An action-oriented public health framework to reduce financial strain and promote financial wellbeing in high-income countries.

BACKGROUND: Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. METHODS: The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. RESULTS: The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. CONCLUSIONS: The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives.

A Policy-Ready Public Health Guidebook of Strategies and Indicators to Promote Financial Well-Being and Address Financial Strain in Response to COVID-19.

INTRODUCTION: The COVID-19 pandemic has adversely affected the financial well-being of populations globally, escalating concerns about links with health care and overall well-being. Governments and organizations need to act quickly to protect population health relative to exacerbated financial strain. However, limited practice- and policy-relevant resources are available to guide action, particularly from a public health perspective, that is, targeting equity, social determinants of health, and health-in-all policies. Our study aimed to create a public health guidebook of strategies and indicators for multisectoral action on financial well-being and financial strain by decision makers in high-income contexts. METHODS: We used a multimethod approach to create the guidebook. We conducted a targeted review of existing theoretical and conceptual work on financial well-being and strain. By using rapid review methodology informed by principles of realist review, we collected data from academic and practice-based sources evaluating financial well-being or financial strain initiatives. We performed a critical review of these sources. We engaged our research-practice team and government and nongovernment partners and participants in Canada and Australia for guidance to strengthen the tool for policy and practice. RESULTS: The guidebook presents 62 targets, 140 evidence-informed strategies, and a sample of process and outcome indicators. CONCLUSION: The guidebook supports action on the root causes of poor financial well-being and financial strain. It addresses a gap in the academic literature around relevant public health strategies to promote financial well-being and reduce financial strain. Community organizations, nonprofit organizations, and governments in high-income countries can use the guidebook to direct initiative design, implementation, and assessment.

Towards cross-Canada monitoring of the unregulated street drug supply.

BACKGROUND: The well-being of people who use drugs (PWUD) continues to be threatened by substances of unknown type or quantity in the unregulated street drug supply. Current efforts to monitor the drug supply are limited in population reach and comparability. This restricts capacity to identify and develop measures that safeguard the health of PWUD. This study describes the development of a low-barrier system for monitoring the contents of drugs in the unregulated street supply. Early results for pilot sites are presented and compared across regions. METHODS: The drug content monitoring system integrates a low-barrier survey and broad spectrum urine toxicology screening to compare substances expected to be consumed and those actually in the drug supply. The system prototype was developed by harm reduction pilot projects in British Columbia (BC) and Montreal with participation of PWUD. Data were collected from harm reduction supply distribution site clients in BC, Edmonton and Montreal between May 2018-March 2019. Survey and urine toxicology data were linked via anonymous codes and analyzed descriptively by region for trends in self-reported and detected use. RESULTS: The sample consisted of 878 participants from 40 sites across 3 regions. Reported use of substances, their detection, and concordance between the two varied across regions. Methamphetamine use was reported and detected most frequently in BC (reported: 62.8%; detected: 72.2%) and Edmonton (58.3%; 68.8%). In Montreal, high concordance was also observed between reported (74.5%) and detected (86.5%) cocaine/crack use. Among those with fentanyl detected, the percentage of participants who used fentanyl unintentionally ranged from 36.1% in BC, 78.6% in Edmonton and 90.9% in Montreal. CONCLUSIONS: This study is the first to describe a feasible, scalable monitoring system for the unregulated drug supply that can contrast expected and actual drug use and compare trends across regions. The system used principles of flexibility, capacity-building and community participation in its design. Results are well-suited to meet the needs of PWUD and inform the local harm reduction services they rely on. Further standardization of the survey tool and knowledge mobilization is needed to expand the system to new jurisdictions.

To what extent do supervised drug consumption services incorporate non-injection routes of administration? A systematic scoping review documenting existing facilities.

