ABSTRACT In this paper, we present the findings of a qualitative study aimed at conceptualizing t... more ABSTRACT In this paper, we present the findings of a qualitative study aimed at conceptualizing the service needs of aging gay men living with HIV (GMLH). Our analysis is based on interview data from 16 gay-identified men living with HIV, ages 50 and over. Drawing on a framework of intersectionality, which theoretically accounts for interlocking expressions of marginalization in groups affected by multiple systems of oppression, we highlight the practical, social, and mental health needs of this population, as well as services that could be designed or adapted to address these concerns. We also emphasize the relevance of specialized training for caring professionals serving older GMLH, and articulate the need for initiatives that more fully engage gay men aging with HIV in the development and delivery of services intended for their use.
El propósito del presente estudio fue estimar la diferencia entre las normas percibidas sobre el ... more El propósito del presente estudio fue estimar la diferencia entre las normas percibidas sobre el uso de drogas por los pares y el uso real informado por estudiantes universitarios, entre 18 a 24 años, del segundo y tercer año en el área de Educación. La teoría de las Normas Sociales fue usada como marco referencial. 286 estudiantes participaron en el estudio, el 67% expresó haber consumido alcohol al menos una vez en la vida y el 28% declaró consumirlo diariamente. Los estudiantes percibieron que 62% de sus compañeros consumen tabaco y el 63% alcohol. El estándar percibido de consumo de drogas fue ligeramente más alto entre las mujeres que en los hombres. Se concluye que los resultados indican una sobreestimación al compararse el estándar percibido con el consumo informado de tabaco y alcohol así como de marihuana y cocaína.
Introduction Opioid overdose epidemic is a public health crisis that is impacting communities aro... more Introduction Opioid overdose epidemic is a public health crisis that is impacting communities around the world. Overdose education and naloxone distribution programs equip and train lay people to respond in the event of an overdose. We aimed to understand factors to consider for the design of naloxone distribution programs in point-ofcare settings from the point of view of community stakeholders. Methods We hosted a multi-stakeholder co-design workshop to elicit suggestions for a naloxone distribution program. We recruited people with lived experience of opioid overdose, community representatives, and other stakeholders from family practice, emergency medicine, addictions medicine, and public health to participate in a full-day facilitated co-design discussion wherein large and small group discussions were audio-recorded, transcribed and analysed using thematic approaches. Results A total of twenty-four participants participated in the multi-stakeholder workshop from five stakeholder groups including geographic and setting diversity. Collaborative dialogue and shared storytelling revealed seven considerations for the design of naloxone distribution programs specific to training needs and the provision of naloxone, these are: recognizing overdose, how much naloxone, impact of stigma, legal risk of responding, position as conventional first aid, friends and family as responders, support to call 911. Conclusion To create an naloxone distribution program in emergency departments, family practice and substance use treatment services, stigma is a central design consideration for training and naloxone kits. Design choices that reference the iconography, type, and form of materials associated with first aid have the potential to satisfy the need to de-stigmatize overdose response.
This study aimed to analyze the relation between university students' perceived norms and actual ... more This study aimed to analyze the relation between university students' perceived norms and actual drug use among their peers. This cross-sectional study was based on a survey. Evaluations involved all second- and third-year students (ages between 18 and 24 years) of the nursing and medicine courses at the Faculdade de Medicina do ABC, located in the city of Santo André, Brazil. Students were invited to answer a questionnaire that evaluated several variables, including their own drug use and their perception of their peers' drug use. In total, 274 students participated. Data analysis was performed using SPSS and descriptive techniques, including frequencies and means. There was an overestimation of the perception regarding drug use in relation to the actual frequency reported by the students.
O objetivo deste estudo foi analisar a relação entre o uso de drogas e as normas percebidas pelos... more O objetivo deste estudo foi analisar a relação entre o uso de drogas e as normas percebidas pelos estudantes universitários entre seus pares. Trata-se de estudo transversal, baseado em um censo. Foram avaliados todos os estudantes dos 2 e 3 anos dos cursos de medicina e enfermagem. O projeto incluiu estudantes entre 18 e 24 anos da Faculdade de Medicina do ABC, em Santo André, Brasil. Os estudantes foram convidados a, voluntariamente, responder um questionário que avalia, entre outras variáveis, consumo próprio de drogas e percepção sobre o uso dos pares. Houve participação de 274 estudantes. A fim de analizar os dados, foi utilizado o pacote SPSS e técnicas descritivas, incluindo-se frequências e médias. Houve superestimativa da percepção do consumo de drogas em relação à frequência descrita de uso próprio pelos estudantes. DESCRITORES: drogas ilícitas; estudantes de ciências da saúde; estudantes de enfermagem; estudantes de medicina
Drugs-education Prevention and Policy, May 22, 2020
Abstract The ‘Satellite Sites’ are a harm reduction intervention in which people who use illicit ... more Abstract The ‘Satellite Sites’ are a harm reduction intervention in which people who use illicit drugs are employed by a community health centre to run satellite harm reduction programs within their homes. Satellite Sites straddle two worlds, at once sites of illicit and stigmatized activities, while also being sites of public health intervention. They offer a unique opportunity to examine the challenges of medicalizing a place that is still criminalized. Using data collected during 7 months of ethnographic observation and 20 interviews with key members of the program, we explore the tactics of medicalization that are deployed to legitimize the Satellite Sites. Medicalization provides legitimacy to Satellite Sites, and provides people who use drugs who run the Satellite Sites with some protection from the criminal justice system. Our results explore the friction between processes of medicalization and criminalization, with continued criminalization of drug possession and distribution negatively impacting the uptake and effectiveness of public health recommendations. Study findings highlight how the ability of public health authorities to develop safer environment interventions to improve the health of people who use drugs—including measures to address the current overdose crisis - may be severely limited by the continued criminalization of drug use.
