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Debenham J, Birrell L, Champion KE, Newton N. An on-line school-based substance use harm reduction programme: The Illicit Project randomized controlled trial results. Addiction 2024; 119:741-752. [PMID: 38105000 DOI: 10.1111/add.16403] [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] [Received: 03/09/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023]
Abstract
AIMS The aim of this study was to measure the effectiveness of an on-line, neuroscience-based harm reduction intervention (The Illicit Project) on substance use, harms and knowledge over a 12-month period. DESIGN We used a two-arm cluster-randomized controlled trial. SETTING The study was conducted at eight secondary schools across New South Wales, Australia. PARTICIPANTS A total of 950 (mean age = 15.9; standard deviation = 0.68) in grades 10-12 at participating schools in 2020 took part. INTERVENTION AND COMPARATOR The Illicit Project intervention group (schools = five, n = 681) received an on-line, universal substance use and harm reduction programme over three classes. The active control group (schools = three, n = 269) received school-based health education as usual. MEASUREMENTS Self-report questionnaires assessed primary [alcohol, nicotine, cannabis, 3,4-methylenedioxymethamphetamine (MDMA), cocaine and prescription drug misuse] and secondary outcomes (alcohol-related harms and drug literacy) at baseline and the 6- and 12-month follow-up assessment. FINDINGS Approximately 63% (n = 595) of the sample completed the 12-month follow-up assessment, including 58% of the intervention group (n = 396/679) and 66% of the active control group (n = 179/271). Participants in the intervention group had slower annual increases in binge drinking [odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.12-0.89], nicotine use (OR = 0.80, 95% CI = 0.52-1.23), MDMA use (OR = 0.14, 95% CI = 0.02-1.00), cocaine use (OR = 0.06, 95% CI = 0.01-0.64) and prescription drug misuse (OR = 0.07, 95% CI = 0.01-0.54) compared with the active control group. There was limited evidence of an intervention effect on cannabis use and alcohol-related harm (P > 0.5). The secondary outcomes showed that the intervention group maintained higher levels of drug literacy knowledge (β = 3.71, 95% CI = 1.86-5.56) and harm reduction help-seeking skills (β = 1.55, 95% CI = 0.62-2.48) compared with the active control group. CONCLUSION The Illicit Project (an on-line, neuroscience-based substance use harm reduction intervention) was effective in slowing the uptake of risky substance use and improving drug literacy skills among late secondary school students in Australia, compared with school-based health education as usual.
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Affiliation(s)
- Jennifer Debenham
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Louise Birrell
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Katrina E Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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Pedroso JMG, Araujo CNDP, Corradi-Webster CM. The joy and pain of being a harm reduction worker: a qualitative study of the meanings about harm reduction in Brazil. Harm Reduct J 2024; 21:56. [PMID: 38439094 PMCID: PMC10910711 DOI: 10.1186/s12954-024-00962-7] [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: 05/22/2023] [Accepted: 02/11/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Although harm reduction is highlighted as an effective intervention for alcohol and drug use, a funding gap for harm reduction interventions has been identified, mainly in low- and middle-income countries. In these countries, tensions between abstinence and harm reduction models have impaired the shift from punitive practices to evidence-based interventions committed to guaranteeing the human rights of people who use drugs. Since 2015, the Brazilian government has adopted a more punitive and abstinence-focused drug policy that jeopardizes the care of people who use alcohol and other drugs and the comprehension of the harm reduction workers' perspective in relation to their practice. Therefore, this study aimed to comprehend the meanings constructed by Brazilian harm reduction workers regarding their practices with vulnerable populations amidst a context of political tension. METHODS We conducted 15 in-depth semi-structured qualitative interviews with harm reduction workers employed in public health services for at least 6 months. Data were analyzed using thematic analysis. RESULTS The thematic axis "The joy and pain of being a harm reduction worker in Brazil" was constructed and divided into four major themes: (1) Invisibility of harm reduction work; (2) Black, poor, and people who use drugs: identification with the service users; (3) Between advocacy and profession: harm reduction as a political act; (4) Small achievements matter. Despite the perceived invisibility of harm reduction workers in the public health and alcohol and drug fields, valuing small achievements and advocacy were important resources to deal with political tension and punitive strategies in Brazil. The findings also highlight the important role of harm reduction workers due to their personal characteristics and understanding of drug use behavior, which bring the target audience closer to actions within the public health system. CONCLUSION There is an urgent need to acknowledge harm reduction based on peer support as a professional category that deserves adequate financial support and workplace benefits. Additionally, expanding evidence-based harm reduction interventions and community-based voluntary drug use treatment centers should be prioritized by public policies to address the human rights violations experienced by people who use drugs.
