow AI might afford possibilities for performing discrete tasks, such as screening, triage or referral. In the context of what we refer to as ‘more-than-human’ care, our findings reveal complex views about the types of affordances that chatbots may produce and foreclose in online care encounters. We conclude by discussing implications for the potential ‘addiction futures’ and care trajectories that AI technologies offer, focussing on how they might inform alcohol and other drug policy, and the design of digital healthcare.
Collapse
Affiliation(s)
- Anthony Barnett
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia.
| | - Michael Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Kiran Pienaar
- School of Humanities and Social Sciences, Deakin University, Melbourne, VIC, Australia; and School of Social Sciences, Monash University, Melbourne, VIC, Australia
| | - Adrian Carter
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia and University of Queensland Centre of Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Narelle Warren
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, VIC, Australia
| | - Emma Sandral
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia
| |
Collapse
|
33
|
Meyers SA, Smith LR, Werb D. Preventing transitions into injection drug use: A call for gender-responsive upstream prevention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102836. [PMID: 32679459 DOI: 10.1016/j.drugpo.2020.102836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 01/30/2023]
Abstract
In 2017, there were large increases (260-500%) in overdose deaths among women in the United States across age groups (30-64 years and 55-64 years). In addition, U.S. women who inject drugs (WWID) are at increased risk for substance use-related disease transmission, bacterial infections, as well as sexual and physical violence compared to men who inject drugs. Relatedly, women face unique access barriers to substance use-related services, such as stigma and low coverage of gender-specific drug use-related services. Despite these heightened risks experienced by WWID, interventions specifically tailored to preventing women from transitioning into injection drug use have not been developed to date. As such, we advocate for the development of gender-responsive programs to prevent injection drug use initiation. This is critical to ensuring a comprehensive approach to preventing injection drug use initiation among those populations at highest risk of injection-related morbidity and mortality.
Collapse
Affiliation(s)
- Stephanie A Meyers
- School of Social Work, College of Health and Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1T8, Canada.
| |
Collapse
|