El propósito del presente estudio fue estimar la diferencia entre las normas percibidas sobre el ... more El propósito del presente estudio fue estimar la diferencia entre las normas percibidas sobre el uso de drogas por los pares y el uso real informado por estudiantes universitarios, entre 18 a 24 años, del segundo y tercer año en el área de Educación. La teoría de las Normas Sociales fue usada como marco referencial. 286 estudiantes participaron en el estudio, el 67% expresó haber consumido alcohol al menos una vez en la vida y el 28% declaró consumirlo diariamente. Los estudiantes percibieron que 62% de sus compañeros consumen tabaco y el 63% alcohol. El estándar percibido de consumo de drogas fue ligeramente más alto entre las mujeres que en los hombres. Se concluye que los resultados indican una sobreestimación al compararse el estándar percibido con el consumo informado de tabaco y alcohol así como de marihuana y cocaína.
Despite the recognition of older gay men's unique health needs, the health care experiences of th... more Despite the recognition of older gay men's unique health needs, the health care experiences of this group have seldom been explored empirically. Accordingly, in this qualitative study, we utilize a poststructuralist approach to grounded theory known as situational analysis to examine older gay men's experiences with health care. Specifically, we draw on interviews with 27 gay men ages 50 and over, 16 of whom disclosed being HIV-positive at the time of recruitment, to consider this group's interactions with formal health systems. We analyze how processes of subjugation and resistance are reflected in older gay men's narrative accounts of navigating health care, and in this process, highlight the role of the HIV/AIDS epidemic in constructing health care as a site of subjugation and resistance for these men. We inductively examine discourses, interpretations of medical practices, and constructions of aging gay bodies that together reflect the historical and contemporary role of HIV/AIDS in shaping present day systems of heath care for older gay men. We conclude the paper with implications for research and policy in the area of gay aging, including the need for specialized psychosocial services targeting the needs of older gay men in health systems.
Context: The United States is in the midst of an opioid overdose epidemic. Opioids killed more th... more Context: The United States is in the midst of an opioid overdose epidemic. Opioids killed more than 28 000 people in 2014, more than any year on record. One approach to addressing this growing epidemic is Opioid Overdose Education and Naloxone Distribution (OEND) training. Little is known about these programs' participants and their effectiveness across different demographic groups. Objectives: To examine (1) whether knowledge and attitudes improved over the course of the training programs; (2) whether training outcomes differ by demographics; and (3) what overdose experiences do attendees have, and whether those experiences influence their knowledge and attitudes. Design: A pre-and posttest survey was used to collect data on participants' demographics, overdose experiences, and opioid overdose knowledge and attitudes. Setting: Surveys that took place at community-wide OEND programs were offered throughout Erie County, New York, during October and November 2015. Participants: Community members who elected to attend the training programs, were at least 18 years of age, spoke English, and were willing and able to participate were included in the sample (N = 198). Intervention: N/A. Main Outcome Measure: The Opioid Overdose Knowledge and Attitudes Scale. Results: Knowledge and attitude scores significantly improved from pre-to posttest assessments, increasing by 23.1% and 15.4%, respectively (Ps < .001). There were significant demographic differences in knowledge and attitudes at the pretest assessment, but these differences were ameliorated by the OEND program and did not persist at posttest assessment. In addition, 62.9% of participants had never experienced, witnessed, or known someone who had overdosed. Conclusion: Results indicate that OEND programs are effective at improving knowledge and attitudes toward opioid overdose. These results indicate that OEND programs are not reaching the highest risk individuals but are instead attracting concerned family and significant others. Future programs should focus on reaching current opioid users, overdose victims, and their families to ensure OEND programs are reaching the target audiences.
Background: Supervised consumption services (SCS) are being implemented across Canada in response... more Background: Supervised consumption services (SCS) are being implemented across Canada in response to a variety of drug-related harms. We explored the implementation context of newly established SCS in Toronto and the role of policing in shaping program access by people who inject drugs (PWID). Methods: We conducted one-to-one qualitative semi-structured interviews with 24 PWID. Participants were purposively recruited. Ethnographic observations were conducted at each of the study sites as well as in their respective neighbourhoods. Relevant policy documents were also reviewed. Results: Policing was overwhelmingly discussed by participants from both SCS sites. However, participant responses varied depending on the site in question. Subthemes from participant responses on policing at site #1 described neighbourhood police presence and fears of police harassment and drug arrests before, during, or after accessing SCS. Conversely, subthemes from participant responses on policing at site #2 described immunity and protection from police while using the SCS, as well as a lack of police presence or fears of police harassment and arrests. These differences in implementation contexts were largely shaped by differences in local neighbourhoods and drug scenes. Police policies highlighted federal laws protecting PWID within SCS, but also the exercise of discretion when applying the rule of law outside of these settings. Conclusions: Participants' perspectives on, and experiences with, policing as they relate to accessing SCS were shaped by the implementation contexts of each SCS site and how neighbourhoods, drug scenes, and differences in policing practices affected service use. Our findings also demonstrate the disconnect between the goals of policing and those of SCS. Until larger structural barriers are addressed (e.g. criminalization), future SCS programming should consider the impact of policing on the SCS implementation context to improve client experience with, and access to, SCS.
El propósito de este estudio fue estimar la diferencia entre el consumo percibido en los pares y ... more El propósito de este estudio fue estimar la diferencia entre el consumo percibido en los pares y el uso real de drogas que tienen los estudiantes universitarios de segundo y tercer año, entre 18 y 24 años de edad, de una universidad pública en la ciudad de Medellín, Colombia. Se trata de un estudio descriptivo transversal basado en una encuesta. Todos los estudiantes de segundo y tercer año de las facultades de Medicina, Odontología, Enfermería y Salud Publica fueron invitados a responder un cuestionario anónimo. Participaron 427 estudiantes. Se encontró una sobreestimacion del consumo de tabaco, marihuana y cocaina en los ultimos doce meses. El consumo de alcohol es percibido de manera exacta. Los estudiantes que consumieron drogas, en el periodo mencionado, sobreestiman más que los que no lo hicieron; también se encontró que las mujeres sobreestiman más que los hombres el consumo de marihuana.