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Affiliation(s)
- João Maurício Gimenes Pedroso
- Psychology Department, Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-900, Brazil.
- Central Paulista University Center - UNICEP, São Carlos, SP, 13563-470, Brazil.
| | - Cristiana Nelise de Paula Araujo
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, 32608, USA
| | - Clarissa Mendonça Corradi-Webster
- Psychology Department, Faculty of Philosophy, Sciences, and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-900, Brazil
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Springer SA. Ending the HIV Epidemic for Persons Who Use Drugs: the Practical Challenges of Meeting People Where They Are. J Gen Intern Med 2023; 38:2816-2818. [PMID: 37002460 PMCID: PMC10506995 DOI: 10.1007/s11606-023-08142-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/09/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Sandra A Springer
- Section of Infectious Diseases, Department of Internal Medicine, Yale AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
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Sajwani HS, Williams AV. A systematic review of the distribution of take-home naloxone in low- and middle-income countries and barriers to the implementation of take-home naloxone programs. Harm Reduct J 2022; 19:117. [PMID: 36266701 PMCID: PMC9585764 DOI: 10.1186/s12954-022-00700-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Opioid overdose epidemic is hitting record highs worldwide, accounting for 76% of mortality related to substance use. Take-home naloxone (THN) strategies are being implemented in many developed countries that suffer from high opioid overdose death rates. They aim to provide overdose identification and naloxone administration training, along with THN delivery to opioid users and others likely to witness an overdose incident such as family members and peers. However, little is known about such measures in low- and middle-income countries (LMIC), where opioid use and opioid-related deaths are reportedly high. This systematic literature review aims to examine the distribution of THN in LMIC, review studies identifying barriers to the implementation of THN programs worldwide, and assess their applicability to LMIC. Methods The literature was searched and analyzed for eligible studies with quality assessment. Results Two studies were found from LMIC on THN programs with promising results, and 13 studies were found on the barriers identified in implementing THN programs worldwide. The main barriers to THN strategies were the lack of training of healthcare providers, lack of privileges, time constraints, cost, legislative/policy restrictions, stigma, fear of litigation, and some misperceptions around THN. Conclusions The barriers outlined in this paper are probably applicable to LMIC, but more difficult to overcome considering the differences in their response to opioid overdose, their cultural attitudes and norms, the high cost, the waivers required, the legislative differences and the severe penalties for drug-related offenses in some of these countries. The solutions suggested to counter-act these obstacles can also be more difficult to achieve in LMIC. Further research is required in this area with larger sample sizes to provide a better understanding of the obstacles to the implementation, feasibility, accessibility, and utilization of THN programs in LMIC.
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Affiliation(s)
- Hawraa Sameer Sajwani
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,University of Adelaide, Adelaide, Australia. .,Virginia Commonwealth University, Richmond, VA, US. .,University of California, Los Angeles, Los Angeles, CA, US. .,Sheikh Khalifa Medical City, Abu Dhabi, UAE.
