The intersectional risk environment of people who use drugs

Collins, Alexandra B.; Boyd, Jade; Cooper, Hannah L.F.; McNeil, Ryan

doi:10.1016/j.socscimed.2019.112384

Cited by 139 publications

(100 citation statements)

References 73 publications

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“…For example, participants with unstable housing or mobility issues described difficulty fully engaging with the program because of its restrictive schedule and operating hours. Understanding the intersection of socio-structural forces (e.g., poverty, unstable housing) and their role in program engagement is critical to the design, implementation, and optimization of future HDM/opioid distribution programs ( Collins et al, 2019 ), and other interventions implemented in response to the overdose crisis.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study

Ivsins

Boyd

Mayer

et al. 2020

Drug and Alcohol Dependence

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Highlights Examines engagement with a hydromorphone distribution program in Vancouver, Canada. Barriers included operating hours, dosing schedule, and generic formulations. Facilitators included reliable source of opioids, agency, and program flexibility. Location in overdose prevention site a barrier and facilitator depending on needs. Such programs represent promising intervention to address the overdose crisis.

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Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study

Ivsins

Boyd

Mayer

et al. 2020

Drug and Alcohol Dependence

Self Cite

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“…When an economic crisis worsens and austerity measures are implemented, public health infrastructure can be stressed and the "risk environments" for SUD may expand (42). Poverty drives people to rely on informal economies (e.g., sex work, drug dealing) associated with illicit drug use.…”

Section: Covid-19 Induced Economic Public Health and Social Challenmentioning

confidence: 99%

Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions

et al. 2020

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COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and wellbeing. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.

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“…When considering the range of potential effects that COVID-19, physical distancing, and other restrictions might have on people who use drugs, it is helpful to consider the established body of work in the field of harm reduction and drug policy that accentuates health as a matter of contingency in relation to environment ( Collins et al, 2019 , Duff, 2007 , Duff, 2013 , Rhodes, 2009 ). This has led to various articulations of ‘risk environment’ and ‘enabling environment’ which appreciate health and harm as emergent dynamics of reciprocal relations produced in adaptive systems in which drugs, individuals, technologies and environments are entangling elements ( Duff, 2014 , Rhodes, 2009 ).…”

Section: Introductionmentioning

confidence: 99%

“…Health, and harm reduction, are viewed as contingent effects of the coming together of multiple social, economic, and political factors. Table 1 illustrates how ‘risk environment’ thinking has been applied in the drug policy field to prompt a depiction of risk and harm as an effect of intersecting environments at differing scales [See, for example: ( Bluthenthal et al, 1999 , Bourgois, 2003 , Collins et al, 2019 , Cooper et al, 2016 , Hunter et al, 2018 , Kolak et al, 2020 , Rhodes, 2002 , Strathdee et al, 2008 , Strathdee et al, 2015 , Thomas et al, 2019 )]. At the same time, articulations of ‘risk environment’ translate health improvement as an effect of the ‘enabling environment’ by accentuating health as contingent upon social interventions and structural changes ( Collins et al, 2019 , Rhodes, 2009 ).…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and the health of people who use drugs: What is and what could be?

Grebely

Cerdá

Rhodes

2020

International Journal of Drug Policy

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SARS-CoV-2, the virus that causes COVID-19, has changed the world as we know it, and continues to do so. How COVID-19 affects people who use drugs, the environments in which they live, and capacities of response, warrants immediate attention. This special issue begins to map how COVID-19 is altering the health of people who use drugs, including in relation to patterns of drug use, service responses, harms that may relate to drug use, interventions to reduce risk of harms, COVID-19 health, and drug policies. We emphasise the need to envisage COVID-19 and its effects as a matter of intersecting ‘complex adaptive systems’: that is, the impacts of COVID-19 extend beyond the virus and related illness conditions to encompass multiple social, cultural, economic, policy and political effects; and these affect the health of people who use drugs directly as well as indirectly by altering the risk and enabling environments in which they live. We synthesize emergent evidence on the impact of COVID-19 on the health of people who use drugs. A key concern we identify is how to sustain policy and service delivery improvements prompted by COVID-19. We need to maintain an ethos of emergent adaptation and experimentation towards the creation of safer environments in relation to the health of people who use drugs.

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The intersectional risk environment of people who use drugs

Cited by 139 publications

References 73 publications

Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study

Barriers and facilitators to a novel low-barrier hydromorphone distribution program in Vancouver, Canada: a qualitative study

Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions

COVID-19 and the health of people who use drugs: What is and what could be?

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