Citation

Boyd J, Collins AB, Mayer S, Maher L, Kerr T, McNeil R. Addiction 2018; 113(12): 2261-2270.

Affiliation

Department of Medicine, University of British Columbia, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.

Copyright

(Copyright © 2018, John Wiley and Sons)

DOI

10.1111/add.14417

PMID

30211453

Abstract

BACKGROUND AND AIMS: North America's overdose epidemic is increasingly driven by fentanyl and fentanyl-adulterated drugs. Supervised consumption sites, including low-threshold models (termed Overdose Prevention Sites; OPS), are now being debated in the United States and implemented in Canada. Despite evidence that gendered and racialized violence shape access to harm reduction among women who use drugs (WWUD), this has not been examined in relation to OPS and amidst the overdose epidemic. This study explores how overlapping epidemics of overdose and gendered and racialized violence in Vancouver's Downtown Eastside, one of North America's overdose epicenters, impacts how marginalized WWUD experience OPS.

DESIGN: Qualitative analysis using rapid ethnographic fieldwork. Data collection included 185 hours of naturalistic observation and in-depth interviews; data were analyzed thematically using NVivo. SETTING: Vancouver, Canada PARTICIPANTS: 35 WWUD recruited from three OPS MEASUREMENTS: Participants' experiences of OPS and the public health emergency.

FINDINGS: The rapid onset and severity of intoxication associated with the use of fentanyl-adulterated drugs in less regulated drug use settings not only amplified WWUD's vulnerability to overdose death but also violence. Participants characterized OPS as safer spaces to consume drugs in contrast to less regulated settings, and accommodation of assisted injections and injecting partnerships was critical to increasing OPS access among WWUD. Peer administered injections disrupted gendered power relations to allow women increased control over their drug use, however, participants indicated that OPS were also gendered and racialized spaces that jeopardized some women's access.

CONCLUSION: Although women who use drugs in Vancouver, Canada appear to feel that Overdose Prevention Sites (OPS) address forms of everyday violence made worse by the overdose epidemic, OPS remain 'masculine spaces' that can jeopardize women's access.

This article is protected by copyright. All rights reserved.

Language: en

Keywords

Harm Reduction; Intersectionality; Overdose; Risk Environment; Safe Consumption Sites; Violence; Women