Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: A cohort study

Kennedy, Mary Clare; Hayashi, Kanna; Milloy, M‐J; Wood, Evan

doi:10.1371/journal.pmed.1002964

Cited by 54 publications

(40 citation statements)

References 71 publications

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“…Similar to other samples of PWUD (Kennedy, et al, 2019), our participants described multiple life challenges such as homelessness, unresolved physical and mental health issues, and life-long trauma.…”

Section: Discussionsupporting

confidence: 54%

A Critical Narrative Inquiry to Understand the Impacts of an Overdose Prevention Site on the Lives of Site Users

Oudshoorn

Bouck

McCann

et al. 2020

Preprint

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Background Globally, communities are struggling to gain support for harm reduction strategies being implemented to address the impacts of substance use. A key part of this discussion is understanding and engaging with people who use drugs to help shape community harm reduction strategies. This study focused on how an overdose prevention site has influenced the lives of people who use drugs.MethodsA critical narrative method was utilized, centred on photo-narratives. Twenty-seven individuals accessing an overdose prevention site were recruited to participate in preliminary interviews. 16 participants subsequently took photographs to describe the impact of the site and participated in a second round of interviews. Through independent coding and several rounds of team analysis, four themes were proposed to constitute a core narrative encompassing the diverse experiences of participants. ResultsA key message shared by participants was the sense that their lives have improved since accessing the site. The core narrative proposed is presented in a series of four themes or ‘chapters’: Enduring, Accessing Safety, Connecting and Belonging, and Transforming. The chapters follow a series of transitions, revealing a journey that participants presented through their own eyes; one of moving from utter despair to hope, opportunity, and inclusion. Where at the outset participants were simply trying to survive the challenges of chaotic substance use, through the relationships and services provided at the site they moved towards small or large life transformations.ConclusionsThis study contributes to an enhanced understanding of how caring relationships with staff at the overdose prevention site impacted site users’ sense of self. We propose that caring relationships are an intervention in and of themselves, and that these relationships contribute to transformation that extends far beyond the public health outcomes of disease reduction. The caring relationships at the site can be a starting point for significant social changes. However, the micro-environment that existed within the site needs to extend beyond its walls for true transformative change to take place. The marginalization and stigmatization that people who use drugs experience outside these sites remains a constant barrier to achieving stability in their lives.

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Section: Discussionsupporting

confidence: 54%

A Critical Narrative Inquiry to Understand the Impacts of an Overdose Prevention Site on the Lives of Site Users

Oudshoorn

Bouck

McCann

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Similar to other samples of PWUD [ 15 ], our participants described multiple life challenges such as homelessness, unresolved physical and mental health issues, and lifelong trauma. Many alluded to complex events that led them to the path of substance use for survival.…”

Section: Discussionmentioning

confidence: 57%

A critical narrative inquiry to understand the impacts of an overdose prevention site on the lives of site users

et al. 2021

View full text Add to dashboard Cite

Background Globally, communities are struggling to gain support for harm reduction strategies being implemented to address the impacts of substance use. A key part of this discussion is understanding and engaging with people who use drugs to help shape community harm reduction strategies. This study focused on how an overdose prevention site has influenced the lives of people who use drugs. Methods A critical narrative method was utilized, centred on photo-narratives. Twenty-seven individuals accessing an overdose prevention site were recruited to participate in preliminary interviews. Sixteen participants subsequently took photographs to describe the impact of the site and participated in a second round of interviews. Through independent coding and several rounds of team analysis, four themes were proposed to constitute a core narrative encompassing the diverse experiences of participants. Results A key message shared by participants was the sense that their lives have improved since accessing the site. The core narrative proposed is presented in a series of four themes or “chapters”: Enduring, Accessing Safety, Connecting and Belonging, and Transforming. The chapters follow a series of transitions, revealing a journey that participants presented through their own eyes: one of moving from utter despair to hope, opportunity, and inclusion. Where at the outset participants were simply trying to survive the challenges of chaotic substance use, through the relationships and services provided at the site they moved towards small or large life transformations. Conclusions This study contributes to an enhanced understanding of how caring relationships with staff at the overdose prevention site impacted site users’ sense of self. We propose that caring relationships are an intervention in and of themselves, and that these relationships contribute to transformation that extends far beyond the public health outcomes of disease reduction. The caring relationships at the site can be a starting point for significant social changes. However, the micro-environment that existed within the site needs to extend beyond its walls for true transformative change to take place. The marginalization and stigmatization that people who use drugs experience outside these sites remains a constant barrier to achieving stability in their lives.

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“…Evidence on the impacts of OPS demonstrates their significant association with reducing overdose fatalities, HIV and HCV transmission, syringe sharing, public injection, ambulance usage, and crime. [161][162][163][164] Furthermore, OPS increase entry into drug treatment, have never housed a fatal overdose, and have been found to be cost-effective. [165][166][167] There is one unsanctioned OPS documented in the United States, 168 although many more likely exist, and a number of US jurisdictions, including Maryland, are considering legislation to legalize these potentially lifesaving spaces.…”

Section: Harm Reductionmentioning

confidence: 99%

Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework

Park

Rouhani

Beletsky³

et al. 2020

Milbank Quarterly

110

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This article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug‐related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies. Context Drug overdose is the leading cause of injury‐related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction. Methods In this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The “continuum of overdose risk” framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally. Findings De‐escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction. Conclusions Without recognizing the full drug‐use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.

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Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: A cohort study

Cited by 54 publications

References 71 publications

A Critical Narrative Inquiry to Understand the Impacts of an Overdose Prevention Site on the Lives of Site Users

A Critical Narrative Inquiry to Understand the Impacts of an Overdose Prevention Site on the Lives of Site Users

A critical narrative inquiry to understand the impacts of an overdose prevention site on the lives of site users

Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework

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