Women's utilization of housing-based overdose prevention sites in Vancouver, Canada: An ethnographic study
Women's utilization of housing-based overdose prevention sites in Vancouver, Canada: An ethnographic study
复制标题
DOI：
10.1016/j.drugpo.2019.102641
复制
发表时间：
2020-02-01
影响因子：
4.4
通讯作者：
McNeil, Ryan
中科院分区：
文献类型：
--
作者：
Collins, Alexandra B.;Boyd, Jade;McNeil, Ryan
背景资料：为了应对芬太尼导致的过量用药危机，加拿大温哥华迅速建立了低阈值监督消费场所，称为过量预防场所。由于该省约88%的致命吸毒过量发生在室内，OPS已被整合到选定的非营利性运营的单间住宿（SRA）住房中。我们研究了这些住房为基础的老年退休金计划（HOPS）对妇女的过量risk.Methods的社会结构特征：人种学研究进行了2017年5月至2018年12月在温哥华。数据包括35个深入访谈的妇女谁使用药物生活在SRA和大约100小时的观察性实地工作在SRA和周边地区。数据进行了分析，使用一个交叉的风险环境的方法，注意公平和violence.Findings：结果表明，HOPS的社会和结构环境的障碍，妇女获得这些干预措施，导致过量用药的风险增加。主要障碍包括不确定还有谁在使用HOPS，禁止吸烟的规定，以及对工作人员有效应对过量用药的能力缺乏信任。大多数参与者认为HOPS是不安全的环境，并表示担心居民和/或客人的暴力行为。感知到的暴力风险来自以前的攻击经历和暴力目击。因此，许多参与者在房间里独自服用药物，以更好地控制他们的安全，尽管过量服用的风险增加。此外，大多数参与者并不认为自己是在过量的风险，由于药物使用的做法和耐受水平，并认为单独使用作为一个更安全的选项比HOPS.Conclusion：研究结果强调如何低障碍的设计和操作的HOPS可以破坏妇女的参与与HOPS。SRA中的过量预防战略还应包括针对性别的模式（例如，仅限女性的HOPS，女性同行工作者），以帮助在当前过量危机的背景下减少获得这些服务的障碍。
Background: In response to a fentanyl-driven overdose crisis, low-threshold supervised consumption sites, termed overdose prevention sites (OPS), have been rapidly implemented in Vancouver, Canada. Since approximately 88% of fatal overdoses in the province occur indoors, OPS have been integrated into select nonprofit-operated single room accommodations (SRA) housing. We examined the social-structural features of these housing-based OPS (HOPS) on women's overdose risk.Methods: Ethnographic research was conducted from May 2017 to December 2018 in Vancouver. Data included 35 in-depth interviews with women who use drugs living in SRAs and approximately 100 h of observational fieldwork in SRAs and surrounding areas. Data were analyzed using an intersectional risk environment approach, with attention to equity and violence.Findings: Findings demonstrate that the social and structural environments of HOPS created barriers for women to access these interventions, resulting in an increased overdose risk. Primary barriers included uncertainty as to who else was accessing HOPS, rules prohibiting smoking, and a lack of trust in staff's abilities to effectively respond to an overdose. Most participants considered HOPS to be unsafe environments, and expressed fear of violence from residents and/or guests. The perceived risk of violence was informed by previous experiences of assault and the witnessing of violence. Many participants thus consumed drugs alone in their rooms to better control their safety, despite heightened overdose risk. Further, most participants did not perceive themselves to be at risk of an overdose due to drug use practices and tolerance levels, and viewed using alone as a safer option than HOPS.Conclusion: Findings highlight how the low-barrier design and operation of HOPS can undermine women's engagement with HOPS. Overdose prevention strategies in SRAs should also include gender-specific models (e.g. women-only HOPS, women peer workers) to help mitigate barriers to these services within the context of the current overdose crisis.