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Ruth A, Ganesh SS, Shah P, Gould EE, Ninh K, Ceasar RC, Duncan DT, Bluthenthal RN. Sleep Health among Community-Recruited Opioid-Using People Who Inject Drugs in Los Angeles, CA and Denver, CO. J Urban Health 2024; 101:1058-1067. [PMID: 39298086 PMCID: PMC11461715 DOI: 10.1007/s11524-024-00922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 09/21/2024]
Abstract
Chronic insufficient and poor-quality sleep are linked to hypertension, diabetes, depression, heart attack, and stroke. While studies on substance use and sleep typically focus on people in or entering treatment, there is a lack of research on sleep health among community-recruited people who inject drugs (PWID). To address this literature gap, we examined factors associated with insufficient and poor-quality sleep among community-recruited PWID. We recruited and interviewed 472 active opioid-using PWID (injected within the last 30 days) in Los Angeles, CA and Denver, CO between 2021 and 2022. Participants completed computer-assisted interviews covering demographics, subsistence measures, drug use patterns, injection-related behaviors, health risks, and sleep duration and quality in the last 3 months. Descriptive statistics were used to analyze all variables for subjects with complete responses to sleep items (n = 464). Bivariate analyses determined factors associated with sleep measures using chi-square and t-tests. Collinear variables were removed, and binomial linear multivariable regression calculated risk ratios (RR) for insufficient and poor-quality sleep in the last 3 months. Participants exhibited low sleep duration (mean = 4.99, standard deviation (SD) = 2.70), with 76% reporting insufficient sleep and 62% poor-quality sleep. Bivariate analyses associated both sleep measures with drug use, high subsistence scores, violent victimization, and poor health outcomes. Multivariable analyses showed a high subsistence score predicting insufficient (RR = 1.31) and poor-quality sleep (RR = 1.69) compared to low subsistence. Poor sleep health is common among structurally vulnerable community-recruited PWID, as measured by subsistence index associated with adverse sleep outcomes. Further research on structural interventions to address sleep and subsequent health outcomes among PWID is imperative.
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Affiliation(s)
- Avaion Ruth
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Siddhi S Ganesh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pooja Shah
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Erin E Gould
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Katrina Ninh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rachel Carmen Ceasar
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dustin T Duncan
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY, USA
| | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Cioffi CC, Flinn RE, Pasman E, Gannon K, Gold D, McCabe SE, Kepner W, Tillson M, Colditz JB, Smith DC, Bohler RM, O'Donnell JE, Hildebran C, Montgomery BW, Clingan S, Lofaro RJ. Beyond the 5-year recovery mark: Perspectives of researchers with lived and living experience on public engagement and discourse. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 133:104599. [PMID: 39341070 DOI: 10.1016/j.drugpo.2024.104599] [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: 05/24/2024] [Revised: 09/13/2024] [Accepted: 09/15/2024] [Indexed: 09/30/2024]
Abstract
There has been growing attention toward including people with lived and living experience (PWLLE) with substance use, substance use disorders, and recovery in public-facing activities. The goals of including PWLLE in sharing their perspectives often include demonstrating that recovery is possible, destigmatizing and humanizing people who have substance use experiences, and leveraging their lived experience to illuminate a particular topic or issue. Recently, the National Council for Mental Wellbeing issued a set of guidelines entitled, "Protecting Individuals with Lived Experience in Public Disclosure," which included a "Lived Experience Safeguard Scale." We offer the present commentary to bolster some of the ideas presented by the Council and to articulate suggested changes to this guidance, with the goal of reducing unintentional gatekeeping and stigma. Specifically, we offer that there are numerous problems with the recommendation to only invite people who have "five or more years of sustained recovery" to contribute to public discourse. The idea of perceived stability after five years of abstinence is not new to us or the field. We suggest that this idea excludes people who have experienced the present rapidly changing substance use landscape, people who have briefly returned to use, some young people, and people with living experience who also can valuably contribute to public discourse. We offer alternative guidelines to the National Council for Mental Wellbeing and others seeking to promote practices that are inclusive to the diversity of PWLLE.
