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Stevens A, Keemink JR, Shirley-Beavan S, Khadjesari Z, Artenie A, Vickerman P, Southwell M, Shorter GW. Overdose prevention centres as spaces of safety, trust and inclusion: A causal pathway based on a realist review. Drug Alcohol Rev 2024. [PMID: 39104059 DOI: 10.1111/dar.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 08/07/2024]
Abstract
ISSUES Overdose prevention centres (OPC) are non-residential spaces where people can use illicit drugs (that they have obtained elsewhere) in the presence of staff who can intervene to prevent and manage any overdoses that occur. Many reviews of OPCs exist but they do not explain how OPCs work. APPROACH We carried out a realist review, using the RAMESES reporting standards. We systematically searched for and then thematically analysed 391 documents that provide information on the contexts, mechanisms and outcomes of OPCs. KEY FINDINGS Our retroductive analysis identified a causal pathway that highlights the feeling of safety - and the immediate outcome of not dying - as conditions of possibility for the people who use OPCs to build trust and experience social inclusion. The combination of safety, trust and social inclusion that is triggered by OPCs can - depending on the contexts in which they operate - generate other positive outcomes, which may include less risky drug use practices, reductions in blood borne viruses and injection-related infections and wounds, and access to housing. These outcomes are contingent on relevant contexts, including political and legal environments, which differ for women and people from racialised minorities. CONCLUSIONS OPCs can enable people who live with structural violence and vulnerability to develop feelings of safety and trust that help them stay alive and to build longer term trajectories of social inclusion, with potential to improve other aspects of their health and living conditions.
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Affiliation(s)
- Alex Stevens
- Social Policy, Sociology and Social Research, University of Kent, Medway, UK
| | - Jolie R Keemink
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Sam Shirley-Beavan
- Social Policy, Sociology and Social Research, University of Kent, Medway, UK
| | | | | | | | | | - Gillian W Shorter
- Drug and Alcohol Research Network, Queen's University Belfast, Belfast, UK
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Rouhani S, Zhang L, Winiker AK, Sherman SG, Bandara S. Emerging models of de facto drug policy reforms in the United States. Drug Alcohol Depend 2024; 260:111341. [PMID: 38815292 DOI: 10.1016/j.drugalcdep.2024.111341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Health and human rights organizations have endorsed drug decriminalization to promote public health-oriented approaches to substance use. In the US, policymakers have begun to pursue this via prosecutorial discretion-or the decision by a prosecutor to decline criminal charges for drug possession in their jurisdiction. This study characterizes drivers of adoption, policy design and implementation processes, and barriers to impact and sustainability of this approach to inform evolving policy efforts promoting the health of people who use drugs (PWUD). METHODS We conducted n=22 key informant interviews with policymakers and national policy experts representing 13 jurisdictions implementing de facto drug policy reforms. Analyses were informed by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and analyzed using a hybrid inductive-deductive approach. RESULTS Drivers of policy adoption included racial inequities, perceived failures of criminalization, and desires to prioritize violent crime given resource constraints. Three distinct policy typologies are described with varying conditions for eligibility, linkage to services, and policy transparency and dissemination. Public misinformation, police resistance and political opposition were seen as threats to sustainability. CONCLUSIONS Given evidence that criminalization amplifies drug-related harms, many policymakers are adopting de facto drug policy reforms in the absence of formal legislation. This is the first study to systematically describe relevant implementation processes and emerging policy models. Findings have implications for designing rigorous evaluations on health outcomes and informing sustainable evidence-based policies to promote health and racial equity of PWUD in the US.
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Affiliation(s)
- Saba Rouhani
- Department of Epidemiology, New York University School of Global Public Health, United States; Center for Anti-racism, Social Justice and Public Health, New York University School of Global Public Health, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Leanne Zhang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Abigail K Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States
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Dunham K, Hill K, Kazal H, Butner JL, Hull I, Sue K, Li L, Doneski K, Dinges B, Rife-Pennington T, Kung S, Thakarar K. In Support of Overdose Prevention Centers: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education and Research in Substance Use and Addiction). SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:328-336. [PMID: 38747578 DOI: 10.1177/29767342241252590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Given increasing rates of fatal overdoses in the United States and the rapidly changing drug supply, overdose prevention centers (OPCs; also known as safe consumption sites) have been identified as a vital, evidence-based strategy that provide people who use drugs (PWUD) the opportunity to use drugs safely and receive immediate, life-saving overdose support from trained personnel. In addition to providing a safe, supervised space to use drugs, OPCs can house further essential harm reduction drop-in services such as sterile supplies, social services, and medical care. There are established national and international data demonstrating the lifesaving services provided by OPCs, inspiring a groundswell of advocacy efforts to expand these programs in the United States. Thus, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) endorses OPCs, in addition to other harm reduction strategies that protect PWUD. Ultimately, it is imperative to increase access to OPCs across the United States and support key policy changes at the local, state, and federal levels that would facilitate urgent expansion.
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Affiliation(s)
- Katherine Dunham
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katherine Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Hannah Kazal
- Division of Addiction Medicine, Department of Family Medicine, Maine Medical Center, Portland, ME, USA
| | - Jenna L Butner
- Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Ilana Hull
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kimberly Sue
- Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Li Li
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin Doneski
- Harm Reduction Program/Needle Exchange, Portland Public Health, Portland, ME, USA
| | - Beth Dinges
- Pharmacy Service, Veteran Affairs Illiana Healthcare System, Danville, IL, USA
| | - Tessa Rife-Pennington
- Pharmacy Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- School of Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Sunny Kung
- Mass General Brigham Community Physicians, Haverhill, MA, USA
| | - Kinna Thakarar
- Center for Interdisciplinary Population and Health Research/Maine, Portland, ME, USA
- Department of Medicine, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
- Maine Medical Partners Adult Infectious Diseases, South Portland, ME, USA
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Thompson RL, Sabounchi NS, Ali SS, Heimer R, D'Onofrio G, Heckmann R. Using qualitative system dynamics modeling to understand overdose bystander behavior in the context of Connecticut's Good Samaritan Laws and identify effective policy options. Harm Reduct J 2024; 21:124. [PMID: 38937759 PMCID: PMC11210010 DOI: 10.1186/s12954-024-00990-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/22/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Good Samaritan Laws are a harm reduction policy intended to facilitate a reduction in fatal opioid overdoses by enabling bystanders, first responders, and health care providers to assist individuals experiencing an overdose without facing civil or criminal liability. However, Good Samaritan Laws may not be reaching their full impact in many communities due to a lack of knowledge of protections under these laws, distrust in law enforcement, and fear of legal consequences among potential bystanders. The purpose of this study was to develop a systems-level understanding of the factors influencing bystander responses to opioid overdose in the context of Connecticut's Good Samaritan Laws and identify high-leverage policies for improving opioid-related outcomes and implementation of these laws in Connecticut (CT). METHODS We conducted six group model building (GMB) workshops that engaged a diverse set of participants with medical and community expertise and lived bystander experience. Through an iterative, stakeholder-engaged process, we developed, refined, and validated a qualitative system dynamics (SD) model in the form of a causal loop diagram (CLD). RESULTS Our resulting qualitative SD model captures our GMB participants' collective understanding of the dynamics driving bystander behavior and other factors influencing the effectiveness of Good Samaritan Laws in the state of CT. In this model, we identified seven balancing (B) and eight reinforcing (R) feedback loops within four narrative domains: Narrative 1 - Overdose, Calling 911, and First Responder Burnout; Narrative 2 - Naloxone Use, Acceptability, and Linking Patients to Services; Narrative 3 - Drug Arrests, Belief in Good Samaritan Laws, and Community Trust in Police; and Narrative 4 - Bystander Naloxone Use, Community Participation in Harm Reduction, and Cultural Change Towards Carrying Naloxone. CONCLUSIONS Our qualitative SD model brings a nuanced systems perspective to the literature on bystander behavior in the context of Good Samaritan Laws. Our model, grounded in local knowledge and experience, shows how the hypothesized non-linear interdependencies of the social, structural, and policy determinants of bystander behavior collectively form endogenous feedback loops that can be leveraged to design policies to advance and sustain systems change.
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Affiliation(s)
- Rachel L Thompson
- Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA
| | - Nasim S Sabounchi
- Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA
- Department of Health Policy and Management, City University of New York Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, USA
| | - Syed Shayan Ali
- University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
- Center for Interdisciplinary Research on AIDS at Yale, 135 College St., Suite 200, New Haven, CT, 06520, USA
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 065108, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
| | - Rebekah Heckmann
- Department of Emergency Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 065108, USA.
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Schaefer M, Panagiotoglou D. Evaluating the effects of supervised consumption sites on housing prices in Montreal, Canada using interrupted time series and hedonic price models. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100242. [PMID: 38948426 PMCID: PMC11214419 DOI: 10.1016/j.dadr.2024.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 07/02/2024]
Abstract
Background In 2017, three brick and mortar supervised consumption sites (SCS) opened in Montreal, Canada. Opponents argued the sites would attract people who use drugs and reduce local real estate prices. Methods We used interrupted time series and hedonic price models to evaluate the effects of Montreal's SCS on local real estate prices. We linked the Quebec Professional Association of Real Estate Brokers' housing sales data provided by Centris Inc. with census tract data and gentrification scores. Homes sold within 200 m of the SCS locations between 1 January 2014 and 31 December 2021 were included. We adjusted for internal (e.g., number of bed/bathrooms, unit size) and external attributes (e.g., neighbourhood demographics), and included a spatio-temporal lag to account for correlation between sales. For sensitivity analysis we used site-specific dummy variables to better account for unmeasured neighbourhood differences, and repeated analyses using 500 m and 1000 m radii. Results We observed a price shock after the opening of the first two SCS in June 2017 (level effect: -10.5%, 95% CI: -19.1%, -1.1%) but prices rose faster month-to-month (trend effect: 1.1%, 95% CI: 0.7%, 1.6%) after implementation. Following the implementation of the third site in November 2017 there was no immediate impact (level effect: 2.4%, 95% CI: -10.4%, 17.0%) but once more prices roses faster (0.9%, 95% CI: 0.4%, 1.5%) thereafter. When we replaced neighbourhood attributes with a site-specific dummy variable, we observed the same pattern. Sales' prices dropped (level effect: -9.6%, 95% CI: -15.0%, -3.8%) but rose faster month-to-month (trend effect: 0.9%, 95% CI: 0.6%, 1.2%) following June 2017's SCS implementations, with no level effect (4.9%, 95% CI: -7.3%, 18.6%) and a positive trend (0.9%, 95% CI: 0.5%, 1.3%) after November 2017's SCS opening. In most 500 m and 1000 m radii models, there were no immediate shocks following SCS opening, however, positive trend effects persisted in all models. Conclusion Our models suggest homes sold near SCS may experience a price shock immediately post-implementation, with evidence of market recovery in the months that follow.
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Affiliation(s)
- Maximilian Schaefer
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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Wenger LD, Morris T, Knight KR, Megerian CE, Davidson PJ, Suen LW, Majano V, Lambdin BH, Kral AH. Radical hospitality: Innovative programming to build community and meet the needs of people who use drugs at a government-sanctioned overdose prevention site in San Francisco, California. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104366. [PMID: 38492432 PMCID: PMC11160962 DOI: 10.1016/j.drugpo.2024.104366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND The Tenderloin Center (TLC), a multi-service center where people could receive or be connected to basic needs, behavioral health care, housing, and medical services, was open in San Francisco for 46 weeks in 2022. Within a week of operation, services expanded to include an overdose prevention site (OPS), also known as safe consumption site. OPSs have operated internationally for over three decades, but government-sanctioned OPSs have only recently been implemented in the United States. We used ethnographic methods to understand the ways in which a sanctioned OPS, situated in a multi-service center, impacts the lives of people who use drugs (PWUD). METHODS We conducted participant observation and in-depth interviews June-December 2022. Extensive field notes and 39 in-depth interviews with 24 TLC guests and 15 TLC staff were analyzed using an inductive analysis approach. Interviewees were asked detailed questions about their experiences using and working at the TLC. RESULTS TLC guests and staff described an atmosphere where radical hospitality-welcoming guests with extraordinary warmth, generosity, and unconditional acceptance-was central to the culture. We found that the co-location of an OPS within a multi-service agency (1) allowed for the culture of radical hospitality to flourish, (2) yielded a convenient one-stop shop model, (3) created a space for community building, and (4) offered safety and respite to guests. CONCLUSIONS The co-location of an OPS within a multi-service drop-in center is an important example of how such an organization can build positive sociality among PWUD while protecting autonomy and reducing overdose mortality. Overdose response and reversal is an act of relational accountability in which friends, peers, and even strangers intervene to protect and revive one another. This powerful intervention was operationalized as an anti-oppressive, horizontal activity through radical hospitality with a built environment that allowed PWUD to be both social and safe.
