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Wagner KD, Lee L. Commentary on Rosen et al.: Attending to the unique needs of pregnant and parenting women at risk for overdose. Addiction 2023; 118:855-856. [PMID: 36823721 DOI: 10.1111/add.16161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Karla D Wagner
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, NV, USA
| | - Lisa Lee
- College of Health Sciences and Public Policy, Walden University, Minneapolis, MN, USA
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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.
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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
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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.
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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
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Injecting drugs alone during an overdose crisis in Vancouver, Canada. Harm Reduct J 2022; 19:125. [PMID: 36397146 PMCID: PMC9670082 DOI: 10.1186/s12954-022-00701-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Settings throughout Canada and the USA continue to experience crises of overdose death due to the toxic unregulated drug supply. Injecting drugs alone limits the potential for intervention and has accounted for a significant proportion of overdose deaths, yet the practice remains understudied. We sought to examine the practice of injecting alone among people who inject drugs (PWID) in Vancouver, Canada. METHODS Data were derived from two prospective cohorts of people who use drugs between June 2016 and November 2018. This analysis was restricted to participants who, in the previous 6 months, reported any injection drug use. Rates of injecting alone were categorized as always, usually, sometimes, or occasionally. We fit a multivariable generalized linear mixed model to identify factors associated with injecting drugs alone. RESULTS Among 1070 PWID who contributed 3307 observations, 931 (87%) reported injecting alone at least once during the study period. In total, there were 729 (22%) reports of always injecting alone, 722 (21.8%) usually, 471 (14.2%) sometimes, 513 (15.5%) occasionally, and 872 (26.4%) never. In a multivariable model, factors positively associated with injecting drugs alone included male sex (adjusted odds ratio [AOR] 1.69; 95% confidence interval [CI] 1.20-2.37), residence in the Downtown Eastside neighbourhood (AOR 1.43; 95% CI 1.08-1.91), binge drug use (AOR 1.36; 95% CI 1.08-1.72), and experiencing physical or sexual violence or both (AOR 1.43; 95% CI 1.00-2.03). Protective factors included Indigenous ancestry (AOR 0.71; 95% CI 0.52-0.98) and being in a relationship (AOR 0.30; 95% CI 0.23-0.39). CONCLUSION We observed that injecting alone, a key risk for overdose mortality, was common among PWID in Vancouver. Our findings underline the need for additional overdose prevention measures that are gender-specific, culturally appropriate, violence- and trauma-informed, and available to those who inject alone.
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LaForge K, Stack E, Shin S, Pope J, Larsen JE, Leichtling G, Leahy JM, Seaman A, Hoover D, Byers M, Barrie C, Chisholm L, Korthuis PT. Knowledge, attitudes, and behaviors related to the fentanyl-adulterated drug supply among people who use drugs in Oregon. J Subst Abuse Treat 2022; 141:108849. [PMID: 35932759 PMCID: PMC10635798 DOI: 10.1016/j.jsat.2022.108849] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/26/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Nonpharmaceutical fentanyl has reconfigured the U.S. illicit drug market, contributing to a drastic increase in overdose drug deaths. While illicit fentanyl has subsumed the drug supply in the Northeast and Midwest, it has more recently reached the West. For this study, we explored knowledge, attitudes, and behaviors among people who use drugs in Oregon in the context of the emergence of fentanyl in the drug supply. METHODS We conducted in-depth interviews by phone with 34 people who use drugs in Oregon from May to June 2021. We used thematic analysis to analyze transcripts and construct themes. RESULTS People who use drugs knew about fentanyl, expressed doubt that fentanyl could be found in methamphetamine; believed those who were younger or less experienced were at higher risk for harm; and received information about fentanyl from drug dealers, syringe service programs, or peers (other people who use drugs). Preference for fentanyl's presence in drugs like heroin or methamphetamine was mixed. Some felt that their preference was irrelevant since fentanyl was unavoidable. Participants reported engaging in harm reduction practices, including communicating about fentanyl with dealers and peers, testing for fentanyl, using smaller quantities of drugs, switching from injecting to smoking, and using naloxone. CONCLUSION People who use drugs are responding to the rise of fentanyl on the West Coast and are concerned about the increasing uncertainty and hazards of the drug supply. They are willing and motivated to adopt harm reduction behaviors. Harm reduction promotion from syringe service programs and public health agencies is essential to reduce injury and death from nonpharmaceutical fentanyl.