We described public views toward harm reduction among Canadian adults and tested a social exposur... more We described public views toward harm reduction among Canadian adults and tested a social exposure model predicting support for these contentious services, drawing on theories in the morality policy, intergroup relations, addiction, and media communication literatures. A quota sample of 4645 adults (18+ years), randomly drawn from an online research panel and stratified to match age and sex distributions of adults within and across Canadian provinces, was recruited in June 2018. Participants completed survey items assessing support for harm reduction for people who use drugs (PWUD) and for seven harm reduction interventions. Additional items assessed exposure to media coverage on harm reduction, and scales assessing stigma toward PWUD (α = .72), personal familiarity with PWUD (α = .84), and disease model beliefs about addiction (α = .79). Most (64%) Canadians supported harm reduction (provincial estimates = 60%-73%). Five of seven interventions received majority support, including: outreach (79%), naloxone (72%), drug checking (70%), needle distribution (60%) and supervised drug consumption (55%). Low-threshold opioid agonist treatment and safe inhalation interventions received less support (49% and 44%). Our social exposure model, adjusted for respondent sex, household income, political views, and education, exhibited good fit and accounted for 17% of variance in public support for harm reduction. Personal familiarity with PWUD and disease model beliefs about addiction were directly associated with support (βs = .07 and-0.10, respectively), and indirectly influenced public support via stigmatized attitudes toward PWUD (βs = 0.01 and-0.01, respectively). Strategies to increase support for harm reduction could problematize certain disease model beliefs (e.g., "There are only two possibilities for an alcoholic or drug addict-permanent abstinence or death") and creating opportunities to reduce social distance between PWUD, the public, and policy makers.
Background: The overdose crisis in Canada has worsened since the emergence of the COVID-19 pandem... more Background: The overdose crisis in Canada has worsened since the emergence of the COVID-19 pandemic. Although this trend is thought to be driven in part by closures or reduced capacity of supervised consumption services (SCS), little is known about the factors that may impede access to such services during the COVID-19 pandemic among people who use drugs. This study sought to characterize the prevalence and correlates of having difficulty accessing SCS during the COVID-19 pandemic among people who use drugs in Vancouver, Canada. Methods: Cross-sectional data from two open prospective cohorts of people who use drugs were collected via phone or videoconferencing interviews conducted between July 2020 and November 2020. Multivariable logistic regression analyses were used to examine factors associated with experiencing difficulty accessing SCS. Results: Among the 428 people who use drugs who participated in the study, 223 (54.7%) self-identified as men and the median age was 51 years (1st to 3rd quartile: 42-58). A total of 58 (13.6%) participants reported experiencing difficulty accessing SCS. In a multivariable analysis, factors positively associated with difficulty accessing SCS included daily crystal methamphetamine use (Adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI] 1.28-5.30), active injection drug use (AOR = 4.06; 95% CI 1.38-11.90), recent non-fatal overdose (AOR = 2.45; 95% CI 1.24-4.85), and unstable housing (AOR = 2.14; 95% CI 1.08-4.23). Age was inversely associated with the outcome (AOR = 0.96; 95% CI 0.93-0.99) in multivariable analyses. The most commonly reported reasons for experiencing difficulty accessing SCS were: COVID-19-related site closure or shortened hours (42.9%) and having to wait too long to use a site (39.3%). Conclusions: We found that people who use drugs with markers of structural vulnerability and drug-related risk were more likely to experience difficulty accessing SCS during the COVID-19 pandemic. These findings point to the need for strategies to support access to such services as part of pandemic response efforts.
International Journal of Tuberculosis and Lung Disease, Apr 1, 2019
To examine how frontline health care workers (HCWs) and decision-makers working in tuberculosis (... more To examine how frontline health care workers (HCWs) and decision-makers working in tuberculosis (TB) care and mental health care conceptualise liberty, harm and the harm principle-which are often invoked in health care legislation to justify liberty restrictions-in the treatment and care of persons with TB and severe and persistent mental illness (SPMI). D E S I G N : Qualitative study of 20 semi-structured interviews with HCWs and decision-makers working in public or mental health from three public health units and two psychiatric hospitals in the Greater Toronto Area in Ontario, Canada. Interviews were evaluated using thematic analysis. R E S U LT S : Three themes were identified: 1) the contextual nature of liberty restrictions; 2) the concept of
BACKGROUND In response to the ongoing overdose crisis, some clinicians in Canada have started pre... more BACKGROUND In response to the ongoing overdose crisis, some clinicians in Canada have started prescribing immediate release hydromorphone (IRH) as an alternative to the toxic unregulated drug supply. This practice is often referred to as safer supply. We aimed to identify and characterize patients receiving safer supply IRH and their prescribers in Ontario. METHODS Using provincial administrative health data, we identified individuals with opioid use disorder prescribed safer supply IRH from January 2016 to March 2020 and reported the number of initiations over time. We summarized demographic, health, and medication use characteristics among patients who received safer supply IRH, and examined select clinical outcomes including retention and death. Finally, we characterized prescribers of safer supply IRH and compared frequent and infrequent prescribers. RESULTS We identified 534 initiations of safer supply IRH (447 distinct individuals) from 155 prescribers. Initiations increased over time with a peak in the third quarter of 2019 (103 initiations). Patients' median age was 42 (interquartile range [IQR] 34-50), and most were male (60.2%), urban residents, (96.2%), and in the lowest neighborhood income quintile (55.7%), with 13.9% having overdosed in the previous one year. The prevalence of HIV was 13.9%. The median duration on IRH was 272 days (IQR 30-1,244) and OAT was co-prescribed in 62.9% of courses. Death while receiving IRH or within 7 days of discontinuation was rare (≤5 courses;≤0.94 per person-year for each). CONCLUSIONS Clinicians are increasingly prescribing safer supply IRH in Ontario. Patients prescribed safer supply IRH had demographic and clinical characteristics associated with high risk of death from opioid-related overdose. Short-term deaths among people receiving safer supply IRH were rare.
