Harm Reduction Policy for the Opioid Epidemic

2019 ◽  
Author(s):  
Yngvild Olsen ◽  
Joshua M. Sharfstein
Keyword(s):  
Social Justice ◽  
Drug Use ◽  
Harm Reduction ◽  
People Who Use Drugs ◽  
Opioid Epidemic ◽  
Negative Consequences

What is harm reduction? Harm reduction is “a set of practical strategies aimed at reducing negative consequences associated with drug use.” It is also “a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”...

scholarly journals Harm reduction via online platforms for people who use drugs in Russia: a qualitative analysis of web outreach work

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Arsen Davitadze ◽  
Peter Meylakhs ◽  
Aleksey Lakhov ◽  
Elizabeth J. King
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Injection Drug Use ◽  
Injection Drug ◽  
People Who Use Drugs ◽  
Structured Interviews ◽  
Advantages And Disadvantages ◽  
Online Platforms ◽  
Outreach Work ◽  
Outreach Workers

Abstract Background Harm reduction services to people who use drugs (PWUD) in Russia are insufficient in terms of quantity, government endorsement, and accessibility. The situation has recently deteriorated even further because of social distancing measures of the COVID-19 pandemic. Several organizations have started to provide some harm reduction services via online platforms by web outreach. However, little is known on how online outreach services are organized and implemented. Drawing on the example of St. Petersburg-based NGO “Humanitarian Action,” we explored web outreach work in Telegram instant messenger. Methods Our data were comprised of 4 semi-structured interviews with the NGO staff and 301 cases of web outreach work with PWUD. We used thematic analysis to study the process of web outreach, harm reduction service provision, and needs of PWUD. Results Three stages of the process of web outreach work were identified: clients initiating communication, NGO workers addressing clients’ needs, and NGO workers receiving clients’ feedback. Communication proceeded in group chat or direct messages. Challenges in addressing clients’ needs happened when clients turned for help after hours, sent recorded voice messages, sent unclear messages, and/or were unwilling to transition to telephone communication. All web outreach workers reported receiving only positive feedback on their work. The needs of PWUD were categorized into two major themes, depending on whether they can be addressed fully or partially online. In cases of online only provision of services, web outreach workers helped PWUD treat minor injection drug use complications, obtain verified harm reduction information and receive general psychological support. In instances of partial online services provision, PWUD were assisted in getting treatment of severe injection drug use complications, overdoses, and in accessing offline medical, psychological, social, legal and harm reduction services. Conclusions Our research demonstrated that web outreach work is a convenient tool for delivering some harm reduction services to PWUD either partially or completely online and for recruiting new clients (including hard-to-reach PWUD that avoid attending brick-and-mortar facilities). Harm reduction organizations should consider incorporating online harm reduction services into their activities. However, further research is needed to explore relative advantages and disadvantages of online harm reduction services.

Harm Reduction Services in Ottawa: The Culture of Drug Use

2020 ◽  
Vol 34 (2) ◽  
pp. 188-202
Author(s):  
Marlene Haines ◽  
Patrick O'Byrne
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Physical Environment ◽  
Best Practice ◽  
Cultural Norms ◽  
People Who Use Drugs ◽  
Access To Services ◽  
Policy Changes ◽  
Best Practice Guidelines ◽  
Depth Interviews

Between January 2016 and June 2019, there were over 13,900 apparent opioid-related deaths in Canada, solidifying the need for appropriate and effective services for people who use drugs (PWUD). Within government initiatives and policies, PWUD are often inappropriately considered a homogeneous group of individuals, with implementation of services nationally often being guided by these governmental bodies without meaningful consultation and collaboration with PWUD. However, recent harm reduction research and best practice guidelines have emphasized the importance of tailoring services to local drug scenes. Despite this, very little research on the cultural norms of PWUD exists in the literature. In an attempt to explore the local culture of drug use in Ottawa, a literature review ultimately uncovered very few articles on this topic. However, by expanding the search beyond Ottawa and using a social determinants of health framework, the factors of culture, income and social status, physical environment, and access to services were revealed as unique experiences for PWUD. Further, through four in-depth interviews with current harm reduction providers in Ottawa, the themes of (1) uncertainty and concerns surrounding the overdose crisis; (2) lack of flexibility in resources and access issues; and (3) diversity in the culture of drug use in Ottawa were explored. Recommendations surrounding partnering with PWUD, policy changes, and a safer supply were subsequently discussed. These findings helped to validate the reality of the unique drug-use culture in Ottawa, and the requirement for harm reduction services to be adapted to the local needs of PWUD.

scholarly journals A critical exploration of professional perceptions of harm reduction policy and practice in Vietnam