BACKGROUND: Most of the existing research on supervised consumption services (SCS) is focused on injection drug use. Less is known about the applicability of SCS for people who consume drugs orally, intranasally, or through inhalation. This is problematic because people who use drugs through modes other than injection are also at risk of overdose death and other harm, and experience barriers accessing health and social services. We aimed to describe existing SCS models that accommodate these alternate routes of drug consumption, and synthesize available information on characteristics of program participants. METHODS: We conducted a systematic scoping review of 9 peer-reviewed and 13 grey literature databases on SCS that incorporate non-injection routes of consumption. We screened 22,882 titles, and excluded 22,843 (99.8%) articles. We ultimately included 39 (0.2%) full-text articles; 28 (72%) of these articles explicitly identified SCS that permit alternate routes of consumption and 21 (54%) discussed characteristics of participants who consume drugs through non-injection routes. Data on study characteristics, terms and definitions, and site and program participant characteristics were extracted and double-coded. Extracted data were analyzed using descriptive statistics and narrative synthesis. RESULTS: Included articles describe 48 SCS that permit non-injection routes of consumption, most of which were located in Germany. The majority of these SCS were legally sanctioned and had models of care that were largely comparable to supervised injection services. Notable differences included physical infrastructure such as ventilated rooms or outdoor areas to accommodate inhalation, and shorter time limits on non-injection drug consumption episodes. Program participants engaging in non-injection forms of consumption were typically men over the age of 30 and structurally vulnerable (e.g., experiencing homelessness or unstable housing). CONCLUSIONS: Extant academic and grey literature indicates that site characteristics and demographics of program participants of SCS that permit non-injection routes of consumption largely reflect those of supervised injection services. Further research on the range of existing SCS that incorporate non-injection routes of consumption is needed to ensure high quality service provision, and improved health outcomes for people who consume drugs via oral, intranasal, and inhalation routes.

Early-Stage Cannabis Regulatory Policy Planning Across Canada's Four Largest Provinces: A Descriptive Overview.

Background: Observing and documenting major shifts in drug policy in a given jurisdiction offer important lessons for other settings worldwide. After nearly a century of prohibition of non-medical use and sale of cannabis, Canada federally legalized the drug in October 2018. Across this geographically large and diverse country, there is a patchwork of cannabis policies as the provinces and territories have developed their own regulatory frameworks. Objectives: As drug policy transitions are often studied well after implementation, we document early stage cannabis regulatory policy planning in the four most populous provinces of Québec, Ontario, Alberta, and British Columbia. Methods: In June 2018, we systematically searched peer-reviewed and gray literature (such as web content, reports, and policy documents authored by varied authorities and organizations) to identify key aspects of the evolving provincial cannabis legalization frameworks. In the absence of peer-reviewed studies, we reviewed primarily gray literature. Results: For each of the four provinces examined, we provide a succinct overview of early-stage public consultation, plans for cannabis distribution and retail, other key regulatory features, endorsements of a public health approach to legalization, general alignment with alcohol policy, and contentious or standout issues. Conclusions/Importance: Our review clearly illustrates that cannabis legalization in Canada is not unfolding as monolithic policy, despite a federal framework, but with divergent approaches. The public health outcomes that will result from the different provincial/territorial regulatory systems remain to be measured and will be closely monitored.

Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks.

BACKGROUND: In Canada, funding, administration, and delivery of health services-including those targeting people who use drugs-are primarily the responsibility of the provinces and territories. Access to harm reduction services varies across jurisdictions, possibly reflecting differences in provincial and territorial policy commitments. We examined the quality of current provincial and territorial harm reduction policies in Canada, relative to how well official documents reflect internationally recognized principles and attributes of a harm reduction approach. METHODS: We employed an iterative search and screening process to generate a corpus of 54 provincial and territorial harm reduction policy documents that were current to the end of 2015. Documents were content-analyzed using a deductive coding framework comprised of 17 indicators that assessed the quality of policies relative to how well they described key population and program aspects of a harm reduction approach. RESULTS: Only two jurisdictions had current provincial-level, stand-alone harm reduction policies; all other documents were focused on either substance use, addiction and/or mental health, or sexually transmitted and/or blood-borne infections. Policies rarely named specific harm reduction interventions and more frequently referred to generic harm reduction programs or services. Only one document met all 17 indicators. Very few documents acknowledged that stigma and discrimination are issues faced by people who use drugs, that not all substance use is problematic, or that people who use drugs are legitimate participants in policymaking. A minority of documents recognized that abstaining from substance use is not required to receive services. Just over a quarter addressed the risk of drug overdose, and even fewer acknowledged the need to apply harm reduction approaches to an array of drugs and modes of use. CONCLUSIONS: Current provincial and territorial policies offer few robust characterizations of harm reduction or go beyond rhetorical or generic support for the approach. By endorsing harm reduction in name, but not in substance, provincial and territorial policies may communicate to diverse stakeholders a general lack of support for key aspects of the approach, potentially challenging efforts to expand harm reduction services.

