The impact of rurality on opioid-related harms: A systematic review of qualitative research

Thomas, Natalie; Ven, Katinka van de; Mulrooney, Kyle

doi:10.1016/j.drugpo.2019.11.015

Cited by 36 publications

(39 citation statements)

References 73 publications

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“…Relatedly, Pear et al have shown that non-fatal overdose rates are more common in impoverished localities (50). Thomas et al reviewed relevant qualitative research studies based in rural areas and found that economic, isolation and other physical conditions, social and policy environments were implicated in opioid-related harm (51).…”

Section: Communities Of Despairmentioning

confidence: 99%

The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided Struggle

Friedman

Krawczyk

Perlman

et al. 2020

Front. Public Health

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The opioid/overdose crisis in the United States and Canada has claimed hundreds of thousands of lives and has become a major field for research and interventions. It has embroiled pharmaceutical companies in lawsuits and possible bankruptcy filings. Effective interventions and policies toward this and future drug-related outbreaks may be improved by understanding the sociostructural roots of this outbreak. Much of the literature on roots of the opioid/overdose outbreak focuses on (1) the actions of pharmaceutical companies in inappropriately promoting the use of prescription opioids; (2) "deaths of despair" based on the deindustrialization of much of rural and urban Canada and the United States, and on the related marginalization and demoralization of those facing lifetimes of joblessness or precarious employment in poorly paid, often dangerous work; and (3) increase in occupationally-induced pain and injuries in the population. All three of these roots of the crisis-pharmaceutical misconduct and unethical marketing practices, despair based on deindustrialization and increased occupational pain-can be traced back, in part, to what has been called the "one-sided class war" that became prominent in the 1970s, became institutionalized as neo-liberalism in and since the 1980s, and may now be beginning to be challenged. We describe this one-sided class war, and how processes it sparked enabled pharmaceutical corporations in their misconduct, nurtured individualistic ideologies that fed into despair and drug use, weakened institutions that created social support in communities, and reduced barriers against injuries and other occupational pain at workplaces by reducing unionization, weakening surviving unions, and weakening the enforcement of rules about workplace safety and health. We then briefly discuss the implications of this analysis for programs and policies to mitigate or reverse the opioid/overdose outbreak.

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Section: Communities Of Despairmentioning

confidence: 99%

The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided Struggle

Friedman

Krawczyk

Perlman

et al. 2020

Front. Public Health

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“…These populations are not exclusively observed in France, and we consider that our programme is a suitable response to the hard-to-reach populations problematic in other countries with some adaptations regarding local conditions and socio-cultural particularities. The difficulty to access harm reduction tools for these populations was already identified in several countries (see [43] for review). Moreover, several times a year, PWUD in neighbouring countries (especially Belgium, Switzerland, and Spain) contact us to benefit from HaRePo.…”

Section: Harepo: a Programme Adapted For People Engaging In Chemsexmentioning

confidence: 99%

HaRePo (harm reduction by post): an innovative and effective harm reduction programme for people who use drugs using email, telephone, and post service