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Affiliation(s)
- Lynn D Wenger
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States.
| | - Terry Morris
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Kelly R Knight
- University of California, San Francisco, San Francisco, CA, United States
| | - Cariné E Megerian
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Peter J Davidson
- Univerity of California, San Diego, San Francisco, CA, United States
| | - Leslie W Suen
- University of California, San Francisco, San Francisco, CA, United States
| | - Veronica Majano
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Barrot H Lambdin
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
| | - Alex H Kral
- RTI International, 2150 Shattuck Ave., Suite 800, Berkeley, CA 94704, United States
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Rammohan I, Gaines T, Scheim A, Bayoumi A, Werb D. Overdose mortality incidence and supervised consumption services in Toronto, Canada: an ecological study and spatial analysis. Lancet Public Health 2024; 9:e79-e87. [PMID: 38307685 DOI: 10.1016/s2468-2667(23)00300-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Supervised consumption services (SCS) prevent overdose deaths onsite; however, less is known about their effect on population-level overdose mortality. We aimed to characterise overdose mortality in Toronto, ON, Canada, and to establish the spatial association between SCS locations and overdose mortality events. METHODS For this ecological study and spatial analysis, we compared crude overdose mortality rates before and after the implementation of nine SCS in Toronto in 2017. Data were obtained from the Office of the Chief Coroner of Ontario on cases of accidental death within the City of Toronto for which the cause of death involved the use of an opiate, synthetic or semi-synthetic opioid, or other psychoactive substance. We assessed overdose incident data for global spatial autocorrelation and local clustering, then used geographically weighted regression to model the association between SCS proximity and overdose mortality incidence in 2018 and 2019. FINDINGS We included 787 overdose mortality events in Toronto between May 1, 2017, and Dec 31, 2019. The overdose mortality rate decreased significantly in neighbourhoods that implemented SCS (8·10 deaths per 100 000 people for May 1-July 31, 2017, vs 2·70 deaths per 100 000 people for May 1-July 31, 2019; p=0·037), but not in other neighbourhoods. In a geographically weighted regression analysis that adjusted for the availability of substance-use-related services and overdose-related sociodemographic factors by neighbourhood, the strongest local regression coefficients of the association between SCS and overdose mortality location ranged from -0·60 to -0·64 per mile in 2018 and from -1·68 to -1·96 per mile in 2019, suggesting an inverse association. INTERPRETATION We found that the period during which SCS were implemented in Toronto was associated with a reduced overdose mortality in surrounding neighbourhoods. The magnitude of this inverse association increased from 2018 to 2019, equalling approximately two overdose fatalities per 100 000 people averted in the square mile surrounding SCS in 2019. Policy makers should consider implementing and sustaining SCS across neighbourhoods where overdose mortality is high. FUNDING The Canadian Institutes of Health Research.
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Affiliation(s)
- Indhu Rammohan
- Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, ON, Canada
| | - Tommi Gaines
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ayden Scheim
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Ahmed Bayoumi
- MAP Centre on Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, ON, Canada; MAP Centre on Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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Davidson PJ, Wenger LD, Morris T, Majano V, Browne EN, Lambdin BH, Suen LW, Kral AH. Impact of a high-volume overdose prevention site on social and drug disorder in surrounding areas in San Francisco. Drug Alcohol Depend 2023; 252:110969. [PMID: 37748424 DOI: 10.1016/j.drugalcdep.2023.110969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/12/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Between January and December 2022 a multi-service center incorporating an overdose prevention site (OPS) operated with city government sanction in San Francisco. One concern often expressed about OPS is that they may increase social nuisance associated with drug use in the surrounding area, despite international evidence that this is not the case. METHODS We conducted systematic street observation of 10 indicators of drug- and homelessness-related social nuisance in a 500 m radius around the OPS and around a comparison point in the same city before and after the introduction of the OPS. We estimated the risk that any given street within sampling areas would have nuisance post-intervention relative to the control area using Poisson regression. RESULTS Ratio of relative risks of any reported nuisance in the 500 m area surrounding the OPS from pre- to post-intervention to that of the comparison area was 0.69 (95% CI: 0.54, 0.87; p=0.002). The relative risk of drug-specific nuisance was similar to the comparison area pre/post intervention (0.90; 95% CI 0.66, 1.24; p=0.53). The risk of homelessness-specific nuisance decreased around the OPS (RR 0.7., 95% CI 0.52, 0.93; p=0.02) whereas they increased around the comparison area (RR 1.33, 95% CI 1.06, 1.68; p=0.02). CONCLUSION We found that implementing authorized OPS services in a U.S. city did not increase the prevalence of visible signs of drug use and homelessness in the surrounding area. These findings are similar to those found at OPS outside the U.S.
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Affiliation(s)
- Peter J Davidson
- Division of Infectious Disease & Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Lynn D Wenger
- Community Health Research Division, RTI International, 2150 Shattuck Avenue Suite 800, Berkeley, CA 94704, USA
| | - Terry Morris
- Community Health Research Division, RTI International, 2150 Shattuck Avenue Suite 800, Berkeley, CA 94704, USA
| | - Veronika Majano
- Community Health Research Division, RTI International, 2150 Shattuck Avenue Suite 800, Berkeley, CA 94704, USA
| | - Erica N Browne
- Community Health Research Division, RTI International, 2150 Shattuck Avenue Suite 800, Berkeley, CA 94704, USA
| | - Barrot H Lambdin
- Community Health Research Division, RTI International, 2150 Shattuck Avenue Suite 800, Berkeley, CA 94704, USA
| | - Leslie W Suen
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94143, USA
| | - Alex H Kral
- Community Health Research Division, RTI International, 2150 Shattuck Avenue Suite 800, Berkeley, CA 94704, USA
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Heo M, Beachler T, Sivaraj LB, Tsai HL, Chea A, Patel A, Litwin AH, Zeller TA. Harm reduction and recovery services support (HRRSS) to mitigate the opioid overdose epidemic in a rural community. Subst Abuse Treat Prev Policy 2023; 18:23. [PMID: 37076898 PMCID: PMC10114389 DOI: 10.1186/s13011-023-00532-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/29/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Rural areas in the United States (US) are ravaged by the opioid overdose epidemic. Oconee County, an entirely rural county in northwest South Carolina, is likewise severely affected. Lack of harm reduction and recovery resources (e.g., social capital) that could mitigate the worst outcomes may be exacerbating the problem. We aimed to identify demographic and other factors associated with support for harm reduction and recovery services in the community. METHODS The Oconee County Opioid Response Taskforce conducted a 46-item survey targeting a general population between May and June in 2022, which was mainly distributed through social media networks. The survey included demographic factors and assessed attitudes and beliefs toward individuals with opioid use disorder (OUD) and medications for OUD, and support for harm reduction and recovery services, such as syringe services programs and safe consumption sites. We developed a Harm Reduction and Recovery Support Score (HRRSS), a composite score of nine items ranging from 0 to 9 to measure level of support for placement of naloxone in public places and harm reduction and recovery service sites. Primary statistical analysis using general linear regression models tested significance of differences in HRRSS between groups defined by item responses adjusting for demographic factors. RESULTS There were 338 survey responses: 67.5% were females, 52.1% were 55 years old or older, 87.3% were Whites, 83.1% were non-Hispanic, 53.0% were employed, and 53.8% had household income greater than US$50,000. The overall HRRSS was relatively low at a mean of 4.1 (SD = 2.3). Younger and employed respondents had significantly greater HRRSS. Among nine significant factors associated with HRRSS after adjusting for demographic factors, agreement that OUD is a disease had the greatest adjusted mean difference in HRSSS (adjusted diff = 1.22, 95% CI=(0.64, 1.80), p < 0.001), followed by effectiveness of medications for OUD (adjusted diff = 1.11, 95%CI=(0.50, 1.71), p < 0.001). CONCLUSIONS Low HRRSS indicates low levels of acceptance of harm reduction potentially impacting both intangible and tangible social capital as it relates to mitigation of the opioid overdose epidemic. Increasing community awareness of the disease model of OUD and the effectiveness of medications for OUD, especially among older and unemployed populations, could be a step toward improving community uptake of the harm reduction and recovery service resources critical to individual recovery efforts.
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Affiliation(s)
- Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
- Prisma Health Addiction Medicine Center, Greenville, SC, 29605, USA
| | - Taylor Beachler
- Prisma Health Addiction Medicine Center, Greenville, SC, 29605, USA
| | - Laksika B Sivaraj
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
- Prisma Health Addiction Medicine Center, Greenville, SC, 29605, USA
| | - Hui-Lin Tsai
- Department of Public Health Sciences, Clemson University, Clemson, SC, 29634, USA
| | - Ashlyn Chea
- University of South Carolina School of Medicine-Greenville, Greenville, SC, 29605, USA
| | - Avish Patel
- University of South Carolina School of Medicine-Columbia, Columbia, SC, 29209, USA
| | - Alain H Litwin
- Prisma Health Addiction Medicine Center, Greenville, SC, 29605, USA
- University of South Carolina School of Medicine-Greenville, Greenville, SC, 29605, USA
- Department of Medicine, Prisma Health, Greenville, SC, 29605, USA
- Clemson University School of Health Research, Greenville, SC, 29605, USA
| | - T Aaron Zeller
- University of South Carolina School of Medicine-Greenville, Greenville, SC, 29605, USA.
- Clemson University School of Health Research, Greenville, SC, 29605, USA.
- Seneca Family Medicine Residency Program, Prisma Health Oconee Memorial Hospital, 139 Lila Doyle Drive, Seneca, SC, 29672, USA.
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Austin T, Lavalley J, Parusel S, Collins AB, Olding M, Boyd J. Women who use drugs: engagement in practices of harm reduction care. Harm Reduct J 2023; 20:49. [PMID: 37055805 PMCID: PMC10100181 DOI: 10.1186/s12954-023-00775-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Harm reduction services that employ or are operated by people who use drugs are an effective means of mitigating overdose risks and other drug-related harms. However, stereotypes portraying people who use criminalized drugs as incapable caregivers persist. This is especially true for women who use drugs, and to a greater extent racialized women, who are characterized as having diverged from traditional ideals of womanhood as a result of drug-user stigma and the intersections of gender- and class-based and racist stereotypes. In an effort to identify and understand how women who use drugs practise care through harm reduction, we explored the experiences of women accessing a low-threshold supervised consumption site exclusively for women (transgender and non-binary inclusive) in Vancouver, Canada. METHODS Data were drawn from research conducted from May 2017 to June 2018 exploring women's experiences accessing the supervised consumption site during an overdose crisis. Data included forty-five semistructured interviews with women recruited from the site, analysed thematically to explore practices of care through harm reduction. FINDINGS Participants reported engaging in both formal and informal care. Acts of care included interventions that both aligned with and deviated from conventional understandings of care practices, including overdose reversal and education, overdose supervision/care, and assisted injection. CONCLUSION The boundary between formal and informal harm reduction care is fluid. Women who use drugs engage in harm reduction across these borders with acts of care that align with or fill the gaps in current harm reduction services in order to meet the needs of drug-using communities, challenging negative stereotypes of women who use drugs. However, these caregiving practices can increase risks to care providers' physical, mental, and emotional health and wellness. Increased financial, social, and institutional supports, including safer supply, assisted injection, and community resources, are needed to better support women as they continue to engage in harm reduction care.
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Affiliation(s)
- Tamar Austin
- Birth Place Lab, UBC Midwifery, Faculty of Medicine, University Boulevard, Vancouver, BC, 3302-5950, Canada
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Lavalley
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Sylvia Parusel
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Michelle Olding
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre On Substance Use, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Burrard Street, Vancouver, BC, 608-1081, Canada.
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11
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Taylor H, Leite Â, Gautier D, Nunes P, Pires J, Curado A. Community perceptions surrounding Lisbon's first mobile drug consumption room. DIALOGUES IN HEALTH 2022; 1:100031. [PMID: 38515893 PMCID: PMC10954018 DOI: 10.1016/j.dialog.2022.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 03/23/2024]
Abstract
Portugal's first Mobile Drug Consumption Room (MDCR) has been operating for over three years in two Lisbon neighborhoods. This qualitative study first creates a baseline understanding of community perceptions concerning the acceptability of and expectations surrounding drug consumption rooms in the communities of intervention. Then, at least six months after the initial interviews, it determines how these perceptions changed and what changes participants perceive in the neighborhoods. Findings highlight widespread acceptance of the MDCR among participants. One of the participants' priorities related to the MDCR was to lessen the visibility of public consumption, a change some participants perceived in the neighborhood. While in the first round of data collection participants primarily conceptualized the MDCR as a service for People Who Use Drugs (PWUD), in the follow-up round, they reported changes in the community.
