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Dertadian GC, Askew R. Towards a social harm approach in drug policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104425. [PMID: 38615484 DOI: 10.1016/j.drugpo.2024.104425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 04/16/2024]
Abstract
In this paper, we explore how the social harm approach can be adapted within drug policy scholarship. Since the mid-2000s, a group of critical criminologists have moved beyond the concept of crime and criminology, towards the study of social harm. This turn proceeds decades of research that highlights the inequities within the criminal legal system, the formation of laws that protect the privileged and punish the disadvantaged, and the systemic challenge of the effectiveness of retribution and punishment at addressing harm in the community. The purpose of this paper is to first identify parallels between the social harm approach and critical drug scholarship, and second to advocate for the adoption of a social harm lens in drug policy scholarship. In the paper, we draw out the similarities between social harm and drug policy literatures, as well as outline what the study of social harm can bring to an analysis of drug policy. This includes a discussion on the ontology of drug crime, the myth of drug crime and the ineffective use of the crime control system in response to drug use. The paper then discusses how these conversations in critical criminology and critical drugs scholarship can be brought together to inform future drug policy research. This reflection details the link between social harm and the impingement of human flourishing, explores the role of decolonizing drug policy, advocates for the centralization of lived experience within the research process and outlines how this might align with harm reduction approaches. We conclude by arguing that the social harm approach challenges the idea that neutrality is the goal in drug policy and explicitly seeks to expand new avenues in activist research and social justice approaches to policymaking.
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Affiliation(s)
| | - Rebecca Askew
- Manchester Metropolitan University: Department of Sociology and Criminology; Visiting Fellow, Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney
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Creativity, care and 'messy' drug use: A collective history of the early days of peer-led needle exchange in Dunedin, New Zealand. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103386. [PMID: 34419321 DOI: 10.1016/j.drugpo.2021.103386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 11/21/2022]
Abstract
Established in 1988, the New Zealand Needle Exchange Program (NZNEP) was the first needle exchange programme in the world to operate nation-wide under legal sanction. As in other countries, the ground for legislative reform was laid by activist action among the affected communities and their allies. In context of growing HIV/AIDS notifications, the provision of injecting equipment was positioned as a necessary, albeit politically contentious, public health priority. The NZNEP operated under a unique organisational model, with a national network of peer organisations formalised and supported to provide 'user pays' needle exchange. Unlike many other programmes of community empowerment instigated in response to HIV/AIDS, the NZNEP has over the past thirty years retained a significant degree of community control. Not without tensions, this history requires commemoration. The body of this essay was originally written as a chapter, focusing on the history of DIVO (Dunedin Intravenous Organisation), for a book to commemorate thirty years of the NZNEP. Under the auspices of a 'secret Facebook group' seven peers who worked at DIVO in the late 1980s and early 90s contributed the memories that make up this piece. As one of these peers, the author collated, coded and thematised these remembrances to create the story of DIVOS early days. From strategic positioning as a drug user organisation 'under wraps' DIVO garnered enough community support and institutional confidence to be 'out and proud' in advocating for the human rights of PWID. Ingenuity and action necessitated 'bending the rules' to protect against hepatitis C, and a community of care was recreated in the warmth of reconnection among the Facebook peer group. Tensions are inevitable in a peer-based organisation innovating in a context of precarious legitimacy, and they weave throughout this essay. This collective history is, however, primarily celebratory - of the achievements and legacy of a network of peers who were instrumental in providing care for their communities and advocating publicly for the rights of PWID in New Zealand.