O álcool é a droga lícita de maior prevalência entre estudantes universitários e consumida de for... more O álcool é a droga lícita de maior prevalência entre estudantes universitários e consumida de forma recreacional. Os objetivos deste estudo foram identificar as normas percebidas sobre o uso de álcool entre estudantes universitários, contrastar a percepção dos estudantes em relação ao uso de álcool por seus pares com a atual prevalência do uso de álcool e comparar o próprio uso de álcool com a percepção do uso de álcool pelos pares. Utilizou-se a técnica (survey) com 275 estudantes de uma universidade pública do Rio de Janeiro (Brasil), em 2008. A percepção dos estudantes sobre o uso de álcool pelos pares uma vez na vida e nos últimos doze meses foi acurada, porém, em relação aos últimos trinta dias houve percepção errônea (hiperestimativa). Os estudantes consomem bebidas alcoólicas de forma recreacional, principalmente em festas e bares, em companhia de amigos e pares. O consumo se mostra acima dos padrões estabelecidos. DESCRITORES: drogas ilícitas; bebidas alcoólicas; estudantes universitários; grupo associado PERCEIVED NORMS OF PEER ALCOHOL USE AMONG UNIVERSITY STUDENTS Alcohol is the most prevalent legal drug among university students, and it is used recreationally. The objectives of this study were to identify the perceived norms of alcohol use among university students, contrast the students' perception regarding peer alcohol use and the actual alcohol use prevalence, and compare the subjects' own alcohol use with their perception of peer alcohol use. A survey was performed on 275 students of a public university located in Rio de Janeiro (Brazil), in 2008. The students' perception about peer alcohol use once in a lifetime and over the last 12 years was correct; but their perception regarding the last 30 days was overestimated. Students consume alcoholic beverages recreationally, mainly at parties and bars with friends and peers. Alcohol use is above established standards. DESCRIPTORS: street drugs; alcoholic beverages; university students; peer group NORMAS PERCIBIDAS POR LOS ESTUDIANTES UNIVERSITARIOS SOBRE EL USO DE ALCOHOL ENTRE SUS PARES El alcohol es la droga lícita de mayor consumo entre estudiantes universitarios, siendo su consumo considerado como de diversión. Los objetivos de este estudio fueron identificar las normas percibidas sobre el uso del alcohol entre estudiantes universitarios. Se deseaba comparar la percepción que los estudiantes tenían en relación al uso de alcohol entre sus pares con el uso real que los propios estudiantes hacían del alcohol. Se utilizó la técnica de la encuesta en 275 estudiantes, en una universidad pública de Río de Janeiro, en Brasil, en 2008. Se encontró que la percepción de los estudiantes sobre el uso del alcohol entre sus pares, en alguna vez en la vida y en los últimos doce meses, fue exacta, pero en relación a los últimos treinta días tuvieron una percepción errónea, esta fue sobreestimada. También, los estudiantes consumen bebidas alcohólicas para divertirse, principalmente en fiestas y bares en compañía de amigos y pares. Finalmente se encontró que el consumo es mayor que los estándares establecidos. Se recomienda prestar atención a los factores protectores.
IntroductionThe surviving opioid overdose with naloxone education and resuscitation (SOONER) proj... more IntroductionThe surviving opioid overdose with naloxone education and resuscitation (SOONER) project uses co-design and trial methods to develop and evaluate a point-of-care overdose education and naloxone distribution (OEND) tool. We plan to conduct a randomised controlled trial to assess the effectiveness of our OEND tool in comparison with best available standard of care by observing participants’ performance as a responder to a simulated overdose. Recruiting and retaining people at risk of or likely to witness opioid overdose raises scientific, logistical and bioethical challenges. A feasibility study is needed to establish the effectiveness of recruitment and retention strategies and acceptability of study procedures prior to launching the full trial.Methods and analysisStrategies to enhance recruitment include candidate-driven recruitment, verbal informed consent, and attractive, destigmatising materials. Adults at risk of or likely to witness opioid overdose will be recruited...
ABSTRACT In this paper, we present the findings of a qualitative study aimed at conceptualizing t... more ABSTRACT In this paper, we present the findings of a qualitative study aimed at conceptualizing the service needs of aging gay men living with HIV (GMLH). Our analysis is based on interview data from 16 gay-identified men living with HIV, ages 50 and over. Drawing on a framework of intersectionality, which theoretically accounts for interlocking expressions of marginalization in groups affected by multiple systems of oppression, we highlight the practical, social, and mental health needs of this population, as well as services that could be designed or adapted to address these concerns. We also emphasize the relevance of specialized training for caring professionals serving older GMLH, and articulate the need for initiatives that more fully engage gay men aging with HIV in the development and delivery of services intended for their use.
El propósito del presente estudio fue estimar la diferencia entre las normas percibidas sobre el ... more El propósito del presente estudio fue estimar la diferencia entre las normas percibidas sobre el uso de drogas por los pares y el uso real informado por estudiantes universitarios, entre 18 a 24 años, del segundo y tercer año en el área de Educación. La teoría de las Normas Sociales fue usada como marco referencial. 286 estudiantes participaron en el estudio, el 67% expresó haber consumido alcohol al menos una vez en la vida y el 28% declaró consumirlo diariamente. Los estudiantes percibieron que 62% de sus compañeros consumen tabaco y el 63% alcohol. El estándar percibido de consumo de drogas fue ligeramente más alto entre las mujeres que en los hombres. Se concluye que los resultados indican una sobreestimación al compararse el estándar percibido con el consumo informado de tabaco y alcohol así como de marihuana y cocaína.