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Affiliation(s)
- Camille C Cioffi
- University of Oregon, Oregon Research Institute, & Influents Innovations, USA.
| | - Ryan E Flinn
- College of Education & Human Development, University of North Dakota, USA.
| | - Emily Pasman
- University of Michigan, Center for the Study of Drugs, Alcohol, Smoking, and Health, USA.
| | | | - Dudi Gold
- Criminologist, Bar-Ilan University, Israel.
| | - Sean Esteban McCabe
- University of Michigan, Center for the Study of Drugs, Alcohol, Smoking, and Health, USA.
| | - Wayne Kepner
- University of California San Diego School of Medicine, USA.
| | | | | | | | - Robert M Bohler
- Jiann-Ping Hsu College of Public Health at Georgia Southern University, USA.
| | | | | | | | | | - Ryan J Lofaro
- Department of Public and Nonprofit Studies, Georgia Southern University, USA.
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LaPoint M, Vu MB, Ricks K, Flower KB, Domino ME, Dave G, Berkowitz SA. Benefits, Challenges, and Opportunities in Addressing Medicaid Beneficiaries' Non-Medical Risks to Health: A Qualitative Analysis. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:597-604. [PMID: 38330375 DOI: 10.1097/phh.0000000000001874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
CONTEXT North Carolina's Healthy Opportunities Pilots (HOP) is a Medicaid 1115 Waiver program that seeks to address nonmedical risks to health for Medicaid beneficiaries through multisector collaboration. Among other stakeholders, HOP involves collaboration between human services organizations that deliver interventions, network leads, which establish and oversee the human services organizations within a region of the state. OBJECTIVE To understand how employees at human services organizations and network leads prepared to deliver HOP services. DESIGN Qualitative analysis of semistructured interviews. Interviews were conducted between April and June 2022. Interviews were recorded, transcribed verbatim, coded thematically, and analyzed using a conceptual model derived from the consolidated framework for implementation research. SETTING Organizations within North Carolina counties participating in HOP. PARTICIPANTS Employees of human services and network lead organizations across all 3 HOP regions of North Carolina. RESULTS The researchers interviewed 37 participants. Overall, organizations experienced benefits from HOP participation, including capacity-building resources, flexibility in allocating resources, and creating community-wide enthusiasm for addressing nonmedical risks to health. There were also key challenges. These included the time needed to build capacity, adjustments to the work processes and regulations inherent to multisector collaboration, geographic variation in availability of services to offer, and the difficulty of addressing different needs. Finally, participants recognized substantial opportunities that HOP presented, including membership in a more extensive network, exposure to a learning community, and a more sustainable funding source. CONCLUSIONS The perspectives of individuals preparing to deliver HOP services offer important lessons for those developing and implementing large-scale programs that can address nonmedical threats to health.
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Affiliation(s)
- Myklynn LaPoint
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Maihan B Vu
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Katharine Ricks
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Kori B Flower
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Marisa Elena Domino
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Gaurav Dave
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
| | - Seth A Berkowitz
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ms LaPoint and Drs Ricks and Berkowitz); Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Vu); Division of General Pediatrics & Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Flower); Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, Arizona (Dr Domino); Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Dr Dave)
- and Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Drs Dave and Berkowitz)
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Fleming T, Boyd J, Gagnon M, Kerr T, McNeil R. Using drugs alone in single room occupancy housing: Understanding environmental drivers of overdose risk. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104444. [PMID: 38754243 PMCID: PMC11420829 DOI: 10.1016/j.drugpo.2024.104444] [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: 02/06/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Across North America most overdose deaths occur in housing, largely due to individuals using drugs alone. In cities, fatalities are disproportionately concentrated in low-income housing, including single room occupancy (SRO) housing. While research has highlighted how SROs operate as risk environments for various poor outcomes, there has been little attention to specific drug use practices (i.e., using alone) associated with overdose vulnerability in these spaces. This study explores how environmental contexts of SROs shape overdose risks, with specific attention to practices of using drugs alone. METHODS In-depth semi-structured interviews were conducted with 30 people who use drugs (PWUD) living in Vancouver SROs. Interviews covered topics such as social-structural environments of housing, drug use practices, and housing-based harm reduction. Thematic analysis drew on the intersectional risk environment framework. RESULTS Narratives positioned SROs as extensions of public space, with similar expectations of risks and behaviours as in public spaces. For some participants, using alone in their room was characterized as a practice in claiming privacy within the context of a public existence. Participants highlighted how certain features of SRO's social-structural environments were routinely leveraged against them (e.g., security cameras, staff surveillance), suggesting using alone as a tactic to minimize risks of hyper-surveillance and punitive policies. Further, participants discussed using alone as "safer," describing how this practice mitigated place-based risks of social-structural harms (e.g., violence, criminalization) in ways that eclipsed overdose risk. CONCLUSION Using drugs alone may be understood as a spatial negotiation of vulnerability to diverse harms produced by environmental contexts of SROs. Interventions accounting for broader contextual factors (e.g., improvements housing quality/quantity, providing a safer supply of drugs) that render using alone as instrumental to survival, and that reduce the implicit threat of punishment from intensive surveillance and control practices are critical to reduce vulnerability to overdose and other harms.
