"That's what I'm supposed to do at work": Gendered labor, self-care, and overdose risk among women who use drugs in Vancouver, Canada.

Through rapid ethnography undertaken in Vancouver, Canada's Downtown Eastside - one of Canada's overdose epicenters - this article examines how gendered expectations of labor shape overdose risk for structurally vulnerable women and gender diverse people who use drugs. Drawing on two participant narratives, we explore how structural, symbolic, and everyday violence frame the lives of women and gender diverse people who use drugs in ways that drive their overdose risk as they balance self-care with caretaking, paid work, and basic survival. This article underscores the need for structural reform of peer overdose response work and funding for gender-attentive harm reduction and ancillary supports to better mitigate overdose risk for these populations.

Navigating post-eviction drug use amidst a changing drug supply: A spatially-oriented qualitative study of overlapping housing and overdose crises in Vancouver, Canada.

BACKGROUND: North American cities are experiencing intersecting housing and overdose crises as illicit drug markets become marked by the proliferation of fentanyl and methamphetamine. Despite recent research documenting associations between evictions and drug-related risks and harms, including overdose, the mechanisms through which these occur remain poorly understood. This study to examines how evictions shape the drug use practices of people who use drugs in Vancouver's Downtown Eastside - a neighbourhood with an established drug scene - as the illicit drug supply changed. METHODS: Qualitative interviews and geo-spatial data collection were conducted with 56 recently evicted PWUD. Data were analyzed by interfacing qualitative and geo-spatial data, and interpreted focusing on how structural vulnerability shaped spatial practices and drug-related risks post-eviction. RESULTS: Findings demonstrate how post-eviction spatial practices and routines produced risk and harm as participants navigated the uncertainties of housing vulnerability and drug supply changes. Post-eviction disruptions complicated participants' ability to engage with trusted drug sellers. Changes to spatial patterns and access to private spaces rendered public drug use inevitable, though this was mitigated to some degree by harm reduction supports. Abrupt changes to drug use patterns occurred due to post-eviction disruptions and included instrumental uses of methamphetamine to increase alertness and navigate survival amidst severe hardship. CONCLUSIONS: Findings demonstrate how post-eviction changes to routines and spatial patterns are framed by structural vulnerability and can exacerbate drug-related harms, particularly in the context of a changing drug supply. There is an urgent need for structural interventions and harm reduction responses to mitigate harms associated with evictions.

(Re)shaping the self: An ethnographic study of the embodied and spatial practices of women who use drugs.

While gendered experiences of drug use have been well-established, understanding how women resist structures that constrain their agency is important for mitigating drug-related harms, especially as overdose has become North America's leading cause of accidental death. Drawing on the intersectional risk environments of WWUD, this ethnographic study examined how gendered expectations of women's drug use, appearance, and comportment influenced vulnerability to overdose within the context of a fentanyl-driven overdose crisis. This community-engaged ethnography, conducted in Vancouver, Canada from May 2017 to December 2018, included in-depth interviews with 35 marginally-housed WWUD (transgender-inclusive) and approximately 100 h of fieldwork in single room accommodation (SRA) housing and an established street-based drug scene. Data were analyzed thematically with attention to embodiment, agency, and intersectionality. Findings highlight how gendered expectations and normative violence impacted women's use of space, both in the drug scene and SRAs. To resist efforts to 'discipline' their bodies, participants engaged in situated gender performances. Physical appearance was also deemed critical to managing drug use disclosure. Participants adopted gendered embodied practices, including altered consumption methods or injecting in less visible areas, to conceal their use from peers and at times, their partners. To resist harms associated with involuntary disclosure, participants often used alone in SRAs or in public spaces. While such practices allowed women to exert agency within constraining systems, they concurrently heightened overdose risk. Findings demonstrate how women engaged in everyday acts of resistance through embodied drug use practices, which increased their agency but elevated overdose risk. Implementing gender-specific programs that increase bodily agency and control (e.g. low-threshold services for personal care, women-focused harm reduction support) are needed to reduce risk of overdose for WWUD.

"Bed Bugs and Beyond": An ethnographic analysis of North America's first women-only supervised drug consumption site.