| | - Anna V Williams
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Dickson-Gomez J, Krechel S, Katende D, Johnston B, Twaibu W, Glasman L, Ogwal M, Musinguzi G. The Role of Context in Integrating Buprenorphine into a Drop-In Center in Kampala, Uganda, Using the Consolidated Framework for Implementation Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10382. [PMID: 36012015 PMCID: PMC9407835 DOI: 10.3390/ijerph191610382] [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: 06/29/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although Africa has long borne the brunt of the human immunodeficiency virus (HIV) epidemic, until recently, the continent has been considered largely free of illicit drug use and injection drug use in particular. In Uganda, the number of people who use or inject drugs (PWUD and PWID, respectively) has increased, and PWID are a key population at high risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. However, harm reduction practices, including providing clean injection equipment and medication-assisted treatment (MAT), have only recently been piloted in the country. This project aims to integrate buprenorphine into a harm reduction drop-in center (DIC). METHODS The Consolidated Framework for Implementation Research was used to guide our preparations to integrate buprenorphine into existing practices at a harm reduction DIC. We conducted key informant interviews with members of a community advisory board and DIC staff to document this process, its successes, and its failures. RESULTS Results indicate that criminalization of drug use and stigmatization of PWUD challenged efforts to provide buprenorphine treatment in less regulated community settings. CONCLUSIONS DIC staff and their commitment to harm reduction and advocacy facilitated the process of obtaining necessary approvals.
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Affiliation(s)
- Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Sarah Krechel
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Dan Katende
- Uganda Harm Reduction Network, Kampala 31762, Uganda
| | - Bryan Johnston
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Wamala Twaibu
- Uganda Harm Reduction Network, Kampala 31762, Uganda
| | - Laura Glasman
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala 7072, Uganda
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Jauffret-Roustide M, Houborg E, Southwell M, Chronopoulou D, Granier JM, Frank VA, Stevens A, Rhodes T. Different Paths and Potentials to Harm Reduction in Different Welfare States: Drug Consumption Rooms in the United Kingdom, Denmark, and France. Am J Public Health 2022; 112:S99-S103. [PMID: 35349322 PMCID: PMC8965185 DOI: 10.2105/ajph.2022.306790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Marie Jauffret-Roustide
- Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France. Esben Houborg and Vibeke Asmussen Frank are with the Center for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark. Matthew Southwell is with the European Network of People Who Use Drugs, Bath, UK. Daphné Chronopoulou is with the European Network of People Who Use Drugs, Mykonos, Greece. Jean-Maxence Granier is with Auto-Support des Usagers de Drogues/Self-Support for People Who Use Drugs, Paris, France. Alex Stevens is with the School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK. Tim Rhodes is with the London School of Hygiene and Tropical Medicine, London, UK. Marie Jauffret-Roustide is also a Guest Editor of this supplement issue
| | - Esben Houborg
- Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France. Esben Houborg and Vibeke Asmussen Frank are with the Center for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark. Matthew Southwell is with the European Network of People Who Use Drugs, Bath, UK. Daphné Chronopoulou is with the European Network of People Who Use Drugs, Mykonos, Greece. Jean-Maxence Granier is with Auto-Support des Usagers de Drogues/Self-Support for People Who Use Drugs, Paris, France. Alex Stevens is with the School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK. Tim Rhodes is with the London School of Hygiene and Tropical Medicine, London, UK. Marie Jauffret-Roustide is also a Guest Editor of this supplement issue
| | - Matthew Southwell
- Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France. Esben Houborg and Vibeke Asmussen Frank are with the Center for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark. Matthew Southwell is with the European Network of People Who Use Drugs, Bath, UK. Daphné Chronopoulou is with the European Network of People Who Use Drugs, Mykonos, Greece. Jean-Maxence Granier is with Auto-Support des Usagers de Drogues/Self-Support for People Who Use Drugs, Paris, France. Alex Stevens is with the School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK. Tim Rhodes is with the London School of Hygiene and Tropical Medicine, London, UK. Marie Jauffret-Roustide is also a Guest Editor of this supplement issue
| | - Daphné Chronopoulou
- Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France. Esben Houborg and Vibeke Asmussen Frank are with the Center for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark. Matthew Southwell is with the European Network of People Who Use Drugs, Bath, UK. Daphné Chronopoulou is with the European Network of People Who Use Drugs, Mykonos, Greece. Jean-Maxence Granier is with Auto-Support des Usagers de Drogues/Self-Support for People Who Use Drugs, Paris, France. Alex Stevens is with the School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK. Tim Rhodes is with the London School of Hygiene and Tropical Medicine, London, UK. Marie Jauffret-Roustide is also a Guest Editor of this supplement issue