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Affiliation(s)
- 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
| | - 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
| | - Marilou Gagnon
- School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada
| | - Thomas Kerr
- 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
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA; Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT 10001, USA.
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Kerman N, Marshall CA, Polillo A, Voronov J, de Pass T, Easton C, Ward B, Noble A, Hwang SW, Kozloff N, Stergiopoulos V, Kidd SA. Service restrictions from emergency shelters among people experiencing homelessness: Uncovering pathways into unsheltered homelessness and institutional circuitry. Soc Sci Med 2024; 348:116831. [PMID: 38574591 DOI: 10.1016/j.socscimed.2024.116831] [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: 09/29/2023] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
Service restrictions refer to temporary or permanent bans of individuals from a program or an organization's services, and are widely used in emergency shelter systems. Limited research exists on how service restrictions unfold and their impacts on people experiencing homelessness. This qualitative study used in-depth interviews with timeline mapping to examine the antecedents and consequences of service restrictions from emergency shelters among people experiencing homelessness in two cities in Ontario, Canada. A total of 49 people experiencing homelessness who had been restricted from an emergency shelter program in the past year were recruited and included in the study analysis. A pragmatic and integrative approach was used for data analysis that involved the development of meta-matrices to identify prominent and divergent perspectives and experiences with regard to service restriction antecedents and consequences. Study findings underscored that service restrictions were often the result of violence and aggression, primarily between service users. There were regional differences in other service restriction reasons, including substance use and possession. Service restrictions affected the shelter status of almost all participants, with many subsequently experiencing unsheltered homelessness, and cycling through institutional health, social, and criminal justice services (i.e., institutional circuitry). Other health and social consequences included substance use relapses and hospitalizations; cold-related injuries due to post-restriction unsheltered homelessness; suicidality; food insecurity; diminished contact with support network and connections; and intense feelings of anger, fear, and hopelessness. Overall, the study findings advance our understanding of the role of homeless services in pathways into unsheltered homelessness and institutional circuitry, which raise critical questions about how to mitigate the harms associated with service restrictions, while concurrently facilitating safety and upholding the rights of people experiencing homelessness and emergency shelter staff.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada.