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Affiliation(s)
| | - Ângela Leite
- Grupo de Ativistas em Tratamentos – GAT, Portugal
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12
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Duhart Clarke SE, Megerian CE, Suen LW, Wenger LD, Lambdin BH, Davidson PJ, Kral AH. Prevalence and factors associated with neck injection among people who inject drugs in San Francisco, California. Drug Alcohol Depend 2022; 241:109686. [PMID: 36402050 DOI: 10.1016/j.drugalcdep.2022.109686] [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] [Received: 06/20/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Groin and neck injections are generally a last resort for people who inject drugs (PWID) who do not have easy access to functioning veins. These alternative injection practices can lead to an increased likelihood of adverse health outcomes. There is still much we do not know about groin and neck injections among PWID in the US, as the literature to-date comes from studies primarily focused on groin injections outside the US. We assessed prevalence, predictors, and associated behaviors of neck injection through a survey fielded in San Francisco, California, US. METHODS The sample comes from a longitudinal observational study that used targeted sampling to recruit PWID in San Francisco. The current study sample includes 239 PWID who completed their 12-month survey between June 2019 and June 2020. RESULTS About a third of the sample reported injecting in their neck in the past 30 days, with the most common reason being lack of available veins. Age, past 6-month abscess / soft tissue infection, and past 30-day use of opioids mixed with cocaine were significantly associated with past 30-day neck injection in the final multivariate model. Past 30-day neck injection was also significantly associated with being injected by another person in the past 30 days. CONCLUSIONS PWID at higher risk for vein deterioration were more likely to inject into their neck. Harm reduction strategies such as safer injection counseling, safe smoking supplies, use of "street doctors," and safe consumption sites may reduce instances of neck injection and/or associated health risks.
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Affiliation(s)
| | - Cariné E Megerian
- RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC 27709, USA
| | - Leslie W Suen
- Division of General Internal Medicine, University of California San Francisco at San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA, USA
| | - Lynn D Wenger
- RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC 27709, USA
| | - Barrot H Lambdin
- RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC 27709, USA; Division of General Internal Medicine, University of California San Francisco at San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA, USA; University of Washington, 1400 NE Campus Parkway, Seattle, WA, USA
| | - Peter J Davidson
- University of California San Diego, 9500 Gillman Drive, La Jolla, CA, USA
| | - Alex H Kral
- RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC 27709, USA
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13
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Nolan S, Kelian S, Kerr T, Young S, Malmgren I, Ghafari C, Harrison S, Wood E, Lysyshyn M, Holliday E. Harm reduction in the hospital: An overdose prevention site (OPS) at a Canadian hospital. Drug Alcohol Depend 2022; 239:109608. [PMID: 36063622 PMCID: PMC9970047 DOI: 10.1016/j.drugalcdep.2022.109608] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/19/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Substance use management in hospitals can be challenging. In response, a Canadian hospital opened an overdose prevention site (OPS) where community members and hospital inpatients can inject pre-obtained illicit drugs under supervision. This study aims to: (1) describe program utilization patterns; (2) characterize OPS visits; and (3) evaluate overdose events and related outcomes. METHODS A retrospective chart review was completed at one hospital in Vancouver, Canada. All community members and hospital inpatients who visited the OPS between May 2018 and July 2019 were included. Client measures included: hospital inpatient status, use of intravenous access line for drug injection, and substances used. Program measures included: number of visits (daily/monthly), overdose (fatal/non-fatal) events and overdose-related outcomes. RESULTS Overall, 11,673 OPS visits were recorded. Monthly visits increased from 306 to 1198 between May 2018 and July 2019 respectively. On average, 26 visits occurred daily. Among all visits, 20% reported being a hospital inpatient, and 5% reported using a hospital intravenous access line for drug injection. Opioids (56%) and stimulants (24%) were the most common substances used. Overall 39 overdose events occurred - 82% required naloxone reversal, 28% required transfer to the hospital's emergency department and none were fatal. Overdose events were more common among hospital inpatients compared to community clients (6.6 vs 2.2 per 1000 visits respectively; p value = 0.046). CONCLUSIONS This unique OPS is an example of a hospital-based harm reduction initiative. Use of the site increased over time among both groups with no fatal overdose events occurring.
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Affiliation(s)
- Seonaid Nolan
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9 BC, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, V6Z 1Y6 BC, Canada.
| | - Salpy Kelian
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9 BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9 BC, Canada
| | - Samantha Young
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 553B-1081 Burrard Street, Vancouver, V6Z 1Y6 BC, Canada; Providence Health Care, 1081 Burrard Street, Vancouver, V6Z 1Y6 BC, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, 155 College Street, 6th floor, Toronto, M5T 3M7 ON, Canada; General Internal Medicine, St. Michael's Hospital, Unity Health, 30 Bond Street, Toronto, M5B 1W8 ON, Canada
| | - Isaac Malmgren
- General Internal Medicine, St. Michael's Hospital, Unity Health, 30 Bond Street, Toronto, M5B 1W8 ON, Canada
| | - Cher Ghafari
- Raincity Housing and Support Society, 616 Powell Street, Vancouver, V6A 1H4 BC, Canada
| | - Scott Harrison
- Providence Health Care, 1081 Burrard Street, Vancouver, V6Z 1Y6 BC, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, V6Z 2A9 BC, Canada
| | - Mark Lysyshyn
- Vancouver Coastal Health, 800-601 West Broadway, V5Z 4C2 BC, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3 BC, Canada
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14
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Sherman SG, Rouhani S, White RH, Weicker N, Morris M, Schneider K, Park JN, Barry C. Acceptability of Overdose Prevention Sites in the Business Community in Baltimore, Maryland. J Urban Health 2022; 99:723-732. [PMID: 35610474 PMCID: PMC9129898 DOI: 10.1007/s11524-022-00647-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/25/2022]
Abstract
Intervetions are urgently needed to reduce the trajectory of the US opioid overdose epidemic, yet implementation is often hampered by resistance or opposition from key community stakeholders. While businesses are economically and physically impacted by the opioid epidemic, they are rarely engaged in efforts to reduce its impact. The establishment of overdose prevention sites (OPS) is being discussed throughout many US jurisdictions with limited attention to the potential positive role of businesses in that process. We surveyed business owners and employees of businesses located in neighborhoods with concentrated drug markets. The study's primary aim was to examine their attitudes to locally-placed OPS. An iterative, two-phase sampling strategy was used to identify recruitment zones. In person (December 2019-March 2020) and telephone-based (April-July 2020) surveys were administered to distinct business owners and employees (N = 149). Sixty-five percent of participants supported OPS in their neighborhood and 47% had recently witnessed an overdose in or around their workplace. While 70% had heard of naloxone, and 38% reported having it on the premises. Correlates of supporting an OPS locally included living in the same neighborhood as work (adjusted odds ratio (aOR) 1.99, 95% confidence intervals (CI): 1.30-3.05); having a more positive attitude towards people who use drugs (aOR 1.33, 95% CI: 1.13-1.58); and having recently seen an overdose in/around the workplace (aOR 2.86, 95% CI: 1.11-7.32). Lack of support being an owner (aOR 0.35, 95% CI: 0.15-0.83). These data indicate the extent to which businesses are directly impacted by the opioid epidemic and the power of personal experience in shaping OPS support in advocacy efforts.
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Affiliation(s)
- Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Saba Rouhani
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noelle Weicker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Miles Morris
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristin Schneider
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ju Nyeong Park
- Alpert Medical School, Brown University Division of General Internal Medicine, Providence, RI, USA
| | - Colleen Barry
- Jeb E. Brooks School of Public Policy, Cornell University, Ithica, NY, USA
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15
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Duncan E, Shufelt S, Barranco M, Udo T. Acceptability of supervised injection facilities among persons who inject drugs in upstate New York. Harm Reduct J 2022; 19:87. [PMID: 35907854 PMCID: PMC9338679 DOI: 10.1186/s12954-022-00665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Supervised injection facilities (SIFs) provide spaces where persons who inject drugs (PWID) can inject under medical supervision and access harm reduction services. Though SIFs are not currently sanctioned in most of the US, such facilities are being considered for approval in several Upstate New York communities. No data exist from PWID in Upstate New York, and little from outside major US urban centers, on willingness to use SIFs and associated factors. METHODS This analysis included 285 PWID (mean age = 38.7; 57.7% male; 72.3% non-Hispanic white) recruited for a study on hepatitis C prevalence among PWID in Upstate New York, where participants were recruited from syringe exchange programs (n = 80) and able to refer other PWID from their injection networks (n = 223). Participants completed an electronic questionnaire that included a brief description of SIFs and assessed willingness to use SIFs. We compared sociodemographic characteristics, drug use/harm reduction history, healthcare experience, and stigma between participants who were willing vs. unwilling to use such programs. RESULTS Overall, 67.4% were willing to use SIFs, 18.3% unwilling, and 14.4% unsure. Among those reporting being willing or unwilling, we found higher willingness among those who were currently homeless (91.8% vs. 74.6%; p = 0.004), who had interacted with police in the past 12 months (85.7% vs. 74.5%; p = 0.04), and who were refused service within a healthcare setting (100% vs. 77.1%; p = 0.03). CONCLUSION Our results support SIF acceptability in several Upstate New York PWID communities, particularly among those reporting feelings of marginalization. A large proportion reported being unsure about usage of SIFs, suggesting room for educating PWID on the potential benefits of this service. Our results support SIF acceptability in Upstate New York and may inform programming for underserved PWID, should SIFs become available.
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Affiliation(s)
- Eliana Duncan
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA.
| | - Sarah Shufelt
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA
| | - Meredith Barranco
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA.,Center for Collaborative HIV Research in Practice and Policy, School of Public Health, University at Albany, 1 University Place, Rensselaer, NY, 12144, USA
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16
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McAdam E, Hayashi K, Dong H, Cui Z, Sedgemore KO, Dietze P, Phillips P, Wilson D, Milloy MJ, DeBeck K. Factors associated with perceived decline in the quality of drugs during the COVID-19 pandemic: Evidence from community-recruited cohorts of people who use drugs in Vancouver, Canada. Drug Alcohol Depend 2022; 236:109471. [PMID: 35489180 PMCID: PMC9043624 DOI: 10.1016/j.drugalcdep.2022.109471] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Driven by an increasingly toxic drug supply, drug toxicity deaths in the United States and Canada have risen to unprecedented levels during the COVID-19 pandemic. This study aimed to characterize the prevalence of and the factors associated with a perceived decline in the quality of drugs during the COVID-19 pandemic among community-recruited cohorts of PWUD in Vancouver, Canada. METHODS Data collection took place between July and November 2020. In adherence with COVID-19 safety protocols, questionnaires were administered by interviewers through remote means (e.g., phone or videoconference). Using multivariable logistic regression, we characterized the prevalence of and factors associated with a perceived decline in drug quality during the start of the COVID-19 pandemic in Vancouver, Canada. RESULTS Of the 738 individuals included in this analysis, 272 (36.9%) reported that the quality of drugs declined during the COVID-19 pandemic. In multivariable analysis, perceived decline in the quality of drugs was significantly associated with: recent non-fatal overdose (adjusted odds ratio [AOR]=2.01, 95% Confidence Interval [CI]: 1.29-3.15), at least weekly injection drug use (AOR=1.94, 95% CI: 1.40-2.71), at least weekly crack use (AOR=1.61, 95%CI: 1.10-2.36), and at least weekly crystal methamphetamine use (AOR=1.46, 95%CI: 1.03-2.08). DISCUSSION Over a third of PWUD perceived that the quality of drugs declined during the COVID-19 pandemic and these individuals were significantly more likely to report experiencing a recent non-fatal overdose, engaging in frequent injection drug and stimulant use. Study findings indicate the need for interventions to address the toxic drug supply, including providing a regulated supply.
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Affiliation(s)
- Erica McAdam
- British Columbia Centre on Substance Use, 400–1045 Howe St., Vancouver, BC V6Z 2A9, Canada,School of Public Policy, Simon Fraser University, 515 West Hastings St., Vancouver, BC V6B 5K3, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400–1045 Howe St., Vancouver, BC V6Z 2A9, Canada,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, 400–1045 Howe St., Vancouver, BC V6Z 2A9, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, 400–1045 Howe St., Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kali-olt Sedgemore
- At-Risk Youth Study (ARYS), BC Centre on Substance Use, 1265 Granville Street, Vancouver, BC V6Z 2B4, Canada
| | - Paul Dietze
- National Drug Research Institute and enAble Institute, Faculty of Health Sciences, Curtin University, Melbourne, VIC 3004, Australia,Burnet Institute, Behaviours and Health Risks Program, Melbourne, VIC 3004, Australia
| | - Paige Phillips
- People with Lived and Living Experience Advisory Committee, BC Centre on Substance Use, 400–1045 Howe St, Vancouver, BC V6Z 2A9, Canada
| | - Dean Wilson
- British Columbia Centre on Substance Use, 400–1045 Howe St., Vancouver, BC V6Z 2A9, Canada
| | - M.-J. Milloy
- British Columbia Centre on Substance Use, 400–1045 Howe St., Vancouver, BC V6Z 2A9, Canada,Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 515 West Hastings St., Vancouver, BC V6B 5K3, Canada.
