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Jozaghi E. The opioid epidemic and accessibility to free Wi-Fi: internet access is a human rights issue. Harm Reduct J 2024; 21:151. [PMID: 39169405 PMCID: PMC11337759 DOI: 10.1186/s12954-024-01061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/15/2024] [Indexed: 08/23/2024] Open
Abstract
The opioid epidemic has taken the lives of thousands of people across North America and Europe. Moreover, lack of housing, inflation, and a rapidly changing economy have affected millions of people, and many have become homeless. Many governments, researchers, health agencies, and not-for-profits have offered innovative ways to tackle this crisis, including many harm-reduction technologies that rely on Internet. In the age of the first artificial intelligence (AI) revolution, where reliance and accessibility to Internet have become a necessity for finding jobs, housing, affordable food, social services, social connection, and staying alive, the creation of free Wi-Fi zones around inner city neighborhood by towns and municipalities is not only a cost-effective way to reduce death, social costs, but a human rights issue during the initial stage of first A.I. revolution.
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Affiliation(s)
- Ehsan Jozaghi
- Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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2
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Lofaro RJ, Sapat A. Occupational and Personal Challenges During the Opioid Crisis: Understanding First Responders' Experiences and Viewpoints of Clients with Opioid Use Disorder. Disaster Med Public Health Prep 2024; 18:e93. [PMID: 38812432 DOI: 10.1017/dmp.2024.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVES This study provides preliminary findings on the experiences of first responders during the opioid crisis and their viewpoints regarding whether clients with opioid use disorder deserve medical rehabilitation. Understanding associations between first responder experiences and viewpoints of client deservedness can help reduce stigma, improve compassionate care, and identify training gaps. METHODS Analyses were run with data from a nationwide survey of Emergency Medical Services-providers and law enforcement workers collected from August to November 2022 (N = 3836). The study used univariate statistics and ordered logistic regression to understand first responders' experiences and viewpoints on client deservedness, as well as the relationship between the two. RESULTS Results show a negative correlation between responding to overdose calls and perceiving clients with opioid use disorder as deserving of medical rehabilitation. Law enforcement, males, and conservatives also had negative viewpoints. Conversely, having a friend experience addiction and believing addiction has had a direct impact on respondents' lives predicted increases in client deservedness. CONCLUSIONS Policy should focus on creating spaces where first responders can have positive interactions with people who use drugs or are in recovery. Better training is needed to help first responders manage on-the-job stressors and understand the complexities of addiction.
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Affiliation(s)
- Ryan J Lofaro
- Assistant Professor in the Department of Public and Nonprofit Studies at Georgia Southern University, Statesboro, GA, USA
| | - Alka Sapat
- Professor in the School of Public Administration at Florida Atlantic University, Boca Raton, FL, USA
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Bailey A, Harps M, Belcher C, Williams H, Amos C, Donovan B, Sedore G, Victoria S, Graham B, Goulet-Stock S, Cartwright J, Robinson J, Farrell-Low A, Willson M, Sutherland C, Stockwell T, Pauly B. Translating the lived experience of illicit drinkers into program guidance for cannabis substitution: Experiences from the Canadian Managed Alcohol Program Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104244. [PMID: 37950943 DOI: 10.1016/j.drugpo.2023.104244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/13/2023]
Abstract
A small but growing body of research has suggested the potential for cannabis substitution to support Managed Alcohol Program (MAP) service users to reduce acute and chronic alcohol-related harms. In 2022, researchers from the Canadian Managed Alcohol Program Study (CMAPS) noted a dearth of accessible, alcohol-specific educational resources to support service users and program staff to implement cannabis substitution pilots at several MAP sites in Canada. In this essay, we draw on over 10-years of collaboration between CMAPS, and organizations of people with lived experience (the Eastside Illicit Drinkers Group for Education (EIDGE) and SOLID Victoria) to describe our experiences co-creating cannabis education resources where none existed to support MAP sites interested in beginning to provide cannabis to participants. The research team relied on the unique lived experiences and informal cannabis-related harm reduction strategies described by EIDGE and SOLID members to create cannabis education resources that were accurate and relevant to MAP sites. EIDGE was familiar with creating peer-oriented educational resources and convened meetings and focus groups to engage peers. CMAPS research team members created standard cannabis unit equivalencies to support program delivery, and clinical advisors ensured that the stated risks and benefits of cannabis substitution, as well as tapering guidance for withdrawal management, were safe and feasible. The collaboration ultimately produced tailored client-facing and provider-facing resources. Our experience demonstrates that the lived expertise of drinkers can play an integral role in creating alcohol harm reduction informational materials, specifically those related to cannabis substitution, when combined with data from rigorous, community-based programs of research like CMAPS. We close by listing additional considerations for cannabis substitution program design for MAP settings emerging from this process of collaboration between illicit drinkers, service providers, clinicians, and researchers for consideration by other programs.
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Affiliation(s)
- Aaron Bailey
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada.