| | - Jean-Maxence Granier
- Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France. Esben Houborg and Vibeke Asmussen Frank are with the Center for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark. Matthew Southwell is with the European Network of People Who Use Drugs, Bath, UK. Daphné Chronopoulou is with the European Network of People Who Use Drugs, Mykonos, Greece. Jean-Maxence Granier is with Auto-Support des Usagers de Drogues/Self-Support for People Who Use Drugs, Paris, France. Alex Stevens is with the School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK. Tim Rhodes is with the London School of Hygiene and Tropical Medicine, London, UK. Marie Jauffret-Roustide is also a Guest Editor of this supplement issue
| | - Vibeke Asmussen Frank
- Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France. Esben Houborg and Vibeke Asmussen Frank are with the Center for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark. Matthew Southwell is with the European Network of People Who Use Drugs, Bath, UK. Daphné Chronopoulou is with the European Network of People Who Use Drugs, Mykonos, Greece. Jean-Maxence Granier is with Auto-Support des Usagers de Drogues/Self-Support for People Who Use Drugs, Paris, France. Alex Stevens is with the School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK. Tim Rhodes is with the London School of Hygiene and Tropical Medicine, London, UK. Marie Jauffret-Roustide is also a Guest Editor of this supplement issue
| | - Alex Stevens
- Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France. Esben Houborg and Vibeke Asmussen Frank are with the Center for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark. Matthew Southwell is with the European Network of People Who Use Drugs, Bath, UK. Daphné Chronopoulou is with the European Network of People Who Use Drugs, Mykonos, Greece. Jean-Maxence Granier is with Auto-Support des Usagers de Drogues/Self-Support for People Who Use Drugs, Paris, France. Alex Stevens is with the School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK. Tim Rhodes is with the London School of Hygiene and Tropical Medicine, London, UK. Marie Jauffret-Roustide is also a Guest Editor of this supplement issue
| | - Tim Rhodes
- Marie Jauffret-Roustide is with the Centre d'Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France. Esben Houborg and Vibeke Asmussen Frank are with the Center for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark. Matthew Southwell is with the European Network of People Who Use Drugs, Bath, UK. Daphné Chronopoulou is with the European Network of People Who Use Drugs, Mykonos, Greece. Jean-Maxence Granier is with Auto-Support des Usagers de Drogues/Self-Support for People Who Use Drugs, Paris, France. Alex Stevens is with the School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK. Tim Rhodes is with the London School of Hygiene and Tropical Medicine, London, UK. Marie Jauffret-Roustide 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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Abstract
Purpose
This paper aims to demonstrate the ways in which the Misuse of Drugs Act (MDA) militates against the interests and situations of people who use drugs. The author reflects on the author’s journey as a drug user, drugs workers and drug user organiser to critique the MDA. The author describes the impact of the MDA on the author’s early experimentation with substances and highlights the limitations of simplistic drugs prevention. The author describes how the MDA maximises drug-related risks and undermines the creation of healthy cultural norms and community learning among people who use drugs. The author talks about the author’s work as a drugs practitioner and mourns the vandalism of the UK’s harm reduction and drug treatment system. This paper describes the opportunity to use drug policy reform as a progressive electoral agenda to begin the journey towards racial and social justice. This paper calls for the rejection of the Big Drugs Lie and the repeal of the failed MDA.
Design/methodology/approach
Personal reflection based on experience as drug user, drugs worker and drug user organiser.
Findings
Successive UK Governments have used the MDA as a tool of social control and racial discrimination. The Big Drugs Lie undermines science-based and rights-compliant drug policy and drug services and criminalises and puts young people at risk. There is the potential to build a progressive political alliance to remove the impediment of the MDA and use drug policy reform as tools for racial and social justice.
Practical implications
The MDA maximises the harms faced by people who use drugs, stokes stigma and discrimination and has undermined the quality of drug services. The MDA needs to be exposed and challenged as a tool for social control and racial discrimination. Delivering drug policy reform as a progressive electoral strategy could maximise its potential to improve social and racial justice.
Originality/value
This paper represents the view of people who use drugs by a drug user, a view which is seldom expressed in the length and level of argument shown here.
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Affiliation(s)
- Shira M. Goldenberg
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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