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17
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Kennedy MC, Hayashi K, Milloy MJ, Compton M, Kerr T. Health impacts of a scale-up of supervised injection services in a Canadian setting: an interrupted time series analysis. Addiction 2022; 117:986-997. [PMID: 34854162 PMCID: PMC8904318 DOI: 10.1111/add.15717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS In response to a dramatic rise in overdose deaths due to injection drug use, there was a rapid scale-up of low-threshold supervised injection services (SIS), termed 'overdose prevention sites' (OPS), in Vancouver, Canada in December 2016. We measured the potential impact of this intervention on SIS use and related health outcomes among people who inject drugs (PWID). DESIGN Segmented regression analyses of interrupted time series data from two community-recruited prospective cohorts of PWID from January 2015 to November 2018 were used to measure the impact of the OPS scale-up on changes in SIS use, public injection, syringe sharing and addiction treatment participation, controlling for pre-existing secular trends. SETTING Vancouver, Canada. PARTICIPANTS Of 745 PWID, 292 (39.7%) were women, 441 (59.6%) self-reported white ancestry and the median age was 47 years (interquartile range = 38, 53) at baseline. MEASUREMENTS Immediate (i.e. step level) and gradual (i.e. slope) changes in the monthly proportion of participants who self-reported past 6-month SIS use, public injection, syringe sharing and participation in any form of addiction treatment. FINDINGS Post OPS expansion, the monthly prevalence of SIS use immediately increased by an estimated 6.4% [95% confidence interval (CI) = 1.7, 11.2] and subsequently further increased by an estimated 0.7% (95% CI = 0.3, 1.1) per month. The monthly prevalence of addiction treatment participation immediately increased by an estimated 4.5% (95% CI = 0.5, 8.5) following the OPS expansion, while public injection and syringe sharing were estimated to immediately decrease by 5.5% (95% CI = 0.9, 10.0) and 2.5% (95% CI = 0.5, 4.6), respectively. Findings were inconclusive as to whether or not an association was present between the intervention and subsequent gradual changes in public injection, syringe sharing and addiction treatment participation. CONCLUSIONS Scaling-up overdose prevention sites in Vancouver, Canada in December 2016 was associated with immediate and continued gradual increases in supervised injection service engagement and immediate increases in related health benefits.
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
| | | | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, BC, Canada,Department of Medicine, University of British Columbia, St Paul’s Hospital, Vancouver, BC, Canada
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18
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Feuerstein-Simon R, Lowenstein M, Dupuis R, Dolan A, Marti XL, Harvey A, Ali H, Meisel ZF, Grande DT, Lenstra N, Cannuscio CC. Substance Use and Overdose in Public Libraries: Results from a Five-State Survey in the US. J Community Health 2022; 47:344-350. [PMID: 35020100 PMCID: PMC8753323 DOI: 10.1007/s10900-021-01048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
In the U.S., overdoses have become a health crisis in both public and private places. We describe the impact of the overdose crisis in public libraries across five U.S. states, and the front-line response of public library workers. We conducted a cross-sectional survey, inviting one worker to respond at each public library in five randomly selected states (CO, CT, FL, MI, and VA), querying participants regarding substance use and overdose in their communities and institutions, and their preparedness to respond. We describe substance use and overdose patterns, as well as correlates of naloxone uptake, in public libraries. Participating library staff (N = 356) reported witnessing alcohol use (45%) and injection drug use (14%) in their libraries in the previous month. Across states surveyed, 12% of respondents reported at least one on-site overdose in the prior year, ranging from a low of 10% in MI to a high of 17% in FL. There was wide variation across states in naloxone uptake at libraries, ranging from 0% of represented libraries in FL to 33% in CO. Prior on-site overdose was associated with higher odds of naloxone uptake by the library (OR 2.5, 95% CI 1.1-5.7). Although 24% of respondents had attended a training regarding substance use in the prior year, over 90% of respondents wanted to receive additional training on the topic. Public health professionals should partner with public libraries to expand and strengthen substance use outreach and overdose prevention efforts.
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Affiliation(s)
- Rachel Feuerstein-Simon
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA.
| | - Margaret Lowenstein
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Abby Dolan
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Alexandra Harvey
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA
| | - Heba Ali
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA
| | - Zachary F Meisel
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - David T Grande
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Noah Lenstra
- Department of Library and Information Science School of Education, The University of North Carolina at Greensboro (UNCG), Greensboro, USA
| | - Carolyn C Cannuscio
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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19
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Riback L, Pérez-Correa AE, Ghiroli MM, López-Castro T, Fox AD. Injecting Alone: Practices and Preferences among People Who Inject Drugs in New York City. Subst Use Misuse 2022; 57:1988-1996. [PMID: 36151968 DOI: 10.1080/10826084.2022.2125273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Injecting alone is a suspected risk factor for opioid overdose death among people who inject drugs (PWID). Better understanding of PWID's injecting practices and preferences could guide pragmatic harm reduction and overdose prevention interventions. We investigated injection practices and preferences among PWID attending syringe services programs (SSPs). We surveyed 108 PWID with opioid use disorder from 3 New York City SSPs between November 2020 and August 2021 to ascertain harm reduction service preferences. This secondary analysis examined injection behavior preferences, reasons for these preferences, and self-reported non-fatal lifetime overdoses. Slightly more participants preferred injecting alone (56%) than with someone present (44%), but most in both groups inject alone most of the time (97% vs 52%, p < 0.01). Commonly reported reasons for preferring to inject alone were privacy (82%) and not wanting to be judged (78%), whereas many preferred to inject with others to have someone present in case of overdose (92%), for camaraderie (69%), and to share drugs (65%). Those preferring to inject alone (vs. with someone present) self-reported higher mean number of lifetime overdoses (3.1 vs 2.6), but differences were not statistically significant. In conclusion, most participants injected alone regardless of preference. While not associated with prior non-fatal overdose, injection preference likely carries risk for future overdose. Participants preferred injecting alone to avoid shame or injecting with others in case of overdose, which can inform public health interventions that support both preferences. Reducing stigma while facilitating rapid overdose response can mitigate the risk of fatal overdose.
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Affiliation(s)
- Lindsey Riback
- Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, New York, USA
| | - Andrés E Pérez-Correa
- Albert Einstein College of Medicine, Division of General Internal Medicine, Bronx, New York, USA
| | - Megan M Ghiroli
- Montefiore Medical Center, Division of General Internal Medicine, Bronx, New York, USA
| | - Teresa López-Castro
- The City College of New York, The City University of New York, New York, New York, USA
| | - Aaron D Fox
- Montefiore Medical Center, Division of General Internal Medicine, Bronx, New York, USA
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Saberi Zafarghandi MB, Eshrati S, Rashedi V, Vameghi M, Arezoomandan R, Clausen T, Waal H. Indicators of Drug-Related Community Impacts of Open Drug Scenes: A Scoping Review. Eur Addict Res 2022; 28:87-102. [PMID: 34794145 DOI: 10.1159/000519886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Places where people deal and/or use drugs publicly are known as open drug scenes (ODSs). Drug-related community impacts (DRCIs) refer to drug-related issues that negatively influence public and individual health, communities, businesses, and recreational and public space enjoyment. There are no well-established criteria for identification of DRCIs. We therefore performed a scoping review of literature to determine DRCIs indicators associated with ODSs. METHODS The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScP). We searched English articles in PubMed, Scopus, Web of Science, and EMBASE databases from 1990 to 2021. The keywords were drug-related crime, drug-related offense, misconduct, social marginalization, homeless drug users, open drug scene, drug-related street disorder, public nuisance, and community impact. RESULTS Sixty-four studies were identified. Twenty-five studies were included. Two studies (8%) were about drug-related public nuisance, 1 (4%) considered drug-related social problems, 2 (8%) focused on drug-related social disorder, and 18 studies (72%) discussed indicators of community impacts such as crime, drug-related litter, safety, noise, and drug use in public. Two studies (8%) included the frequency of drug use in ODSs. DISCUSSION DRCI indicators are heterogenic, and various factors affect the indicators. The factors include social mores, political discourse, and historical approaches to dealing with and using drugs. Some societies do not tolerate the existence of ODSs. In contrast, many countries have adopted harm reduction programs to manage DRCIs. Identified DRCI indicators were drug using and dealing in public, drug-related litter, crime, drug-related loitering, street-based income generation activities, noise, and unsafety feelings in inhabitants. To solve the problems associated with DRCIs and to make a major change in ODSs, it is necessary to pay attention to the improvement of the economic conditions (e.g., employment opportunities), amendment (e.g., determine the limits of criminalization in drug use), and adoption of social policies (e.g., providing low-threshold and supportive services for homeless drug users).
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Affiliation(s)
- Mohammad Bagher Saberi Zafarghandi
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Eshrati
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Meroe Vameghi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Arezoomandan
- Addiction Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Thomas Clausen
- Norwegian Center for Addiction Research (SERAF), Institution of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helge Waal
- Norwegian Center for Addiction Research (SERAF), Institution of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Improved syringe disposal practices associated with unsanctioned safe consumption site use: A cohort study of people who inject drugs in the United States. Drug Alcohol Depend 2021; 229:109075. [PMID: 34654588 DOI: 10.1016/j.drugalcdep.2021.109075] [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] [Received: 05/19/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Community opposition to safe consumption sites often centers around improper syringe disposal. People are concerned these sites might attract people who inject drugs to the neighborhood, which might in turn lead to more used syringes left in public settings. METHODS We evaluated an unsanctioned safe consumption site in an undisclosed United States city in 2018-2020 to assess whether use of the site was associated with improper syringe disposal practices. We recruited people who inject drugs (N=494) using targeted sampling methods, and interviewed participants at baseline, 6 months, and 12 months. We employed a quasi-experimental design involving inverse probability of treatment weighting using propensity scores. We used generalized estimating equations and Poisson models to calculate relative risk and incidence rate ratios of improper syringe disposal. RESULTS The risk of any improper syringe disposal was comparable among people who used and did not use the unsanctioned safe consumption site in prior 30 days (relative risk 1.03; 95% confidence interval=0.53, 1.17). The rate of improperly disposed syringes per number of injections in prior 30 days was significantly lower among people who had used the unsanctioned safe consumption site during the same period (incident rate ratio 0.42; 95% confidence interval=0.18, 0.88). CONCLUSION When people used this unsanctioned safe consumption site, they disposed of significantly fewer syringes in public places, including streets, sidewalks, parks, or parking lots, than people not using the site. This study helps allay concerns that implementing safe consumption sites in the US would lead to increases in improperly disposed syringes.
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Tran V, Reid SE, Roxburgh A, Day CA. Assessing Drug Consumption Rooms and Longer Term (5 Year) Impacts on Community and Clients. Risk Manag Healthc Policy 2021; 14:4639-4647. [PMID: 34815725 PMCID: PMC8604650 DOI: 10.2147/rmhp.s244720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Drug consumption rooms (DCRs) and supervised injecting facilities (SIFs) provide a safe environment in which people who inject drugs (PWIDs) can inject under hygienic and supervised conditions. Numerous reviews have documented the benefits of these facilities; however, there is a lack of clarity surrounding their long-term effects. PURPOSE To conduct, with a systematic approach, a literature review, of published peer-reviewed literature assessing the long-term impacts of DCRs/SIFs. METHODS A systematic search of the PubMed and Embase database was performed using the keywords: ("SUPERVISED" OR "SAFE*") AND ("CONSUMPTION" OR "INJECT*" OR "SHOOTING") AND ("FACILITY*" OR "ROOM*" OR "GALLERY*" OR "CENTRE*" OR "CENTER*" OR "SITE*"). Included studies were original articles reporting outcomes for five or more years and addressed at least one of the following client or community outcomes; (i) drug-related harms; (ii) access to substance use treatment and other health services; (iii) impact on local PWID population; (iv) impact on public drug use, drug-related crime and violence; and (v) local community attitudes to DCRs. RESULTS Four publications met our inclusion criteria, addressing four of the five outcomes. Long-term data suggested that while the health of PWID naturally declined over time, DCRs/SIFs helped reduce injecting-related harms. The studies showed that DCRs/SIFs facilitate drug treatment, access to health services and cessation of drug injecting. Local residents and business owners reported less public drug use and public syringe disposal following the opening of a DCR/SIF. CONCLUSION Long-term evidence on DCRs/SIFs is consistent with established short-term research demonstrating the benefits of these facilities. A relative paucity of studies was identified, with most evidence originating from Sydney and Vancouver. The overall body of evidence would be improved by future studies following outcomes over longer periods and being undertaken in a variety of jurisdictions and models of DCRs/SIFs.