| | - Myles Harps
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Clint Belcher
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Henry Williams
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Cecil Amos
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Brent Donovan
- SOLID Victoria, 1056 N Park Street, Victoria, BC V8T 1C6, Canada
| | - George Sedore
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Solid Victoria
- SOLID Victoria, 1056 N Park Street, Victoria, BC V8T 1C6, Canada
| | - Brittany Graham
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Sybil Goulet-Stock
- Department of Psychology, University of Victoria, 3800 Finnerty Rd, Cornett Building (COR), A236, Victoria, BC V8P 5C2, Canada
| | - Jenny Cartwright
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada
| | - Jennifer Robinson
- Department of Anthropology, University of Victoria, 3800 Finnerty Rd, Cornett Building (COR), B228, Victoria, BC V8P 5C2, Canada
| | - Amanda Farrell-Low
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada
| | - Mark Willson
- SOLID Victoria, 1056 N Park Street, Victoria, BC V8T 1C6, Canada
| | - Christy Sutherland
- PHS Community Services Society, 9 E Hastings St, Vancouver, BC V6A 1M9, Canada
| | - Tim Stockwell
- Department of Psychology, University of Victoria, 3800 Finnerty Rd, Cornett Building (COR), A236, Victoria, BC V8P 5C2, Canada
| | - Bernie Pauly
- Department of Nursing, University of Victoria, 3800 Finnerty Rd, HSD Building, A402A, Victoria BC V8P 5C2, Canada
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4
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Chen Y, Yuan Y, Reed BG. Experiences of peer work in drug use service settings: A systematic review of qualitative evidence. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104182. [PMID: 37683570 DOI: 10.1016/j.drugpo.2023.104182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND People with lived or living experiences of drug use and services have been increasingly incorporated into nonpeer-led mainstream organizational settings as a unique workforce. Despite the much discussed effectiveness of peer services in achieving measurable outcomes, limited attention has been given to the experiential aspects of peer work from the perspectives of peers, clients, or others involved. This systematic review synthesized qualitative evidence examining the experiences of peer work in nonpeer-led drug use service settings. It focused on the benefits of incorporating peers as a unique workforce, the challenges they face, and the organizational factors that influence their practices. METHODS A search of 15 databases identified 3,940 unique citations, 33 of which met inclusion criteria. Thematic analysis was utilized to synthesize their findings. RESULTS Foregrounding the uniqueness of peers' shared experience, studies have shown that incorporating peers into nonpeer-led settings can provide benefits at the client, organizational, and societal levels while promoting peers' personal and professional growth. The unique shared experience of peers can also present multidimensional challenges, such as triggering, boundary negotiation, and feelings of being trapped by their peer identity. To fully integrate peers into the system, organizations need to work with them to reconstruct organizational mission, culture, and structures in a way that recognizes and genuine commits to peers' unique values. CONCLUSION This review highlights the significance of understanding peer uniqueness for organizations to create nourishing conditions for peer services and calls for future research exploring context- and setting-specific peer roles and organizational enablers and barriers.
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Affiliation(s)
- Yun Chen
- School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI, 48109, United States.
| | - Yeqing Yuan
- School of Social Work, College of Health, University of Alaska Anchorage, UAA Professional Studies Building, 2533 Providence Dr, Suite 234, Anchorage, AK 99508, United States
| | - Beth Glover Reed
- School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI, 48109, United States
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Bailey A, Graham B, Harps M, Sedore G. Vancouver's Alcohol Knowledge Exchange: lessons learned from creating a peer-involved alcohol harm reduction strategy in Vancouver's Downtown Eastside. Harm Reduct J 2023; 20:93. [PMID: 37495993 PMCID: PMC10373358 DOI: 10.1186/s12954-023-00838-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 07/22/2023] [Indexed: 07/28/2023] Open
Abstract
Despite high rates of harm attributable to alcohol use itself and the associated marginalization of illicit drinkers in Vancouver's Downtown Eastside (DTES), alcohol-specific harm reduction services there are under-resourced and highly disconnected from one another. In response to these conditions and high rates of death amongst its membership, the Eastside Illicit Drinkers Group for Education, an affiliate group of the Vancouver Area Network of Drug Users, convened a regular meeting of stakeholders, termed a "community of practice" in 2019 to bring together peers who used beverage and non-beverage alcohol, shelter and harm reduction service providers, public health professionals, clinicians, and policymakers to improve system-level capacity to reduce alcohol-related harm. The discussions that followed from these meetings were transformed into the Vancouver Alcohol Strategy (VAS), a comprehensive, harm reduction-oriented policy framework for alcohol harm reduction in the DTES. This article highlights our experiences producing community-led alcohol policy through the VAS with specific attention to the ways in which people who use alcohol themselves were centred throughout the policy development process. We also provide summary overviews of each of the VAS document's 6 thematic areas for action, highlighting a sampling of the 47 total unique recommendations. Historically, people who use non-beverage alcohol and whose use of alcohol in public spaces is criminalized due to housing precarity and visible poverty have been excluded from the development of population-level alcohol policies that can harm this specific population. The process of policy development undertaken by the VAS has attempted to resist this top-down approach to public health policy development related to alcohol control by intentionally creating space for people with lived experience to guide our recommendations. We conclude by suggesting that a grassroots enthusiasm for harm reduction focused policy development exists in Vancouver's DTES, and requires resources from governmental public health institutions to meaningfully prevent and reduce alcohol-related and policy-induced harms.
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Affiliation(s)
- Aaron Bailey
- Eastside Illicit Drinkers Group for Education, Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada.
| | - Brittany Graham
- Eastside Illicit Drinkers Group for Education, Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | - Myles Harps
- Eastside Illicit Drinkers Group for Education, Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | - George Sedore
- Eastside Illicit Drinkers Group for Education, Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
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Dawes J, May T, Fancourt D, Burton A. The Impact of the COVID-19 Pandemic and Associated Societal Restrictions on People Experiencing Homelessness (PEH): A Qualitative Interview Study with PEH and Service Providers in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15526. [PMID: 36497601 PMCID: PMC9739517 DOI: 10.3390/ijerph192315526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
People experiencing homelessness (PEH) faced unique challenges during the COVID-19 pandemic, including changes to accommodation availability, societal restrictions impacting access to essentials like food, and services moving to online and remote access. This in-depth qualitative research aims to add to the existing, but limited research exploring how the pandemic affected PEH. 33 semi-structured qualitative interviews (22 with PEH during the pandemic and 11 with homelessness sector service providers) were undertaken in the United Kingdom between April 2021 and January 2022. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis. To ensure consistency of coding, 10% of interviews were coded by two researchers. The PEH sample was 50% female, aged 24-59 years, 59% white British, and included people who had lived in hostels/hotels, with friends/family, and on the streets during the COVID-19 pandemic. Providers came from varied services, including support charities, housing, and addiction services. Five key themes were identified: (i) the understanding of and adherence to public health guidance and restrictions; (ii) the experience of people accommodated by the 'Everyone In' initiative; (iii) the impact of social distancing guidelines on PEH experiences in public spaces; (iv) the importance of social support and connections to others; and (v) how homelessness services adapted their provision. Policy makers and public health communicators must learn from PEH to maximize the effectiveness of future public health strategies. Housing providers and support services should recognize the implications of imposing a lack of choice on people who need accommodation during a public health emergency. The loss of usual support for PEH triggered a loss of ability to rely on usual 'survival strategies', which negatively influenced their health. This research highlights successes and difficulties in supporting PEH during the COVID-19 pandemic and informs planning for similar public health events.