| | - Carrie Anne Marshall
- Western University, School of Occupational Therapy, 1201 Western Road, London, Ontario, Canada
| | - Alexia Polillo
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Joseph Voronov
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Timothy de Pass
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Corinna Easton
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada
| | - Brooklyn Ward
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, 1919 Riverside Drive, Ottawa, Ontario, Canada
| | - Amanda Noble
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor Street West, Toronto, Ontario, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Division of General Internal Medicine, 1 King's College Circle, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
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Wenger LD, Morris T, Knight KR, Megerian CE, Davidson PJ, Suen LW, Majano V, Lambdin BH, Kral AH. Radical hospitality: Innovative programming to build community and meet the needs of people who use drugs at a government-sanctioned overdose prevention site in San Francisco, California. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104366. [PMID: 38492432 PMCID: PMC11160962 DOI: 10.1016/j.drugpo.2024.104366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND The Tenderloin Center (TLC), a multi-service center where people could receive or be connected to basic needs, behavioral health care, housing, and medical services, was open in San Francisco for 46 weeks in 2022. Within a week of operation, services expanded to include an overdose prevention site (OPS), also known as safe consumption site. OPSs have operated internationally for over three decades, but government-sanctioned OPSs have only recently been implemented in the United States. We used ethnographic methods to understand the ways in which a sanctioned OPS, situated in a multi-service center, impacts the lives of people who use drugs (PWUD). METHODS We conducted participant observation and in-depth interviews June-December 2022. Extensive field notes and 39 in-depth interviews with 24 TLC guests and 15 TLC staff were analyzed using an inductive analysis approach. Interviewees were asked detailed questions about their experiences using and working at the TLC. RESULTS TLC guests and staff described an atmosphere where radical hospitality-welcoming guests with extraordinary warmth, generosity, and unconditional acceptance-was central to the culture. We found that the co-location of an OPS within a multi-service agency (1) allowed for the culture of radical hospitality to flourish, (2) yielded a convenient one-stop shop model, (3) created a space for community building, and (4) offered safety and respite to guests. CONCLUSIONS The co-location of an OPS within a multi-service drop-in center is an important example of how such an organization can build positive sociality among PWUD while protecting autonomy and reducing overdose mortality. Overdose response and reversal is an act of relational accountability in which friends, peers, and even strangers intervene to protect and revive one another. This powerful intervention was operationalized as an anti-oppressive, horizontal activity through radical hospitality with a built environment that allowed PWUD to be both social and safe.
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Affiliation(s)
- Lynn D Wenger
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States.
| | - Terry Morris
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Kelly R Knight
- University of California, San Francisco, San Francisco, CA, United States
| | - Cariné E Megerian
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Peter J Davidson
- Univerity of California, San Diego, San Francisco, CA, United States
| | - Leslie W Suen
- University of California, San Francisco, San Francisco, CA, United States
| | - Veronica Majano
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Barrot H Lambdin
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Alex H Kral
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
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Eschliman EL, Patel EU, Murray SM, German D, Kirk GD, Mehta SH, Kaufman MR, Genberg BL. Drug Use-Related Discrimination in Healthcare Settings and Subsequent Emergency Department Utilization in a Prospective Cohort Study of People With a History of Injection Drug Use. Subst Use Misuse 2024; 59:1210-1220. [PMID: 38519443 PMCID: PMC11194036 DOI: 10.1080/10826084.2024.2330906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
BACKGROUND People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been established in this population. METHODS This analysis used longitudinal data collected between January 2014 and March 2020 from participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based observational cohort study of people with a history of injection drug use in Baltimore, Maryland. Logistic regressions with generalized estimating equations were used to estimate associations between drug use-related discrimination in healthcare settings and subsequent ED utilization for the sample overall and six subgroups based on race, sex, and HIV status. RESULTS 1,342 participants contributed data from 7,289 semiannual study visits. Participants were predominately Black (82%), mostly male (66%), and 33% were living with HIV. Drug use-related discrimination in healthcare settings (reported at 6% of study visits) was positively associated with any subsequent ED use (OR = 1.40, 95% CI: 1.15-1.72). Positive associations persisted after adjusting for covariates, including past sixth-month ED use and drug use, among the overall sample (aOR = 1.28, 95% CI: 1.04-1.59) and among some subgroups. CONCLUSIONS Drug use-related discrimination in healthcare settings was associated with greater subsequent ED utilization in this sample. Further exploration of mechanisms driving this relationship may help improve care and optimize healthcare engagement for people with a history of injection drug use.