Caring for Hospitalized Adults With Opioid Use Disorder in the Era of Fentanyl: A Review.

Importance: The rise of fentanyl and other high-potency synthetic opioids across US and Canada has been associated with increasing hospitalizations and unprecedented overdose deaths. Hospitalization is a critical touchpoint to engage patients and offer life-saving opioid use disorder (OUD) care when admitted for OUD or other medical conditions. Observations: Clinical best practices include managing acute withdrawal and pain, initiating medication for OUD, integrating harm reduction principles and practices, addressing in-hospital substance use, and supporting hospital-to-community care transitions. Fentanyl complicates hospital OUD care. Fentanyl's high potency intensifies pain, withdrawal, and cravings and increases the risk for overdose and other harms. Fentanyl's unique pharmacology has rendered traditional techniques for managing opioid withdrawal and initiating buprenorphine and methadone inadequate for some patients, necessitating novel strategies. Further, co-use of opioids with stimulants drugs is common, and the opioid supply is unpredictable and can be contaminated with benzodiazepines, xylazine, and other substances. To address these challenges, clinicians are increasingly relying on emerging practices, such as low-dose buprenorphine initiation with opioid continuation, rapid methadone titration, and the use of alternative opioid agonists. Hospitals must also reconsider conventional approaches to in-hospital substance use and expand clinicians' understanding and embrace of harm reduction, which is a philosophy and set of practical strategies that supports people who use drugs to be safer and healthier without judgment, coercion, or discrimination. Hospital-to-community care transitions should ensure uninterrupted access to OUD care after discharge, which requires special consideration and coordination. Finally, improving hospital-based addiction care requires dedicated infrastructure and expertise. Preparing hospitals across the US and Canada to deliver OUD best practices requires investments in clinical champions, staff education, leadership commitment, community partnerships, quality metrics, and financing. Conclusions and Relevance: The findings of this review indicate that fentanyl creates increased urgency and new challenges for hospital OUD care. Hospital clinicians and systems have a central role in addressing the current drug crisis.

Perspectives of patients who inject drugs on a needle and syringe program at a large acute care hospital.

BACKGROUND: People who inject drugs in North America often continue to inject while hospitalized, and are at increased risk of premature hospital discharge, unplanned readmission, and death. In-hospital access to sterile injection supplies may reduce some harms associated with ongoing injection drug use. However, access to needle and syringe programs in acute care settings is limited. We explored the implementation of a needle and syringe program integrated into a large urban tertiary hospital in Western Canada. The needle and syringe program was administered by an addiction medicine consult team that offers patients access to specialized clinical care and connection to community services. METHODS: We utilized a focused ethnographic design and semi-structured interviews to elicit experiences and potential improvements from 25 hospitalized people who inject drugs who were offered supplies from the needle and syringe program. RESULTS: Participants were motivated to accept supplies to prevent injection-related harms and access to supplies was facilitated by trust in consult team staff. However, fears of negative repercussions from non-consult team staff, including premature discharge or undesired changes to medication regimes, caused some participants to hesitate or refuse to accept supplies. Participants described modifications to hospital policies regarding inpatient drug use or access to an inpatient supervised consumption service as potential ways to mitigate patients' fears. CONCLUSIONS: Acute care needle and syringe programs may aid hospital providers in reducing harms and improving hospital outcomes for people who inject drugs. However, modifications to hospital policies and settings may be necessary.

Operating an overdose prevention site within a temporary emergency shelter during the COVID-19 pandemic.