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Affiliation(s)
- Jo Dawes
- Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care, University College London (UCL), London WC1E 7HB, UK
| | - Tom May
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London WC1E 7HB, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London WC1E 7HB, UK
| | - Alexandra Burton
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London (UCL), London WC1E 7HB, UK
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Gehring ND, Speed KA, Wild TC, Pauly B, Salvalaggio G, Hyshka E. Policy actor views on structural vulnerability in harm reduction and policymaking for illegal drugs: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103805. [PMID: 35907373 DOI: 10.1016/j.drugpo.2022.103805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Health risks associated with drug use are concentrated amongst structurally vulnerable people who use illegal drugs (PWUD). We described how Canadian policy actors view structural vulnerability in relation to harm reduction and policymaking for illegal drugs, and what solutions they suggest to reduce structural vulnerability for PWUD. METHODS The Canadian Harm Reduction Policy Project is a mixed-method, multiple case study. The qualitative component included 73 semi-structured interviews conducted with harm reduction policy actors across Canada's 13 provinces and territories between November 2016 and December 2017. Interviews explored perspectives on harm reduction and illegal drug policies and the conditions that facilitate or constrain policy change. Our sub-analysis utilized a two-step inductive analytic process. First, we identified transcript segments that discussed structural vulnerability or analogous terms. Second, we conducted latent content analysis on the identified excerpts to generate main findings. RESULTS The central role of structural vulnerability (including poverty, unstable/lack of housing, racialization) in driving harm for PWUD was acknowledged by participants in all provinces and territories. Criminalization, in particular, was seen as a major contributor to structural vulnerability by justifying formal and informal sanctions against drug use and, by extension, PWUD. Many participants expressed that their personal understanding of harm reduction included addressing the structural conditions facing PWUD, yet identified that formal government harm reduction policies focused solely on drug use rather than structural factors. Participants identified several potential policy solutions to intervene on structural vulnerability including decriminalization, safer supply, and enacting policies encompassing all health and social sectors. CONCLUSIONS Structural vulnerability is salient within Canadian policy actors' discourses; however, formal government policies are seen as falling short of addressing the structural conditions of PWUD. Decriminalization and safer supply have the potential to mitigate immediate structural vulnerability of PWUD while policies evolve to advance social, economic, and cultural equity.
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Affiliation(s)
- Nicole D Gehring
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Kelsey A Speed
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Bernie Pauly
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
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Jozaghi E. The overdose epidemic: a study protocol to determine whether people who use drugs can influence or shape public opinion via mass media. HEALTH & JUSTICE 2022; 10:22. [PMID: 35870016 PMCID: PMC9307426 DOI: 10.1186/s40352-022-00189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND We are currently witnessing an ongoing drug overdose death epidemic in many nations linked to the distribution of illegally manufactured potent synthetic opioids. While many health policy makers and researchers have focused on the root causes and possible solutions to the current crisis, there has been little focus on the power of advocacy and community action by people who use drugs (PWUDs). Specifically, there has been no research on the role of PWUDs in engaging and influencing mass media opinion. METHODS By relying on one of the longest and largest peer-run drug user advocacy groups in the world, the Vancouver Area Network of Drug Users (VANDU), newspaper articles, television reports, and magazines that VANDU or its members have been directly involved in will be identified via two data bases (the Canadian Newsstream & Google News). The news articles and videos related to the health of PWUDs and issues affecting PWUDs from 1997 to the end of 2020 will be analyzed qualitatively using Nvivo software. DISCUSSION As our communities are entering another phase of the drug overdose epidemic, acknowledging and partnering with PWUDs could play an integral part in advancing the goals of harm reduction, treatment, and human rights.
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Affiliation(s)
- Ehsan Jozaghi
- UBC Faculty of Dentistry, Nobel Biocare Oral Health Centre, 2151 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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Pauly B, Sullivan G, Inglis D, Cameron F, Phillips J, Rosen C, Bullock B, Cartwright J, Hainstock T, Trytten C, Urbanoski K. Applicability of a national strategy for patient-oriented research to people who use(d) substances: a Canadian experience. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:22. [PMID: 35610726 PMCID: PMC9127478 DOI: 10.1186/s40900-022-00351-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Europe and North America are in the grips of a devastating overdose crisis. People who use substances often feel unsafe to access healthcare due to fears of stigma, blame, judgement, poor treatment, or other repercussions. As a result, they often avoid, delay, or leave care, resulting in premature death and missed opportunities for care. Internationally, there have been concerted efforts to move towards patient-engaged research to enhance the quality of health care systems and services. In Canada, the Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR) initiative promotes engagement of patients as active partners in health care research. As part of a community based patient oriented research project, we critically analyze the SPOR framework to provide insights into what constitutes safer research with people who use(d) substances. METHODS We undertook a two-stage process that began with a review of community based research principles and the SPOR framework. At the second stage, we undertook a qualitative descriptive study employing focus groups to generate description of the adequacy and appropriateness of the SPOR framework for guiding research with people who use(d) substances on four key dimensions (patient engagement, guiding principles, core areas of engagement and benefits). The data were analyzed using qualitative content analysis to identify key issues and insights. RESULTS While the SPOR framework includes a range of patient roles, principles and areas for engagement, there are issues and gaps related to essential elements of safe patient-oriented research for people who use substances. These include an individualized focus on patients as partners, lack of recognition of community benefits, power imbalances and distrust due to systemic stigma, engagement as one way capacity building and learning, and lack of accountability for taking action on research findings. CONCLUSIONS Given the extent of stigma in health care and the ongoing illicit drug policy crisis, strategies for enhancing equitable Patient-Oriented Research (POR) include shifting language from patient partners to community researchers, recognizing power inequities and adding trust and equity as core POR principles including pay equity. Employing community based participatory research as a POR methodology allows the lead researchers to fully engage community throughout the research process, enhances community benefits and accountability for action.