Torres-Leguizamon¹,

Reynaud

Néfau³

et al. 2020

Harm Reduct J

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Background: Despite multiple harm reduction (HR) programmes worldwide, there are still an important number of people who use drugs (PWUD) who do not access those services. Their difficulties to obtain HR tools are due to their inability to reach such services (remoteness and/or limited customer service hours), costs, quantitative restrictions, fear of judgement, lack of confidentiality in pharmacy, and unfamiliarity with HR programmes. We tested an innovative approach using the power of remote online communication and the national postal distribution network to improve HR tool access and counselling. Methods: Based on these observations, SAFE association created HaRePo in 2011, a free and confidential programme designed for people who have difficulties accessing HR tools and counselling. PWUD can access the programme by phone and/or email. An HR professional delivers HR counselling and HR tools and connects PWUD to other HR services, medical, and social workers. HR tools are prepared and sent according to the person's needs through the French postal service to consumers across Metropolitan France and overseas territories. Results: Since 2011, 1920 PWUD have benefited from HaRePo: 10,450 parcels were sent accounting for more than 1.7 million syringes and 6 million HR-related items. HaRePo receives positive feedback from PWUD who have improved their practices through remote but trusted communication. The percentage of people that, after joining the programme, never reuse and/or share HR tools have significantly increased. On average, 71.5% of beneficiaries never reuse syringes and 81% do not reuse needles. And they are 98.5% consumers who never share syringes and 99% needles any longer. Between 44 and 80% HaRePo beneficiaries have reported that their drug-related practices (injection, inhalation, and snorting) are now safer. Finally, between 39 and 53% HaRePo consumers declared that their overall physical state has improved (e.g. venous condition, the appearance of point of injection, swelling of arms, legs, and hands). Conclusion: HaRePo is an innovative HR programme efficient for hard-to-reach PWUD. It shows evidence of a positive feedback loop for PWUD in improving their practices. Finally, HaRePo represents a clear benefit for health authorities in France, who decided to expand the programme in 2016.

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“…These populations are not exclusively observed in France and we consider that our program is a suitable response to the hard-to-reach populations problematic in other countries with some adaptations regarding local conditions and socio-cultural particularities. The di culty to access harm reduction tools for these populations was already identi ed in several countries (see [43] for review). Moreover, several times a year PWUD in neighbouring countries (especially Belgium, Switzerland, and Spain) contact us to bene t from HaRePo.…”

Section: Is Harepo a Solution Adapted To Other Countries?mentioning

confidence: 99%

HaRePo (Harm Reduction by Post): An Innovative and Effective Harm Reduction Program for People Who Use Drugs Using Email, Telephone and Post-Service.

Leguizamon¹,

Reynaud

Néfau

et al. 2020

Preprint

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BackgroundDespite multiple Harm Reduction (HR) programs worldwide, there are still an important number of people who use drugs (PWUD) who do not access those services. Their difficulties to obtain HR tools are due to their inability to reach such services (remoteness and/or limited customer service hours), costs, quantitative restrictions, fear of judgment, lack of confidentiality in pharmacy and unfamiliarity with HR programs. We tested an innovative approach using the power of remote online communication and the national postal distribution network to improve HR tools access and counselling.MethodsBased on these observations, SAFE association created HaRePo in 2011, a free and confidential program designed for people who have difficulties accessing HR tools and counselling. PWUD can access the program by phone and/or email. An HR professional answers any questions, delivers HR counselling, and connects the PWUD to other HR services, medical, and social workers. HR tools are prepared and sent according to the person’s needs through the French postal service to users across Metropolitan France and overseas territories.ResultsSince 2011, 1920 PWUD have benefited from HaRePo: 10,450 parcels were sent accounting for more than 1.7 million syringes and 6 million HR related items. HaRePo receives positive feedback from PWUD who have improved their practices through remote but trusted communication. The percentage of people that, after joining the program, never reuse and/or share HR tools have significantly increased. On average 71.5% of beneficiaries never reuse syringes and 81% do not reuse needles. And they are 98.5% users who never share syringes and 99% needles any longer. Between 44% and 80% HaRePo beneficiaries have reported that their drug-related practices (injection, inhalation and snorting) are now safer. Finally, between 39% and 53% HaRePo users declared that their overall physical state has improved (e.g., venous condition, the appearance of point of injection, swelling of arms, legs, and hands).ConclusionHaRePo is an innovative HR program efficient for hard-to-reach PWUD. It shows evidence of a positive feedback loop for PWUD in improving their practices. Finally, HaRePo represents a clear benefit for health authorities in France, who decided to expand the program in 2016.

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The impact of rurality on opioid-related harms: A systematic review of qualitative research

Cited by 36 publications

References 73 publications

The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided Struggle

The Opioid/Overdose Crisis as a Dialectics of Pain, Despair, and One-Sided Struggle

HaRePo (harm reduction by post): an innovative and effective harm reduction programme for people who use drugs using email, telephone, and post service

HaRePo (Harm Reduction by Post): An Innovative and Effective Harm Reduction Program for People Who Use Drugs Using Email, Telephone and Post-Service.

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