(Re)situating expertise in community-based overdose response: Insights from an ethnographic study of overdose prevention sites (OPS) in Vancouver, Canada.
(Re)situating expertise in community-based overdose response: Insights from an ethnographic study of overdose prevention sites (OPS) in Vancouver, Canada.
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（重新）定位基于社区的药物过量反应的专业知识：来自加拿大温哥华药物过量预防站点（OPS）的人种学研究的见解。
DOI：
10.1016/j.drugpo.2022.103929
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
McNeil,Ryan
中科院分区：
文献类型：
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作者：
Olding,Michelle;Boyd,Jade;Kerr,Thomas;Fowler,Al;McNeil,Ryan
过量预防站点（OPS）是低门槛服务，人们可以在经过培训的工作人员的监督下使用非法药物，以便在过量时提供挽救生命的护理。在加拿大不列颠哥伦比亚省，OPS作为以社区为基础的应对过量危机的措施已迅速扩大，其工作人员主要由同时也是吸毒者的社区成员组成（PWUD）。虽然已知PWUD在OPS和其他以社区为基础的过量干预中发挥着重要作用，但PWUD在这项工作中的专业知识和专家知识仍然缺乏理论化。本研究利用在不列颠哥伦比亚省温哥华（2018年7月至2020年3月）进行的20个月的人种学田野调查，探索PWUD的OPS应答者如何在过量反应方面发展和制定专业知识。人种学田野调查的重点是位于温哥华市中心东区（DTES）和市中心南区的四个OPS。方法包括在站点及周边地区进行100小时的观察，与OPS响应者（n=20）组成3个站点特定焦点小组，与OPS响应者（n=14）和服务用户（n=23）进行半结构化访谈。对数据进行了分析，目的是表征支持响应者专业知识的知识，以及允许形成和制定专业知识的安排。我们发现，OPS响应者的专业知识是建立在经验知识的基础上的，这些经验知识是通过他们作为PWUD和从事互助的更广泛的活动分子社区成员的地位获得的。通过频繁的实践，反应者在过量反应方面变得熟练，并利用他们在过量方面的经验和具体知识，提供既精通技术又能满足PWUD更广泛需求的护理（例如，防止刑事定罪和污名化治疗）。答复者强调，项目厅的空间安排通过促进更专门和全面的过量治疗来支持专门知识的发展。由于应急小组对过量管理形成了共同的理解，包括管理不确定性的过程、授权小组责任和分享决策，OPS成为了过量管理方面的集体专业知识的场所。本研究重新定位了社区过量反应专业知识的理论理解，并对过量预防干预产生了影响。研究结果强调了PWUD作为社区反应者的经验和具体专业知识；支持环境和以团队为基础的方法对过量反应的重要性；社区驱动的培训的好处不仅仅是过量识别和纳洛酮管理的技术技能。
Overdose Prevention Sites (OPS) are low-barrier services where people may use illicit drugs under the monitoring of staff trained to provide life-saving care in the event of an overdose. In British Columbia (BC), Canada, OPS have been rapidly scaled-up as a community-based response to the overdose crisis and are staffed primarily by community members who are also people who use drugs (PWUD). While it is known that PWUD perform vital roles in OPS and other community-based overdose interventions, the expertise and expert knowledge of PWUD in this work remains under-theorised. This study draws on 20 months of ethnographic fieldwork in Vancouver, BC (July 2018 to March 2020), to explore how OPS responders who are PWUD developed and enacted expertise in overdose response. Ethnographic fieldwork focused on four OPS located in Vancouver's Downtown Eastside (DTES) and Downtown South neighbourhoods. Methods included 100 hours of observation in the sites and surrounding areas, three site-specific focus groups with OPS responders (n=20), and semi-structured interviews with OPS responders (n=14) and service users (n=23). Data was analysed with the aim of characterizing the knowledge underpinning responders’ expertise, and the arrangements which allow for the formation and enactment of expertise. We found that OPS responders’ expertise was grounded in experiential knowledge acquired through their positionality as PWUD and members of a broader community of activists engaged in mutual aid. Responders became skilled in overdose response through frequent practice and drew on their experiential and embodied knowledge of overdose to provide care that was both technically proficient and responsive to the broader needs of PWUD (e.g. protection from criminalization and stigmatizing treatment). Responders emphasized that the spatial arrangements of OPS supported the development of expertise by facilitating more specialized and comprehensive overdose care. OPS became sites of collective expertise around overdose management as responder teams developed shared understandings of overdose management, including processes for managing uncertainty, delegating team responsibilities, and sharing decision-making. This research re-situates theoretical understandings of expertise in community-based overdose response with implications for overdose prevention interventions. Findings underscore the experiential and embodied expertise of PWUD as community-based responders; the importance of supportive environments and team-based approaches for overdose response; and the benefits of community-driven training that extends beyond technical skills of overdose identification and naloxone administration.