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Bardwell G, Anderson S, Richardson L, Bird L, Lampkin H, Small W, McNeil R. The perspectives of structurally vulnerable people who use drugs on volunteer stipends and work experiences provided through a drug user organization: Opportunities and limitations. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:40-46. [PMID: 29501928 PMCID: PMC7046180 DOI: 10.1016/j.drugpo.2018.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/02/2017] [Accepted: 02/12/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND While drug user organizations (DUO) have received public health attention as a means to potentially reduce the harms associated with drug use, there is a lack of research on the compensation and structural forces that promote or inhibit participation in DUO. Against the backdrop of structural vulnerability experienced by people who use drugs (PWUD), we examined the impact of monetary 'volunteer stipends' provided through a DUO and explore their role in providing low-threshold employment opportunities and shaping participation in DUO. METHODS Participants were purposively sampled to reflect a range of perspectives and experiences volunteering at Vancouver Area Network of Drug Users (VANDU) and receiving stipends. Semi-structured qualitative interviews were conducted with 23 members of VANDU. Interview transcripts were coded in Atlas.ti 7 for key a priori themes and emergent categories from the data and analyzed thematically. RESULTS Stipends provided participants with symbolic and material recognition of the time, effort, and expertise they contribute to the organization, and functioned to facilitate ongoing participation. Payments that rewarded, skills, labour and drug-related knowledge reduced participant's perception of stigma against PWUD. Paid work in VANDU further provided participants with non-material benefits commonly attributed to regular employment, including social connections and a sense of purpose. Participants also identified the low level of pay as a limitation of VANDU's paid participation program. The daily demands of survival (accessing shelter, food, and drugs) posed more complex structural vulnerabilities to participate in VANDU, as small stipends were not sufficient to address these needs. CONCLUSION Low threshold employment opportunities within DUO may provide significant individual and public health benefits. However, these benefits are constrained by the small size of stipends. Therefore, to ensure better inclusion of PWUD, our findings recommend the development and expansion of equitable, accessible, well-paying employment programs for PWUD.
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Affiliation(s)
- Geoff Bardwell
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Solanna Anderson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Sociology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Lorna Bird
- Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | - Hugh Lampkin
- Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | - Will Small
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, 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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Belackova V, Wilkins C. Consumer agency in cannabis supply - Exploring auto-regulatory documents of the cannabis social clubs in Spain. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:26-34. [PMID: 29367012 DOI: 10.1016/j.drugpo.2017.12.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is growing experience with the not-for-profit, consumer-driven cannabis social club (CSC) model that builds on self-supply, self-organization and harm-reduction; these are principles upon which people who use drugs (PWUD) have been engaging for decades. Recent legalization of cannabis in a number of jurisdictions and the related challenges in regulating production, sale, taxation and health-related matters have raised interest in non-commercial models of cannabis supply. The "codes of conduct" (CsoC) of CSC federations in Spain might reveal whether a consumer-based model could overcome these challenges. METHODS To examine the content of the CSC auto-regulatory documents, an online search using key terms to identify the CsoC was conducted. Six documents were found; analysis of the main thematic categories and overarching themes was conducted. It was discussed how these corresponded to the areas of cannabis policy regulation and what the main limitations of the CSC model were. RESULTS The CsoC detailed the rules for CSC administration, not-for-profit aims, "invitation only" and other conditions of membership, collective cultivation and security as well as for operation of the consumption venue and health-related initiatives. The themes in the CsoC overlapped with cannabis regulatory areas as outlined internationally. Concern over cannabis prices and potency was missing in the CsoC. The potential strengths of the CSC model might include safe environment for peer-delivered harm reduction practice, preventing illicit transactions, quality control, shifting economic surplus to the consumers and increased consumer responsibility. The limitations of the CSC model include high threshold, disguised motives, tax revenue and the risk of both under- and over-regulation. CONCLUSION CSCs represent an opportunity to enhance consumer agency and responsibility. The right "to be self-supplied" with psychoactive substances can be granted to consumer associations - but authorities need to provide a framework to facilitate this voluntary self-organization, including minimum standards around public health and safety, and to involve consumers in the development of these regulations.