BACKGROUND: Attention to how women are differentially impacted within harm reduction environments is salient amidst North America's overdose crisis. Harm reduction interventions are typically 'gender-neutral', thus failing to address the systemic and everyday racialized and gendered discrimination, stigma, and violence extending into service settings and limiting some women's access. Such dynamics highlight the significance of North America's first low-threshold supervised consumption site exclusively for women (transgender and non-binary inclusive), SisterSpace, in Vancouver, Canada. This study explores women's lived experiences of this unique harm reduction intervention. METHODS: Ethnographic research was conducted from May 2017 to June 2018 to explore women's experiences with SisterSpace in Vancouver's Downtown Eastside, an epicenter of Canada's overdose crisis. Data include more than 100 hours of ethnographic fieldwork, including unstructured conversations with structurally vulnerable women who use illegal drugs, and in-depth interviews with 45 women recruited from this site. Data were analyzed in NVivo by drawing on deductive and inductive approaches. FINDINGS: The setting (non-institutional), operational policies (no men; inclusive), and environment (diversity of structurally vulnerable women who use illegal drugs), constituted a space affording participants a temporary reprieve from some forms of stigma and discrimination, gendered and social violence and drug-related harms, including overdose. SisterSpace fostered a sense of safety and subjective autonomy (though structurally constrained) among those often defined as 'deviant' and 'victims', enabling knowledge-sharing of experiences through a gendered lens. CONCLUSION: SisterSpace demonstrates the value and effectiveness of initiatives that engage with socio-structural factors beyond the often narrow focus of overdose prevention and that account for the complex social relations that constitute such initiatives. In the context of structural inequities, criminalization, and an overdose crisis, SisterSpace represents an innovative approach to harm reduction that accounts for situations of gender inequality not being met by mixed-gender services, with relevance to other settings.

Housing in crisis: A qualitative study of the socio-legal contexts of residential evictions in Vancouver's Downtown Eastside.

BACKGROUND: People who use drugs (PWUD) commonly experience housing vulnerability due to the intersection of drug laws, housing policies, gentrification, and social marginalization. Housing vulnerability produces social suffering amongst PWUD and is linked to health and social harms. In Vancouver, Canada, the rapid gentrification of the Downtown Eastside - a low-income inner-city neighbourhood - and the lack of affordable housing has led to residential evictions emerging as a key community concern. This study sought to understand the policies and practices that produced evictions among PWUD, situating vulnerabilities to evictions within the context of wider structural vulnerability of PWUD. METHODS: Between June 2015 and March 2016, baseline and 3-6 month follow-up qualitative interviews were conducted with recently evicted (past 60 days) PWUD in the Downtown Eastside. Participants were recruited by Peer Research Assistants. Baseline interviews (n = 56) focused on causes and socio-legal contexts of evictions, with follow-up interviews (n = 41) focusing on longer-term impacts. Interviews were analyzed thematically and interpreted by drawing on the concept of structural vulnerability. RESULTS: Most participants were evicted unlawfully, unfairly, and into homelessness. Participants were rendered structurally vulnerable to unlawful evictions by the shortcomings of existing residential tenancy laws and current dispute mechanisms. Residents of non-profit buildings, for whom it was unclear if provincial residential protections apply, found their housing security further undermined through the denial of rights extended to privately-housed tenants. Attempts to assert tenant rights further increased participants' vulnerability to eviction through landlord retaliation and targeting. CONCLUSION: Findings demonstrate the inadequacy of existing housing policies and tenancy supports to account for the structural vulnerability of PWUD and their role in driving harms. Policy reforms are needed to address unlawful evictions and increase tenancy security, and must be accompanied by low-barrier interventions to more fully address this key driver of social suffering among PWUD.

Surviving the housing crisis: Social violence and the production of evictions among women who use drugs in Vancouver, Canada.

Single room accommodation (SRA) housing is among the only forms of accessible housing to marginalized women who use illicit drugs in many urban settings. However, SRA housing environments may create specific health and drug risks for women. Little research has examined the gendered mechanisms contributing to housing vulnerability for women who use drugs and the subsequent ways they aim to mitigate harm. This study examines the gendered vulnerabilities to, and harms stemming from, evictions from SRAs in Vancouver, Canada. Qualitative interviews were conducted with 56 people who use drugs who were recently evicted (past 60 days) from SRAs in Vancouver's Downtown Eastside neighbourhood, 19 of whom identified as women which informed this analysis. Participants were recruited by Peer Researcher Assistants for baseline and follow-up interviews three to six months later. Interview transcripts were analyzed thematically and interpreted by drawing on concepts of social violence. Findings underscore how gendered violence and forms of social control operationalized within SRAs normalized violence against women and restricted their agency. Surveillance mechanisms increased women's experiences of violence as they sought to evade such interventions. Post-eviction, women faced pronounced vulnerability to harm which reinforced their social and spatial marginality within a drug scene. Collectively, women's experiences within SRAs highlight how the hybrid forms of disciplinary mechanisms used within these housing environments significantly impacted women's experiences of harm. Greater attention to the impacts of housing and building policies on women who use drugs is needed to better address the morbidity and mortality of this population.