Vancouver, Canada, and Lisbon, Portugal, are both celebrated for their world-leading harm reduction policies and programs and regarded as models for other cities contending with the effects of increasing levels of drug use in the context of growing urban poverty. However, we challenge the notion that internationally celebrated places like Lisbon and Vancouver are meeting the harm reduction needs of young people who use drugs (YPWUD; referring here to individuals between the ages of 14 and 29). In particular, the needs of YPWUD in the context of unstable housing, homelessness, and ongoing poverty—a context which we summarize here as “street involvement”—are not being adequately met. We are a group of community and academic researchers and activists working in Vancouver, Lisbon, and Pittsburgh. Most of us identify as YPWUD and have lived and living experience with the issues described in this comment. We make several calls to action to support the harm reduction needs of YPWUD in the context of street involvement in and beyond our settings.
Community-based participatory research (CBPR) is increasingly standard practice for critical qualitative health research with young people who use(d) drugs in Vancouver, Canada. One aim of CBPR in this context is to redress the essentialization, erasure, and exploitation of people who use(d) drugs in health research. In this paper, we reflect on a partnership that began in 2018 between three university researchers and roughly ten young people (ages 17–28) who have current or past experience with drug use and homelessness in Greater Vancouver. We focus on moments when our guiding principles of shared leadership, safety, and inclusion became fraught in practice, forcing us in some cases to re-imagine these principles, and in others to accept that certain ethical dilemmas in research can never be fully resolved. We argue that this messiness can be traced to the complex and diverse positionalities of each person on our team, including young people. As such, creating space for mess was ethically necessary and empirically valuable for our CBPR project.
Objective: Youth experiencing street-involvement are particularly vulnerable to substance use-related harms. Since an overdose public health emergency was declared in British Columbia (BC) in 2016, there have been concerted efforts to expand youth's access to integrated mental health and substance use treatment across the province. The present study sought to explore how youth were navigating this rapidly evolving treatment landscape.Methods: Focus groups were conducted with youth experiencing street-involvement in three BC cities, followed by a summit event in Vancouver. Audio recordings were transcribed verbatim and coded thematically alongside observational field notes. All activities were undertaken in collaboration with a Youth Advisory Council.Results: Across BC, youth expressed desires to achieve aspects of what some called a "normal life" following treatment, which required having "somewhere to go next." In the absence of desirable housing and adequate income, youth were often left with the crushing sense that, despite their efforts, treatment would not ultimately help them to "get somewhere better." Negative experiences in treatment settings were also shaped by the files that "followed" youth across care settings, inappropriate information sharing between providers, and an overemphasis on pharmacotherapies (namely, opioid agonist therapies and psychotropic medications).
Conclusion:Our findings point to the inability of existing services and systems to address entrenched marginalization and chronic instability. Our findings also underscore the importance of relationship-, trust-, and future-building to providing treatment and care to youth. Young people must be empowered with control over their treatment trajectories, including decisionmaking surrounding pharmacotherapies and information sharing.
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