Push and Pull: Migration Patterns and Links to Harm Reduction Services Among People Who Use Drugs

Schreiber, Yoko; Lin, Dolly; Muldoon, Katherine A.; Beckerleg, Weiwei; Marshall, Zack; Lazarus, Lisa; White, Ashley; Ramsay, Tim; Tyndall, Mark

doi:10.1097/cxa.0000000000000018

Cited by 2 publications

(2 citation statements)

References 28 publications

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“…However, there are also risks associated with this. Other studies have found that recent migrants in a period of "transition" were significantly less likely to access harm reduction and social support services, or be more likely to engage in risk behaviours [86,88,90,95]. The individuals in the current study noted having important connections locally to family, children, social networks, social services, among others.…”

Section: Physical Environmentmentioning

confidence: 43%

“…As previously described, longer physical distances from services lead to reduced access and increased risk behaviours [46][47][48][49][50]. As one strategy to address distancerelated issues, other studies have highlighted a migratory element with relation to accessing services, with focus on people who use drugs [58,59,61,[86][87][88][89][90], as well as the interlinked field of mental health and homelessness services [91][92][93][94]. Perez Torruella [59] describes that such migration is encouraged by Puerto Rican authorities, on the basis of improved treatment access.…”

Section: Physical Environmentmentioning

confidence: 99%

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Varying drug policies and unequal access to harm reduction: Experiences, mobility, and risk management of people who use drugs

Holeksa

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Sweden has a history of a restrictive drug policy, with a national policy focus on achieving a “drug free society.” This has led to a relatively slow development of “harm reduction” services, those services which aim to reduce risk and vulnerability for people who use drugs (PWUD), without requiring drug abstention. The harm reduction services which do exist are inequitably distributed across the country. In this context, this project aims to explore the attitudes of social work professionals (SWP) towards harm reduction, and the experiences of Swedish PWUD. The data consist of a survey of SWP (208 responses), interviews with PWUD in an area of limited harm reduction (11), and interviews with PWUD who had travelled to Denmark, a country with a less restrictive drug policy approach (17). Article I utilizes survey data to explore the perspectives of Swedish SWP regarding the philosophy of harm reduction and specific harm reduction initiatives. The study reveals a generally positive attitude towards harm reduction, albeit with significant geographical variances. There were low levels of support concerning the adoption of newer harm reduction strategies. Less positive attitudes and negativity regarding new interventions were significantly associated with SWP in areas with lesser exposure to harm reduction practices. Article II examines how PWUD in a small urban center handle the absence of local harm reduction services. The participants’ experiences are interpreted using the theoretical concept of “risk environment” which highlights how various environmental factors interact to produce risk of drug-related harm. Strategies ranged from traveling to external needle exchange programs, relying on unofficial secondary distribution, to risk behaviours such as stealing, reusing, or sharing injection equipment. Many were homeless, articulating a continuous struggle to find temporary shelter. They injected drugs in unsafe places, such as public toilets, increasing risk of overdose or infection. They also expressed 10 feeling stigmatized and excluded from society which compounded their stress, risk of disease transmission and overdose, and poor overall wellbeing. Article III explores the motivations behind the mobility of PWUD from Sweden to Denmark. The “risk environment” framework was used to contextualize decision-making and risks, based on the physical, social, policy, and economic environments. The study identifies harm reduction service availability, stigma, social networks, the drug scene, and policing practices, as key drivers for relocation. Despite the perceived benefits of moving, such as improved access to harm reduction services, participants also reported exposure to new risks, including violence, potential exclusion from a range of services, and exposure to new drugs. Article IV analyzes the reflections of PWUD on their experiences in Sweden and Denmark in the context of each nation’s drug policy. The analysis explored experiences of stigma and coupled these to concepts of identity and social exclusion. In daily interactions, participants felt ignored and dehumanized in Sweden’s zero-tolerance environment, whereas in Denmark, a country with a harm reduction approach, they felt visible and valued as individuals. This, combined with more developed services and a less punitive policing approach, led participants to feel included in society in Denmark. Contrasts between experiences in the two countries were also echoed in participants’ interactions with the healthcare system, relating to feeling controlled in Sweden, or being given autonomy and trust over their care in Denmark. Collectively, this thesis highlights the interplay between drug policies, care formats, policing practices, social interactions, the attitudes of SWP, and the lived experiences of PWUD. While overall positive, the attitudes towards care goals and interventions differ between different areas, among professionals who provide care to PWUD. PWUDs’ movement to and experiences in different settings can be used to offer an insight into their own policy preferences. The project demonstrates the role of constructions, and resulting drug policy, in how they influence PWUDs’ experiences of stigma and exclusion, and their risk environments.

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Section: Physical Environmentmentioning

confidence: 43%

Section: Physical Environmentmentioning

confidence: 99%

Varying drug policies and unequal access to harm reduction: Experiences, mobility, and risk management of people who use drugs

Holeksa

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Dealing with low access to harm reduction: a qualitative study of the strategies and risk environments of people who use drugs in a small Swedish city

Holeksa

2022

Harm Reduct J

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Background The development of harm reduction has been limited in many areas of Sweden. This study aims to understand the implications that this has for the life circumstances and risk management of people who use drugs in areas of low access. Methods Eleven qualitative, semi-structured interviews were undertaken with people who use drugs in a small urban centre with no needle and syringe exchange program (NSP) or Housing First policy. Results Participants reported many solutions to lack of NSP, including travel to an external NSP, creating bridging distribution networks, stealing, borrowing, reusing, ordering online, and smuggling injection equipment. They were at risk of having their equipment confiscated by police. Participants were mostly homeless, and to address exclusion from housing services, were forced to frequently find new temporary solutions, sheltering themselves in public places, with friends, in cars, among others. Participants felt the lack of services reflected stigmatized notions of drug use and heightened their exclusion from general society. For example, they avoided accessing other health care services for fear of discrimination. These issues caused high levels of stress and anxiety, in addition to serious risk for many somatic and psychological health conditions, including HIV and HCV transmission. Conclusion Lack of harm reduction services placed a great burden on study participants to develop strategies due to gaps in official programming. It also contributes to a vicious cycle of exclusion from services. The implementation of such evidence-based programs will reduce this burden, as well as provide the indirect, symbolic effect of inclusion.

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Push and Pull: Migration Patterns and Links to Harm Reduction Services Among People Who Use Drugs

Cited by 2 publications

References 28 publications

Varying drug policies and unequal access to harm reduction: Experiences, mobility, and risk management of people who use drugs

Varying drug policies and unequal access to harm reduction: Experiences, mobility, and risk management of people who use drugs

Dealing with low access to harm reduction: a qualitative study of the strategies and risk environments of people who use drugs in a small Swedish city

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