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Affiliation(s)
- Kate LaForge
- Comagine Health, 650 NE Holladay St # 1700, Portland, OR 97232, United States of America.
| | - Erin Stack
- Comagine Health, 650 NE Holladay St # 1700, Portland, OR 97232, United States of America
| | - Sarah Shin
- Comagine Health, 650 NE Holladay St # 1700, Portland, OR 97232, United States of America
| | - Justine Pope
- Comagine Health, 650 NE Holladay St # 1700, Portland, OR 97232, United States of America
| | - Jessica E Larsen
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - Gillian Leichtling
- Comagine Health, 650 NE Holladay St # 1700, Portland, OR 97232, United States of America
| | - Judith M Leahy
- Oregon Health Authority, Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Salem, OR, United States of America
| | - Andrew Seaman
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States of America; Old Town Clinic/Central City Concern, Portland, OR, United States of America; Better Life Partners, Hanover, NH, United States of America
| | - Dan Hoover
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | | | - Caiti Barrie
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States of America
| | - Laura Chisholm
- Oregon Health Authority, Injury, and Violence Prevention Program, Public Health Division, Oregon Health Authority, Portland, OR, United States of America
| | - P Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States of America; Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, United States of America
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Ivsins A, MacKinnon L, Bowles JM, Slaunwhite A, Bardwell G. Overdose Prevention and Housing: a Qualitative Study Examining Drug Use, Overdose Risk, and Access to Safer Supply in Permanent Supportive Housing in Vancouver, Canada. J Urban Health 2022; 99:855-864. [PMID: 36044156 PMCID: PMC9430005 DOI: 10.1007/s11524-022-00679-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/25/2022]
Abstract
The majority of overdose deaths in British Columbia (BC) occur among people using illicit substances alone in private residences. Some supportive housing in BC includes on-site access to a variety of health and substance use-related services. More recently, a number of supportive housing locations have started offering prescribed safer supply medications to people at high overdose risk, though these remain limited and under-evaluated. In this study, we describe the drug use practices - including access to and use of on-site supervised consumption, OAT, and prescribed safer supply medications - of study participants living in permanent supportive housing with integrated primary care, substance use treatment services, and supervised consumption spaces. Qualitative interviews were conducted with 30 residents of a permanent supportive housing site in Vancouver, Canada. Data were analyzed using a sequential process to identify both a priori (e.g., low-barrier substance use treatment, pandemic effects on service access) and emerging themes (e.g., using alone). Most (N = 27) study participants reported using alone in their rooms, despite having access to an on-site supervised consumption area. Reasons for using alone include the following: preference for being alone, discretion/stigma, and restrictive housing policies. Less than half (N = 12) of the study participants accessed on-site prescribed safer supply medications. Participants receiving on-site prescribed safer supply described positive benefits including reduced use of illicit opioids, and less reliance on illicit income generation activities. On-site prescribed safer supply programs within supportive housing environments are an important tool in addressing overdose risk.
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Affiliation(s)
- Andrew Ivsins
- 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.