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Affiliation(s)
- Bernadette Pauly
- University of Victoria School of Nursing, Canadian Institute for Substance Use Research, Victoria, Canada.
| | - Ginger Sullivan
- University of Victoria School of Nursing, Canadian Institute for Substance Use Research, Victoria, Canada
| | - Dakota Inglis
- University of Victoria, Canadian Institute for Substance Use Research, Victoria, Canada
| | | | | | - Conor Rosen
- Umbrella Society for Addictions and Mental Health, Victoria, Canada
| | - Bill Bullock
- Victoria Division of Family Practice, Victoria, Canada
| | - Jennifer Cartwright
- BC Support Unit, Advancing Patient Oriented Research, Vancouver Island Regional Centre, Victoria, Canada
| | - Taylor Hainstock
- BC Support Unit, Advancing Patient Oriented Research, Vancouver Island Regional Centre, Victoria, Canada
| | | | - Karen Urbanoski
- University of Victoria, Canadian Institute for Substance Use Research, Victoria, Canada
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Salvalaggio G, Ferguson L, Brooks HL, Campbell S, Gladue V, Hyshka E, Lam L, Morris H, Nixon L, Springett J. Impact of health system engagement on the health and well-being of people who use drugs: a realist review protocol. Syst Rev 2022; 11:66. [PMID: 35418306 PMCID: PMC9008896 DOI: 10.1186/s13643-022-01938-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although community-level benefits of health system engagement (i.e., health service planning, delivery, and quality improvement, engaged research and evaluation, and collaborative advocacy) are well established, individual-level impacts on the health and well-being of community members are less explored, in particular for people who use or have used illegal drugs (PWUD). Capacity building, personal growth, reduced/safer drug use, and other positive outcomes may or may not be experienced by PWUD involved in engagement activities. Indeed, PWUD may also encounter stigma and harm when interacting with healthcare and academic structures. Our objective is to uncover why, how, and under what circumstances positive and negative health outcomes occur during health system engagement by PWUD. METHODS We propose a realist review approach due to its explanatory lens. Through preliminary exploration of literature, lived experience input, and consideration of formal theories, an explanatory model was drafted. The model describes contexts, mechanisms, and health outcomes (e.g., mental health, stable/safer drug use) involved in health system engagement. The explanatory model will be tested against the literature and iteratively refined against formal theories. A participatory lens will also be used, wherein PWUD with lived experience of health system engagement will contribute throughout all stages of the review. DISCUSSION We believe this is the first realist review to explore the contextual factors and underlying mechanisms of health outcomes for PWUD who participate in health system engagement. A thorough understanding of the relevant literature and theoretical underpinnings of this process will offer insights and recommendations to improve the engagement processes of PWUD.
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Affiliation(s)
- Ginetta Salvalaggio
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
| | - Lawrence Ferguson
- Faculty of Medicine & Dentistry, University of Alberta, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Hannah L Brooks
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave. NW, Edmonton, AB, T6G 1C9, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, 2K3.28 Mackenzie Centre, Edmonton, AB, T6G 2R7, Canada
| | - Vanessa Gladue
- Alberta Alliance Who Educate and Advocate Responsibly, 10116 105 Ave. NW, Edmonton, AB, T5H 0K2, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave. NW, Edmonton, AB, T6G 1C9, Canada
| | - Linda Lam
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Heather Morris
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave. NW, Edmonton, AB, T6G 1C9, Canada
| | - Lara Nixon
- Department of Family Medicine, University of Calgary, G012 Health Sciences Centre, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Jane Springett
- Centre for Healthy Communities, School of Public Health, University of Alberta, 3-289 Edmonton Clinic Health Academy 11405-87 Ave. NW, Edmonton, AB, T6G 1C9, Canada
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Bouzanis K, Joshi S, Lokker C, Pavalagantharajah S, Qiu Y, Sidhu H, Mbuagbaw L, Qutob M, Henedi A, Levine MAH, Lennox R, Tarride JE, Kalina D, Alvarez E. Health programmes and services addressing the prevention and management of infectious diseases in people who inject drugs in Canada: a systematic integrative review. BMJ Open 2021; 11:e047511. [PMID: 34556508 PMCID: PMC8461723 DOI: 10.1136/bmjopen-2020-047511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 08/24/2021] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES People who inject drugs (PWID) experience a high burden of injection drug use-related infectious disease and challenges in accessing adequate care. This study sought to identify programmes and services in Canada addressing the prevention and management of infectious disease in PWID. DESIGN This study employed a systematic integrative review methodology. Electronic databases (PubMed, CINAHL and Web of Science Core Collection) and relevant websites were searched for literature published between 2008 and 2019 (last search date was 6 June 2019). Eligible articles and documents were required to address injection or intravenous drug use and health programmes or services relating to the prevention or management of infectious diseases in Canada. RESULTS This study identified 1607 unique articles and 97 were included in this study. The health programmes and services identified included testing and management of HIV and hepatitis C virus (n=27), supervised injection facilities (n=19), medication treatment for opioid use disorder (n=12), integrated infectious disease and addiction programmes (n=10), needle exchange programmes (n=9), harm reduction strategies broadly (n=6), mobile care initiatives (n=5), peer-delivered services (n=3), management of IDU-related bacterial infections (n=2) and others (n=4). Key implications for policy, practice and future research were identified based on the results of the included studies, which include addressing individual and systemic factors that impede care, furthering evaluation of programmes and the need to provide comprehensive care to PWID, involving medical care, social support and harm reduction. CONCLUSIONS These results demonstrate the need for expanded services across a variety of settings and populations. Our study emphasises the importance of addressing social and structural factors that impede infectious disease care for PWID. Further research is needed to improve evaluation of health programmes and services and contextual factors surrounding accessing services or returning to care. PROSPERO REGISTRATION NUMBER CRD42020142947.