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Affiliation(s)
- Vincent Tran
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon E Reid
- Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Amanda Roxburgh
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
- National Drug and Alcohol Research Centre, UNSW, Randwick, New South Wales, Australia
- Monash Addiction Research Centre, Monash University, Clayton, Victoria, Australia
| | - Carolyn A Day
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, New South Wales, Australia
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Supervised Injection Facilities as Harm Reduction: A Systematic Review. Am J Prev Med 2021; 61:738-749. [PMID: 34218964 PMCID: PMC8541900 DOI: 10.1016/j.amepre.2021.04.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/29/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022]
Abstract
CONTEXT Supervised injection facilities are harm reduction interventions that allow people who inject drugs to use previously obtained substances under the supervision of health professionals. Although currently considered illegal under U.S. federal law, several U.S. cities are considering implementing supervised injection facilities anyway as a response to the escalating overdose crisis. The objective of this review is to determine the effectiveness of supervised injection facilities, compared with that of control conditions, for harm reduction and community outcomes. EVIDENCE ACQUISITION Studies were identified from 2 sources: a high-quality, broader review examining supervised injection facility-induced benefits and harms (from database inception to January 2014) and an updated search using the same search strategy (January 2014‒September 2019). Systematic review methods developed by the Guide to Community Preventive Services were used (screening and analysis, September 2019‒December 2020). EVIDENCE SYNTHESIS A total of 22 studies were included in this review: 16 focused on 1 supervised injection facility in Vancouver, Canada. Quantitative synthesis was not conducted given inconsistent outcome measurement across the studies. Supervised injection facilities in the included studies (n=number of studies per outcome category) were mostly associated with significant reductions in opioid overdose morbidity and mortality (n=5), significant improvements in injection behaviors and harm reduction (n=7), significant improvements in access to addiction treatment programs (n=7), and no increase or reductions in crime and public nuisance (n=7). CONCLUSIONS For people who inject drugs, supervised injection facilities may reduce the risk of overdose morbidity and mortality and improve access to care while not increasing crime or public nuisance to the surrounding community.
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Scheim AI, Sniderman R, Wang R, Bouck Z, McLean E, Mason K, Bardwell G, Mitra S, Greenwald ZR, Thavorn K, Garber G, Baral SD, Rourke SB, Werb D. The Ontario Integrated Supervised Injection Services Cohort Study of People Who Inject Drugs in Toronto, Canada (OiSIS-Toronto): Cohort Profile. J Urban Health 2021; 98:538-550. [PMID: 34181179 PMCID: PMC8237772 DOI: 10.1007/s11524-021-00547-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
The Ontario Integrated Supervised Injection Services cohort in Toronto, Canada (OiSIS-Toronto) is an open prospective cohort of people who inject drugs (PWID). OiSIS-Toronto was established to evaluate the impacts of supervised consumption services (SCS) integrated within three community health agencies on health status and service use. The cohort includes PWID who do and do not use SCS, recruited via self-referral, snowball sampling, and community/street outreach. From 5 November 2018 to 19 March 2020, we enrolled 701 eligible PWID aged 18+ who lived in Toronto. Participants complete interviewer-administered questionnaires at baseline and semi-annually thereafter and are asked to consent to linkages with provincial healthcare administrative databases (90.2% consented; of whom 82.4% were successfully linked) and SCS client databases. At baseline, 86.5% of participants (64.0% cisgender men, median ([IQR] age= 39 [33-49]) had used SCS in the previous 6 months, of whom most (69.7%) used SCS for <75% of their injections. A majority (56.8%) injected daily, and approximately half (48.0%) reported fentanyl as their most frequently injected drug. As of 23 April 2021, 291 (41.5%) participants had returned for follow-up. Administrative and self-report data are being used to (1) evaluate the impact of integrated SCS on healthcare use, uptake of community health agency services, and health outcomes; (2) identify barriers and facilitators to SCS use; and (3) identify potential enhancements to SCS delivery. Nested sub-studies include evaluation of "safer opioid supply" programs and impacts of COVID-19.
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Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.,Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ruby Sniderman
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Zachary Bouck
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Elizabeth McLean
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada
| | - Kate Mason
- South Riverdale Community Health Centre, Toronto, ON, Canada
| | - Geoff Bardwell
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada.,British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, Canada
| | - Sanjana Mitra
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 2357 Main Mall, Vancouver, BC, 270, V6T 1Z4, Canada
| | - Zoë R Greenwald
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Gary Garber
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Box, Ottawa, ON, Canada
| | - Stefan D Baral
- Department of Epidemiology, John Hopkins University School of Public Health, Baltimore, MD, USA
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1X1, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA.
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25
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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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Navigating post-eviction drug use amidst a changing drug supply: A spatially-oriented qualitative study of overlapping housing and overdose crises in Vancouver, Canada. Drug Alcohol Depend 2021; 222:108666. [PMID: 33766440 PMCID: PMC8117050 DOI: 10.1016/j.drugalcdep.2021.108666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND North American cities are experiencing intersecting housing and overdose crises as illicit drug markets become marked by the proliferation of fentanyl and methamphetamine. Despite recent research documenting associations between evictions and drug-related risks and harms, including overdose, the mechanisms through which these occur remain poorly understood. This study to examines how evictions shape the drug use practices of people who use drugs in Vancouver's Downtown Eastside - a neighbourhood with an established drug scene - as the illicit drug supply changed. METHODS Qualitative interviews and geo-spatial data collection were conducted with 56 recently evicted PWUD. Data were analyzed by interfacing qualitative and geo-spatial data, and interpreted focusing on how structural vulnerability shaped spatial practices and drug-related risks post-eviction. RESULTS Findings demonstrate how post-eviction spatial practices and routines produced risk and harm as participants navigated the uncertainties of housing vulnerability and drug supply changes. Post-eviction disruptions complicated participants' ability to engage with trusted drug sellers. Changes to spatial patterns and access to private spaces rendered public drug use inevitable, though this was mitigated to some degree by harm reduction supports. Abrupt changes to drug use patterns occurred due to post-eviction disruptions and included instrumental uses of methamphetamine to increase alertness and navigate survival amidst severe hardship. CONCLUSIONS Findings demonstrate how post-eviction changes to routines and spatial patterns are framed by structural vulnerability and can exacerbate drug-related harms, particularly in the context of a changing drug supply. There is an urgent need for structural interventions and harm reduction responses to mitigate harms associated with evictions.
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Ondocsin J, Mars SG, Howe M, Ciccarone D. Hostility, compassion and role reversal in West Virginia's long opioid overdose emergency. Harm Reduct J 2020; 17:74. [PMID: 33046092 PMCID: PMC7549084 DOI: 10.1186/s12954-020-00416-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/24/2020] [Indexed: 12/04/2022] Open
Abstract
Background West Virginia is a largely rural state with strong ties of kinship, mutual systems of support and charitable giving. At the same time, wealth inequalities are extreme and the state’s drug overdose fatality rate stands above all others in the USA at 51.5/100,000 in 2018, largely opioid-related. In recent years, harm reduction services have been active in the state but in 2018 Charleston’s needle and syringe program was forced to close. This paper considers the risk environment in which the state’s drug-related loss of life, and those attempting to prevent it, exist. Methods This rapid ethnographic study involved semi-structured interviews (n = 21), observation and video recordings of injection sequences (n = 5), initially recruiting people who inject heroin/fentanyl (PWIH) at the Charleston needle and syringe program. Snowball sampling led the research team to surrounding towns in southern West Virginia. Telephone interviews (n = 2) with individuals involved in service provision were also carried out. Results PWIH in southern West Virginia described an often unsupportive, at times hostile risk environment that may increase the risk of overdose fatalities. Negative experiences, including from some emergency responders, and fears of punitive legal consequences from calling these services may deter PWIH from seeking essential help. Compassion fatigue and burnout may play a part in this, along with resentment regarding high demands placed by the overdose crisis on impoverished state resources. We also found low levels of knowledge about safe injection practices among PWIH. Conclusions Hostility faced by PWIH may increase their risk of overdose fatalities, injection-related injury and the risk of HIV and hepatitis C transmission by deterring help-seeking and limiting the range of harm reduction services provided locally. Greater provision of overdose prevention education and naloxone for peer distribution could help PWIH to reverse overdoses while alleviating the burden on emergency services. Although essential for reducing mortality, measures that address drug use alone are not enough to safeguard longer-term public health. The new wave of psychostimulant-related deaths underline the urgency of addressing the deeper causes that feed high-risk patterns of drug use beyond drugs and drug use.
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Affiliation(s)
- Jeff Ondocsin
- Heroin in Transition Study, UCSF Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, Milberry Union East, 3rd Floor, San Francisco, CA, 94143, USA
| | - Sarah G Mars
- Heroin in Transition Study, UCSF Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, Milberry Union East, 3rd Floor, San Francisco, CA, 94143, USA
| | - Mary Howe
- Homeless Youth Alliance, PO Box 170427, San Francisco, CA, 94117, USA
| | - Daniel Ciccarone
- Heroin in Transition Study, UCSF Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, Milberry Union East, 3rd Floor, San Francisco, CA, 94143, USA.
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Klein KS, Glick SN, Mauro PM. Anticipated use of a supervised drug consumption site among syringe services program clients in King County, Washington: Assessing the role of opioid overdose and injection behavior. Drug Alcohol Depend 2020; 213:108121. [PMID: 32585421 DOI: 10.1016/j.drugalcdep.2020.108121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND US jurisdictions are considering implementing supervised drug consumption sites (SCSs) to combat the overdose epidemic. No sanctioned SCS exists in the US, but King County, Washington has proposed Community Health Engagement Locations (CHELs), which would include supervised drug consumption. We assessed characteristics of people engaged in syringe services programs (SSPs) who anticipated SCS use. METHODS We estimated prevalence of anticipated SCS use in a 2017 cross-sectional sample of King County SSP participants (N = 377). We used Poisson regression with robust standard errors to estimate likelihood of anticipated SCS use by overdose history (experienced, witnessed only, neither), public injection frequency (always, some/most times, never), drug use behaviors, and sociodemographic characteristics. RESULTS The sample was primarily male (66.8 %), white (69.5 %), and averaged 37 years old. Almost two-thirds of participants witnessed or experienced an overdose in the past year (43.2 % witnessed only; 19.6 % experienced overdose). Four in five SSP participants (83.0 %) anticipated any SCS use. Anticipated SCS use was higher among participants who experienced an overdose (risk ratio [RR] = 1.14, 95 % CI = 1.04, 1.24) than those with no overdose experience. In multivariable analyses, anticipated SCS use was higher among people reporting injecting publicly (e.g., always vs. never: aRR = 1.26, 95 % CI = 1.11, 1.43), and lower among people primarily using methamphetamine (aRR = 0.80, 95 % CI = 0.67, 0.96) compared to people primarily using opioids. CONCLUSIONS In King County, SCS services would be used by people at high risk of overdose, including SSP participants reporting injecting in public. SCSs could be an important step to promote health and safety across communities.
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Affiliation(s)
- Kathryn S Klein
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th St., New York, NY, 10032, United States.
| | - Sara N Glick
- University of Washington School of Medicine, Division of Allergy and Infectious Diseases, 325 9th Ave., Box 359777, Seattle, WA, 98104, United States; Public Health--Seattle & King County, HIV/STD Program, 401 5th Ave., Seattle, WA, 98104, United States
| | - Pia M Mauro
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th St., New York, NY, 10032, United States
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Trayner KMA, Palmateer NE, Hutchinson SJ, Goldberg DJ, Shepherd SJ, Gunson RN, Tweed EJ, Priyadarshi S, Sumnall H, Atkinson A, McAuley A. High willingness to use drug consumption rooms among people who inject drugs in Scotland: findings from a national bio-behavioural survey among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:102731. [PMID: 32331859 PMCID: PMC8063177 DOI: 10.1016/j.drugpo.2020.102731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND To address rising drug-related harms (including significant transmission of HIV) among people who inject drugs (PWID) in Glasgow, officials have proposed the introduction of the UK's first drug consumption room (DCR) in Glasgow city centre. Using a nationally representative sample, this study aimed to determine willingness to use a DCR among PWID nationally, in Glasgow city centre (the proposed DCR location), other Scottish city centres (excluding Glasgow) and the rest of Scotland (excluding city centres). METHODS Bio-behavioural survey, of 1469 current PWID (injected in last 6 months) across Scotland during 2017-18. Willingness to use DCRs was examined by drug-related risk behaviours and harms overall in Scotland, and then stratified by Glasgow city centre (n = 219), other Scottish city centres (n = 226) and the rest of Scotland (n = 1024). RESULTS The majority of PWID overall in Scotland (75%) were willing to use a DCR; willingness was higher among those recruited in Glasgow city centre (83%) and other Scottish city centres (83%), compared to the rest of Scotland (72%) (p < 0.001). Willingness was greater among PWID who reported (compared to those who did not report) injecting heroin (76%, p = 0.002), cocaine injecting (79%, p = 0.014), homelessness (86%, p < 0.001), public injecting (87%, p < 0.001) and an overdose (80%, p = 0.026). Willingness was found to be associated with a cumulative multiple risk variable: increased from 66% among those with a score of zero to 85% with a score of at least three (p < 0.001). CONCLUSIONS The vast majority of PWID at greatest risk of drug-related harm in Glasgow and elsewhere in Scotland would be willing to use a DCR, supporting proposals for the introduction of DCRs nationally.
