Citation

Ziegler BR, Wray AJ, Luginaah I. Int. J. Drug Policy 2019; 74: 98-111.

Affiliation

Department of Geography, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; Health Hazards and Environment Lab, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.drugpo.2019.09.006

PMID

31586776

Abstract

BACKGROUND: We analyze the ongoing debate surrounding supervised injection sites in Ontario, Canada and changing policies that impact host communities. Despite a plethora of evidence proving the effectiveness of supervised injection sites on harm reduction strategy, the topic remains highly controversial with constantly changing rhetoric in the Ontario drug policy landscape.

METHODS: We reviewed government reports, policies, and media sources spanning from prior to the establishment of the first Canadian supervised injection site in 2000 to early 2019, adopting an advocacy coalition framework approach to this policy analysis. Various advocacy coalitions emerge from this analysis, including all three levels of government, law enforcement, health practitioners, and community groups. We describe the narratives constructed by these coalitions, analyzing the supervised injection site model as a harm reduction strategy within a continually shifting socio-political landscape.

RESULTS: Emerging from the analysis are competing narratives put forward by various stakeholders within the policy subsystem. We find policy-makers tend to leverage scientific uncertainty as a tool to defend the interests of the most powerful actor in the subsystem. Despite an increase in the number of deaths due to the opioid crisis and evidence highlighting the efficacy of supervised injection sites as a harm reduction tool, various stakeholders are locked in a battle of claims and counter-claims about the appropriate policy response to opioids.

CONCLUSIONS: These findings have broad implications for drug policy in other contexts. Our case study demonstrates the strength of stopgap measures, like supervised injection, to reduce harm from controlled substances.

Copyright © 2019 Elsevier B.V. All rights reserved.

Language: en

Keywords

Harm reduction; Land use; Opioids; Policy; Supervised injection sites