SETTING: A temporary emergency shelter was established inside the Commonwealth Stadium in Edmonton, Alberta, to reduce COVID-19 transmission and mitigate health risks among people experiencing homelessness. INTERVENTION: A non-profit organization, Boyle Street Community Services, opened an overdose prevention site (OPS) between February and March 2022 inside the temporary emergency shelter. People accessed the shelter-based OPS to consume unregulated drugs (via injection, intranasally, or orally), receive medical aid, access sterile drug use equipment, and be connected to additional health and social supports, without leaving the shelter. We conducted short interviewer-administered surveys with OPS participants to examine participant views and identify suggested improvements. OUTCOMES: The shelter-based OPS was accessed a total of 1346 times by 174 unique people. Fentanyl was the most common self-reported drug consumed (59%) and most consumption (99% of episodes) was by injection. OPS staff responded to 66 overdoses and reported no deaths. Survey respondents reported that the shelter-based OPS was convenient, with no need to forfeit their shelter spot or find transportation to another OPS. Respondents indicated that the OPS felt safe and accessible and reported that it reduced drug use in other shelter areas. Participants identified the OPS' exclusion of inhalation as a limitation. IMPLICATIONS: People who use unregulated drugs and are experiencing homelessness are at a higher risk of negative health outcomes, which COVID-19 exacerbated. Integrating temporary shelter/housing and harm reduction services may be an innovative way to lower barriers, increase accessibility, and improve well-being for this structurally vulnerable population. Future operators should consider incorporating inhalation services to further reduce service gaps.

RéSUMé: LIEU: Un refuge d'urgence temporaire avait été établi dans le stade du Commonwealth à Edmonton (Alberta) pour réduire la transmission de la COVID-19 et atténuer les risques pour la santé chez les personnes en situation d'itinérance. INTERVENTION: Un organisme sans but lucratif, Boyle Street Community Services, a ouvert un centre de prévention des surdoses (CPS) entre février et mars 2022 à l'intérieur de ce refuge d'urgence temporaire. Les gens avaient accès au CPS du refuge pour consommer des médicaments non réglementés (par injection ou par voie intranasale ou buccale), recevoir de l'aide médicale, se procurer du matériel de consommation stérile et être mis en rapport avec d'autres intervenants et intervenantes de la santé et des services sociaux sans sortir du refuge. Nous avons mené de brefs sondages administrés par l'enquêteur ou l'enquêtrice auprès des participantes et des participants du CPS pour étudier leurs points de vue et formuler des suggestions d'améliorations. RéSULTATS: Le CPS du refuge a été utilisé 1 346 fois par 174 personnes. Le fentanyl a été le médicament le plus souvent consommé selon les utilisateurs et utilisatrices (59 %), et la plupart du temps (dans 99 % des cas), il était consommé par injection. Le personnel du CPS est intervenu lors de 66 surdoses et n'a rapporté aucun décès. Les répondantes et répondants aux sondages ont indiqué que le CPS du refuge était pratique, car il n'était pas nécessaire d'abandonner leur place dans le refuge, ni de trouver un moyen de se rendre dans un autre CPS. Ces personnes ont trouvé le CPS sûr et accessible et ont dit qu'il avait réduit la consommation de drogue dans d'autres zones de refuge. Les participantes et participants ont indiqué que l'exclusion de la consommation par inhalation dans le CPS était toutefois une contrainte. CONSéQUENCES: Les personnes en situation d'itinérance qui consomment des médicaments non réglementés courent un plus grand risque d'avoir des résultats cliniques négatifs, ce que la COVID-19 a exacerbé. L'intégration de refuges/logements temporaires et de services de réduction des méfaits peut être un moyen novateur de réduire les obstacles, d'accroître l'accessibilité et d'améliorer le bien-être de cette population structurellement vulnérable. Les futurs gestionnaires devraient songer à intégrer des services d'inhalation pour réduire encore davantage les lacunes dans les services.

Challenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysis.