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Affiliation(s)
- Vendula Belackova
- External lecturer, Department of Institutional, Environmental and Experimental Economics, University of Economics in Prague, Nam. W. Churchilla, Prague 3, 130 00, Czech Republic; Senior Project Officer, Uniting Medically Supervised Injecting Centre, 66 Darlinghurst Road, Potts Point, NSW 2011, Australia.
| | - Chris Wilkins
- Drugs Team Leader, SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
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Weeks MR, Dickson-Gómez J, Mosack KE, Convey M, Martinez M, Clair S. The Risk Avoidance Partnership: Training Active Drug Users as Peer Health Advocates. JOURNAL OF DRUG ISSUES 2016; 36:541-570. [DOI: 10.1177/002204260603600303] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Efforts have expanded to create AIDS prevention programs for drug users that consider the social context and interpersonal relationships within which risky practices take place. The Risk Avoidance Partnership (RAP) project is designed to train active drug users as peer/public health advocates (PHAs) to bring a structured, peer-led intervention into the sites where they and their drug-using social networks use illicit drugs. The RAP peer health advocacy training curriculum and peer-led intervention promote harm reduction among drug users and support drug-user organization to reduce infectious disease and other harm in the context of injection drug use, crack cocaine use, and sexual activity. Initial findings suggest that RAP PHAs perceive a significant positive role change in themselves while conducting health advocacy work and willingly and successfully carry the peer-led intervention into locations of high-risk drug activity to deliver it to their peers even in the absence of project staff support.
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Thomas N, Bull M, Dioso-Villa R, Smith C. Governing drug use through partnerships: Towards a genealogy of government/non-government relations in drug policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 28:34-42. [DOI: 10.1016/j.drugpo.2015.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 10/19/2015] [Accepted: 11/04/2015] [Indexed: 12/01/2022]
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Smith ME, Robinowitz N, Chaulk P, Johnson KE. Self-care and risk reduction habits in older injection drug users with chronic wounds: a cross-sectional study. Harm Reduct J 2014; 11:28. [PMID: 25326686 PMCID: PMC4213493 DOI: 10.1186/1477-7517-11-28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/22/2014] [Indexed: 11/25/2022] Open
Abstract
Background We surveyed a population of injection drug users (IDUs) frequenting the mobile Baltimore City Needle Exchange Program (BNEP) to investigate self-care factors associated with chronic wounds, a significant cause of morbidity especially among older IDUs. Methods Participants ≥18 years old completed a survey regarding chronic wounds (duration ≥8 weeks), injection and hygiene practices. Study staff visually verified the presence of wounds. Participants were categorized into four groups by age and wound status. Factors associated with the presence of chronic wounds in participants ≥45 years were analyzed using logistic regression. Results Of the 152 participants, 19.7% had a chronic wound. Of those with chronic wounds, 18 were ≥45 years old (60.0%). Individuals ≥45 years old with chronic wounds were more likely to be enrolled in a drug treatment program (Odds ratio (OR) 3.4, 95% Confidence interval (CI) 1.0–10.8) and less likely to use cigarette filters when drawing up prepared drug (OR 0.2, 95% CI 0.03–0.7) compared to the same age group without chronic wounds. Compared to individuals <45 years old without chronic wounds, individuals ≥45 with a chronic wound were more likely to report cleaning reused needles with bleach (OR 10.7, 95% CI 1.2–93.9) and to use the clinic, rather than an emergency room, as a primary source of medical care (OR 3.4, 95% CI 1.1–10.4). Conclusions Older IDUs with chronic wounds have different, and perhaps less risky, injection and hygiene behaviors than their peers and younger IDUs without wounds in Baltimore City. Because of these differences, older IDUs with wounds may be more receptive to community-based healthcare and substance abuse treatment messages.
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Affiliation(s)
| | | | | | - Kristine E Johnson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins Medical Institutions, 5200 Eastern Avenue, MFL Building, Center Tower, 3rd Floor, Baltimore, MD 21224, USA.
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Wagner KD, Davidson PJ, Iverson E, Washburn R, Burke E, Kral AH, McNeeley M, Jackson Bloom J, Lankenau SE. "I felt like a superhero": the experience of responding to drug overdose among individuals trained in overdose prevention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:157-65. [PMID: 23932166 DOI: 10.1016/j.drugpo.2013.07.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/01/2013] [Accepted: 07/07/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Overdose prevention programs (OPPs) train people who inject drugs and other community members to prevent, recognise and respond to opioid overdose. However, little is known about the experience of taking up the role of an "overdose responder" for the participants. METHODS We present findings from qualitative interviews with 30 participants from two OPPs in Los Angeles, CA, USA from 2010 to 2011 who had responded to at least one overdose since being trained in overdose prevention and response. RESULTS Being trained by an OPP and responding to overdoses had both positive and negative effects for trained "responders". Positive effects include an increased sense of control and confidence, feelings of heroism and pride, and a recognition and appreciation of one's expertise. Negative effects include a sense of burden, regret, fear, and anger, which sometimes led to cutting social ties, but might also be mitigated by the increased empowerment associated with the positive effects. CONCLUSION Findings suggest that becoming an overdose responder can involve taking up a new social role that has positive effects, but also confers some stress that may require additional support. OPPs should provide flexible opportunities for social support to individuals making the transition to this new and critical social role. Equipping individuals with the skills, technology, and support they need to respond to drug overdose has the potential to confer both individual and community-wide benefits.