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Affiliation(s)
- Katrina Bouzanis
- Department of Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Siddharth Joshi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Yun Qiu
- School of Health Sciences, Jiangsu Institute of Commerce, Nanjing, Jiangsu, China
| | - Hargun Sidhu
- Department of Undergraduate Medical Education, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Majdi Qutob
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alia Henedi
- Faculty of Pharmacy, Eastern Mediterranean University, Famagusta, North Cyprus, Cyprus
| | - Mitchell A H Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robin Lennox
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Dale Kalina
- Department of Infectious Diseases, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
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12
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Morris H, Hyshka E, Schulz P, Jenkins E, Haines-Saah RJ. "It's a Bit of a Double-Edged Sword": Motivation and Personal Impact of Bereaved Mothers' Advocacy for Drug Policy Reform. QUALITATIVE HEALTH RESEARCH 2021; 31:1812-1822. [PMID: 34525864 PMCID: PMC8446895 DOI: 10.1177/10497323211006383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
North America's overdose crisis is an urgent public health issue that has resulted in thousands of deaths. As the crisis began to take hold across Canada in 2016, bereaved parents, mainly mothers, emerged as vocal advocates for drug policy reform and harm reduction, using their stories to challenge the stigma of drug-related death. In 2017, we launched a qualitative research partnership with leading family organizations in Canada, conducting interviews with 43 mothers whose children had died from substance use, to understand their experiences of drug policy advocacy. Our findings showed that participants' motivations for engaging in advocacy were rooted in their experiences of grief, and that advocacy led to feelings of empowerment and connection to others. Our research suggests that advocacy can be cathartic and associated with healing from grief, but that "going public" in sharing a family story of substance use death can also have a considerable personal cost.
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Affiliation(s)
| | | | - Petra Schulz
- Moms Stop the Harm, Victoria,
British Columbia, Canada
| | - Emily Jenkins
- The University of British
Columbia, Vancouver, British Columbia, Canada
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13
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An Inside Perspective of the Opioid Overdose Crisis in Vancouver: A Secondary Qualitative Study. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Nowell M, Masuda JR. "You need to just provide health services:" navigating the politics of harm reduction in the twin housing and overdose crises in Vancouver, BC. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102774. [PMID: 32512342 DOI: 10.1016/j.drugpo.2020.102774] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Since harm reduction's origins as a grassroots, activist movement, cooperation and compromise among people who use drugs, bureaucrats, politicians, and other actors have been critical to its advancement in Canada. Critics have argued, however, that the institutionalization of harm reduction practice within the context of a politically sensitive environment has eroded its radical potential. The overdose crisis in Vancouver's Downtown Eastside (DTES) community has led to innovative harm reduction organizing that has been replicated globally. In this paper, we explore how one such intervention, the Tenant Overdose Response Organizers (TORO) program, has supported a resurgence in tenant-led harm reduction organizing in Single Room Occupancy (SRO) buildings in the DTES. METHODS We draw on 15 months of ethnographic fieldwork conducted between May 2017 and August 2018, over 100 hours of participant observation of TORO activities, and 15 semi-structured interviews with key stakeholders in the program. RESULTS TORO's leaders attempted to mobilize harm reduction intervention towards collective action on SRO risk environments underlying drug-related harms, but their efforts were constrained by the necessity of meeting practical expectations of funders regarding health education and supply distribution. Navigating these constraints ultimately shaped the development of the TORO program, helping to secure its longevity but also limiting its ability to organize a coordinated harm reduction and tenants' rights response to the dual housing and overdose crises. CONCLUSION Our examination of TORO demonstrates how the harm reduction movement continues to be shaped by conflict, cooperation, and compromise between the state and grassroots groups. Even as actors strive to work collaboratively, the unequal distribution of power inherent in this relationship may contribute to the reinscription of a depoliticized harm reduction approach. We discuss the potential role of the risk environment framework in lending political legitimacy to grassroots harm reduction initiatives.
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Affiliation(s)
- Magnus Nowell
- Centre for Environmental Health Equity (CEHE), School of Kinesiology and Health Studies, Queen's University, 28 Division St, Kingston, ON, K7L 3N6, Canada.
| | - Jeffrey R Masuda
- Centre for Environmental Health Equity (CEHE), School of Kinesiology and Health Studies, Queen's University, 28 Division St, Kingston, ON, K7L 3N6, Canada
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- Downtown Eastside SRO Collaborative Society (SRO-C), 203-268 Keefer St, Vancouver, BC, V6A 1×5, Canada
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15
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Jozaghi E. The Opioid Epidemic: Task-Shifting in Health Care and the Case for Access to Harm Reduction for People Who Use Drugs. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 52:261-268. [PMID: 32268811 DOI: 10.1177/0020731420914820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We are sadly experiencing unprecedented levels of overdose mortalities attributed to the increased availability of synthetic opioids in illegal markets. While the majority of attention in North America has focused on preventing drug overdose cases through the distribution and administration of naloxone, in addition to stricter regulations of opioid prescriptions and greater law enforcement in illegal markets, little attention has been given to other alternative models and treatments for people who use drugs that are tailored specifically to the health care needs of this marginalized population. Through this analysis, the implications of task-shifting in health care via the distribution of naloxone for an already marginalized population are discussed. Alternatively, the role of pioneering harm-reduction programs - such as supervised injection/consumption sites, a variety of opioids maintenance therapies, and social-structural interventions - are highlighted as crucial interventions in the current ongoing opioid crisis. Moreover, people with lived experiences of illegal drug use are discussed as having a pivotal role but being ultimately overshadowed by public health partners.