Introduction Opioid overdose epidemic is a public health crisis that is impacting communities aro... more Introduction Opioid overdose epidemic is a public health crisis that is impacting communities around the world. Overdose education and naloxone distribution programs equip and train lay people to respond in the event of an overdose. We aimed to understand factors to consider for the design of naloxone distribution programs in point-ofcare settings from the point of view of community stakeholders. Methods We hosted a multi-stakeholder co-design workshop to elicit suggestions for a naloxone distribution program. We recruited people with lived experience of opioid overdose, community representatives, and other stakeholders from family practice, emergency medicine, addictions medicine, and public health to participate in a full-day facilitated co-design discussion wherein large and small group discussions were audio-recorded, transcribed and analysed using thematic approaches. Results A total of twenty-four participants participated in the multi-stakeholder workshop from five stakeholder groups including geographic and setting diversity. Collaborative dialogue and shared storytelling revealed seven considerations for the design of naloxone distribution programs specific to training needs and the provision of naloxone, these are: recognizing overdose, how much naloxone, impact of stigma, legal risk of responding, position as conventional first aid, friends and family as responders, support to call 911. Conclusion To create an naloxone distribution program in emergency departments, family practice and substance use treatment services, stigma is a central design consideration for training and naloxone kits. Design choices that reference the iconography, type, and form of materials associated with first aid have the potential to satisfy the need to de-stigmatize overdose response.
This study aimed to analyze the relation between university students' perceived norms and actual ... more This study aimed to analyze the relation between university students' perceived norms and actual drug use among their peers. This cross-sectional study was based on a survey. Evaluations involved all second- and third-year students (ages between 18 and 24 years) of the nursing and medicine courses at the Faculdade de Medicina do ABC, located in the city of Santo André, Brazil. Students were invited to answer a questionnaire that evaluated several variables, including their own drug use and their perception of their peers' drug use. In total, 274 students participated. Data analysis was performed using SPSS and descriptive techniques, including frequencies and means. There was an overestimation of the perception regarding drug use in relation to the actual frequency reported by the students.
O objetivo deste estudo foi analisar a relação entre o uso de drogas e as normas percebidas pelos... more O objetivo deste estudo foi analisar a relação entre o uso de drogas e as normas percebidas pelos estudantes universitários entre seus pares. Trata-se de estudo transversal, baseado em um censo. Foram avaliados todos os estudantes dos 2 e 3 anos dos cursos de medicina e enfermagem. O projeto incluiu estudantes entre 18 e 24 anos da Faculdade de Medicina do ABC, em Santo André, Brasil. Os estudantes foram convidados a, voluntariamente, responder um questionário que avalia, entre outras variáveis, consumo próprio de drogas e percepção sobre o uso dos pares. Houve participação de 274 estudantes. A fim de analizar os dados, foi utilizado o pacote SPSS e técnicas descritivas, incluindo-se frequências e médias. Houve superestimativa da percepção do consumo de drogas em relação à frequência descrita de uso próprio pelos estudantes. DESCRITORES: drogas ilícitas; estudantes de ciências da saúde; estudantes de enfermagem; estudantes de medicina
Drugs-education Prevention and Policy, May 22, 2020
Abstract The ‘Satellite Sites’ are a harm reduction intervention in which people who use illicit ... more Abstract The ‘Satellite Sites’ are a harm reduction intervention in which people who use illicit drugs are employed by a community health centre to run satellite harm reduction programs within their homes. Satellite Sites straddle two worlds, at once sites of illicit and stigmatized activities, while also being sites of public health intervention. They offer a unique opportunity to examine the challenges of medicalizing a place that is still criminalized. Using data collected during 7 months of ethnographic observation and 20 interviews with key members of the program, we explore the tactics of medicalization that are deployed to legitimize the Satellite Sites. Medicalization provides legitimacy to Satellite Sites, and provides people who use drugs who run the Satellite Sites with some protection from the criminal justice system. Our results explore the friction between processes of medicalization and criminalization, with continued criminalization of drug possession and distribution negatively impacting the uptake and effectiveness of public health recommendations. Study findings highlight how the ability of public health authorities to develop safer environment interventions to improve the health of people who use drugs—including measures to address the current overdose crisis - may be severely limited by the continued criminalization of drug use.
El propósito del presente estudio fue estimar la diferencia entre las normas percibidas sobre el ... more El propósito del presente estudio fue estimar la diferencia entre las normas percibidas sobre el uso de drogas por los pares y el uso real informado por estudiantes universitarios, entre 18 a 24 años, del segundo y tercer año en el área de Educación. La teoría de las Normas Sociales fue usada como marco referencial. 286 estudiantes participaron en el estudio, el 67% expresó haber consumido alcohol al menos una vez en la vida y el 28% declaró consumirlo diariamente. Los estudiantes percibieron que 62% de sus compañeros consumen tabaco y el 63% alcohol. El estándar percibido de consumo de drogas fue ligeramente más alto entre las mujeres que en los hombres. Se concluye que los resultados indican una sobreestimación al compararse el estándar percibido con el consumo informado de tabaco y alcohol así como de marihuana y cocaína.