2021 ◽  
Author(s):  
◽  
Tuan Dung Truong
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Quantitative Methods ◽  
Brain Diseases ◽  
People Who Use Drugs ◽  
Structured Interviews ◽  
Policy And Practice ◽  
Public Health Perspective ◽  
Qualitative And Quantitative Methods ◽  
Reduction Strategies

<p>Throughout the 1990s, Vietnam experienced a dramatic rise in the prevalence of HIV among people who use drugs. In response, Vietnam’s Ministry of Health implemented several legal and policy interventions in the name of harm reduction. However, perceptions about drug use, people who use drugs, addiction and the nature of official interventions are contested. For many Vietnamese officials, abstinence remains the dominant philosophy. Drug use is considered a ‘social evil’ in Vietnam and people who use drugs face draconian controls and incarceration in the name of treatment and crime prevention.  Against this background, this thesis explores how key stakeholders perceive harm reduction philosophy and how they apply it in policy and practice. Based on qualitative and quantitative methods, it presents findings from a survey with 250 respondents and 26 semi-structured interviews, all with professionals involved in responding to drug use in Vietnam. The thesis illustrates that these professionals prefer abstinence approaches, and often see addiction as the result of moral failings and brain diseases.  While some interventions in the name of harm reduction are accepted, they are firmly rooted within a narrow public health perspective. Professional misperceptions about the key principles and practices of ‘authentic’ harm reduction are widespread. Many professionals believe, for example, that harms can only be limited through reductions in the demand and supply of drugs, or that detaining people who use drugs in compulsory treatment centres is a form of harm reduction.  These rationales have resulted in continuing police crackdowns, and the use of ‘pseudo’ harm reduction strategies to control and punish people who use drugs. Meanwhile, there are limited official attempts to address problems experienced by people who use drugs, like social isolation, stigma, discrimination, human rights violations, or problems of community reintegration. In conclusion, while a harm reduction rhetoric is regularly employed in Vietnam, ‘pseudo’ harm reduction strategies are carried out.</p>

The “Drugs-Crime Nexus”

2018 ◽  
Author(s):  
Dominique de Andrade
Keyword(s):  
At Risk ◽  
Drug Use ◽  
Harm Reduction ◽  
Good Evidence ◽  
People Who Use Drugs ◽  
Correctional Institutions ◽  
Reduction Strategies ◽  
At Risk Populations ◽  
Prison Populations ◽  
The Impact

The prioritization of imprisonment as a response to drug use in many countries has led to growing prison populations, with little impact on drug use, drug-related harm, or drug-related crime. There is increased international debate around how to best manage and respond to at-risk populations, with good evidence to suggest that embracing harm reduction strategies in the community and in prison can lead to reduced rates of imprisonment, infectious disease, and other preventable harms. Despite this, evidence-based treatment and harm reduction programs have largely failed to penetrate the walls of correctional institutions in most countries. This chapter provides an overview of major drug groups and explores the impact of drug policy on international imprisonment rates, and the diversity of responses to people who use drugs in the community and prison. The potential for corrections to play a significant therapeutic role in addressing the urgent treatment and harm reduction needs of at-risk, drug-using populations in prison and during their transition back to the community is highlighted.

scholarly journals Palliative care & the injustice of mass incarceration

2019 ◽  
Vol 1 (2) ◽  
pp. 4-16
Author(s):  
Helen Hudson ◽  
Amélie Perron ◽  
David Kenneth Wright
Keyword(s):  
Palliative Care ◽  
Social Justice ◽  
Harm Reduction ◽  
End Of Life ◽  
Mass Incarceration ◽  
Aging Population ◽  
Social Disadvantage ◽  
People Who Use Drugs ◽  
Political Work ◽  
The Social

Due to the criminalization of marginalized people, many markers of social disadvantage are overrepresented among prisoners. With an aging population, end of life in prison thus becomes a social justice issue that nurses must contend with, engaging with the dual suffering of dying and of incarceration. However, prison palliative care is constrained by the punitive mandate of the institution and has been critiqued for normalizing death behind bars and appealing to discourses of individual redemption. This paper argues that prison palliative has much to learn from harm reduction. Critical reflections from harm reduction scholars and practitioners hold important insights for prison palliative care: decoupled from its historical efforts to reshape the social terrain inhabited by people who use drugs, harm reduction can become institutionalized and depoliticized. Efforts to address the harms of substandard palliative care must therefore be interwoven with the necessarily political work of addressing the injustice of incarceration.

scholarly journals Harm reduction via online platforms for people who use drugs in Russia: A qualitative analysis of web outreach work