BACKGROUND: Canada is experiencing an unprecedented drug toxicity crisis driven by a highly toxic unregulated drug supply contaminated with fentanyl, benzodiazepine, and other drugs. Safer supply pilot programs provide prescribed doses of pharmaceutical alternatives to individuals accessing the unregulated drug supply and have been implemented to prevent overdose and reduce related harms. Given the recent emergence of these pilot programs and the paucity of data on implementation challenges, we sought to document challenges in their initial implementation phase. METHODS: We obtained organizational progress reports from Health Canada, submitted between 2020 and 2022 by 11 pilot programs located in British Columbia, Ontario, and New Brunswick. We analyzed the data using deductive and inductive approaches via thematic analysis. Analyses were informed by the consolidated framework for implementation research. RESULTS: We obtained 45 progress reports from 11 pilot programs. Six centres were based in British Columbia, four in Ontario, and one in New Brunswick. Four overarching themes were identified regarding the challenges faced during the establishment and implementation of pilot programs: i) Organizational features (e.g., physical space constraints, staff shortages); ii) Outer contexts (e.g., limited operational funds and resources, structural inequities to access, public perceptions); iii) Intervention characteristics (e.g., clients' unmet medication needs); and iv) Implementation process (e.g., pandemic-related challenges, overly medicalized and high-barrier safer supply models). CONCLUSIONS: Safer supply pilot programs in Canada face multiple inner and outer implementation challenges. Given the potential role of safer supply programs in addressing the drug toxicity crisis in Canada and the possibility of future scale-up, services should be well-supported during their implementation phases. Refining service provision within safer supply programs based on the feedback and experiences of clients and program administrators is warranted, along with efforts to ensure that appropriate medications are available to meet the clients' needs.

Canada moving backwards on illegal drugs.

Internationally, illegal drug use remains a major public health problem. In response, many countries have begun to shift their illegal drug policies away from enforcement and towards public health objectives. Recently, both the Global Commission on Drug Policy and the Supreme Court of Canada have endorsed this change in direction, supporting empirically sound illegal drug policies that reduce criminalization and stigmatization of drug users and bolster treatment and harm reduction efforts. Until recently, Canada was a participant in this growing movement towards rational drug policy. Unfortunately, in recent years, policy changes have made Canada one of the few remaining advocates of a "war-on-drugs" approach. Indeed, the current government has implemented a number of new illegal drug policies that contradict well-established scientific evidence from public health, criminology and other fields. As such, their approach is expected to do little to reduce the harms associated with substance use in Canada. The authors call on the current government to heed the recommendations of the Global Commission's report and learn from the many countries that are innovating in illegal drug policy by prioritizing evidence, human rights and public health.

Public health approaches to substance use: a scoping review protocol.

OBJECTIVE: The aim of this scoping review is to describe how a public health approach to legal and illegal psychoactive substance use has been previously defined, and to identify its core values, concepts, activities, and goals. INTRODUCTION: Jurisdictions globally are increasingly endorsing a public health approach to addressing psychoactive substance use. However, there is currently no agreed definition of this approach, and this term has been applied inconsistently in the literature, policy, and practice. A critical first step toward advancing a public health approach to substance use is identifying and articulating its core components. INCLUSION CRITERIA: This review will consider all peer-reviewed and gray literature in English focused on conceptualizing, defining, or describing a public health approach to substance use. Our review does not place limitations on populations, psychoactive substance types, or other contextual factors. METHODS: We will search PROSPERO, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and Scopus, as well as health and social science databases; websites of prominent nonprofit, civil society, and government agencies/organizations in public health and substance use fields; and reference lists of included articles. Two independent reviewers will screen titles/abstracts of peer-reviewed literature, and 1 reviewer will screen titles/abstracts of gray literature. Two independent reviewers will conduct the full-text screening. A data extraction sheet will be pilot tested through double extraction. Findings will be presented as a narrative summary supported by tables and diagrams and, if feasible, a conceptual framework for understanding and applying a public health approach to substance use. SCOPING REVIEW REGISTRATION NUMBER: Open Science Framework https://osf.io/sv25e.

Policy actor views on structural vulnerability in harm reduction and policymaking for illegal drugs: A qualitative study.