Despite the recognition of older gay men's unique health needs, the health care experiences of th... more Despite the recognition of older gay men's unique health needs, the health care experiences of this group have seldom been explored empirically. Accordingly, in this qualitative study, we utilize a poststructuralist approach to grounded theory known as situational analysis to examine older gay men's experiences with health care. Specifically, we draw on interviews with 27 gay men ages 50 and over, 16 of whom disclosed being HIV-positive at the time of recruitment, to consider this group's interactions with formal health systems. We analyze how processes of subjugation and resistance are reflected in older gay men's narrative accounts of navigating health care, and in this process, highlight the role of the HIV/AIDS epidemic in constructing health care as a site of subjugation and resistance for these men. We inductively examine discourses, interpretations of medical practices, and constructions of aging gay bodies that together reflect the historical and contemporary role of HIV/AIDS in shaping present day systems of heath care for older gay men. We conclude the paper with implications for research and policy in the area of gay aging, including the need for specialized psychosocial services targeting the needs of older gay men in health systems.
Context: The United States is in the midst of an opioid overdose epidemic. Opioids killed more th... more Context: The United States is in the midst of an opioid overdose epidemic. Opioids killed more than 28 000 people in 2014, more than any year on record. One approach to addressing this growing epidemic is Opioid Overdose Education and Naloxone Distribution (OEND) training. Little is known about these programs' participants and their effectiveness across different demographic groups. Objectives: To examine (1) whether knowledge and attitudes improved over the course of the training programs; (2) whether training outcomes differ by demographics; and (3) what overdose experiences do attendees have, and whether those experiences influence their knowledge and attitudes. Design: A pre-and posttest survey was used to collect data on participants' demographics, overdose experiences, and opioid overdose knowledge and attitudes. Setting: Surveys that took place at community-wide OEND programs were offered throughout Erie County, New York, during October and November 2015. Participants: Community members who elected to attend the training programs, were at least 18 years of age, spoke English, and were willing and able to participate were included in the sample (N = 198). Intervention: N/A. Main Outcome Measure: The Opioid Overdose Knowledge and Attitudes Scale. Results: Knowledge and attitude scores significantly improved from pre-to posttest assessments, increasing by 23.1% and 15.4%, respectively (Ps < .001). There were significant demographic differences in knowledge and attitudes at the pretest assessment, but these differences were ameliorated by the OEND program and did not persist at posttest assessment. In addition, 62.9% of participants had never experienced, witnessed, or known someone who had overdosed. Conclusion: Results indicate that OEND programs are effective at improving knowledge and attitudes toward opioid overdose. These results indicate that OEND programs are not reaching the highest risk individuals but are instead attracting concerned family and significant others. Future programs should focus on reaching current opioid users, overdose victims, and their families to ensure OEND programs are reaching the target audiences.
Background: Supervised consumption services (SCS) are being implemented across Canada in response... more Background: Supervised consumption services (SCS) are being implemented across Canada in response to a variety of drug-related harms. We explored the implementation context of newly established SCS in Toronto and the role of policing in shaping program access by people who inject drugs (PWID). Methods: We conducted one-to-one qualitative semi-structured interviews with 24 PWID. Participants were purposively recruited. Ethnographic observations were conducted at each of the study sites as well as in their respective neighbourhoods. Relevant policy documents were also reviewed. Results: Policing was overwhelmingly discussed by participants from both SCS sites. However, participant responses varied depending on the site in question. Subthemes from participant responses on policing at site #1 described neighbourhood police presence and fears of police harassment and drug arrests before, during, or after accessing SCS. Conversely, subthemes from participant responses on policing at site #2 described immunity and protection from police while using the SCS, as well as a lack of police presence or fears of police harassment and arrests. These differences in implementation contexts were largely shaped by differences in local neighbourhoods and drug scenes. Police policies highlighted federal laws protecting PWID within SCS, but also the exercise of discretion when applying the rule of law outside of these settings. Conclusions: Participants' perspectives on, and experiences with, policing as they relate to accessing SCS were shaped by the implementation contexts of each SCS site and how neighbourhoods, drug scenes, and differences in policing practices affected service use. Our findings also demonstrate the disconnect between the goals of policing and those of SCS. Until larger structural barriers are addressed (e.g. criminalization), future SCS programming should consider the impact of policing on the SCS implementation context to improve client experience with, and access to, SCS.
El propósito de este estudio fue estimar la diferencia entre el consumo percibido en los pares y ... more El propósito de este estudio fue estimar la diferencia entre el consumo percibido en los pares y el uso real de drogas que tienen los estudiantes universitarios de segundo y tercer año, entre 18 y 24 años de edad, de una universidad pública en la ciudad de Medellín, Colombia. Se trata de un estudio descriptivo transversal basado en una encuesta. Todos los estudiantes de segundo y tercer año de las facultades de Medicina, Odontología, Enfermería y Salud Publica fueron invitados a responder un cuestionario anónimo. Participaron 427 estudiantes. Se encontró una sobreestimacion del consumo de tabaco, marihuana y cocaina en los ultimos doce meses. El consumo de alcohol es percibido de manera exacta. Los estudiantes que consumieron drogas, en el periodo mencionado, sobreestiman más que los que no lo hicieron; también se encontró que las mujeres sobreestiman más que los hombres el consumo de marihuana.
We described public views toward harm reduction among Canadian adults and tested a social exposur... more We described public views toward harm reduction among Canadian adults and tested a social exposure model predicting support for these contentious services, drawing on theories in the morality policy, intergroup relations, addiction, and media communication literatures. A quota sample of 4645 adults (18+ years), randomly drawn from an online research panel and stratified to match age and sex distributions of adults within and across Canadian provinces, was recruited in June 2018. Participants completed survey items assessing support for harm reduction for people who use drugs (PWUD) and for seven harm reduction interventions. Additional items assessed exposure to media coverage on harm reduction, and scales assessing stigma toward PWUD (α = .72), personal familiarity with PWUD (α = .84), and disease model beliefs about addiction (α = .79). Most (64%) Canadians supported harm reduction (provincial estimates = 60%-73%). Five of seven interventions received majority support, including: outreach (79%), naloxone (72%), drug checking (70%), needle distribution (60%) and supervised drug consumption (55%). Low-threshold opioid agonist treatment and safe inhalation interventions received less support (49% and 44%). Our social exposure model, adjusted for respondent sex, household income, political views, and education, exhibited good fit and accounted for 17% of variance in public support for harm reduction. Personal familiarity with PWUD and disease model beliefs about addiction were directly associated with support (βs = .07 and-0.10, respectively), and indirectly influenced public support via stigmatized attitudes toward PWUD (βs = 0.01 and-0.01, respectively). Strategies to increase support for harm reduction could problematize certain disease model beliefs (e.g., "There are only two possibilities for an alcoholic or drug addict-permanent abstinence or death") and creating opportunities to reduce social distance between PWUD, the public, and policy makers.