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Affiliation(s)
- Karla D Wagner
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA 92093-0507, USA.
| | - Peter J Davidson
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, San Diego, CA 92093-0507, USA
| | - Ellen Iverson
- Division of Adolescent Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS 2, Los Angeles, CA 90027, USA
| | - Rachel Washburn
- Department of Sociology, Loyola Marymount University, One LMU Drive, Suite 4314, Los Angeles, CA 90045-2659, USA
| | - Emily Burke
- Department of Community Health and Prevention, Drexel University School of Public Health, 1505 Race Street, Bellet Building, Philadelphia, PA 19102-1192, USA
| | - Alex H Kral
- Urban Health Program, RTI International, San Francisco Regional Office, 114 Sansome Street, Suite 500, San Francisco, CA 94104, USA
| | - Miles McNeeley
- Community, Health Outcomes and Intervention Research Program, The Saban Research Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS 30, Los Angeles, CA 90027, USA
| | - Jennifer Jackson Bloom
- Division of Adolescent Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS 2, Los Angeles, CA 90027, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Drexel University School of Public Health, 1505 Race Street, Bellet Building, Philadelphia, PA 19102-1192, USA
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Callon C, Charles G, Alexander R, Small W, Kerr T. 'On the same level': facilitators' experiences running a drug user-led safer injecting education campaign. Harm Reduct J 2013; 10:4. [PMID: 23497293 PMCID: PMC3605366 DOI: 10.1186/1477-7517-10-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022] Open
Abstract
Background Unsafe injection practices play a major role in elevated rates of morbidity and mortality among people who inject drugs (IDU). There is growing interest in the direct involvement of IDU in interventions that seek to address unsafe injecting. This study describes a drug user-led safer injecting education campaign, and explores facilitators’ experiences delivering educational workshops. Methods We conducted semi-structured qualitative interviews with 8 members of the Injection Support (IS) Team who developed and facilitated a series of safer injecting education workshops. Interviews explored facilitator’s perceptions of the workshops, experiences being a facilitator, and perspectives on the educational campaign. Interviews were transcribed verbatim and a thematic analysis was conducted. Results IS Team facilitators described how the workshop’s structure and content enabled effective communication of information about safer injecting practices, while targeting the unsafe practices of workshop participants. Facilitators’ identity as IDU enhanced their ability to relate to workshop participants and communicate educational messages in language accessible to workshop participants. Facilitators reported gaining knowledge and skills from their involvement in the campaign, as well as positive feelings about themselves from the realization that they were helping people to protect their health. Overall, facilitators felt that this campaign provided IDU with valuable information, although facilitators also critiqued the campaign and suggested improvements for future efforts. Conclusions This study demonstrates the feasibility of involving IDU in educational initiatives targeting unsafe injecting. Findings illustrate how IDU involvement in prevention activities improves relevance and cultural appropriateness of interventions while providing individual, social, and professional benefits to those IDU delivering education.