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Affiliation(s)
- Ehsan Jozaghi
- The School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Rigoni R, Woods S, Breeksema JJ. From opiates to methamphetamine: building new harm reduction responses in Jakarta, Indonesia. Harm Reduct J 2019; 16:67. [PMID: 31829253 PMCID: PMC6907268 DOI: 10.1186/s12954-019-0341-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 11/14/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Despite the rise of stimulant use, most harm reduction programs still focus on people who inject opioids, leaving many people who use methamphetamine (PWUM) underserviced. In Asia, especially, where methamphetamine prevalence has overtaken opioids prevalence, harm reduction programs assisting PWUM are rare. The few existing innovative practices focusing on methamphetamine use lie underreported. Understanding how these programs moved their focus from opiates to methamphetamine could help inspire new harm reduction responses. Hence, this paper analyzes a newly implemented outreach program assisting methamphetamine users in Jakarta, Indonesia. It addresses the program's critical learning points when making the transition to respond to stimulant use. METHODS This case study is part of a more extensive research on good practices of harm reduction for stimulant use. For this case study, data was collected through Indonesian contextual documents and documents from the program, structured questionnaire, in-depth interviews with service staff and service users, a focus group discussion with service users, and in-loco observations of activities. For this paper, data was reinterpreted to focus on the key topics that needed to be addressed when the program transitioned from working with people who use opioids to PWUM. RESULTS Four key topics were found: (1) getting in touch with different types of PWUM and building trust relationships; (2) adapting safer smoking kits to local circumstances; (3) reframing partnerships while finding ways to address mental health issues; and (4) responding to local law enforcement practices. CONCLUSIONS The meaningful involvement of PWUM was essential in the development and evaluation of outreach work, the planning, and the adaptation of safer smoking kits to local circumstances. Also, it helped to gain understanding of the broader needs of PWUM, including mental health care and their difficulties related to law enforcement activities. Operating under a broad harm reduction definition and addressing a broad spectrum of individual and social needs are preferable to focusing solely on specific interventions and supplies for safer drug use. Since many PWUM smoke rather than inject, securing funding for harm reduction focused on people who do not inject drugs and/or who do not use opioids is fundamental in keeping programs sustainable.
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Affiliation(s)
- Rafaela Rigoni
- Mainline Foundation, Amsterdam, Netherlands.
- Department of History and Art History, Utrecht University, Utrecht, Netherlands.
| | - Sara Woods
- Mainline Foundation, Amsterdam, Netherlands
| | - Joost J Breeksema
- University Center of Psychiatry, University Medical Center of Groningen, Groningen, Netherlands
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17
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Neufeld SD, Chapman J, Crier N, Marsh S, McLeod J, Deane LA. Research 101: A process for developing local guidelines for ethical research in heavily researched communities. Harm Reduct J 2019; 16:41. [PMID: 31262305 PMCID: PMC6604375 DOI: 10.1186/s12954-019-0315-5] [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: 02/01/2019] [Accepted: 06/10/2019] [Indexed: 01/22/2023] Open
Abstract
Background Marginalized communities often attract more than their share of research. Too often, this research benefits researchers disproportionately and leaves such communities feeling exploited, misrepresented, and exhausted. The Downtown Eastside (DTES) neighborhood of Vancouver, Canada, has been the site of multiple public health epidemics related to injection drug use as well as the site of much community-led resistance and struggle that has led to the development of cutting-edge harm reduction interventions (e.g., North America’s first supervised injection facility, Insite) and a strong sense of community organization. This background has made the DTES one of the most heavily researched communities in the world. Amidst ongoing experiences of unethical or disrespectful research engagement in the neighborhood, a collaboration between local academic researchers and community representatives developed to explore how we could work together to encourage more respectful, community-responsive research and discourage exploitative or disrespectful research. Methods We developed a series of six weekly workshops called “Research 101.” These workshops brought together approximately 13 representatives from peer-based organizations in the DTES with a variety of experiences with research. Research 101 created space for community members themselves to discuss the pitfalls and potential of research in their neighborhood and to express community expectations for more ethical and respectful research. Results We summarized workshop discussions in a co-authored “Manifesto for Ethical Research in the Downtown Eastside.” This document serves as a resource to empower community organizations to develop more equitable partnerships with researchers and help researchers ground their work in the principles of locally developed “community ethics.” Manifesto guidelines include increased researcher transparency, community-based ethical review of projects, empowering peer researchers in meaningful roles within a research project, and taking seriously the need for reciprocity in the research exchange. Conclusions Research 101 was a process for eliciting and presenting a local vision of “community ethics” in a heavily researched neighborhood to guide researchers and empower community organizations. Our ongoing work involves building consensus for these guidelines within the community and communicating these expectations to researchers and ethics offices at local universities. We also describe how our Research 101 process could be replicated in other heavily researched communities. Electronic supplementary material The online version of this article (10.1186/s12954-019-0315-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Scott D Neufeld
- Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, BC, Canada. .,BC Centre on Substance Use, 400-1045 Howe St, Vancouver, V6Z 2A9, BC, Canada.