BACKGROUND: Health risks associated with drug use are concentrated amongst structurally vulnerable people who use illegal drugs (PWUD). We described how Canadian policy actors view structural vulnerability in relation to harm reduction and policymaking for illegal drugs, and what solutions they suggest to reduce structural vulnerability for PWUD. METHODS: The Canadian Harm Reduction Policy Project is a mixed-method, multiple case study. The qualitative component included 73 semi-structured interviews conducted with harm reduction policy actors across Canada's 13 provinces and territories between November 2016 and December 2017. Interviews explored perspectives on harm reduction and illegal drug policies and the conditions that facilitate or constrain policy change. Our sub-analysis utilized a two-step inductive analytic process. First, we identified transcript segments that discussed structural vulnerability or analogous terms. Second, we conducted latent content analysis on the identified excerpts to generate main findings. RESULTS: The central role of structural vulnerability (including poverty, unstable/lack of housing, racialization) in driving harm for PWUD was acknowledged by participants in all provinces and territories. Criminalization, in particular, was seen as a major contributor to structural vulnerability by justifying formal and informal sanctions against drug use and, by extension, PWUD. Many participants expressed that their personal understanding of harm reduction included addressing the structural conditions facing PWUD, yet identified that formal government harm reduction policies focused solely on drug use rather than structural factors. Participants identified several potential policy solutions to intervene on structural vulnerability including decriminalization, safer supply, and enacting policies encompassing all health and social sectors. CONCLUSIONS: Structural vulnerability is salient within Canadian policy actors' discourses; however, formal government policies are seen as falling short of addressing the structural conditions of PWUD. Decriminalization and safer supply have the potential to mitigate immediate structural vulnerability of PWUD while policies evolve to advance social, economic, and cultural equity.

A comparison of the COVID-19 response for urban underserved patients experiencing healthcare transitions in three Canadian cities.

OBJECTIVES: The COVID-19 pandemic and response has highlighted existing strengths within the system of care for urban underserved populations, but also many fault lines, in particular during care transitions. The objectives of this study were to describe COVID-19 response policies for urban underserved populations in three Canadian cities; examine how these policies impact continuity of care for urban underserved populations; determine whether and how urban underserved community members were engaged in policy processes; and develop policy and operational recommendations for optimizing continuity of care for urban underserved populations during public health crises. METHODS: Using Walt & Gilson's Policy Triangle framework as a conceptual guide, 237 policy and media documents were retrieved. Five complementary virtual group interview sessions were held with 22 front-line and lived-experience key informants to capture less well-documented policy responses and experiences. Documents and interview transcripts were analyzed inductively for policy content, context, actors, and processes involved in the pandemic response. RESULTS: Available documents suggest little focus on care continuity for urban underserved populations during the pandemic, despite public health measures having disproportionately negative impacts on their care. Policy responses were largely reactive and temporary, and community members were rarely involved. However, a number of community-based initiatives were developed in response to policy gaps. Promising practices emerged, including examples of new multi-level and multi-sector collaboration. CONCLUSION: The pandemic response has exposed inequities for urban underserved populations experiencing care transitions; however, it has also exposed system strengths and opportunities for improvement to inform future policy direction.

RéSUMé: OBJECTIFS: La pandémie et la riposte au COVID-19 ont mis en évidence les forces existantes au sein du système de soins pour les populations urbaines mal desservies, mais aussi de nombreuses faillites, en particulier lors des transitions de soins. Les objectifs de cette étude étaient de décrire les politiques de réponse au COVID-19 pour les populations urbaines mal desservies dans trois villes canadiennes; examiner l'impact de ces politiques sur la continuité des soins pour les populations urbaines mal desservies; déterminer si et comment les membres de la communauté urbaine mal desservie ont été impliqués dans les processus politiques; et développer des recommandations politiques et opérationnelles pour optimiser la continuité des soins pour les populations urbaines mal desservies pendant les crises de santé publique. MéTHODES: Utilisant le cadre Policy Triangle de Walt et Gilson comme guide conceptuel, 237 documents politiques et des médias ont été récupérés. Cinq séances d'entrevues de groupe virtuelles complémentaires ont été organisées avec 22 informateurs clés de première ligne et d'expérience vécue pour saisir des réponses et des expériences politiques moins bien documentées. Les documents et les transcriptions des entrevues ont été analysés de manière inductive pour le contenu politique, le contexte, les acteurs et les processus impliqués dans la riposte à la pandémie. RéSULTATS: Les documents disponibles suggèrent que l'accent est peu mis sur la continuité des soins pour les populations urbaines mal desservies pendant la pandémie, malgré les mesures de santé publique ayant des impacts négatifs disproportionnés sur leurs soins. Les réponses politiques étaient en grande partie réactives et temporaires, et les membres de la communauté étaient rarement impliqués. Cependant, un certain nombre d'initiatives communautaires ont été élaborées en réponse aux lacunes des politiques. Des pratiques prometteuses ont émergé, y compris des exemples de nouvelles collaborations multiniveaux et multisectorielles. CONCLUSION: La réponse à la pandémie a révélé des inégalités pour les populations urbaines mal desservies qui subissent des transitions de soins, mais elle a également exposé les forces du système et les possibilités d'amélioration pour éclairer l'orientation future des politiques.