| | - Laura MacKinnon
- British Columbia Centre On Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Jeanette M Bowles
- Centre On Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 3M6, Canada
| | - Amanda Slaunwhite
- BC Centre for Disease Control, 655 W 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Centre for Health Evaluation & Outcome Sciences, 620B-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - 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
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McMahan VM, Arenander J, Matheson T, Lambert AM, Brennan S, Green TC, Walley AY, Coffin PO. “There’s No Heroin Around Anymore. It’s All Fentanyl.” Adaptation of an Opioid Overdose Prevention Counseling Approach to Address Fentanyl Overdose: Formative Study. JMIR Form Res 2022; 6:e37483. [PMID: 36069781 PMCID: PMC9494212 DOI: 10.2196/37483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/13/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background Drug overdose mortality continues to increase, now driven by fentanyl. Prevention tools such as naloxone and medications to treat opioid use disorder are not sufficient to control overdose rates; additional strategies are urgently needed. Objective We sought to adapt a behavioral intervention to prevent opioid overdose (repeated-dose behavioral intervention to reduce opioid overdose [REBOOT]) that had been successfully piloted in San Francisco, California, United States, to the setting of Boston, Massachusetts, United States, and the era of fentanyl for a full efficacy trial. Methods We used the assessment, decision, adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework for intervention adaptation. We first identified opioid overdose survivors who were actively using opioids as the population of interest and REBOOT as the intervention to be adapted. We then performed theater testing and elicited feedback with 2 focus groups (n=10) in Boston in 2018. All participants had used opioids that were not prescribed to them in the past year and experienced an opioid overdose during their lifetime. We incorporated focus group findings into our initial draft of the adapted REBOOT intervention. The adapted intervention was reviewed by 3 topical experts, and their feedback was integrated into a subsequent draft. We trained study staff on the intervention and made final refinements based on internal piloting. This paper describes the overall ADAPT-ITT process for intervention adaptation, as well as a qualitative analysis of the focus groups. Working independently, 2 authors (VMM and JA) reviewed the focus group transcripts and coded them for salient and common themes using the constant comparison method, meeting to discuss any discrepancies until consensus was reached. Codes and themes were then mapped onto the REBOOT counseling steps. Results Focus group findings contributed to substantial changes in the counseling intervention to better address fentanyl overdose risk. Participants described the widespread prevalence of fentanyl and said that, although they tried to avoid it, avoidance was becoming impossible. Using alone and lower opioid tolerance were identified as contributors to overdose risk. Slow shots or tester shots were acceptable and considered effective to reduce risk. Naloxone was considered an effective reversal strategy. Although calling emergency services was not ruled out, participants described techniques to prevent the arrival of police on the scene. Expert review and internal piloting improved the intervention manual through increased participant centeredness, clarity, and usability. Conclusions We successfully completed the ADAPT-ITT approach for an overdose prevention intervention, using theater testing with people who use opioids to incorporate the perspectives of people who use drugs into a substance use intervention. In the current crisis, overdose prevention strategies must be adapted to the context of fentanyl, and innovative strategies must be deployed, including behavioral interventions. Trial Registration ClinicalTrials.gov NCT03838510; https://clinicaltrials.gov/ct2/show/NCT03838510
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Affiliation(s)
- Vanessa M McMahan
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Justine Arenander
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Tim Matheson
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Audrey M Lambert
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, School of Medicine, Boston University, Boston, MA, United States
- Boston Medical Center, Boston University, Boston, MA, United States
| | - Sarah Brennan
- San Francisco Department of Public Health, San Francisco, CA, United States
| | - Traci C Green
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI, United States
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, School of Medicine, Boston University, Boston, MA, United States
- Boston Medical Center, Boston University, Boston, MA, United States
| | - Phillip O Coffin
- San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Urmanche AA, Beharie N, Harocopos A. Fentanyl preference among people who use opioids in New York City. Drug Alcohol Depend 2022; 237:109519. [PMID: 35714532 PMCID: PMC10089663 DOI: 10.1016/j.drugalcdep.2022.109519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Several studies have pointed to a sub-sample of people who use drugs (PWUD) who prefer the use of non-pharmaceutical fentanyl (NPF) and, as such, pose a unique challenge for public health initiatives amidst the continued rise in overdose mortality. However, matters of drug preference and autonomy of choice remain under-studied and often misunderstood. This paper examined the experiences of PWUD reporting a preference for NPF or an NPF-heroin mixture, specifically how they navigate the perceived benefits of NPF and its established risks. METHODS 22 in-depth interviews were conducted in New York City between March 2018 and August 2019 with PWUD who self-reported a preference for NPF or an NPF-heroin mix. Interviews were audio-recorded, and the resulting transcripts analyzed using a thematic approach. RESULTS Participants highlighted various factors that contributed to expressed preference for NPF or an NPF-heroin mix, including a desire to feel good, financial resources, drug availability, decreased consumer autonomy, and physiological demand. Participants reported practicing several risk reduction strategies; however, they highlighted that many, particularly carrying naloxone and always using with someone else, were difficult to implement in the context of illicit drug use. CONCLUSIONS Our results demonstrate participants' decreased consumer agency and greater exposure to systemic factors in the illicit markets, highlighting the need for expansion of various services, including drug checking resources and systems of outreach for PWUD who do not use intravenously. To promote tailored interventions, continued efforts in overdose prevention ought to more thoughtfully consider the context, perceptions, preferences, and behaviors of PWUD.
