Two steps forward, one step back: current harm reduction policy and politics in the United States

Nadelmann, Ethan A.; LaSalle, Lindsay

doi:10.1186/s12954-017-0157-y

Cited by 60 publications

(40 citation statements)

References 20 publications

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“…In effort to address this ongoing public health crisis, a number of overdose response interventions have been implemented or scaled up in North America in recent years (Nadelmann & LaSalle, 2017;Wood, 2018). For example, cities across Canada have increasingly opened supervised consumption facilities (SCFs), where individuals can consume pre-obtained drugs under the supervision of healthcare professionals or trained staff (Health Canada, 2018b;Kerr et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada

Kennedy

Boyd

Mayer

et al. 2019

Social Science & Medicine

118

148

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Overdose prevention sites (OPS) are a form of supervised consumption facility that have been implemented in Vancouver, Canada as an innovative response to an ongoing overdose epidemic. OPS are primarily staffed by peers-people who use(d) drugs (PWUD)-trained in overdose response. We sought to characterize peer worker involvement in OPS programming, including how this shapes service dynamics and health outcomes among PWUD. Data were drawn from a rapid ethnographic study examining the implementation, operations and impacts of OPS in Vancouver from December 2016 to April 2017. We conducted approximately 185 hours of observational fieldwork at OPS and 72 in-depth qualitative interviews with PWUD. Data were analyzed thematically, with a focus on peer worker involvement at OPS and related outcomes. OPS implementation and operations depended on peer worker involvement and thus allowed for recognition of capacities developed through roles that peers were already undertaking through local programming for PWUD. Peer involvement at OPS enhanced feelings of comfort and facilitated engagement with OPS among PWUD. These dynamics and appreciation of peer worker expertise enabled communication with staff in ways that fostered harm reduction practices and

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Section: Introductionmentioning

confidence: 99%

Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada

Kennedy

Boyd

Mayer

et al. 2019

Social Science & Medicine

118

148

View full text Add to dashboard Cite

show abstract

“…While abstinence‐based approaches have been a long‐standing component of programs addressing opioid use, recently, harm reduction strategies have been employed (Nadelman & LaSalle, ; O'Byrne & Holmes, ). These aim not to eliminate opioid use, but to minimize their associated sequelae.…”

Section: Introductionmentioning

confidence: 99%

Methadone maintenance treatment as social control: Analyzing patient experiences

O’Byrne

Pearson

2018

Nursing Inquiry

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Methadone maintenance treatment (MMT) is a harm reduction approach for persons who wish to stop using opioids and is rather effective if used for a minimum of 12 months. Notably, research demonstrates that many persons enrolled in MMT programs discontinue care before this time, limiting its effects. To better understand this process, we undertook an exploratory descriptive qualitative study and interviewed 12 men and women who were using MMT. Using the theoretical work of Foucault and Hardt and Negri, the interview data highlighted that MMT continues to be strongly stigmatized, and that it is a system of care that involves rewards and penalties, based on if patients behave according to prescribed norms. These results suggest that MMT is a disciplinary mechanism, albeit one that impedes its own access. We consequently recommend that healthcare providers work to facilitate access to MMT, which means altering care delivery.

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“…Our analysis extends this by highlighting major differences in binge alcohol and substance use, including poly-use, between Millennials and other generational cohorts. Millennials exhibited statistically significant higher risk of substance use over the study period, 2007–16, with especially worrisome patterns of increase in heroin and oxycontin use, a trend which is particularly concerning in the context of the recent prescription opioid and heroin epidemic [ 32 ] and the measures introduced by the Obama administration to address this crisis such as improved access to naloxone and improved training among law enforcement agencies [ 33 ]. These differences appear to be exacerbated by the impact of austerity and a high degree of socioeconomic vulnerability, including: being uninsured or insured on Medicaid, receiving government assistance, income less than 100% FPL, poor self rated health, and unemployment.…”

Section: Discussionmentioning

confidence: 99%

Binge alcohol and substance use across birth cohorts and the global financial crisis in the United States

2018

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BackgroundThe social and economic consequences of the global financial crisis (GFC) of 2007–9 has had serious impacts on population health, economic prospects, and overall wellbeing in all generations, particularly Millennials, Generation X, and Baby Boomers. The ways in which intergenerational inequality and global economic crises have affected population health, particularly with respect to excessive drinking and substance use in disadvantaged population groups has been understudied. Consequently, in this article, we seek to characterise the effects of the GFC on national trends in binge alcohol and substance use among Millennials, Generation X, and Baby Boomers. By doing so, we aim to contribute to a fuller understanding of the ways in which socioeconomic disadvantage engendered by the GFC has disparately affected the wellbeing of these generational cohorts.Methods and findingsWe present results from National Survey on Drug Use and Health from 2007–16 to characterise binge alcohol and substance use among different generational cohorts in the United States during and after the GFC. Bivariate descriptive analysis and maximum-likelihood logit regressions focused on: (a) individual substances and binge drinking, (b) poly-use and (c) any use to simultaneously model how socioeconomic, demographic, and health characteristics were related to past-month substance use and to report the social, economic, and demographic correlates of substance use. Socioeconomic vulnerability was captured on a five-point scale comprised of: (1) health insurance status, (2) government assistance, (3) income, (4) self rated health, and (5) employment status. Millennials showed generally higher risk of binge alcohol and substance use during 2007–16 than Generation X, while Baby Boomers generally exhibited lower risk. Comparison of individual and poly-use patterns for the birth cohorts before and after reveals: Millennials were at significantly increased risk of use of binge alcohol (AOR = 1.51; 95% CI = 1.46–1.56), cocaine (AOR = 1.19; 95% CI = 1.03–1.37), heroin (AOR = 1.39; 95% CI = 1.01–1.91), and oxycontin (AOR = 2.33; 95% CI = 1.74–3.12) than Gen X while Baby Boomers were at significantly reduced risk of all substances. Nevertheless, Millennials were at significantly reduced risk of crack use (AOR = 0.33; 95% CI = 0.25–0.43) and poly-use (AOR = 0.56; 95% CI = 0.45–0.70) compared to Gen X. These differences may be related to measures of austerity and socioeconomic vulnerability. Millennials exhibited the highest vulnerability related to austerity with an average vulnerability score of 0.97 (95% CI = 0.96–0.98) while Baby Boomers exhibited the lowest average vulnerability score of 0.65 (95% CI = 0.64–0.66) with Generation X in between with 0.72 (95% CI = 0.71–0.73). Increased social and economic vulnerability after the 2007 crisis is strongly associated with higher rates of substance use in all generations.ConclusionMillennials have been especially affected by socioeconomic changes associated with the GFC as reflected by their heightened...

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Two steps forward, one step back: current harm reduction policy and politics in the United States

Cited by 60 publications

References 20 publications

Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada

Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada

Methadone maintenance treatment as social control: Analyzing patient experiences

Binge alcohol and substance use across birth cohorts and the global financial crisis in the United States

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