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Affiliation(s)
- Kirsten M A Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
| | - David J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
| | | | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | - Emily J Tweed
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | | | | | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
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Belackova V, Salmon AM, Jauncey M, Day CA. Safer injecting facilities-is the research there? A comment on Caulkins et al. (2019). Addiction 2020; 115:784-785. [PMID: 31692143 DOI: 10.1111/add.14885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Vendula Belackova
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia.,Social Policy Research Centre, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Allison M Salmon
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Carolyn A Day
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia.,Addiction Medicine, The Sydney Central Clinical School (C39), Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
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Kennedy MC, Hayashi K, Milloy MJ, Boyd J, Wood E, Kerr T. Supervised injection facility use and exposure to violence among a cohort of people who inject drugs: A gender-based analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 78:102692. [PMID: 32200269 DOI: 10.1016/j.drugpo.2020.102692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Supervised injection facilities (SIFs) have been established in many settings, in part to reduce risks associated with injecting in public, including exposure to violence. However, the relationship between SIF use and experiencing violence has not yet been thoroughly evaluated. We sought to longitudinally examine the gender-specific relationship between SIF use and exposure to violence among people who inject drugs (PWID) in a Canadian setting. METHODS Data were drawn from two prospective cohort studies of PWID in Vancouver, Canada, between December 2005 and December 2016. Semi-annually, participants completed questionnaires that elicited data concerning sociodemographic characteristics, behavioural patterns, violent encounters and health service utilization. We used multivariable generalized estimating equations (GEE) to estimate the independent association between exclusively injecting drugs at a SIF and experiencing physical or sexual violence among men and women PWID, respectively. RESULTS Of 1930 PWID followed for a median of four years, 679 (35.2%) were women and the median age was 41 years at baseline. In total, 353 (52.0%) women and 694 (55.5%) men reported experiencing at least one incident of violence during follow-up. In multivariable analyses, exclusive SIF use was associated with decreased odds of experiencing violence among men after adjusting for potential confounders (Adjusted Odds Ratio [AOR] = 0.64; 95% confidence interval [CI]: 0.46-0.89). Exclusive SIF use was not significantly associated with experiencing violence among women in adjusted analyses (AOR = 0.97; 95% CI: 0.57-1.66). CONCLUSION In light of the recent expansion of SIFs in Canada, our finding of a protective association between exclusive SIF use and exposure to violence among men is encouraging. The fact that we did not observe a significant association between SIF use and experiencing violence among women highlights the need for social-structural interventions that are more responsive to the specific needs of women PWID in relation to violence prevention.
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada.
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
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Measham F. City checking: Piloting the UK's first community-based drug safety testing (drug checking) service in 2 city centres. Br J Clin Pharmacol 2020; 86:420-428. [PMID: 32030770 DOI: 10.1111/bcp.14231] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/05/2020] [Accepted: 01/12/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS To explore the feasibility of delivering community-based drug safety testing (drug checking), to trial service design characteristics and to compare with festival-based testing. METHODS In total, 171 substances of concern were submitted on 5 dates at 3 venues in 2 UK cities and tested using up to 6 analytical techniques. Test results and harm reduction advice were distributed directly to over 200 service users through 144 tailored healthcare consultations, to stakeholders, and through early warning systems, media and social media alerts. RESULTS The 171 samples were submitted and identified as MDMA (43.3%), cocaine (12.9%), ketamine (12.9%), various psychedelics submitted by students, and heroin and a synthetic cannabinoid submitted by rough sleeping communities, with 76% of samples' test results as expected. The 144 primary service users identified as 91.7% white, 68.1% male, with an average age of 26.7 years. Reported harm reduction intentions included alerting friends and acquaintances (37.5%), being more careful mixing that substance (35.4%), lowered dosage (27.8%), disposal of further substances (6.9%) and additionally 2.8% handed over further substances for verified destruction. CONCLUSION Community-based drug safety testing (drug checking) was piloted for the first time in the UK-within a drugs service, a community centre and a church-with consideration given to meso-level operational feasibility and micro-level behavioural outcomes. Service design characteristics such as venue, day of week, prior publicity, service provider, and direct and indirect dissemination of results all may impact on outcomes. Future studies should consider cost-benefit analyses of community and event-based testing and context-appropriate macro, meso and micro-level evaluations.
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Affiliation(s)
- Fiona Measham
- Chair in Criminology, Department of Sociology, Social Policy and Criminology, University of Liverpool, UK, and Honorary Professor, RMIT, Australia
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Trayner KMA, McAuley A, Palmateer NE, Goldberg DJ, Shepherd SJ, Gunson RN, Tweed EJ, Priyadarshi S, Milosevic C, Hutchinson SJ. Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 77:102663. [PMID: 31981949 PMCID: PMC8330401 DOI: 10.1016/j.drugpo.2020.102663] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/27/2019] [Accepted: 01/02/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Whilst injecting drugs in public places is considered a proxy for high risk behaviour among people who inject drugs (PWID), studies quantifying its relationship with multiple drug-related harms are lacking and none have examined this in the context of an ongoing HIV outbreak (located in Glasgow, Scotland). We aimed to: 1) estimate the prevalence of public injecting in Scotland and associated risk factors; and 2) estimate the association between public injecting and HIV, current HCV, overdose, and skin and soft tissue infections (SSTI). METHODS Cross-sectional, bio-behavioural survey (including dried blood spot testing to determine HIV and HCV infection) of 1469 current PWID (injected in last 6 months) recruited by independent interviewers from 139 harm reduction services across Scotland during 2017-18. Primary outcomes were: injecting in a public place (yes/no); HIV infection; current HCV infection; self-reported overdose in the last year (yes/no) and SSTI the last year (yes/no). Multi-variable logistic regression was used to determine factors associated with public injecting and to estimate the association between public injecting and drug-related harms (HIV, current HCV, overdose and SSTI). RESULTS Prevalence of public injecting was 16% overall in Scotland and 47% in Glasgow city centre. Factors associated with increased odds of public injecting were: recruitment in Glasgow city centre (aOR=5.45, 95% CI 3.48-8.54, p<0.001), homelessness (aOR=3.68, 95% CI 2.61-5.19, p<0.001), high alcohol consumption (aOR=2.42, 95% CI 1.69-3.44, p<0.001), high injection frequency (≥4 per day) (aOR=3.16, 95% CI 1.93-5.18, p<0.001) and cocaine injecting (aOR=1.46, 95% CI 1.00 to 2.13, p = 0.046). Odds were lower for those receiving opiate substitution therapy (OST) (aOR=0.37, 95% CI 0.24 to 0.56, p<0.001) and older age (per year increase) (aOR=0.97, 95% CI 0.95 to 0.99, p = 0.013). Public injecting was associated with an increased risk of HIV infection (aOR=2.11, 95% CI 1.13-3.92, p = 0.019), current HCV infection (aOR=1.49, 95% CI 1.01-2.19, p = 0.043), overdose (aOR=1.59, 95% CI 1.27-2.01, p<0.001) and SSTI (aOR=1.42, 95% CI 1.17-1.73, p<0.001). CONCLUSIONS These findings highlight the need to address the additional harms observed among people who inject in public places and provide evidence to inform proposals in the UK and elsewhere to introduce facilities that offer safer drug consumption environments.
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Affiliation(s)
- Kirsten M A Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK.
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
| | - David J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
| | | | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | - Emily J Tweed
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Catriona Milosevic
- Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
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34
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Behrends CN, Paone D, Nolan ML, Tuazon E, Murphy SM, Kapadia SN, Jeng PJ, Bayoumi AM, Kunins HV, Schackman BR. Estimated impact of supervised injection facilities on overdose fatalities and healthcare costs in New York City. J Subst Abuse Treat 2019; 106:79-88. [DOI: 10.1016/j.jsat.2019.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/23/2019] [Accepted: 08/13/2019] [Indexed: 12/20/2022]
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The prevalence of non-fatal overdose among people who inject drugs: A multi-stage systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 73:172-184. [DOI: 10.1016/j.drugpo.2019.07.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
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Kennedy MC, Klassen DC, Dong H, Milloy MJS, Hayashi K, Kerr TH. Supervised Injection Facility Utilization Patterns: A Prospective Cohort Study in Vancouver, Canada. Am J Prev Med 2019; 57:330-337. [PMID: 31377091 PMCID: PMC7056297 DOI: 10.1016/j.amepre.2019.04.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Although the health and community benefits of supervised injection facilities are well documented, little is known about long-term patterns of utilization of this form of health service. The present study seeks to longitudinally characterize discontinuation of use of a supervised injection facility in Vancouver, Canada. METHODS Data were drawn from 2 community-recruited prospective cohorts of people who inject drugs between December 2005 and December 2016. In 2018, extended Cox regression for recurrent events was used to examine factors associated with time to cessation of supervised injection facility use during periods of active injection. RESULTS Of 1,336 people who inject drugs that were followed for a median of 50 months, 847 (63.4%) participants reported 1,663 6-month periods of supervised injection facility use cessation while actively injecting drugs (incidence density of 26.6 events per 100 person-years). An additional 2,282 (57.8%) of the total 3,945 6-month periods of supervised injection facility use cessation occurred during periods of injection cessation. In multivariable analyses, enrollment in methadone maintenance therapy (adjusted hazard ratio=1.41) and HIV seropositivity (adjusted hazard ratio=1.23) were positively associated with supervised injection facility use cessation during periods of active injection, whereas homelessness (adjusted hazard ratio=0.59), at least daily heroin injection (adjusted hazard ratio=0.70), binge injection (adjusted hazard ratio=0.68), public injection (adjusted hazard ratio=0.67), nonfatal overdose (adjusted hazard ratio=0.73), difficulty accessing addiction treatment (adjusted hazard ratio=0.69), and incarceration (adjusted hazard ratio=0.70) were inversely associated with this outcome (all p<0.05). The most commonly reported reasons for supervised injection facility use cessation were injection drug use cessation (42.3%) and a preference for injecting at home (30.7%). CONCLUSIONS These findings suggest that this supervised injection facility successfully retains people who inject drugs at elevated risk of drug-related harms and indicate that many supervised injection facility clients neither use this service nor inject drugs perpetually.
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - David C Klassen
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - M-J S Milloy
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Thomas H Kerr
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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O'Rourke A, White RH, Park JN, Rodriguez K, Kilkenny ME, Sherman SG, Allen ST. Acceptability of safe drug consumption spaces among people who inject drugs in rural West Virginia. Harm Reduct J 2019; 16:51. [PMID: 31470864 PMCID: PMC6717345 DOI: 10.1186/s12954-019-0320-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/30/2019] [Indexed: 12/16/2022] Open
Abstract
Aim Safe consumption spaces (SCS) are indoor environments in which people can use drugs with trained personnel on site to provide overdose reversal and risk reduction services. SCS have been shown to reduce fatal overdoses, decrease public syringe disposal, and reduce public drug consumption. Existing SCS research in the USA has explored acceptability for the hypothetical use of SCS, but primarily among urban populations of people who inject drugs (PWID). Given the disproportionate impact of the opioid crisis in rural communities, this research examines hypothetical SCS acceptability among a rural sample of PWID in West Virginia. Methods Data were drawn from a 2018 cross-sectional survey of PWID (n = 373) who reported injection drug use in the previous 6 months and residence in Cabell County, West Virginia. Participants were asked about their hypothetical use of a SCS with responses dichotomized into two groups, likely and unlikely SCS users. Chi-square and t tests were conducted to identify differences between likely and unlikely SCS users across demographic, substance use, and health measures. Results Survey participants were 59.5% male, 83.4% non-Hispanic White, and 79.1% reported likely hypothetical SCS use. Hypothetical SCS users were significantly (p < .05) more likely to have recently (past 6 months) injected cocaine (38.3% vs. 25.7%), speedball (41.0% vs. 24.3%), and to report preferring drugs containing fentanyl (32.5% vs. 20.3%). Additionally, likely SCS users were significantly more likely to have recently experienced an overdose (46.8% vs. 32.4%), witnessed an overdose (78.3% vs. 60.8%), and received naloxone (51.2% vs. 37.8%). Likely SCS users were less likely to have borrowed a syringe from a friend (34.6% vs. 48.7%). Conclusions Rural PWID engaging in high-risk behaviors perceive SCS as an acceptable harm reduction strategy. SCS may be a viable option to reduce overdose fatalities in rural communities.
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Affiliation(s)
- Allison O'Rourke
- DC Center for AIDS Research, Department of Psychology, George Washington University, 2125 G St. NW, Washington, DC, 20052, USA.