Background: The overdose crisis in Canada has worsened since the emergence of the COVID-19 pandem... more Background: The overdose crisis in Canada has worsened since the emergence of the COVID-19 pandemic. Although this trend is thought to be driven in part by closures or reduced capacity of supervised consumption services (SCS), little is known about the factors that may impede access to such services during the COVID-19 pandemic among people who use drugs. This study sought to characterize the prevalence and correlates of having difficulty accessing SCS during the COVID-19 pandemic among people who use drugs in Vancouver, Canada. Methods: Cross-sectional data from two open prospective cohorts of people who use drugs were collected via phone or videoconferencing interviews conducted between July 2020 and November 2020. Multivariable logistic regression analyses were used to examine factors associated with experiencing difficulty accessing SCS. Results: Among the 428 people who use drugs who participated in the study, 223 (54.7%) self-identified as men and the median age was 51 years (1st to 3rd quartile: 42-58). A total of 58 (13.6%) participants reported experiencing difficulty accessing SCS. In a multivariable analysis, factors positively associated with difficulty accessing SCS included daily crystal methamphetamine use (Adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI] 1.28-5.30), active injection drug use (AOR = 4.06; 95% CI 1.38-11.90), recent non-fatal overdose (AOR = 2.45; 95% CI 1.24-4.85), and unstable housing (AOR = 2.14; 95% CI 1.08-4.23). Age was inversely associated with the outcome (AOR = 0.96; 95% CI 0.93-0.99) in multivariable analyses. The most commonly reported reasons for experiencing difficulty accessing SCS were: COVID-19-related site closure or shortened hours (42.9%) and having to wait too long to use a site (39.3%). Conclusions: We found that people who use drugs with markers of structural vulnerability and drug-related risk were more likely to experience difficulty accessing SCS during the COVID-19 pandemic. These findings point to the need for strategies to support access to such services as part of pandemic response efforts.
International Journal of Tuberculosis and Lung Disease, Apr 1, 2019
To examine how frontline health care workers (HCWs) and decision-makers working in tuberculosis (... more To examine how frontline health care workers (HCWs) and decision-makers working in tuberculosis (TB) care and mental health care conceptualise liberty, harm and the harm principle-which are often invoked in health care legislation to justify liberty restrictions-in the treatment and care of persons with TB and severe and persistent mental illness (SPMI). D E S I G N : Qualitative study of 20 semi-structured interviews with HCWs and decision-makers working in public or mental health from three public health units and two psychiatric hospitals in the Greater Toronto Area in Ontario, Canada. Interviews were evaluated using thematic analysis. R E S U LT S : Three themes were identified: 1) the contextual nature of liberty restrictions; 2) the concept of
BACKGROUND In response to the ongoing overdose crisis, some clinicians in Canada have started pre... more BACKGROUND In response to the ongoing overdose crisis, some clinicians in Canada have started prescribing immediate release hydromorphone (IRH) as an alternative to the toxic unregulated drug supply. This practice is often referred to as safer supply. We aimed to identify and characterize patients receiving safer supply IRH and their prescribers in Ontario. METHODS Using provincial administrative health data, we identified individuals with opioid use disorder prescribed safer supply IRH from January 2016 to March 2020 and reported the number of initiations over time. We summarized demographic, health, and medication use characteristics among patients who received safer supply IRH, and examined select clinical outcomes including retention and death. Finally, we characterized prescribers of safer supply IRH and compared frequent and infrequent prescribers. RESULTS We identified 534 initiations of safer supply IRH (447 distinct individuals) from 155 prescribers. Initiations increased over time with a peak in the third quarter of 2019 (103 initiations). Patients' median age was 42 (interquartile range [IQR] 34-50), and most were male (60.2%), urban residents, (96.2%), and in the lowest neighborhood income quintile (55.7%), with 13.9% having overdosed in the previous one year. The prevalence of HIV was 13.9%. The median duration on IRH was 272 days (IQR 30-1,244) and OAT was co-prescribed in 62.9% of courses. Death while receiving IRH or within 7 days of discontinuation was rare (≤5 courses;≤0.94 per person-year for each). CONCLUSIONS Clinicians are increasingly prescribing safer supply IRH in Ontario. Patients prescribed safer supply IRH had demographic and clinical characteristics associated with high risk of death from opioid-related overdose. Short-term deaths among people receiving safer supply IRH were rare.
