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Whiteside B, Dunn M. Voices represented and voices silenced: Represented voices in the media coverage of the implementation of a supervised injecting facility. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104213. [PMID: 37776603 DOI: 10.1016/j.drugpo.2023.104213] [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: 12/02/2022] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Victoria's first medically supervised injecting room (MSIR) has remained controversial despite mounting evidence in support of the facility. The opposition to a policy idea is subject to a myriad of factors including the media. Favouring the opinions of various actors, the media are a fundamental element of the narrative formation process. In this article, we examine the voices represented and voice silenced in print news media and the possible effects of such reporting. METHODS A quantitative content and qualitative thematic analysis of Victorian print media (n=645) focusing on the implementation and continued operation of North Richmond Community Health's medically supervised injecting room was conducted. RESULTS The representations of the MSIR were debated by three predominant actors - politicians, public, and residents. Politicians largely relied on the 'saving lives' rhetoric when supporting the facility. In addition, competing representations of 'public amenity' were presented by both advocates and proponents of the MSIR. We found the voices of people who inject drugs were inadequately represented within the data. Instead, overdose statistics were featured as were discursive descriptions of people who inject drugs such as 'addicts', 'junkies', and 'druggies'. CONCLUSION Despite people who inject drugs being the population the MSIR is designed to benefit, their experiences and voices were lacking, highlighting social power structures, denying the silenced power, and obstructing social change. Overdose rates were consistently presented as numbers, negating personal experiences and lacking meaningful debate. Further, negative discourse referring to people who inject drugs may have implications regarding internalised and externalised stigma and drug policy.
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Affiliation(s)
- Bianca Whiteside
- School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Australia; Institute for Health Transformation, Faculty of Health, Deakin University, Australia.
| | - Matthew Dunn
- School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Australia; Institute for Health Transformation, Faculty of Health, Deakin University, Australia
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Maguet S, Laliberte N, Moore L, Milkovich T, Burmeister C, Scow M, Sproule W, Dove N, Martens S. An evaluation of the Compassion, Inclusion, and Engagement initiative: learning from PWLE and communities across British Columbia. Harm Reduct J 2023; 20:89. [PMID: 37452328 PMCID: PMC10347729 DOI: 10.1186/s12954-023-00819-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The Compassion, Inclusion and Engagement initiative (CIE) was a social contact intervention that operated in British Columbia between 2015 and 2021. The primary objective of CIE was to increase the participation of people with lived experience of substance use (PWLE) in the planning, design, implementation, and evaluation of harm reduction supports and services. CASE PRESENTATION CIE used the developmental evaluation methodology outcome mapping to define and measure progress towards its goals. Developmental evaluation emphasizes learning in contrast to other forms of evaluation which are often more focused on determining the value or success of a project or programme based on predetermined criteria. Outcome mapping is a relational practice which acknowledges that change is achieved by an initiative's partners and the role of the initiative is to provide access to resources, ideas and opportunities that can facilitate and support change. CONCLUSIONS Through the implementation and evaluation of CIE, it became clear that directly supporting PWLE facilitated more meaningful and lasting change than solely working to improve the health and social services that supported them. The impacts of the CIE initiative extend far beyond the outcomes of any of the dialogues it facilitated and are largely the result of an increase in social capital. CIE engagements created the opportunity for change by inviting people most affected by the toxic drug supply together with those committed to supporting them, but their ability to bring about systemic change was limited. Both PWLE and service providers noted the lack of support to attend CIE engagements, lack of support for actions that came from those engagements, and lack of PWLE inclusion in decision-making by health authorities as limiting factors for systemic change. The lack of response at a systemic level often resulted in PWLE carrying the burden of responding to toxic drug poisonings, often without resources, support, or compensation.