Supporting the full participation of people who use drugs in policy fora: Provision of a temporary, conference-based overdose prevention site.

The overdose epidemic in North America remains acute and interventions are needed to mitigate harm and prevent death. People who use/d drugs (PWUD) hold essential knowledge to guide the development of these interventions and conferences are vital fora for hearing their perspectives and building support for new policies and programs. However, little guidance exists on how to best ensure the safety of PWUD during conferences. In October 2018, a low-threshold overdose prevention site (OPS) was implemented at a national drug policy and harm reduction conference in Edmonton, Canada. The OPS provided delegates with a monitored space to consume drugs and access drug consumption supplies. This commentary describes the implementation of the OPS with the aim of providing practical guidance for organizers of future substance use-related conferences, meetings, and other events.

Uptake into a bedside needle and syringe program for acute care inpatients who inject drugs.

INTRODUCTION AND AIMS: Injection drug use is associated with significant morbidity and mortality worldwide. Needle and syringe programs (NSP) have been shown to reduce negative health outcomes for people who inject drugs. However, NSPs have limited reach in hospitals, and no peer-reviewed research has examined NSP implementation in acute care settings. We describe the implementation of an inpatient NSP offered through an addiction medicine consultation service in a large, urban acute care hospital in Edmonton, Canada, and compared characteristics of inpatients who did versus did not access the NSP. DESIGN AND METHODS: Administrative data were reviewed for all addiction medicine consult service intakes between 11 July 2016 and 14 January 2018. We calculated the proportion of intakes in which patients: (i) were offered syringes; and (ii) accepted syringes. Multivariate analyses were used to examine associations between these outcomes and patient age and sex. RESULTS: Patients reported injecting drugs in 597 (31%) of 1907 intakes during the study period. People who inject drugs were offered syringes in 334 (56%) of these intakes, and accepted syringes in 124 (37%) of them. Female patients were more likely to accept syringes. DISCUSSION AND CONCLUSIONS: In a recently implemented NSP for hospital inpatients, just over half of patients who reported injection drug use were offered syringes, and the rate of patient acceptance was low. Further research is necessary to describe best practice for inpatient NSPs and identify and remove any barriers that prevent some inpatients from either being offered or accepting syringes.

Media coverage of harm reduction, 2000-2016: A content analysis of tone, topics, and interventions in Canadian print news.

BACKGROUND: Harm reduction interventions reduce mortality and morbidity for people who use drugs (PWUD), but are contentious and haphazardly implemented. This study describes volume and content of Canadian newspaper coverage of harm reduction produced from 2000 to 2016. METHODS: Searches of 54 English-language newspapers identified 5681 texts, coded for type (news reports, opinion pieces), tone (positive, negative, or neutral/balanced coverage), topic (health, crime, social welfare, and political perspectives on harm reduction), and seven harm reduction interventions. RESULTS: Volume of coverage doubled in 2008 (after removal of harm reduction from federal drug policy and legal challenges to Vancouver's supervised consumption program) and quadrupled in 2016 (tracking Canada's opioid emergency). Health perspectives on harm reduction were most common (39% of texts) while criminal perspectives were rare (3%). Negative coverage was over 10 times more common in opinion pieces (31%) compared to news reports (3%); this trend was more pronounced in British Columbia and Alberta, a region particularly affected by Canada's opioid emergency. Supervised drug consumption accounted for 49% of all newspaper coverage. CONCLUSIONS: Although federal policy support for harm reduction waxed and waned over 17 years, Canadian newspapers independently shaped public discourse, frequently characterizing harm reduction positively/neutrally and from a health perspective. However, issue framing and agenda setting was also evident: supervised drug consumption offered in a single Canadian city crowded out coverage of all other harm reduction services, except for naloxone. This narrow sense of 'newsworthiness' obscured public discourse on the full spectrum of evidence-based harm reduction services that could benefit PWUD.