O álcool é a droga lícita de maior prevalência entre estudantes universitários e consumida de for... more O álcool é a droga lícita de maior prevalência entre estudantes universitários e consumida de forma recreacional. Os objetivos deste estudo foram identificar as normas percebidas sobre o uso de álcool entre estudantes universitários, contrastar a percepção dos estudantes em relação ao uso de álcool por seus pares com a atual prevalência do uso de álcool e comparar o próprio uso de álcool com a percepção do uso de álcool pelos pares. Utilizou-se a técnica (survey) com 275 estudantes de uma universidade pública do Rio de Janeiro (Brasil), em 2008. A percepção dos estudantes sobre o uso de álcool pelos pares uma vez na vida e nos últimos doze meses foi acurada, porém, em relação aos últimos trinta dias houve percepção errônea (hiperestimativa). Os estudantes consomem bebidas alcoólicas de forma recreacional, principalmente em festas e bares, em companhia de amigos e pares. O consumo se mostra acima dos padrões estabelecidos. DESCRITORES: drogas ilícitas; bebidas alcoólicas; estudantes universitários; grupo associado PERCEIVED NORMS OF PEER ALCOHOL USE AMONG UNIVERSITY STUDENTS Alcohol is the most prevalent legal drug among university students, and it is used recreationally. The objectives of this study were to identify the perceived norms of alcohol use among university students, contrast the students' perception regarding peer alcohol use and the actual alcohol use prevalence, and compare the subjects' own alcohol use with their perception of peer alcohol use. A survey was performed on 275 students of a public university located in Rio de Janeiro (Brazil), in 2008. The students' perception about peer alcohol use once in a lifetime and over the last 12 years was correct; but their perception regarding the last 30 days was overestimated. Students consume alcoholic beverages recreationally, mainly at parties and bars with friends and peers. Alcohol use is above established standards. DESCRIPTORS: street drugs; alcoholic beverages; university students; peer group NORMAS PERCIBIDAS POR LOS ESTUDIANTES UNIVERSITARIOS SOBRE EL USO DE ALCOHOL ENTRE SUS PARES El alcohol es la droga lícita de mayor consumo entre estudiantes universitarios, siendo su consumo considerado como de diversión. Los objetivos de este estudio fueron identificar las normas percibidas sobre el uso del alcohol entre estudiantes universitarios. Se deseaba comparar la percepción que los estudiantes tenían en relación al uso de alcohol entre sus pares con el uso real que los propios estudiantes hacían del alcohol. Se utilizó la técnica de la encuesta en 275 estudiantes, en una universidad pública de Río de Janeiro, en Brasil, en 2008. Se encontró que la percepción de los estudiantes sobre el uso del alcohol entre sus pares, en alguna vez en la vida y en los últimos doce meses, fue exacta, pero en relación a los últimos treinta días tuvieron una percepción errónea, esta fue sobreestimada. También, los estudiantes consumen bebidas alcohólicas para divertirse, principalmente en fiestas y bares en compañía de amigos y pares. Finalmente se encontró que el consumo es mayor que los estándares establecidos. Se recomienda prestar atención a los factores protectores.
IntroductionThe surviving opioid overdose with naloxone education and resuscitation (SOONER) proj... more IntroductionThe surviving opioid overdose with naloxone education and resuscitation (SOONER) project uses co-design and trial methods to develop and evaluate a point-of-care overdose education and naloxone distribution (OEND) tool. We plan to conduct a randomised controlled trial to assess the effectiveness of our OEND tool in comparison with best available standard of care by observing participants’ performance as a responder to a simulated overdose. Recruiting and retaining people at risk of or likely to witness opioid overdose raises scientific, logistical and bioethical challenges. A feasibility study is needed to establish the effectiveness of recruitment and retention strategies and acceptability of study procedures prior to launching the full trial.Methods and analysisStrategies to enhance recruitment include candidate-driven recruitment, verbal informed consent, and attractive, destigmatising materials. Adults at risk of or likely to witness opioid overdose will be recruited...
Drug use practices that can lead to transmission of HIV, HCV, and other harms are pressing issues... more Drug use practices that can lead to transmission of HIV, HCV, and other harms are pressing issues affecting communities throughout Canada. Existing best practice recommendations for needle and syringe programs are out of date. To stay current with the best available scientific evidence and ensure that people have access to high-quality services that help prevent drug-related harms, best practices must undergo review and update. We created an updated set of user-friendly recommendations that will benefit harm reduction programs across the country. Our community-based team involved members from across Canada representing people who use drugs, service providers, researchers, and policy makers. We used a consensus process to design the project and make all project decisions. Using a narrative synthesis method, we reviewed and synthesised best-available scientific evidence to create best practice recommendations related to: needle and syringe distribution; other injecting equipment distribution; safer crack cocaine smoking equipment distribution; safer disposal and handling of used drug use equipment; safer drug use education; and use of naloxone in overdose prevention. By using a broad dissemination strategy, we will reach a wide audience who will use the document, including people who use drugs and service providers, at harm reduction programs across Canada.
Our aim was to create an evidence-based set of user-friendly recommendations for Canadian harm re... more Our aim was to create an evidence-based set of user-friendly recommendations for Canadian harm reduction programs that provide service to people who use drugs and are at risk for HIV and other harms. This new document addresses practice issues not addressed in Part 1 (see www.catie.ca/en/programming/best-practices-harm-reduction) which focused on equipment distribution for injection drug use and smoking crack cocaine, safer drug use education, and overdose prevention. We used a narrative synthesis method to search, retrieve, assess, and synthesize the most up-to-date evidence from Canada, United States, Great Britain, Europe, Australia, and other countries with public health systems similar to Canada. Scientific evidence was reviewed to create syntheses and recommendations concerning the following areas of practice: service model design; equipment distribution for steroid/hormone injection, piercing and tattooing, smoking heroin, and smoking crystal methamphetamine; testing and vaccination; skin and vein care; referrals to HIV and HCV treatment, substance use treatment, mental health services, and housing services; education and other services for the prison context; and relationships with law enforcement. Due to study designs (i.e., evidence from cross-sectional studies) and/or limited available evidence, it was difficult to ascertain ‘key’ intervention components for some topic areas. Using varied knowledge exchange methods by multiple team members (including conference presentations, webinars, fact sheets, and panel discussions), our goal is to promote awareness of and access to the Best Practice Recommendations among harm reduction practitioners across Canada. Changing existing harm reduction policies and practices to be in line with these newer recommendations will improve the health of marginalized populations by reducing inequities including improved access to safer injection and inhalation supplies.
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