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Affiliation(s)
- Sally Maguet
- Provincial Health Services Authority, Vancouver, Canada.
| | | | - Laura Moore
- BC Centre for Disease Control, Vancouver, Canada
| | | | | | - Marnie Scow
- BC Centre for Disease Control, Vancouver, Canada
| | | | - Naomi Dove
- BC Centre for Disease Control, Vancouver, Canada
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Morris H, Bwala H, Wesley J, Hyshka E. Public support for safer supply programs: analysis of a cross-sectional survey of Canadians in two provinces. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:484-492. [PMID: 36689127 PMCID: PMC9869824 DOI: 10.17269/s41997-022-00736-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/19/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Canada's ongoing drug poisoning crisis has contributed to unprecedented rates of morbidity and mortality. Health Canada has funded safer supply pilot programs to help connect people who use drugs to pharmaceutical grade medications that reduce their reliance on a toxic drug supply. However, most provinces, including Alberta and Saskatchewan, have not endorsed these initiatives. We explored public support for safer supply programs in these two Canadian provinces and identified predictors of support for this policy option. METHODS Cross-sectional data were examined from an online panel survey that included measures assessing views on policy responses to substance use and addiction. A total of 1602 adults were recruited during March 2021. We used descriptive statistics to characterize support for safer supply programs in Alberta and Saskatchewan and multinominal logistic regression analysis to examine predictors of public support for safer supply. RESULTS The majority of respondents (AB: 63.5% and SK: 56.3%) supported safer supply programs that replace illegal street drugs with pharmaceutical alternatives for those unable to stop using. Predicted probabilities show a greater probability of support for safer supply among those with higher education and those leaning left on the political spectrum. CONCLUSION A majority of Canadians from Alberta and Saskatchewan supported provincial government efforts to expand safer supply, suggesting a lack of public support is not the main barrier to implementation. Efforts at mobilizing this public opinion are needed to scale up and facilitate evaluation of this drug poisoning response.
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Affiliation(s)
- Heather Morris
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Hauwa Bwala
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Jared Wesley
- Faculty of Arts-Political Science Department, University of Alberta, Edmonton, AB, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Wild TC, Koziel J, Anderson-Baron J, Asbridge M, Belle-Isle L, Dell C, Elliott R, Hathaway A, MacPherson D, McBride K, Pauly B, Strike C, Galovan A, Hyshka E. Public support for harm reduction: A population survey of Canadian adults. PLoS One 2021; 16:e0251860. [PMID: 34010338 PMCID: PMC8133460 DOI: 10.1371/journal.pone.0251860] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/05/2021] [Indexed: 11/19/2022] Open
Abstract
We described public views toward harm reduction among Canadian adults and tested a social exposure model predicting support for these contentious services, drawing on theories in the morality policy, intergroup relations, addiction, and media communication literatures. A quota sample of 4645 adults (18+ years), randomly drawn from an online research panel and stratified to match age and sex distributions of adults within and across Canadian provinces, was recruited in June 2018. Participants completed survey items assessing support for harm reduction for people who use drugs (PWUD) and for seven harm reduction interventions. Additional items assessed exposure to media coverage on harm reduction, and scales assessing stigma toward PWUD (α = .72), personal familiarity with PWUD (α = .84), and disease model beliefs about addiction (α = .79). Most (64%) Canadians supported harm reduction (provincial estimates = 60% - 73%). Five of seven interventions received majority support, including: outreach (79%), naloxone (72%), drug checking (70%), needle distribution (60%) and supervised drug consumption (55%). Low-threshold opioid agonist treatment and safe inhalation interventions received less support (49% and 44%). Our social exposure model, adjusted for respondent sex, household income, political views, and education, exhibited good fit and accounted for 17% of variance in public support for harm reduction. Personal familiarity with PWUD and disease model beliefs about addiction were directly associated with support (βs = .07 and -0.10, respectively), and indirectly influenced public support via stigmatized attitudes toward PWUD (βs = 0.01 and -0.01, respectively). Strategies to increase support for harm reduction could problematize certain disease model beliefs (e.g., "There are only two possibilities for an alcoholic or drug addict-permanent abstinence or death") and creating opportunities to reduce social distance between PWUD, the public, and policy makers.