| | - Jule Chapman
- Sex Workers United Against Violence, 334 Alexander St, Vancouver, BC, V6A 1C3, Canada
| | - Nicolas Crier
- Megaphone Magazine Speaker's Bureau, 312 Main St, Vancouver, BC, V6A 2 T2, Canada.,Illicit: A Shadow Story, Vancouver, BC, Canada
| | - Samona Marsh
- Sex Workers United Against Violence, 334 Alexander St, Vancouver, BC, V6A 1C3, Canada.,Illicit: A Shadow Story, Vancouver, BC, Canada.,Vancouver Area Network of Drug Users, 380 E Hastings St, Vancouver, BC, V6A 1P4, Canada.,BC Yukon Association of Drug War Survivors, Vancouver, BC, Canada.,Canadian Association of People Who Use Drugs, Vancouver, BC, Canada
| | - Jim McLeod
- Illicit: A Shadow Story, Vancouver, BC, Canada.,Hives for Humanity, 206-312 Main St, Vancouver, BC, V6A 2 T2, Canada
| | - Lindsay A Deane
- Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, BC, Canada
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18
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McCall J, Phillips JC, Estafan A, Caine V. Exploring the experiences of staff working at an opiate assisted treatment clinic: An interpretive descriptive study. Appl Nurs Res 2018; 45:45-51. [PMID: 30683250 DOI: 10.1016/j.apnr.2018.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/14/2018] [Accepted: 12/08/2018] [Indexed: 12/14/2022]
Abstract
There have been many advances in harm reduction over the past three decades. One of the newest approaches is the provision of medical grade heroin to people with opiate addiction, known as opiate assisted treatment (OAT). There is one clinic in North America which provides this service. The goal of this study was to uncover how clinic staff provide care to those who attend this clinic, their perspectives on how the clinic program impacted them and their patients, and their opinions about the program itself. This was a qualitative study with an interpretive descriptive methodology underpinned by critical social theory. Convenience sampling yielded 22 participants - 18 nurses, two social workers and two peer support workers. Thematic analysis was undertaken to identify recurring, converging and contradictory patterns of interaction, key concepts and emerging themes. The study location was the OAT clinic located in the downtown eastside of Vancouver, BC. The findings were organized around the following six themes: from chaos to stability, it's not all roses, a little preparation would be good, putting the patient at the centre, the stigma hasn't gone away, and the clinic is life transforming. Taken together, these themes indicate the complexities of working in this environment. The findings can guide clinic staff, including nurses, in how they provide care to patients with addiction problems and also provide direction for policy makers on harm reduction planning. CONTRIBUTION OF THE PAPER: What is already known about the topic? What does this paper add?
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Affiliation(s)
- Jane McCall
- University of Alberta, Edmonton, Alberta, Canada.
| | | | | | - Vera Caine
- University of Alberta, Edmonton, Alberta, Canada
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19
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Jozaghi E, Greer AM, Lampkin H, Buxton JA. Activism and scientific research: 20 years of community action by the Vancouver area network of drug users. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2018; 13:18. [PMID: 29788975 PMCID: PMC5964704 DOI: 10.1186/s13011-018-0158-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/17/2018] [Indexed: 01/20/2023]
Abstract
Background Over the past several decades, there have been numerous peer-reviewed articles written about people who use drugs (PWUDs) from the Downtown Eastside neighborhood of Vancouver, Canada. While individual researchers have engaged and acknowledged this population as participants and community partners in their work, there has been comparatively little attention given to the role of PWUDs and drug user organizations in directing, influencing, and shaping research agendas. Methods In this community-driven research, we examine 20 years of peer-reviewed studies, university theses, books, and reports that have been directed, influenced, and shaped by members of the activist organization the Vancouver Area Network of Drug Users (VANDU). In this paper, we have summarized VANDU’s work based on different themes from each article. Results After applying the inclusion criteria to over 400 articles, 59 items containing peer-reviewed studies, books, and reports were included and three themes of topics researched or discussed were identified. Theme 1: ‘health needs’ of marginalized groups was found in 39% of articles, Theme 2: ‘evaluation of projects’ related to harm reduction in 19%, and Theme 3: ‘activism’ related work in 42%. Ninety-four percent of co-authors were from British Columbia and 44% of research was qualitative. Works that have been co-authored by VANDU’s members or acknowledged their participations created 628 citations. Moreover, their work has been accessed more than 149,600 times. Conclusions Peer-based, democratic harm reduction organizations are important partners in facilitating groundbreaking health and social research, and through research can advocate for the improved health and wellbeing of PWUDs and other marginalized groups in their community. This article also recommends that PWUDs should be more respectfully engaged and given appropriate credit for their contributions.
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Affiliation(s)
- Ehsan Jozaghi
- The British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada. .,The School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Alissa M Greer
- The British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada.,The School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Hugh Lampkin
- Vancouver Area Network of Drug Users, 380 E Hastings St, Vancouver, BC, V6A 1P4, Canada
| | - Jane A Buxton
- The British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada.,The School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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20
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Bouchard M, Hashimi S, Tsai K, Lampkin H, Jozaghi E. Back to the core: A network approach to bolster harm reduction among persons who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 51:95-104. [PMID: 29227844 DOI: 10.1016/j.drugpo.2017.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/31/2017] [Accepted: 10/11/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Injecting drugs safely almost always includes the presence of one's social network, especially for the prevention of overdose. Yet, the systematic analysis of users' social networks has yet to be established as a focal method in harm reduction research, and interventions. METHODS This study draws from 200 interviews with persons who inject drugs recruited from North America's first sanctioned supervised injection facility and a drug user's advocacy group. Respondents were asked about the individuals they personally considered as facilitators of harm reduction, and the relations between them. Collectively, these 200 respondents provided over 900 individuals whom they considered as members of their harm reduction network. The aim was to locate individuals that would potentially make the network denser (harm reduction champions) and users that were situated in the "periphery" of the network, and in practice, further away from the harm reduction core. RESULTS Of the 1135 network members, 63 individuals formed the "core" of the harm reduction network, collectively reaching approximately 70% of individuals in the network. We also uncovered 31 individuals that acted as "articulation points"- these individuals were not as connected, but were more effective at reaching peripheral individuals. CONCLUSION Former or current injecting drug users that were sampled were surrounded by a relatively rich harm reduction network, but the network approach showed that only a minority of individuals were true harm reduction "champions". Recruitment of a combination of well-connected harm reduction champions, and strategically connected articulation points, would be most effective in planning network interventions that encourage harm reduction behaviors among this population.