2020 ◽  
Author(s):  
Arsen Davitadze ◽  
Peter Meylakhs ◽  
Aleksey Lakhov ◽  
Elizabeth J. King
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Injection Drug Use ◽  
Injection Drug ◽  
People Who Use Drugs ◽  
Advantages And Disadvantages ◽  
Services Delivery ◽  
Online Platforms ◽  
Outreach Work ◽  
Outreach Workers

Abstract Background Harm reduction services to people who use drugs (PWUD) in Russia are insufficient in terms of quantity, government endorsement, and accessibility. The situation has recently deteriorated even further because of social distancing measures of the COVID-19 pandemic. Recently several harm reduction organizations have started to provide some harm reduction services via online platforms by web outreach. However, little is known on how online outreach services are organized and implemented. Drawing on the example of St. Petersburg-based NGO “Humanitarian Action” we explored web outreach work in Telegram instant messenger. Methods 4 semi-structured interviews with the NGO staff and 301 cases of web outreach work with PWUD comprised the dataset. The process of web outreach, service provision to PWUD, and PWUD’s needs were thematically analyzed. Results Three stages of the process of web outreach work were determined: clients initiating communication, NGO workers addressing clients’ needs, and NGO workers receiving clients’ feedback. Communication proceeded either in group chat or in direct messages. Challenges in addressing clients’ needs happened when clients turned for help in nighttime, sent recorded voice messages, sent unclear messages, and/or were unwilling to transition to telephone communication. All web outreach workers reported receiving only positive feedback on their work. PWUD’s needs were categorized into two major themes, depending on whether they can be addressed fully or partially online. In cases of online only provision of services, web outreach workers helped PWUD treat minor injection drug use complications, obtain verified harm reduction information and receive general psychological support. In instances of partial online services provision, PWUD were assisted in getting treatment of severe injection drug use complications, overdoses, and in accessing offline medical, psychological, social, legal and harm reduction services. Conclusions Our research demonstrated that web outreach work is a convenient tool for delivering some harm reduction services to PWUD either partially or completely online and recruiting new clients (including hard-to-reach PWUD that avoid attending brick-and-mortar facilities). It indicates that harm reduction organizations should consider incorporating online harm reduction services into their activities. However, more research is needed to explore relative advantages and disadvantages of online harm reduction services delivery.

scholarly journals Research led by people who use drugs: centering the expertise of lived experience

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zach R. Salazar ◽  
Louise Vincent ◽  
Mary C. Figgatt ◽  
Michael K. Gilbert ◽  
Nabarun Dasgupta
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Critical Role ◽  
Drug Market ◽  
Research Process ◽  
Medical Community ◽  
People Who Use Drugs ◽  
Main Body ◽  
Research Collaborations ◽  
History Of

Abstract Background Research collaborations between people who use drugs (PWUD) and researchers are largely underutilized, despite the long history of successful, community-led harm reduction interventions and growing health disparities experienced by PWUD. PWUD play a critical role in identifying emerging issues in the drug market, as well as associated health behaviors and outcomes. As such, PWUD are well positioned to meaningfully participate in all aspects of the research process, including population of research questions, conceptualization of study design, and contextualization of findings. Main body We argue PWUD embody unparalleled and current insight to drug use behaviors, including understanding of novel synthetic drug bodies and the dynamics at play in the drug market; they also hold intimate and trusting relationships with other PWUD. This perfectly situates PWUD to collaborate with researchers in investigation of drug use behaviors and development of harm reduction interventions. While PWUD have a history of mistrust with the medical community, community-led harm reduction organizations have earned their trust and are uniquely poised to facilitate research projects. We offer the North Carolina Survivors Union as one such example, having successfully conducted a number of projects with reputable research institutions. We also detail the fallacy of meaningful engagement posed by traditional mechanisms of capturing community voice. As a counter, we detail the framework developed and implemented by the union in hopes it may serve as guidance for other community-led organizations. We also situate research as a mechanism to diversify the job opportunities available to PWUD and offer a real-time example of the integration of these principles into public policy and direct service provision. Conclusion In order to effectively mitigate the risks posed by the fluid and volatile drug market, research collaborations must empower PWUD to play meaningful roles in the entirety of the research process. Historically, the most effective harm reduction interventions have been born of the innovation and heart possessed by PWUD; during the current overdose crisis, there is no reason to believe they will not continue to be.

scholarly journals (Re)politicizing harm reduction: Poststructuralist thinking to challenge the medicalization of harms among people who use drugs

Aporia ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 26-35
Author(s):  
Trevor Goodyear
Keyword(s):  
Social Justice ◽  
Health Policy ◽  
Harm Reduction ◽  
People Who Use Drugs ◽  
Policy And Practice ◽  
Policy Makers ◽  
Health Related ◽  
Health Policy And Practice