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Affiliation(s)
- Cody Callon
- British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Ti L, Tzemis D, Buxton JA. Engaging people who use drugs in policy and program development: a review of the literature. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2012; 7:47. [PMID: 23176382 PMCID: PMC3551750 DOI: 10.1186/1747-597x-7-47] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 11/08/2012] [Indexed: 11/14/2022]
Abstract
Health policies and programs are increasingly being driven by people from the community to more effectively address their needs. While a large body of evidence supports peer engagement in the context of policy and program development for various populations, little is known about this form of engagement among people who use drugs (PWUD). Therefore, a narrative literature review was undertaken to provide an overview of this topic. Searches of PubMed and Academic Search Premier databases covering 1995–2010 were conducted to identify articles assessing peer engagement in policy and program development. In total, 19 articles were included for review. Our findings indicate that PWUD face many challenges that restrict their ability to engage with public health professionals and policy makers, including the high levels of stigma and discrimination that persist among this population. Although the literature shows that many international organizations are recommending the involvement of PWUD in policy and program development, our findings revealed a lack of published data on the implementation of these efforts. Gaps in the current evidence highlight the need for additional research to explore and document the engagement of PWUD in the areas of policy and program development. Further, efforts to minimize stigmatizing barriers associated with illicit drug use are urgently needed to improve the engagement of PWUD in decision making processes.
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Affiliation(s)
- Lianping Ti
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
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Affiliation(s)
- Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Baltimore, Maryland 21205, USA.
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Affiliation(s)
- John Ryan
- Anex, Fitzroy North, Melbourne, Victoria, Australia.
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Frank VA, Anker J, Tammi T. Drug user organizations in the Nordic countries--local, national, and international dimensions. Subst Use Misuse 2012; 47:462-73. [PMID: 22428815 DOI: 10.3109/10826084.2012.644095] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The article focuses on drug user organizations that represent and advocate for active "hard drug" users in the Nordic countries. It discusses the opportunities and challenges that these organizations face in their search for legitimacy and political influence. The comparative perspective points at similarities and differences in national contexts that both support and challenges the existence of drug user organizations, including drug policy, social welfare policy, trends in drug use, and organizational conditions. The article also discusses the importance of international network and transnational organizations that support drug user organizations.
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Affiliation(s)
- Vibeke Asmussen Frank
- Centre for Alcohol and Drug Research, Faculty of Social Sciences, Aarhus University, Aarhus, Denmark.
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Affiliation(s)
- John Kleinig
- Department of Criminal Justice, John Jay College of Criminal Justice, City University of New York, New York, New York 10019, USA.
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Small W, Wood E, Tobin D, Rikley J, Lapushinsky D, Kerr T. The Injection Support Team: a peer-driven program to address unsafe injecting in a Canadian setting. Subst Use Misuse 2012; 47:491-501. [PMID: 22428817 DOI: 10.3109/10826084.2012.644107] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2005, members of the Vancouver Area Network of Drug Users (VANDU) formed the Injection Support Team (IST). A community-based research project examined this drug-user-led intervention through observation of team activities, over 30 interviews with team members, and 9 interviews with people reached by the team. The IST is composed of recognized "hit doctors," who perform outreach in the open drug scene to provide safer injecting education and instruction regarding safer assisted-injection. The IST represents a unique drug-user-led response to the gaps in local harm reduction efforts including programmatic barriers to attending the local supervised injection facility.
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Affiliation(s)
- Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Adams PJ, Prescott A, Dixon R. Strange bedfellows: meta-narrative traditions in the alcohol and other drug field. Drug Alcohol Rev 2011; 31:591-7. [PMID: 22145863 DOI: 10.1111/j.1465-3362.2011.00386.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Peter J Adams
- School of Population Health, University of Auckland, Auckland, New Zealand.
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Beyrer C, Malinowska-Sempruch K, Kamarulzaman A, Kazatchkine M, Sidibe M, Strathdee SA. Time to act: a call for comprehensive responses to HIV in people who use drugs. Lancet 2010; 376:551-63. [PMID: 20650515 PMCID: PMC3682471 DOI: 10.1016/s0140-6736(10)60928-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The published work on HIV in people who use drugs shows that the global burden of HIV infection in this group can be reduced. Concerted action by governments, multilateral organisations, health systems, and individuals could lead to enormous benefits for families, communities, and societies. We review the evidence and identify synergies between biomedical science, public health, and human rights. Cost-effective interventions, including needle and syringe exchange programmes, opioid substitution therapy, and expanded access to HIV treatment and care, are supported on public health and human rights grounds; however, only around 10% of people who use drugs worldwide are being reached, and far too many are imprisoned for minor offences or detained without trial. To change this situation will take commitment, advocacy, and political courage to advance the action agenda. Failure to do so will exacerbate the spread of HIV infection, undermine treatment programmes, and continue to expand prison populations with patients in need of care.