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Affiliation(s)
- Martin Bouchard
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Sadaf Hashimi
- Rutgers University, Center for Law and Justice, 123 Washington Street, Newark, NJ, 07102-309, United States
| | - Kristen Tsai
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Hugh Lampkin
- Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | - Ehsan Jozaghi
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada; BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
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Jozaghi E, Lampkin H, Andresen MA. Peer-engagement and its role in reducing the risky behavior among crack and methamphetamine smokers of the Downtown Eastside community of Vancouver, Canada. Harm Reduct J 2016; 13:19. [PMID: 27278459 PMCID: PMC4898457 DOI: 10.1186/s12954-016-0108-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/04/2016] [Indexed: 02/14/2023] Open
Abstract
Background The role of peers (former or current drug users) in reducing risky behavior within methamphetamine and crack smokers has not been well described or researched. The current study not only explores the role of peers in reducing risk factors for morbidity within the illicit drug smoking population in the Downtown Eastside (DTES) community of Vancouver but it also investigates the changes in the nature of drug use after the closure of an unsanctioned smoking facility. Methods The data pertain to qualitative interviews with 10 peers and 10 illicit drug smokers. The semi-structured interviews were conducted through community-based research, and the digital transcripts were analyzed via NVivo 10 software. Results The results indicate that peers (former and current drug users who are employed as educators) are instrumental in transferring risk reduction knowledge within crack and methamphetamine smokers. For example, these peers have been able to teach users about the risk of sharing pipes, using brillo, and using public drug. Furthermore, the Vancouver Area Network of Drug Users provides employment for crack and methamphetamine users in Vancouver who tend to have scarce sources of employment. However, since the closure of the unsanctioned inhalation facility, there has been significantly more public drug use and pipe sharing in the vicinity of the facility, placing drug smokers at significant risk of arrest, violence, and blood-borne infections. Conclusions The current study recommends expanding the harm reduction peer network for people who smoke illicit drugs in the DTES community of Vancouver who have historically been underserved.
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Affiliation(s)
- Ehsan Jozaghi
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, V5Z 4R4, British Columbia, Canada
| | - Hugh Lampkin
- Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, V6A 1P4, British Columbia, Canada
| | - Martin A Andresen
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, V5A 1S6, British Columbia, Canada.
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Jozaghi E. Exploring the role of an unsanctioned, supervised peer driven injection facility in reducing HIV and hepatitis C infections in people that require assistance during injection. HEALTH & JUSTICE 2015; 3:16. [PMCID: PMC5151785 DOI: 10.1186/s40352-015-0028-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/17/2015] [Indexed: 07/28/2023]
Abstract
Background Supervised consumption rooms or supervised injection facilities (SIFs) are venues that have reduced the risk of needle sharing and deaths caused by drug overdose among people who inject drugs (PWID). As a result of such a decline in the mortality rate, numerous studies have been able to illustrate its cost-effectiveness. However, studies have neglected to examine the same phenomena for unsanctioned SIFs that are run by peer drug users and provide assisted injections. Methods The current study will determine whether the former unsanctioned SIF, that provided assisted injection and was operated by the grass root organization called Vancouver Area Network of Drug Users (VANDU), cost less than the health care consequences of not having such a program in Vancouver, Canada. By analyzing data gathered in 2013, this paper relies on two mathematical models to estimate the number of new HIV and HCV infections prevented by the former unsanctioned facility in Vancouver’s Downtown Eastside. Results A conservative estimate indicates that the SIF location that provided assisted injections has a benefit-cost ratio of 33.1:1 due to its low operational cost. At the baseline sharing rate, the facility, on an average, reduced 81 HCV and 30 HIV cases among PWID each year. Such reductions in blood borne infections among PWID resulted in annual savings worth CAN$4.3 million dollars in health care expenditure. In addition to this, the current paper relies on a sensitivity analysis based on different needle sharing rate scenarios. Conclusions The sensitivity analysis and the baseline rates indicate that funding SIF facilities operated by peer drug users that facilitate assisted injection appear to be an efficient and effective use of financial resources in the public health domain since they lead to a significant decline in the rate of mortality within a vulnerable population.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, Burnaby, British Columbia Canada
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23
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Jozaghi E, Carleton R, Andresen MA. Utility of the theory of planned behaviour for predicating needle sharing among injection drug users. JOURNAL OF SUBSTANCE USE 2015. [DOI: 10.3109/14659891.2015.1009507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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24
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Jozaghi E. "SALOME gave my dignity back": the role of randomized heroin trials in transforming lives in the Downtown Eastside of Vancouver, Canada. Int J Qual Stud Health Well-being 2014; 9:23698. [PMID: 24646474 PMCID: PMC3955773 DOI: 10.3402/qhw.v9.23698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2014] [Indexed: 12/03/2022] Open
Abstract
Although numerous studies on heroin-assisted treatment (HAT) have been published in leading international journals, little attention has been given to HAT’s clients, their stories, and what constitutes the most influential factor in the treatment process. The present study investigates the role of HAT in transforming the lives of injection drug users (IDUs) in Vancouver, Canada. This study is qualitative focusing on 16 in-depth interviews with patients from the randomized trials of HAT. Interviews were transcribed verbatim and analyzed thematically using NVivo 10 software. The findings revealed a positive change in many respects: the randomized trials reduce criminal activity, sex work, and illicit drug use. In addition, the trials improved the health and social functioning of its clients, with some participants acquiring work or volunteer positions. Many of the participants have been able to reconnect with their family members, which was not possible before the program. Furthermore, the relationship between the staff and patients at the project appears to have transformed the behavior of participants. Attending HAT in Vancouver has been particularly effective in creating a unique microenvironment where IDUs who have attended HAT have been able to form a collective identity advocating for their rights. The result of this research points to the need for continuation of the project beyond the current study, leading toward a permanent program.
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Affiliation(s)
- Ehsan Jozaghi
- School of Criminology, Simon Fraser University, Burnaby, Canada
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Jozaghi E, Carleton R. The identification of subtypes among injection drug users: HIV and hepatitis C differences as indicated with the theory of planned behaviour. JOURNAL OF SUBSTANCE USE 2013. [DOI: 10.3109/14659891.2013.866987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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