Safety and danger: Perceptions of the implementation of harm reduction programs in two communities in Nova Scotia, Canada

Abstract

People who use substances (PWUS), and specifically individuals who use injection drugs and/or smoke crack cocaine, experience risks which harm reduction programmes can help reduce. Prior to implementing harm reduction programmes, however, it is critical to understand how programme users and others in the community perceive the programmes as their perceptions may influence implementation.A mixed-methods study asked PWUS and key informants about their perceptions of implementing five harm reduction programmes in their communities, including perceptions of the advantages of the programmes, where best to locate them, and community support. Questionnaires were administered to 160 PWUS, and qualitative interviews were conducted with 11 purposefully sampled key informants. Data were collected in one medium-size and one small-size community/municipality in Nova Scotia, Canada, during 2017-2018. SPSS was used to generate descriptive statistics and means from the quantitative data, and the qualitative data were analysed for key themes using thematic analysis. Both PWUS and key informants perceived numerous advantages of the harm reduction programmes, but some key informants suggested that there might be potential opposition to the implementation of additional needle distribution and disposal programmes in some locations and potential opposition to safer consumption sites. Further research is needed to understand why these programmes were viewed as potentially generating opposition, but findings suggest that a key factor is the association of the programmes with 'danger' because the programmes are directly linked with criminalized drug use. In contrast, the three other programmes are linked to 'safety' because naloxone saves lives, peer navigation programmes support access to existing programmes and detoxification programmes are associated with safety through the reduction/elimination of drug use. Legalization/ decriminalization of drugs might help to change the association of some programmes with 'danger' and therefore help support the implementation of harm reduction programmes that appear to be perceived by some as linked to danger.

Client experiences using a new supervised consumption service in Sudbury, Ontario: A qualitative study

“…In a study by Jackson et al, (2022), PWUD in Nova Scotia primarily believed a SCS should be located in the same place as their local needle exchange, indicating the importance of a centralized and easily accessible location [ 30 ]. Many participants also suggested that SCS should be mobile, which can also increase accessibility [ 30 ]. However, finding a suitable location that community members can agree on can also be a contentious issue, which may be particularly relevant for smaller more tight-knit communities, as was the case for The Spot.…”

“…Therefore, having the site integrated within other existing services as a one-stop-shop for PWUD within Sudbury could facilitate connections and referrals to other services. In a study by Jackson et al, (2022), PWUD in Nova Scotia primarily believed a SCS should be located in the same place as their local needle exchange, indicating the importance of a centralized and easily accessible location [30]. Many participants also suggested that SCS should be mobile, which can also increase accessibility [30].…”

How do we understand the value of drug checking as a component of harm reduction services? A qualitative exploration of client and provider perspectives

“…The role of harm reduction services within communities have long reflected a central tension: in contrast with abstinence and criminalization models, harm reduction is often socially and politically criticized as enabling drug use and making neighborhoods less safe [67][68][69], while research consistently finds harm reduction to yield positive outcomes for both service users and surrounding communities [70,71]. In addition to improving the health and wellbeing of people using drugs, evidence suggests that those accessing harm reduction services are more likely to ultimately seek treatment and pursue recovery [49,70,72,73].…”

Governing Risk Through Forced Confinement: Clawback of Pre-Pandemic Reforms

“…At the same time, certain people are constructed as “vulnerable” through policy discourse (Larios and Paterson 2021). In public health and policy literatures, opposition to health programming, in the community and in carceral institutions, is linked to the association of programs with danger, particularly that presented by criminalized populations, and the desire for those populations to be spatially contained to protect those deemed vulnerable (Jackson et al 2021). Literature on dangerous offenders and protective surveillance has long recognized mobilization against those labelled “risky” (Matravers and Hughes 2003; Shore 2021).…”