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Affiliation(s)
- Adelya A Urmanche
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY 11101, USA; Derner School of Psychology, Adelphi University, Hy Weinberg Center, 158 Cambridge Avenue, Garden City, NY 11530, USA.
| | - Nisha Beharie
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY 11101, USA.
| | - Alex Harocopos
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th St, Queens, NY 11101, USA.
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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).
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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
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Nelson EUE. Rationalities of Space and Drug-Related Harms: Accounts of People Who Inject Drugs in Nigeria. Subst Use Misuse 2022; 57:114-122. [PMID: 34709121 DOI: 10.1080/10826084.2021.1990339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies have examined how people who inject drugs (PWID) navigate public spaces for drug consumption, but little is known about consumption of drugs in private apartments. This study explores social, structural and physical environment factors influencing injecting practices and the rationalities shaping how PWID make decisions about where to consume drugs. METHODS The study is based on qualitative data from 41 in-depth interviews conducted with both homeless and housed PWID recruited through snowball sampling in Uyo, Nigeria. Thematic analysis, framed by the theoretical constructs of structural and everyday violence, and situated rationality theories, was undertaken on transcripts. RESULTS Analysis revealed different socio-spatial rationalities underlying decisions about where to use drugs: avoidance of police arrest, convenience and relaxation, avoidance of drug sharing, avoidance of drug-scene violence, and stigma and shame. These factors show the impacts of social, structural and physical environment factors on the lived experiences of PWID. Injecting in private apartments potentially offset the risk of stigma, police arrest and violence linked to public injecting, but increase the risk of overdose and sharing of drugs and needle-syringes based on social relations of trust. CONCLUSIONS Findings show that PWID chose between competing risks when deciding on where to inject drugs. Interventions should consider the situated contexts of risk, and adapt harm reduction measures to the risk profile of different populations of PWID.
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Affiliation(s)
- Ediomo-Ubong Ekpo Nelson
- Global Drug Policy Observatory, Swansea University, Swansea, UK.,Centre for Research and Information on Substance Abuse, Uyo, Nigeria
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Cristiano N. Fentanyl Contamination as a Risk Priority: the Impact of the Fentanyl Epidemic on Club Drug-Using Behaviours. Subst Use Misuse 2022; 57:975-982. [PMID: 35354372 DOI: 10.1080/10826084.2022.2058705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Over the last decade, rates of fentanyl-related overdoses have increased substantially across North America, a phenomenon which has widely been described as the "fentanyl epidemic." While research has explored the cultural impact of the fentanyl epidemic on opioid and/or injection drug use, less is known about its impact on other types of drug use. Drawing on two years of ethnographic research with people who use club drugs in Toronto's Electronic Dance Music (EDM) scene, this study looks at how people who use club drugs make sense of and respond to the fentanyl epidemic. METHODS Data for the study was collected via participant observation and semi-structured interviews (n = 26). FINDINGS The key finding was that fentanyl contamination had become a "risk priority" for the participants. They thereby adjusted their drug-using behaviors to account for this risk. However, by prioritizing fentanyl contamination above everything else, they often overlooked and/or disregarded other forms of harm reduction that they had once practiced (like getting testing kits to test for other adulterants). CONCLUSION The findings suggest that the fentanyl epidemic has impacted not only practices of illegal opioid use, but also practices of club drug use. They suggest that the fentanyl epidemic has in some ways facilitated the adoption of risk management, while in other ways undermined it. The findings are interpreted with reference to Rhodes' "risk environment" framework and with particular attention to the need for harm reduction interventions that take into consideration how risk perceptions and behaviors are situation- and context-dependent.
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