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Affiliation(s)
- Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Abstract
We reviewed evidence from more than 900 studies and reports on the link between human rights abuses experienced by people who use drugs and vulnerability to HIV infection and access to services. Published work documents widespread abuses of human rights, which increase vulnerability to HIV infection and negatively affect delivery of HIV programmes. These abuses include denial of harm-reduction services, discriminatory access to antiretroviral therapy, abusive law enforcement practices, and coercion in the guise of treatment for drug dependence. Protection of the human rights of people who use drugs therefore is important not only because their rights must be respected, protected, and fulfilled, but also because it is an essential precondition to improving the health of people who use drugs. Rights-based responses to HIV and drug use have had good outcomes where they have been implemented, and they should be replicated in other countries.
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Affiliation(s)
- Ralf Jürgens
- HIV/AIDS, Health, Policy and Human Rights, Quebec, Canada.
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Kerr T, Hayashi K, Fairbairn N, Kaplan K, Suwannawong P, Zhang R, Wood E. Expanding the reach of harm reduction in Thailand: Experiences with a drug user-run drop-in centre. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:255-8. [DOI: 10.1016/j.drugpo.2009.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 07/08/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
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Mold A, Berridge V. ‘The rise of the user’? Voluntary organizations, the state and illegal drugs in England since the 1960s. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630801937330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ritter A, Cameron J. A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs. Drug Alcohol Rev 2009; 25:611-24. [PMID: 17132577 DOI: 10.1080/09595230600944529] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Harm reduction is both a policy approach and used to describe a specific set of interventions. These interventions aim to reduce the harms associated with drug use. Employing a strict definition of harm reduction, evidence for the efficacy and effectiveness of alcohol, tobacco and illicit drug harm reduction interventions were reviewed. Systematic searches of the published literature were undertaken. Studies were included if they provided evaluation data (pre-post, or control group comparisons). More than 650 articles were included in the review. The majority of the literature concerned illicit drugs. For alcohol, harm reduction interventions to reduce road trauma are well-founded in evidence. Otherwise, there is limited research to support the efficacy and effectiveness of other alcohol harm reduction interventions. For tobacco, the area is controversial but promising new products that reduce the harms associated with smoking are being developed. In the area of illicit drugs there is solid efficacy, effectiveness and economic data to support needle syringe programmes and outreach programmes. There is limited published evidence to date for other harm reduction interventions such as non-injecting routes of administration, brief interventions and emerging positive evidence for supervised injecting facilities. There is sufficient evidence to support the wide-spread adoption of harm reduction interventions and to use harm reduction as an overarching policy approach in relation to illicit drugs. The same cannot be concluded for alcohol or tobacco. Research at a broad policy level is required, especially in light of the failure by many policy makers to adopt cost-effective harm reduction interventions.
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Affiliation(s)
- Alison Ritter
- Australian National University, Canberra, Australian Capital Territory, Australia.
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Rhodes T, Treloar C. The social production of hepatitis C risk among injecting drug users: a qualitative synthesis. Addiction 2008; 103:1593-603. [PMID: 18821870 DOI: 10.1111/j.1360-0443.2008.02306.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intervention impact on reductions in hepatitis C virus (HCV) incidence among injecting drug users (IDUs) are modest. There is a need to explore how drug injectors' interpret HCV risk. AIMS To review English-language qualitative empirical studies of HCV risk among IDUs. METHODS Qualitative synthesis using a meta-ethnographic approach. Searching of eight electronic databases and reference lists identified manually papers in peer-reviewed journals since 2000. Only studies investigating IDU perspectives on HCV risk were included. Themes across studies were identified systematically and compared, leading to a synthesis of second- and third-order constructs. FINDINGS We included 31 papers, representing 24 studies among over 1000 IDUs. Seven themes were generated: risk ubiquity; relative viral risk; knowledge uncertainty; hygiene and the body; trust and intimacy; risk environment; and the individualization of risk responsibility. Evidence supports a perception of HCV as a risk accepted rather than avoided. HCV was perceived largely as socially accommodated and expected, and in relative terms to human immunodeficiency virus (HIV) as the 'master status' of viral dangers. Symbolic knowledge systems, rather than biomedical risk calculus, and especially narratives of hygiene and trust, played a primary role in shaping interpretations of HCV risk. Critical factors in the risk environment included policing, homelessness and gendered risk. CONCLUSIONS Appealing to risk calculus alone is insufficient. Interventions should build upon the salience of hygiene and trust narratives in HCV risk rationality, and foster community changes towards the perceived preventability of HCV. Structural interventions in harm reduction should target policing, homelessness and gendered risk.
