‘The biggest mistake God ever made was to create junkies’: Unsafe injection practices, health care discrimination and overdose deaths in Montreal, Canada

Jozaghi, Ehsan

doi:10.15353/cgjsc-rcessc.v2i1.16

Cited by 5 publications

(5 citation statements)

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“…This increased risk among the unstably housed may be a consequence of inability to maintain safe and hygienic injection practices when injecting in public places, where injections may be hurried, with a lack of clean surfaces, poor lighting and difficulties in accessing clean water to use as a drug solvent [11][12][13][14][15]. The use of water from toilets, cisterns, ditches and puddles has been noted [11,[15][16][17][18][19][20][21][22][23], and these sources are likely to be contaminated with particulates and microorganisms. Although few studies have specifically explored the role of water used to prepare injections in relation to SSTI among PWID, there are indications that the use of puddle and toilet water is a risk [20,21].…”

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confidence: 99%

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

et al. 2020

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Background: The United Kingdom is experiencing an increase in drug-related deaths and serious bacterial infections among its most vulnerable citizens. Cuts to essential services, coupled with a growing homeless population, create a challenging environment to tackle this public health crisis. In this paper, we highlight an underexplored environmental constraint faced by people living and injecting drugs on the streets. Access to water for injection is restricted in the UK, due to legislative and financial barriers. Austerity measures, such as public toilet closures, further restrict the ability of people made homeless to access clean water and protect themselves from health harms. Methods: We generated questionnaire (n = 455) and in-depth qualitative interview (n = 32) data with people who inject drugs in London for the Care and Prevent study. Participants provided detail on their life history; drug use, injecting and living environments; health conditions and care seeking practices. Findings: A high proportion of the survey sample reported lifetime history of street homelessness (78%), bacterial infections (65%) and related hospitalisation (30%). Qualitative accounts highlight unsafe, potentially dangerous, injection practices in semi-public spaces. Multiple constraints to sourcing sterile water for injection preparation were reported. Alternatives to sterile water included puddle water, toilet cistern water, whisky, cola soda and saliva. Participants who injected heroin and crack cocaine together unanimously reported adding water at two stages during injection preparation: first, adding water as a vehicle for heroin (which was then heated); second, adding cold water to the heroin mixture prior to adding the crack cocaine. This new finding of a stage addition of solvent may represent an additional risk of infection.(Continued on next page)

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confidence: 99%

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

et al. 2020

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“…The study was facilitated through recruitment of participants through purposive sampling via key informants (Jozaghi & Andresen, 2013 ; Jozaghi, 2013 ). The researcher and the key informants had a pre-existing relationship that was established during the researcher’s previous volunteer work in the DTES.…”

Section: Methodsmentioning

confidence: 99%

“SALOME gave my dignity back”: The role of randomized heroin trials in transforming lives in the Downtown Eastside of Vancouver, Canada

Jozaghi

2014

International Journal of Qualitative Studies on Health and Well

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Although numerous studies on heroin-assisted treatment (HAT) have been published in leading international journals, little attention has been given to HAT’s clients, their stories, and what constitutes the most influential factor in the treatment process. The present study investigates the role of HAT in transforming the lives of injection drug users (IDUs) in Vancouver, Canada. This study is qualitative focusing on 16 in-depth interviews with patients from the randomized trials of HAT. Interviews were transcribed verbatim and analyzed thematically using NVivo 10 software. The findings revealed a positive change in many respects: the randomized trials reduce criminal activity, sex work, and illicit drug use. In addition, the trials improved the health and social functioning of its clients, with some participants acquiring work or volunteer positions. Many of the participants have been able to reconnect with their family members, which was not possible before the program. Furthermore, the relationship between the staff and patients at the project appears to have transformed the behavior of participants. Attending HAT in Vancouver has been particularly effective in creating a unique microenvironment where IDUs who have attended HAT have been able to form a collective identity advocating for their rights. The result of this research points to the need for continuation of the project beyond the current study, leading toward a permanent program.

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“…Across all cities, PWID were accessible and congregated in public spaces. This is to be expected and is described in the literature and ascribed to easy access to both consumers and dealers [ 28 ], safety-seeking [ 28 , 29 ], income generation [ 30 ] and socialisation [ 29 ]. The complex nexus of police action and ability to practice harm reduction in public spaces has also been described in the literature [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 96%

“…This finding confirms similar reports noting the need to improve relationships between PWID and law enforcement officers, with a move away from criminalising people who use drugs [ 36 – 39 ] and exploring options of police assisted referral to harm reduction services [ 40 ]. International data from various settings highlights that fear of and experienced negative engagement with police contributes to rushed and unsafe injecting practices [ 30 , 41 – 44 ]. The role of private security, who play an integral part of South Africa’s security sector, has also been described as having a negative impact on access to health services and the rights of PWID [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Using a programmatic mapping approach to plan for HIV prevention and harm reduction interventions for people who inject drugs in three South African cities

et al. 2017

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BackgroundStigma, criminalisation and a lack of data on drug use contribute to the “invisibility” of people who inject drugs (PWID) and make HIV prevention and treatment service delivery challenging. We aimed to confirm locations where PWID congregate in Cape Town, eThekwini and Tshwane (South Africa) and to estimate PWID population sizes within selected electoral wards in these areas to inform South Africa’s first multi-site HIV prevention project for PWID.MethodsField workers (including PWID peers) interviewed community informants to identify suspected injecting locations in selected electoral wards in each city and then visited these locations and interviewed PWID. Interviews were used to gather information about the accessibility of sterile injecting equipment, location coordinates and movement patterns. We used the Delphi method to obtain final population size estimates for the mapped wards based on estimates from wisdom of the crowd methods, the literature and programmatic data.ResultsBetween January and April 2015, we mapped 45 wards. Tshwane teams interviewed 39 PWID in 12 wards, resulting in an estimated number of accessible PWID ranging from 568 to 1431. In eThekwini, teams interviewed 40 PWID in 15 wards with an estimated number of accessible PWID ranging from 184 to 350. The Cape Town team interviewed 61 PWID in 18 wards with an estimated number of accessible PWID ranging between 398 and 503. Sterile needles were only available at one location. Almost all needles were bought from pharmacies. Between 80 and 86% of PWID frequented more than one location per day. PWID who reported movement visited a median of three locations a day.ConclusionsProgrammatic mapping led by PWID peers can be used effectively to identify and reach PWID and build relationships where access to HIV prevention commodities for PWID is limited. PWID reported limited access to sterile injecting equipment, highlighting an important HIV prevention need. Programmatic mapping data show that outreach programmes should be flexible and account for the mobile nature of PWID populations. The PWID population size estimates can be used to develop service delivery targets and as baseline measures.

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‘The biggest mistake God ever made was to create junkies’: Unsafe injection practices, health care discrimination and overdose deaths in Montreal, Canada

Abstract: Despite the existence of prevention programmes in Montreal, Canada, injection drug users (IDUs) continue to share their injection drug equipment. This practice has led to an increase in the incidences of HIV and Hepatitis C (HCV)

Cited by 5 publications

References 20 publications

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

“SALOME gave my dignity back”: The role of randomized heroin trials in transforming lives in the Downtown Eastside of Vancouver, Canada

Using a programmatic mapping approach to plan for HIV prevention and harm reduction interventions for people who inject drugs in three South African cities

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