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Kayla Rodriguez
- Joan C. Edwards School of Medicine, Marshall University, 1249 15th Street, Huntington, WV, 25701, USA
| | - Michael E Kilkenny
- Cabell-Huntington Health Department, 703 7th Ave, Huntington, WV, 25701, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Sean T Allen
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
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Taylor H, Curado A, Tavares J, Oliveira M, Gautier D, Maria JS. Prospective client survey and participatory process ahead of opening a mobile drug consumption room in Lisbon. Harm Reduct J 2019; 16:49. [PMID: 31399097 PMCID: PMC6688324 DOI: 10.1186/s12954-019-0319-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/30/2019] [Indexed: 11/26/2022] Open
Abstract
Background Ahead of opening Portugal’s first mobile drug consumption room (MDCR) in Lisbon, information from People Who Use Drugs (PWUD) and local community members was necessary to determine current needs and shape the intervention. A participatory and peer-led process was ensured at all stages of data gathering and planning of the intervention. Methods Prospective clients were surveyed to determine their willingness to use the service and preferences for use and to gain sociodemographic information. Persons over the age of 18 who reported injection drug use (PWID) were recruited using convenience sampling in the main open drug use scenes in Lisbon. In-person interviews were conducted by trained peer workers between November and December of 2017. The results (n = 72) of the questionnaires were analyzed, providing descriptive statistics. Results There is a high level of willingness to use the MDCR, primarily for reasons of hygiene, privacy, and security. Most participants expressed a desire to use the MDCR daily. Potential clients are socially marginalized, and many suffer from unstable housing. Most are daily users and engage in unsafe injecting practices, such as public injecting and material sharing. High levels of hepatitis C, HIV, and hepatitis B were observed among the target population with low levels of healthcare access and utilization. Preferences were gauged regarding the scheduling of the MDCR’s hours and amount of time willing to travel to reach the MDCR and will be taken into account for implementation. The combination of high levels of willingness to utilize the service and high levels of need among the target population support the implementation of Lisbon’s first MDCR. Conclusions Continual participation of PWUD and other community members will be necessary to maximize the public health and social impacts of this intervention, relative to this baseline. The plan to continue the participatory and peer-led development of the MDCR includes integrating peer workers, clients, and local community members within the operation, management, and evaluation of the service. This research adds to a growing literature about drug consumption rooms (DCRs) in Europe, which is especially limited concerning MDCRs.
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Affiliation(s)
- Hannah Taylor
- Universidade Nova de Lisboa Faculdade de Ciencias Sociais e Humanas, Lisbon, Portugal.
| | - Adriana Curado
- GAT - Grupo de Ativistas em Tratamentos, Lisbon, Portugal
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Fozouni L, Buchheit B, Walley AY, Testa M, Chatterjee A. Public restrooms and the opioid epidemic. Subst Abus 2019; 41:432-436. [DOI: 10.1080/08897077.2019.1640834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Laila Fozouni
- Department of Quantitative Methods, Harvard T. Chan School of Public Health, Boston, Massachusetts, USA
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Bradley Buchheit
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alexander Y. Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA; University of Massachusetts School of Medicine, Worcester, Massachusetts, USA
| | - Marcia Testa
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Avik Chatterjee
- Boston Health Care for the Homeless Program, Boston, Massachusetts, USA
- Division of Global Health Equity, Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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40
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Park JN, Sherman SG, Rouhani S, Morales KB, McKenzie M, Allen ST, Marshall BDL, Green TC. Willingness to Use Safe Consumption Spaces among Opioid Users at High Risk of Fentanyl Overdose in Baltimore, Providence, and Boston. J Urban Health 2019; 96:353-366. [PMID: 31168735 PMCID: PMC6565790 DOI: 10.1007/s11524-019-00365-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Safe consumption spaces (SCS) are evidence-based interventions that reduce drug-related morbidity and mortality operating in many countries. However, SCS are yet to be widely implemented in the USA despite the escalating overdose epidemic. The aim of this multi-city study was to identify the factors associated with willingness to use a SCS among people who use drugs (PWUD) in Baltimore, Providence, and Boston, stratified by injection drug use status. Our secondary aim was to characterize the anticipated barriers to accessing SCS if they were to be implemented in these cities. PWUD were invited to complete a cross-sectional survey in 2017. The analysis was restricted to 326 opioid users (i.e., heroin, fentanyl, and non-medical opioid pill use). The majority (77%) of participants expressed willingness to use a SCS (Baltimore, 78%; Providence, 68%; Boston. 84%). Most respondents were male (59%), older than 35 years (76%), non-white (64%), relied on public/semi-public settings to inject (60%), had a history of overdose (64%), and recently suspected fentanyl contamination of their drugs (73%). A quarter (26%) preferred drugs containing fentanyl. Among injectors, female gender, racial minority status, suspicion of drugs containing fentanyl, and drug use in public/semi-public settings were associated with higher willingness to use a SCS; prior arrest was associated with lower willingness. Among non-injectors, racial minority status, preference for fentanyl, and drug use in public/semi-public settings were associated with higher willingness, whereas recent overdose held a negative association. The most commonly anticipated barriers to accessing a SCS in the future were concerns around arrest (38%), privacy (34%), confidentiality/trust/safety (25%), and cost/time/transportation (16%). These data provide evidence of high SCS acceptability among high-risk PWUD in the USA, including those who prefer street fentanyl. As SCS are implemented in the USA, targeted engagement efforts may be required to reach individuals exposed to the criminal justice system.
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Affiliation(s)
- Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saba Rouhani
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth B Morales
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle McKenzie
- Miriam Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sean T Allen
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Emergency Medicine, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Roth AM, Kral AH, Mitchell A, Mukherjee R, Davidson P, Lankenau SE. Overdose Prevention Site Acceptability among Residents and Businesses Surrounding a Proposed Site in Philadelphia, USA. J Urban Health 2019; 96:341-352. [PMID: 31168733 PMCID: PMC6565835 DOI: 10.1007/s11524-019-00364-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Overdose prevention sites (OPS) are places where people use previously obtained drugs under the supervision of a health professional. They have been proposed in six United States (US) cities, including Philadelphia, to help reduce opioid-related overdose deaths and public injection. Philadelphia has the highest overdose rate among large cities in the US, which has led a local community-based organization to plan the implementation of OPS. Kensington, a neighborhood with the highest drug mortality overdose rates in the city, is a likely site for the proposed OPS. Given the dearth of research systematically assessing public opinion towards OPS prior to implementation, we enrolled 360 residents and 79 business owners/staff in the Kensington neighborhood in a cross-sectional acceptability study. Face-to-face surveys assessed participant characteristics, experiences with drug-related social problems, and OPS acceptability. Using descriptive statistics, we estimated factors associated with favorability towards opening an OPS in the Kensington neighborhood. Ninety percent of residents were in favor of an OPS opening in Kensington. Support was significantly higher among unstably housed individuals and persons who currently use opioids. In the business sample, 63% of owners/staff were in favor of opening an OPS in Kensington. A greater proportion of Asian/Pacific Islanders, Hispanic/Latinx respondents, and non-Hispanic/Latinx Black respondents were in favor of an OPS opening in Kensington compared with white respondents (p < 0.04). While details about implementation are still being considered, results indicate general acceptability among Kensington residents and businesses for an OPS, especially if it can deliver benefits that curb drug-related social problems. Should an OPS be implemented in Philadelphia, it would be important to monitor changes in drug-related social problems and acceptability post implementation.
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Affiliation(s)
- Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA.
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, San Francisco, CA, USA
| | - Allison Mitchell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
| | - Rohit Mukherjee
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
| | - Peter Davidson
- Department of Medicine, University of California, San Diego, CA, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market Street, Room 435, Philadelphia, PA, 19104, USA
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Belackova V, Salmon AM, Day CA, Ritter A, Shanahan M, Hedrich D, Kerr T, Jauncey M. Drug consumption rooms: A systematic review of evaluation methodologies. Drug Alcohol Rev 2019; 38:406-422. [PMID: 30938025 DOI: 10.1111/dar.12919] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 01/27/2023]
Abstract
ISSUES Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies. APPROACH Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF 'exposure' were recorded. KEY FINDINGS Two hundred and nineteen eligible peer-reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty-six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on blood-borne diseases, overdose deaths and costs. Papers using individual-level data included four prospective cohorts (n = 28), cross-sectional surveys (n = 7) and service records (n = 5). Individual-level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service 'exposure'. IMPLICATIONS Research around DCRs/SIFs has used ecological, modelling, cross-sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self-reported proportion of injections at SIFs or a stepped-wedge or a cluster trial comparing localities. CONCLUSIONS Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted.
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Affiliation(s)
| | - Allison M Salmon
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - Carolyn A Day
- Central Clinical School, Addiction Medicine, University of Sydney, Royal Prince Albert Hospital, Sydney, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, UNSW Sydney, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Thomas Kerr
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, Australia.,National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Kennedy-Hendricks A, Bluestein J, Kral AH, Barry CL, Sherman SG. Establishing Sanctioned Safe Consumption Sites in the United States: Five Jurisdictions Moving the Policy Agenda Forward. Psychiatr Serv 2019; 70:294-301. [PMID: 30755131 DOI: 10.1176/appi.ps.201800398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Safe consumption sites enable use of preobtained drugs in hygienic settings where trained staff are available to respond to overdoses and connect individuals with health and social services. This study examined efforts to advance policies to establish safe consumption sites in the United States, where no sanctioned sites exist. METHODS Between April and July 2018, the authors conducted 25 telephone interviews with a purposive sample of key informants in five communities considering safe consumption site implementation. Participants included organizers and advocates, government officials, and personnel with social service and health organizations. Interview notes were analyzed by using hybrid inductive-deductive coding. RESULTS Key strategies for organizing support for safe consumption sites included involving people who use drugs, engaging diverse partners, supporting allies in related causes, and using various tactics to garner support from policy makers. Major barriers to adoption included identifying the right locations, uncertainty about the federal response, mistrust arising from racial injustice in drug policy, and financing. Participants identified facilitators of progress toward safe consumption site adoption, such as building on existing harm reduction programs, securing political champions, and exposing community officials to programs operating internationally. CONCLUSIONS A window of opportunity may be opening to advance policy related to safe consumption sites; whether sanctioned sites become part of the broader policy strategy for addressing drug use and overdose in the United States will depend on the experiences of the first sites. Organizing around this issue may facilitate engagement among people who use drugs in broader conversations about drug policy.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Jenna Bluestein
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Alex H Kral
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Colleen L Barry
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
| | - Susan G Sherman
- Department of Health Policy and Management (Kennedy-Hendricks, Bluestein, Barry), Center for Mental Health and Addiction Policy Research (Kennedy-Hendricks, Bluestein, Barry, Sherman), and Department of Health Behavior and Society (Sherman), all at Johns Hopkins Bloomberg School of Public Health, Baltimore; Behavioral Health and Criminal Justice Division, RTI International, San Francisco (Kral)
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Mitra S, Rachlis B, Krysowaty B, Marshall Z, Olsen C, Rourke S, Kerr T. Potential use of supervised injection services among people who inject drugs in a remote and mid-size Canadian setting. BMC Public Health 2019; 19:284. [PMID: 30849946 PMCID: PMC6408761 DOI: 10.1186/s12889-019-6606-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 02/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While supervised injection services (SIS) feasibility research has been conducted in large urban centres across North America, it is unknown whether these services are acceptable among people who inject drugs (PWID) in remote, mid-size cities. We assessed willingness to use SIS and expected frequency of SIS use among PWID in Thunder Bay, a community in Northwestern, Ontario, Canada, serving people from suburban, rural and remote areas of the region. METHODS Between June and October 2016, peer research associates administered surveys to PWID. Sociodemographic characteristics, drug use and behavioural patterns associated with willingness to use SIS and expected frequency of SIS use were estimated using bivariable and multivariable logistic regression models. Design preferences and amenities identified as important to provide alongside SIS were assessed descriptively. RESULTS Among 200 PWID (median age, IQR: 35, 28-43; 43% female), 137 (69%) reported willingness to use SIS. In multivariable analyses, public injecting was positively associated with willingness to use (Adjusted Odds Ratio (AOR): 4.15; 95% confidence interval (CI): 2.08-8.29). Among those willing to use SIS, 87 (64%) said they would always/usually use SIS, while 48 (36%) said they would sometime/occasionally use SIS. In multivariable analyses, being female (AOR: 2.44; 95% CI: 1.06-5.65) and reporting injecting alone was positively associated with higher expected frequency of use (AOR: 2.59; 95% CI: 1.02-6.58). CONCLUSIONS Our findings suggest that SIS could play a role in addressing the harms of injection drug use in remote and mid-sized settings particularly for those who inject in public, as well as women and those who inject alone, who report higher expected frequency of SIS use. Design preferences of local PWID, in addition to differences according to gender should be taken into consideration to maximize the uptake of SIS, alongside existing health and social service provisions available to PWID.