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Affiliation(s)
- T. Cameron Wild
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jakob Koziel
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | | | - Mark Asbridge
- Department of Community Health and Epidemiology, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lynne Belle-Isle
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Colleen Dell
- Department of Sociology, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Andrew Hathaway
- Department of Sociology and Anthropology, University of Guelph, Guelph, Ontario, Canada
| | | | | | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adam Galovan
- Department of Human Ecology, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Munoz Sastre MT, Kpanake L, Mullet E. French People's positions on supervised injection facilities for drug users. Subst Abuse Treat Prev Policy 2020; 15:79. [PMID: 33054832 PMCID: PMC7557075 DOI: 10.1186/s13011-020-00321-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Supervised injection facilities have been set-up in many countries to curb the health risks associated with unsafe injection practices. These facilities have, however, been met with vocal opposition, notably in France. As harm reduction policies can only succeed to the extent that people agree with them, this study mapped French people's opinions regarding the setting-up of these facilities. METHOD A sample of 318 adults--among them health professionals--were presented with 48 vignettes depicting plans to create a supervised injection facility in their town. Each vignette contained three pieces of information: (a) the type of substance that would be injected in the facility (amphetamines only, amphetamines and cocaine only, or amphetamines, cocaine and heroin), (b) the type of staff who would be working in the facility (physicians and nurses, specially trained former drug users, specially trained current drug users, or trained volunteers recruited by the municipality), and (c) the staff members' mission (to be present and observe only, technical counselling about safe injection, counselling about safe injection and hygiene, or counselling and encouragement to follow a detoxification program). RESULTS Through cluster analysis, three qualitatively different positions were found: Not very acceptable (20%), Depends on staff and mission (49%), and Always acceptable (31%). These positions were associated with demographic characteristics--namely gender, age and political orientation. CONCLUSION French people's positions regarding supervised injection facilities were extremely diverse. One type of facility would, however, be accepted by a large majority of people: supervised injection facilities run by health professionals whose mission would be, in addition to technical and hygienic counselling, to encourage patrons to enter detoxification or rehabilitation programs.
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Affiliation(s)
- Maria Teresa Munoz Sastre
- CERPPS, Maison de la recherche, Federal University of Toulouse, 5 allées Antonio Machado, 31058 Toulouse cedex 9, France
| | - Lonzozou Kpanake
- University of Québec – TELUQ, 5800, rue Saint-Denis, Bureau 1105, Montréal (Québec), Montréal, H2S 3L5 Canada
| | - Etienne Mullet
- Institute of Advanced Studies (EPHE), 17 bis, rue Quefes, Plaisance du Touch, 31830 Paris, France
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Cameron Wild T, Koziel J, Anderson-Baron J, Hathaway J, McCurdy A, Xu X, Asbridge M, Belle-Isle L, Hathaway A, MacPherson D, Hyshka E. Media coverage of harm reduction, 2000-2016: A content analysis of tone, topics, and interventions in Canadian print news. Drug Alcohol Depend 2019; 205:107599. [PMID: 31610295 DOI: 10.1016/j.drugalcdep.2019.107599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/24/2019] [Accepted: 07/28/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Harm reduction interventions reduce mortality and morbidity for people who use drugs (PWUD), but are contentious and haphazardly implemented. This study describes volume and content of Canadian newspaper coverage of harm reduction produced from 2000 to 2016. METHODS Searches of 54 English-language newspapers identified 5681 texts, coded for type (news reports, opinion pieces), tone (positive, negative, or neutral/balanced coverage), topic (health, crime, social welfare, and political perspectives on harm reduction), and seven harm reduction interventions. RESULTS Volume of coverage doubled in 2008 (after removal of harm reduction from federal drug policy and legal challenges to Vancouver's supervised consumption program) and quadrupled in 2016 (tracking Canada's opioid emergency). Health perspectives on harm reduction were most common (39% of texts) while criminal perspectives were rare (3%). Negative coverage was over 10 times more common in opinion pieces (31%) compared to news reports (3%); this trend was more pronounced in British Columbia and Alberta, a region particularly affected by Canada's opioid emergency. Supervised drug consumption accounted for 49% of all newspaper coverage. CONCLUSIONS Although federal policy support for harm reduction waxed and waned over 17 years, Canadian newspapers independently shaped public discourse, frequently characterizing harm reduction positively/neutrally and from a health perspective. However, issue framing and agenda setting was also evident: supervised drug consumption offered in a single Canadian city crowded out coverage of all other harm reduction services, except for naloxone. This narrow sense of 'newsworthiness' obscured public discourse on the full spectrum of evidence-based harm reduction services that could benefit PWUD.