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Affiliation(s)
- Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, University of London, London, UK.
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Allman D, Myers T, Schellenberg J, Strike C, Cockerill R, Cavalieri W. Peer networking for the reduction of drug-related harm. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2006. [DOI: 10.1016/j.drugpo.2006.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harm reduction by a “user-run” organization: A case study of the Vancouver Area Network of Drug Users (VANDU). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2006. [DOI: 10.1016/j.drugpo.2006.01.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Roe G. Harm reduction as paradigm: Is better than bad good enough? The origins of harm reduction. CRITICAL PUBLIC HEALTH 2005. [DOI: 10.1080/09581590500372188] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Information exchange among injecting drug users: a role for an expanded peer education workforce. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2005. [DOI: 10.1016/j.drugpo.2004.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Weeks MR, Clair S, Singer M, Radda K, Schensul JJ, Wilson DS, Martinez M, Scott G, Knight G. High Risk Drug Use Sites, Meaning and Practice: Implications for AidS Prevention. JOURNAL OF DRUG ISSUES 2001. [DOI: 10.1177/002204260103100314] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A study of drug use locations in Hartford, CT, Is designed to understand the environmental and social conditions within “high risk sites” where drug users inject drugs or smoke crack, In order to develop AIDS prevention models that build upon the physical and social organization of these locations. The study assesses high-risk sites characterized on the basis of type of location or structure, presence and strength of gatekeepers, and presence and strength of HIV prevention opportunities and pressures. A combination of ethnographic, epidemiological, and social network methods are used to document the characteristics, social organization, natural history, and dynamics of these sites, the network relations of site users, and the various opportunities for, or barriers to, on-site social-level HIV prevention intervention. This paper provides an overview of the study and presents preliminary findings, Including the degree to which drug injectors and crack smokers use specific types of sites in Hartford. The paper also discusses the ways these findings Inform development of on-site, type-specific and peer-led or structural HIV-prevention Interventions.
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Abstract
Research into resocialization of criminals or into recovery from substance dependence has stressed the need to give up the deviant identity and lifestyle. However, addiction careers, crime, and other types of deviant behavior require a wide range of skills. Such competence may facilitate the alternative or simultaneous pursuit of "respectable" careers in treatment, prevention, research, or policy matters. Former alcoholics fill important positions in the service structures of Alcoholics Anonymous, current or former users are appreciated as partners in AIDS prevention programs, and drug addicts can become privileged-access interviewers and be recruited by research institutes. The paper discusses "market conditions" that favor or impede career shifts. How society and professionals perceive individuals with a history of stigma varies from complete rejection to admiration or recognition of usefulness. This assessment depends on such factors as degree of political and scientific interest in controlling, changing, and detecting hidden deviant populations, as well as public fascination with "authentic" deviants, combined with increasing scepticism about conventional expert knowledge.
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Affiliation(s)
- H K Klingemann
- Swiss Institute for the Prevention of Alcohol and Drug Problems, Lausanne.
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Blewett N, Stimson GV, Rhodes T, Bowtell B. Comments on Hulse's "Australia's public health response to HIV and HCV: a role for 'affected' communities". Drug Alcohol Rev 1997; 16:177-81. [PMID: 16203424 DOI: 10.1080/09595239700186471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- N Blewett
- Australian High Commission, Australia House, Strand, London, WC2B 4LA, UK
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