Objective We sought to describe an emerging drug use pattern characterized by injection of both methamphetamine and heroin. We examined differences in drug injection patterns by demographics, injection behaviors, HIV and HCV status, and overdose. Methods Persons who inject drugs (PWID) were recruited as part of the National HIV Behavioral Surveillance (NHBS) system in Denver, Colorado. We used chi-square statistics to assess differences between those who reported only heroin injection, only methamphetamine injection, and combined heroin and methamphetamine injection. We used generalized linear models to estimate unadjusted and adjusted prevalence ratios to describe the association between drug injection pattern and reported nonfatal overdose in 2015. We also examined changes in the drug reported as most frequently injected across previous NHBS cycles from 2005, 2009, and 2012. Results Of 592 participants who completed the survey in 2015, 173 (29.2%) reported only injecting heroin, 123 (20.8%) reported only injecting methamphetamine, and 296 (50.0%) reported injecting both drugs during the past 12 months. Injecting both heroin and methamphetamine was associated with a 2.8 (95% confidence interval: 1.7, 4.5) fold increase in reported overdose in the past 12 months compared with only injecting heroin. The proportion of those reporting methamphetamine as the most frequently injected drug increased from 2.1% in 2005 to 29.6% in 2015 (p < 0.001). Conclusions The rapid increase in methamphetamine injection, and the emergence of combining methamphetamine with heroin, may have serious public health implications.

Background Overdose Education and Naloxone Distribution (OEND) training for persons who inject drugs (PWID) underlines the importance of summoning emergency medical services (EMS). To encourage PWID to do so, Colorado enacted a Good Samaritan law providing limited immunity from prosecution for possession of a controlled substance and/or drug paraphernalia to the overdose victim and the witnesses who in good faith provide emergency assistance. This paper examines the law’s influence by describing OEND trained PWIDs’ experience reversing overdoses and their decision about calling for EMS support. Methods Findings from two complementary studies, a qualitative study based on semi-structured interviews with OEND trained PWID who had reversed one or more overdoses, and an on-going fieldwork-based project examining PWIDs’ self-identified health concerns were triangulated to describe and explain participants’ decision to call for EMS. Results In most overdose reversals described, no EMS call was made. Participants reported several reasons for not doing so. Most frequent was the fear that despite the Good Samaritan law, a police response would result in arrest of the victim and/or witness for outstanding warrants, or sentence violations. Fears were based on individual and collective experience, and reinforced by the city of Denver’s aggressive approach to managing homelessness through increased enforcement of misdemeanors and the imposition of more recent ordinances, including a camping ban, to control space. The city’s homeless crisis was reflected as well in the concern expressed by housed PWID that an EMS intervention would jeopardize their public housing. Conclusion Results suggest that the immunity provided by the Good Samaritan law does not address PWIDs’ fear that their current legal status as well as the victim’s will result in arrest and incarceration. As currently conceived, the Good Samaritan law does not provide immunity for PWIDs’ already enmeshed in the criminal justice system, or PWID fearful of losing their housing.

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As gentrification processes accelerate in American cities, how do newcomers become solidly in-place while longtime residents become hopelessly out-of-place in neighbourhood public spaces? Bringing focus to the often-overlooked public right-of-way – streets, sidewalks and alleys – I examine social rhythms comprising this network of public spaces when used as an everyday infrastructure of transportation and socialisation or when configured for special events. Using the notion of symbolic economy to link the social production of public space with the municipal regulation of public space, this essay approaches gentrification from three perspectives: conflict, commodification and cosmopolitanism. Focusing on Highland, a rapidly gentrifying neighbourhood in Denver, Colorado, I first delve into skirmishes over street legitimacy. I then unpack quiet workaday measures used by cities to regulate the public right-of-way, namely parking policy and liquor license issuances. I move on to the commodification of ethnic culture by those who ultimately benefit from the displacement of Latino families from North Denver. Lastly, I engage with the concept cosmopolitanism, arguing that diversity discourses, both in the academy and on the street, obscure important relationships between asymmetrically positioned symbolic economies and low-level regulation of public space. Foregrounding routine urban governance over neoliberal agendas, this study critiques gentrification as a commonsense urban policy.

People reside in homes; however, they live in neighbourhoods comprised of parks, sidewalks, restaurants, shops and other everyday places. Whether current or potential neighbourhood residents feel at home in these places remains an undertheorised aspect of neighbourhood change. Rather than housing policy or real estate development, this essay explores public space as a mechanism of neighbourhood change. Drawing from ethnographic research in the Latino barrios of North Denver, It deconstructs the history of one small yet vital public space-la Raza Park. During the 1970s, this park, its pool and the many events it grounded, built community cohesion and fostered cultural identity. In 1981, city authorities went so far as to deploy a SWAT team to la Raza Park to enforce a permit violation. The following summer, they demolished its pool. North Denver is now gentrifying rapidly. This essay stitches these disparate-seeming events into a story of neighbourhood change.