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Affiliation(s)
- T Cameron Wild
- School of Public Health, University of Alberta, Alberta, Canada.
| | - Jakob Koziel
- School of Public Health, University of Alberta, Alberta, Canada
| | | | - Josh Hathaway
- School of Public Health, University of Alberta, Alberta, Canada
| | - Ashley McCurdy
- School of Public Health, University of Alberta, Alberta, Canada
| | - Xin Xu
- School of Public Health, University of Alberta, Alberta, Canada
| | | | - Lynne Belle-Isle
- Canadian AIDS Society and Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | | | | | - Elaine Hyshka
- School of Public Health, University of Alberta, Alberta, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Kim BJ, Harley DA. Needle and Syringe Programs in Rural Areas: Addressing the Intravenous Drug Use Epidemic. REHABILITATION RESEARCH POLICY AND EDUCATION 2019. [DOI: 10.1891/2168-6653.33.1.56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundOpioid use has reached epidemic proportions in rural communities in the United States and injection of drugs is commonly used. As a result of shared or reusing needles and syringes, the risk for contracting blood-borne diseases is significantly increased. Rural areas face many social and attitudinal barriers regarding syringe exchange programs (SEPs).ObjectiveThis article describes national trends for drug injection problems in rural areas and discusses effectiveness of needle and SEPs as a harm reduction healthcare policy. Ethical and practical considerations in the implementation of SEPs are also presented.MethodThe rehabilitation literature was reviewed on trends in substance abuse and intravenous (IV) drug use in rural areas to identify the status and need for SEPs to address risk factors of infectious diseases resulting from needle sharing and reusing of needles.FindingsIV drug use in rural communities has reached epidemic proportions with resulting dramatic increases in hepatitis C and B and incidence of HIV. Yet, many rural communities continue to object to the implementation of SEPs due to fears that such programs will increase drug use and crime in the community.ConclusionIV drug use is a critical public health issue for users and non-IV users in rural communities, and is increasingly becoming an issue about which rural rehabilitation counselors will need to be informed. For the sake of public health, SEPs should be recognized as an economical, ethical, and effective factor in the larger response to the epidemic of IV drug use in rural America.
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Kulesza M, Teachman BA, Werntz AJ, Gasser ML, Lindgren KP. Correlates of public support toward federal funding for harm reduction strategies. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:25. [PMID: 26122408 PMCID: PMC4490612 DOI: 10.1186/s13011-015-0022-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/26/2015] [Indexed: 12/31/2022]
Abstract
Background Historically, US federal policy has not supported harm reduction interventions, such as safe injection facilities (SIFs) and needle and syringe programs (NSPs), which can reduce the burden associated with injection drug use. Given recent increases in abuse of both legal and illegal opioids, there has been a renewed debate about effective ways to address this problem. The current study (1) assessed participants’ support for SIFs and NSPs, and (2) evaluated several demographic factors (e.g., age, gender, race, education, political ideology, and religiosity) and individual differences in stigmatizing beliefs about people who inject drugs (PWID) that might relate to support for these interventions. Methods U.S. adults (N = 899) completed a web-based study that assessed self-reported support for NSPs and SIFs, and stigma about PWID. Results The majority of participants were at least somewhat supportive of both NSPs and SIFs. Regression analyses indicated greater support for NSPs and SIFs was predicted by more liberal political ideology, more agreement that PWID deserve help rather than punishment, older age, and male gender. Also, participants who endorsed lower stigma about PWID were more supportive of NSPs and SIFs. Race, religiosity, and education did not predict support for NSPs and SIFs. Conclusions Most participants tended to report support for harm reduction strategies. Age, political ideology, and individual differences in stigmatizing beliefs about PWID were significantly associated with support. Given the potential malleability of stigmatizing beliefs, efforts that seek to shift stigma about PWID could have important implications for public policy towards harm reduction strategies for PWID.
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Affiliation(s)
- Magdalena Kulesza
- Department of Psychiatry, University of Washington, 1100 NE 45th Street, Seattle, WA, 98105, USA. .,RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA.
| | - Bethany A Teachman
- University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA.
| | - Alexandra J Werntz
- University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA.
| | - Melissa L Gasser
- Department of Psychiatry, University of Washington, 1100 NE 45th Street, Seattle, WA, 98105, USA.
| | - Kristen P Lindgren
- Department of Psychiatry, University of Washington, 1100 NE 45th Street, Seattle, WA, 98105, USA.
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