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Affiliation(s)
- Evan L. Eschliman
- Department of Epidemiology, Columbia University Mailman School of Public Health
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Eshan U. Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Michelle R. Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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8
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Seo B, Rider N, Rioux W, Teare A, Jones S, Taplay P, Monty Ghosh S. Understanding the barriers and facilitators to implementing and sustaining Mobile Overdose Response Services from the perspective of Canadian key interest groups: a qualitative study. Harm Reduct J 2024; 21:28. [PMID: 38308262 PMCID: PMC10837862 DOI: 10.1186/s12954-024-00946-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/25/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Unregulated supply of fentanyl and adulterants continues to drive the overdose crisis. Mobile Overdose Response Services (MORS) are novel technologies that offer virtual supervised consumption to minimize the risk of fatal overdose for those who are unable to access other forms of harm reduction. However, as newly implemented services, they are also faced with numerous limitations. The aim of this study was to examine the facilitators and barriers to the adoption of MORS in Canada. METHODS A total of 64 semi-structured interviews were conducted between November 2021 and April 2022. Participants consisted of people who use substances (PWUS), family members of PWUS, health care professionals, harm reduction workers, MORS operators, and members of the general public. Inductive thematic analysis was used to identify the major themes and subthemes. RESULTS Respondents revealed that MORS facilitated a safe, anonymous, and nonjudgmental environment for PWUS to seek harm reduction and other necessary support. It also created a new sense of purpose for operators to positively contribute to the community. Further advertising and promotional efforts were deemed important to increase its awareness. However, barriers to MORS implementation included concerns regarding privacy/confidentiality, uncertainty of funding, and compassion fatigue among the operators. CONCLUSION Although MORS were generally viewed as a useful addition to the currently existing harm reduction services, it's important to monitor and tackle these barriers by engaging the perspectives of key interest groups.
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Affiliation(s)
- Boogyung Seo
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nathan Rider
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - William Rioux
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Adrian Teare
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
- Department of Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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Goldshear JL, Kitonga N, Angelo N, Cowan A, Henwood BF, Bluthenthal RN. "Notice of major cleaning": A qualitative study of the negative impact of encampment sweeps on the ontological security of unhoused people who use drugs. Soc Sci Med 2023; 339:116408. [PMID: 37980786 DOI: 10.1016/j.socscimed.2023.116408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/15/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Unhoused people who use drugs in the United States are at risk for a variety of negative health outcomes. As the crisis of houselessness continues to impact major urban areas, a wave of punitive policies has been enacted to remove visible unhoused people from public spaces. There is reason to believe that harsh policies of encampment displacement will have negative immediate and downstream impacts on this community. METHODS Participant observation was conducted weekly or bi-weekly at unhoused encampments in Los Angeles County, USA over the course of two years (2021, 2022). Data were generated through the lens of ontological security theory via in-field jottings and comprehensive field notes. Formal, semi-structured qualitative interviews were conducted with 30 unhoused people who use drugs recruited primarily through peer-referral sampling at these same venues. Data were coded and analyzed thematically using the Template Analysis approach. Field notes were used to triangulate and further contextualize thematic analysis of interview data. RESULTS Encampment sweeps impacted nearly all participants and occurred multiple times at every visited field site. They were observed to occur both with and without the presence of police, but always resulted in the loss of the personal property of encampment residents. Sweeps occurred across seasons, hazardous weather, and without offers of alternative shelter. Participants described sweeps as impacting all aspects of their ontological security, including dismantling material and social constancy, disrupting routines of daily life and resource management, increasing feelings of surveillance, and potentially creating negative identity formation. CONCLUSIONS In both ethnographic observation and participant interviews, encampment sweeps were noted to be physically, psychologically, and socially destructive. Sweeps left participants feeling anger, loss, and hopelessness while further driving the societal marginalization of unhoused people who use drugs. Sweeps should be discontinued as they harm the capacity of unhoused people to improve their well-being.
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Affiliation(s)
- J L Goldshear
- Keck Medicine of University of Southern California, Department of Population and Public Health Sciences, United States; University of California San Diego School of Medicine, Department of Medicine, Division of Infectious Diseases & Global Public Health, United States.
| | - N Kitonga
- Angeles Workshop School, Palms Unhoused Mutual Aid, United States
| | - N Angelo
- Community Health Project Los Angeles, United States
| | - A Cowan
- Angeles Workshop School, Palms Unhoused Mutual Aid, United States
| | - B F Henwood
- University of Southern California, Suzanne Dworak-Peck School of Social Work, United States
| | - R N Bluthenthal
- Keck Medicine of University of Southern California, Department of Population and Public Health Sciences, United States
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