Illicit drug use and harms, and related interventions and policy in Canada: A narrative review of select key indicators and developments since 2000

Fischer, Benedikt; Murphy, Yoko; Rudzinski, Katherine; MacPherson, Donald

doi:10.1016/j.drugpo.2015.08.007

Cited by 38 publications

(27 citation statements)

References 115 publications

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“…Also, after 2006, papers using qualitative methods have spiked including those focused on DCR clients or staff , and on other stakeholders . Since 2013, an increasing number of papers analysed SIF‐related laws and policies . In 2016 and 2017, a larger number of publications emphasised the need to expand DCRs/SIFs , including studies that examined the willingness to use SIFs/DCRs among people who use drugs (PWUD) , community support for these services and cost‐effectiveness of scaling them up (Figure ).…”

Section: Resultsmentioning

confidence: 99%

Drug consumption rooms: A systematic review of evaluation methodologies

Běláčková¹,

Salmon²,

Day

et al. 2019

Drug and Alcohol Review

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Issues. Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies. Approach. Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF 'exposure' were recorded. Key Findings. Two hundred and nineteen eligible peer-reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty-six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on bloodborne diseases, overdose deaths and costs. Papers using individual-level data included four prospective cohorts (n = 28), cross-sectional surveys (n = 7) and service records (n = 5). Individual-level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service 'exposure'. Implications. Research around DCRs/SIFs has used ecological, modelling, cross-sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self-reported proportion of injections at SIFs or a stepped-wedge or a cluster trial comparing localities. Conclusions. Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted. [

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Section: Resultsmentioning

confidence: 99%

Drug consumption rooms: A systematic review of evaluation methodologies

Běláčková¹,

Salmon²,

Day

et al. 2019

Drug and Alcohol Review

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“…275 HAT programmes are well received in Germany and Switzerland, for example, where it is recognized that, like methadone therapy, they enable people to stabilise their cravings without having to rely on street drugs of unknown quality and toxicity from illicit dealers. 314 The HAT trial in Montreal and Vancouver, Canada, in spite of excellent results, was discontinued by the Conservative-led government in 2013 with the pronouncement that HAT was “in direct opposition to the government’s anti-drug policy.” 315 A 2014 court decision, however, allowed patients already receiving HAT to continue doing so. 316 …”

Section: Treatment For Drug Dependence: the Need For Standardsmentioning

confidence: 99%

“…Subsidized treatment slots may be scarce and waiting lists long, even in countries with well-developed health systems, as in Western Europe and Canada. 315,325 In the US, realizing the promise of the Affordable Care Act (ACA) to expand health insurance coverage for drug dependence-related services for millions unable to afford them before ACA has been hampered by lack of human resources to expand care and lack of integration of these services with other federally qualified health services. 326 …”

Section: Treatment For Drug Dependence: the Need For Standardsmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

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Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

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“…This setting is also unique in terms of the high concentration of addictions services located there. Available services include harm reduction-informed programs such as needle exchange programs, methadone maintenance therapy (MMT) and Suboxone programs, and the provision of take home opioid antagonist (naloxone) kits [35]. The city is home to two federally approved supervised injection facilities (Insite and the Dr. Peter Centre), several temporary emergency overdose prevention sites located in DTES, and two harm reduction-informed detox facilities (Onsite and Directions Youth Detox).…”

Section: Introductionmentioning

confidence: 99%

“…Abstinence-based programs (e.g., 12-step programs) are also accessible, including in residential settings such as recovery houses and detoxification (detox) and drug treatment facilities. In comparison to harm reduction informed programs and facilities, these programs and settings tend to have more rigid and structured policies, and prohibit any use of illicit drugs [35]. …”

Section: Introductionmentioning

confidence: 99%

Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study

et al. 2017

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BackgroundInjection drug use is associated with HIV and hepatitis C transmission, overdose, and other preventable harms. These harms are heightened for structurally vulnerable injection drug-using populations, as their social conditions pose barriers to safer injecting. Previous research on injection cessation has largely focused on adult drug-using populations. Little qualitative work has examined the social, structural, and environmental factors that shape periods of injection cessation among youth and young adults. Such research is essential to understanding how we can best reduce harms among this vulnerable population as they move in and out of periods of injection cessation.MethodsWe conducted 22 semi-structured, qualitative interviews with street-involved young people who use drugs (SY), focused on characterizing their transitions into periods of injection cessation and perceived barriers to injection cessation. Adopting an ethno-epidemiological approach, participants who had experienced at least 6 months of injection cessation were purposively recruited from an ongoing prospective cohort study of SY in Vancouver, Canada to participate in qualitative interviews. Qualitative interview findings were triangulated with the findings of a longitudinal program of ethnographic research with SY in this setting. This ethno-epidemiological approach allowed for a more robust exploration of contextual factors surrounding drug use patterns than would be possible through traditional epidemiological methods alone.ResultsFindings indicate that periods of injection cessation were influenced by access to harm reduction-informed youth-focused services, transitions in route of administration (e.g., from injecting methamphetamine to the smoking of methamphetamine), and the provision of housing and social supports (e.g., from friends, family, and care providers). Conversely, participants indicated that inadequate social supports and, for some, abstinence-focused treatment methods (e.g., 12-step programs), impeded efforts to cease injecting.ConclusionsTo reduce harms, it is imperative to reorient attention toward the social, structural, and spatial contexts that surround injection drug use and shape periods of injection cessation for SY. There is an urgent need for more comprehensive youth-focused services for those engaged in injection drug use, and further study of innovative means of engaging youth.

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Illicit drug use and harms, and related interventions and policy in Canada: A narrative review of select key indicators and developments since 2000

Cited by 38 publications

References 115 publications

Drug consumption rooms: A systematic review of evaluation methodologies

Drug consumption rooms: A systematic review of evaluation methodologies

Public health and international drug policy

Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study

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