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Affiliation(s)
- Sanjana Mitra
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, H.R. MacMillan Building, Vancouver, BC V6T 1Z4 Canada
| | - Beth Rachlis
- Institute for Clinical and Evaluative Sciences, 2075 Bayview Avenue, G172, Toronto, ON M4N 3M5 Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
| | - Bonnie Krysowaty
- Lakehead Social Planning Council, #38-125 Syndicate Avenue South, Thunder Bay, ON P7E 6H8 Canada
| | - Zack Marshall
- School of Social Work, McGill University, 3506 University Street, Room 300, Montreal, QC H3A 2A7 Canada
| | - Cynthia Olsen
- Thunder Bay Drug Strategy, City of Thunder Bay, 500 Donald Street East, P.O. Box 800, Thunder Bay, ON P7C 2K4 Canada
| | - Sean Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, 3rd Floor, Toronto, ON M5B 1T8 Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8 Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
- Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
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45
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Auriacombe M, Roux P, Briand Madrid L, Kirchherr S, Kervran C, Chauvin C, Gutowski M, Denis C, Carrieri MP, Lalanne L, Jauffret-Roustide M. Impact of drug consumption rooms on risk practices and access to care in people who inject drugs in France: the COSINUS prospective cohort study protocol. BMJ Open 2019; 9:e023683. [PMID: 30796121 PMCID: PMC6398695 DOI: 10.1136/bmjopen-2018-023683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 12/27/2018] [Accepted: 01/04/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The high prevalence of hepatitis C and the persistence of HIV and hepatitis C virus (HCV) risk practices in people who inject drugs (PWID) in France underlines the need for innovative prevention interventions. The main objective of this article is to describe the design of the COSINUS cohort study and outline the issues it will explore to evaluate the impact of drug consumption rooms (DCR) on PWID outcomes. Secondary objectives are to assess how DCR (a) influence other drug-related practices, such as the transition from intravenous to less risky modes of use, (b) reduce drug use frequency/quantity, (c) increase access to treatment for addiction and comorbidities (infectious, psychiatric and other), (d) improve social conditions and (e) reduce levels of violence experienced and drug-related offences. COSINUS will also give us the opportunity to investigate the impact of other harm reduction tools in France and their combined effect with DCR on reducing HIV-HCV risk practices. Furthermore, we will be better able to identify PWID needs. METHODS AND ANALYSIS Enrollment in this prospective multi-site cohort study started in June 2016. Overall, 680 PWID in four different cities (Bordeaux, Marseilles, Paris and Strasbourg) will be enrolled and followed up for 12 months through face-to-face structured interviews administered by trained staff to all eligible participants at baseline (M0), 3 month (M3), 6 month (M6) and 12 month (M12) follow-up visits. These interviews gather data on socio-demographic characteristics, past and current drug and alcohol consumption, drug-use related practices, access to care and social services, experience of violence (as victims), offences, other psychosocial issues and perception and needs about harm reduction interventions and services. Longitudinal data analysis will use a mixed logistic model to assess the impact of individual and structural factors, including DCR attendance and exposure to other harm reduction services, on the main outcome (HIV-HCV risk practices). ETHICS AND DISSEMINATION This study was reviewed and approved by the institutional review board of the French Institute of Medical Research and Health (opinion number: 14-166). The findings of this cohort study will help to assess the impact of DCR on HIV-HCV risk practices and other psycho-social outcomes and trajectories. Moreover, they will enable health authorities to shape health and harm reduction policies according to PWID needs. Finally, they will also help to improve current harm reduction and therapeutic interventions and to create novel ones.
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Affiliation(s)
- Marc Auriacombe
- University of Bordeaux, Bordeaux, Aquitaine, France
- Addiction Team, SANPSY, CNRS USR 3413, Bordeaux, France
- Department of Psychiatry, University of Pennsylvania Center for Studies of Addiction, Philadelphia, Pennsylvania, USA
- Pôle Addictologie, CH Charles Perrens and CHU de Bordeaux, Bordeaux, France
| | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Laélia Briand Madrid
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Sébastien Kirchherr
- Department of Psychiatry and Addictology, INSERM 1114, University Hospital of Strasbourg, Strasbourg, France
| | - Charlotte Kervran
- University of Bordeaux, Bordeaux, Aquitaine, France
- Addiction Team, SANPSY, CNRS USR 3413, Bordeaux, France
| | - Carole Chauvin
- CERMES3 (INSERM U988/UMR CNRS 8211/EHESS/Paris Descartes University), Paris, France
| | - Marie Gutowski
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Cécile Denis
- Addiction Team, SANPSY, CNRS USR 3413, Bordeaux, France
- Department of Psychiatry, University of Pennsylvania Center for Studies of Addiction, Philadelphia, Pennsylvania, USA
| | - Maria Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Laurence Lalanne
- INSERM U1114, Strasbourg, Alsace, France
- Department of Psychiatry and Addictology, Hopitaux universitaires de Strasbourg, Strasbourg, France
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Jiao S. Harm reduction: Philosophical drivers of conceptual tensions and ways forward. Nurs Inq 2019; 26:e12286. [PMID: 30773745 DOI: 10.1111/nin.12286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
Abstract
Of the various debates surrounding harm reduction, a conceptual tension that perhaps has the most relevance for the provision of services is that of harm reduction as a technical solution versus a contextualized social practice. The aim of this paper was to examine this conceptual tension. First, the two perspectives will be presented through the use of examples. Second, philosophical drivers that serve to underpin and justify each perspective will be explicated at the level of the knowledge that we privilege; the ideologies that we subscribe to; and the interests that we stand to serve. In this paper, I argue that the existing tension between technical and social approaches to harm reduction is embedded within discord pertaining to ways of knowing, paradigms of inquiry, prevailing ideologies, and notions of harm and risk. Building on these sources of tension, I suggest a means of philosophical reconciliation between the two approaches and ways forward, namely through acknowledging multiple sources of knowledge, through embracing paradigmatic incommensurability, through considering alternative conceptions of people who use drugs as political subjects, through involving service providers and end-users in shared decision-making, and lastly through reaffirming people who use drugs as the intended beneficiaries of services.
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Affiliation(s)
- Sunny Jiao
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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47
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Beck F, Lermenier-Jeannet A, Nguyen-Thanh V. [Monitoring and tackling smoking and other addictions: Current situation and perspectives]. Bull Cancer 2019; 106:656-664. [PMID: 30616838 DOI: 10.1016/j.bulcan.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
Abstract
After decades of policies targetting illicit drugs, the French drug addiction policy has progressively switched to incorporate a concept of « addictive behavior », including alchol, tobacco, pharmaceuticals and even behaviors such as gambling. Among the French general population, alcohol and tobacco uses are by far the most important health risk factors, with a very high burden of morbidity and mortality. Illicit drugs have very low prevalences except cannabis, with the highest prevalence in Europe, among adults as well as among adolescents. However, actions have long been implemented to tackle illicit drugs uses, in particular intraveinous drug use regarding its role in the HIV infection, with harm reduction tools such as opioids substitution treatments or needle exchange programs. While continuing this harm reduction policy, public authorities have strengthened measures towards alcohol, and moreover towards tobacco use with many legal and public health improvements. The goals are to reduce tobacco visibility (smoking bans in public places and even in pubs and restaurants), tobacco accessibility (price increase, ban on sales to minors…) and also to develop helps for those who wish to quit. The objective is to « denormalize » tobacco until there is a whole tobacco free generation in 2032 in France. One the one hand, this aim does not seem too irrealistic as the last general population survey results show a recent decrease in the tobacco smoking prevalence, as well as a decrease in social inequalities in tobacco use. One the other hand, the implementation of an harm reduction approach for alcohol, tobacco and cannabis remains to build.
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Affiliation(s)
- François Beck
- Institut national de la statistique et des études économiques, 88, avenue Verdier, CS 70058, 92541 Montrouge cedex, France; Université Paris-Sud, Université Paris-Saclay, faculté de médecine, faculté de médecine UVSQ, Inserm, CESP, 92541 Villejuif, France.
| | - Aurélie Lermenier-Jeannet
- Observatoire français des drogues et des toxicomanies (OFDT), 69, rue de Varenne, 75007 Paris, France
| | - Viêt Nguyen-Thanh
- Santé publique France, 12, rue du Val d'Osne, 94415 Saint-Maurice, France
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Arguments supporting and opposing legalization of safe consumption sites in the U.S. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 63:18-22. [DOI: 10.1016/j.drugpo.2018.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 09/05/2018] [Accepted: 10/31/2018] [Indexed: 01/05/2023]
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49
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Mittal ML, Guise A, Rafful C, Gonzalez-Zuñiga P, Davidson P, Vashishtha D, Strathdee SA, Werb D. "Another Person Was Going to Do It": The Provision of Injection Drug Use Initiation Assistance in a High-Risk U.S.-Mexico Border Region. Subst Use Misuse 2019; 54:2338-2350. [PMID: 31389282 PMCID: PMC6883155 DOI: 10.1080/10826084.2019.1648514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Persons who inject drugs (PWID) play a key role in assisting others' initiation into injection drug use (IDU). We aimed to explore the pathways and socio-structural contexts for this phenomenon in Tijuana, Mexico, a border setting marked by a large PWID population with limited access to health and social services. Methods: Preventing Injecting by Modifying Existing Responses (PRIMER) is a multi-cohort study assessing socio-structural factors associated with PWID assisting others into initiating IDU. Semi-structured qualitative interviews in Tijuana included participants ≥18 years old, who reported IDU within the month prior to cohort enrollment and ever initiating others into IDU. Purposive sampling ensured a range of drug use experiences and behaviors related to injection initiation assistance. Thematic analysis was used to develop recurring and significant data categories. Results: Twenty-one participants were interviewed (8 women, 13 men). Broadly, participants considered public injection to increase curiosity about IDU. Many considered transitioning into IDU as inevitable. Emergent themes included providing assistance to mitigate overdose risk and to protect initiates from being taken advantage of by others. Participants described reluctance in engaging in this process. For some, access to resources (e.g., shared drugs or a monetary fee) was a motivator to initiate others. Conclusion: In Tijuana, public injection and a lack of harm reduction services are perceived to fuel the incidence of IDU initiation and to incentivize PWID to assist in injection initiation. IDU prevention efforts should address structural factors driving PWID participation in IDU initiation while including PWID in their development and implementation.
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Affiliation(s)
- Maria L Mittal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Facultad de Medicina, Universidad Xochicalco, Tijuana, Mexico
| | - Andrew Guise
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Division of Health and Social Care Research, King's College, London, UK
| | - Claudia Rafful
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
| | - Patricia Gonzalez-Zuñiga
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Peter Davidson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Devesh Vashishtha
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
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50
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Harm reduction in Italy: the experience of an unsanctioned supervised injection facility run by drug users. DRUGS AND ALCOHOL TODAY 2018. [DOI: 10.1108/dat-03-2018-0011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Efforts to establish harm reduction interventions in Italy have persisted since the mid-1990s. Despite this, no sanctioned SIF has ever been implemented. The purpose of this paper is to provide information about a 10 year unsanctioned drug user-run SIF experience in Italy called Stanzetta.
Design/methodology/approach
The aim of the paper is to assess how Stanzetta met its objectives. Analysis was conducted compiling narrative accounts from the staff working in the NSP, which is adjacent to the Stanzetta, and conducting a simple frequency analysis of the available statistical data.
Findings
The Stanzetta unsanctioned SIF has been running for ten years and continues to be vulnerable due to its legal status. Being open 24 h/days has maximised its accessibility, but at the same time, it has encouraged a misuse of the Stanzetta. Although not trained, drug users became self-empowered to run the Stanzetta and to keep it clean, but the hygiene-health aspect is seen as one of the greatest challenges by the NSP professional staff. Over 10 years, not a single overdose death has been recorded. Drug use in the park has shifted from more visible places to the Stanzetta. As a result, the abandoned syringes have diminished in number and those disposed of correctly have increased. Moreover, no complaints from citizens or law enforcement were ever made. The neighbourhood acceptance seems to be the main goal of the peer-run unsanctioned SIF.
Research limitations/implications
The paper is based on a narrative account from the point of view of the professional staff involved, and results are specific to the context in which the study was conducted. Because of the chosen approach, the research results lack scientific generalisability. A relevant limitation is that no peer was involved in this study. Despite this, the research contributes to the information based on peer-run SIFs and makes a case for the de-medicalisation of SIFs in Europe.
Practical implications
This paper gives visibility to a long-lasting drug user-run SIF experience that was not made public mostly for an unclear legislative background about SIF in Italy.
Social implications
Efforts to establish harm reduction interventions in Italy have persisted since the mid-1990s and were undertaken primarily in response to epidemics of HIV infection and overdose (DPA, 2017). Despite this, no sanctioned SIF has ever been implemented. Primarily, this study wants to underline the urgency for an SIF pilot in Italy, and secondly the need to consider de-medicalising these services through direct support for peer-based models.
Originality/value
The Stanzetta unsanctioned SIF in Italy that has been running for ten years. Despite this, the venue continues to be vulnerable due to its legal status. For this reason, these results were never made public before. The experience showed a good working synergy between NSP professionals and the SIF peers. This model can be considered as a “light” de-medicalisation form to be explored and eventually to be implemented as a pilot SIF in Italy.
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