Poststructuralism, with its critical interpretations of knowledge, discourse, truth, and power, offers a set of compelling analytic tools for disentangling and deconstructing the ways in which health-related phenomena exist and are understood. This paper adopts a poststructuralist stance to outline the impacts of medical hegemony on the lives of people who use drugs, as well as responses to the harms experienced by this population. This analysis reveals how structuralist projects have narrowed the scope and impact of harm reduction through processes of medicalization, neoliberal responsibilitization, and medical co-opting and depoliticization. Nomadic thinking is then introduced as a means for health policy makers and practitioners to transform the boundaries of dominant approaches to harm reduction – particularly, in ways that (re)politicize harm reduction through forms of equity-promoting and social justice-oriented action. Implications for (re)politicized, community-engaged, and structurally responsive approaches to harm reduction in health policy and practice are then discussed.

scholarly journals A qualitative study on overdose response in the era of COVID-19 and beyond: how to spot someone so they never have to use alone

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Melissa Perri ◽  
Natalie Kaminski ◽  
Matthew Bonn ◽  
Gillian Kolla ◽  
Adrian Guta ◽  
...  
Keyword(s):  
Drug Use ◽  
Harm Reduction ◽  
Emergency Services ◽  
Community Support ◽  
People Who Use Drugs ◽  
Sexually Transmitted ◽  
Prevention Services ◽  
Rural Settings ◽  
Structured Audio ◽  
Research Assistants

Abstract Background Spotting is an informal practice among people who use drugs (PWUD) where they witness other people using drugs and respond if an overdose occurs. During COVID-19 restrictions, remote spotting (e.g., using a telephone, video call, and/or a social media app) emerged to address physical distancing requirements and reduced access to harm reduction and/or sexually transmitted blood borne infection (STBBI’s) prevention services. We explored spotting implementation issues from the perspectives of spotters and spottees. Methods Research assistants with lived/living expertise of drug use used personal networks and word of mouth to recruit PWUD from Ontario and Nova Scotia who provided or used informal spotting. All participants completed a semi-structured, audio-recorded telephone interview about spotting service design, benefits, challenges, and recommendations. Recordings were transcribed and thematic analysis was used. Results We interviewed 20 individuals between 08/2020–11/2020 who were involved in informal spotting. Spotting was provided on various platforms (e.g., telephone, video calls, and through texts) and locations (e.g. home, car), offered connection and community support, and addressed barriers to the use of supervised consumption sites (e.g., location, stigma, confidentiality, safety, availability, COVID-19 related closures). Spotting calls often began with setting an overdose response plan (i.e., when and who to call). Many participants noted that, due to the criminalization of drug use and fear of arrest, they preferred that roommates/friends/family members be called instead of emergency services in case of an overdose. Both spotters and spottees raised concerns about the timeliness of overdose response, particularly in remote and rural settings. Conclusion Spotting is a novel addition to, but not replacement for, existing harm reduction services. To optimize overdose/COVID-19/STBBI’s prevention services, additional supports (e.g., changes to Good Samaritan Laws) are needed. The criminalization of drug use may limit uptake of formal spotting services.

scholarly journals Harm Reduction Policing: From Drug Law Enforcement to Protection

2019 ◽  
Vol 46 (4) ◽  
pp. 345-362 ◽  
Author(s):  
Tobias Kammersgaard
Keyword(s):  
Law Enforcement ◽  
Harm Reduction ◽  
Document Analysis ◽  
People Who Use Drugs ◽  
Negative Consequences ◽  
Limited Extent ◽  
Drug Law ◽  
Drug Law Enforcement ◽  
Police Action ◽  
Potential Benefits

Several drug policy researchers have noted that the concept of harm reduction could be applied to the field of drug policing in order to assess the negative consequences and potential benefits of policing in this area. However, the application of harm reduction principles to drug policing has only been realized to a limited extent in the current responses to drug use and markets. Accordingly, studies that empirically investigate already existing policing practices, which might be described as operating within such a harm reduction framework, are relatively scarce. In order to address this gap, this article provides an investigation of how policing of an open drug scene has been organized in Denmark since drug possession has been partly decriminalized, following the introduction of drug consumption rooms in Copenhagen. The policing of this open drug scene was investigated through document analysis, interviews, and observations with a patrolling police officer. The article argues that decriminalization has resulted in a shift in the “logics” of policing by enabling the production of an alternative “governable identity” for the drug-using subject, where people who use drugs could more readily be perceived as citizens with rights rather than just as offenders. Accordingly, in this new logic, the violence and victimization experienced by marginalized people who use drugs could more readily be identified as proper objects for police action. The study contributes to our knowledge of how the police can become potential allies rather than adversaries in harm reduction initiatives and broader public health concerns.

Sign in / Sign up

Export Citation Format

Share Document