Combining respondent-driven sampling with a community-based participatory action study of people who smoke drugs in two cities in British Columbia, Canada.

BACKGROUND: The smoking of illicit drugs presents a serious social and economic burden in Canada. People who smoke drugs (PWSD) are at increased risk of contracting multiple infections through risky drug practices. Peer-led harm reduction activities, and the resulting social networks that form around them, can potentially minimize the dangers associated with the smoking illicit drugs. GOAL: The goals of this study were to pilot test the combined approaches of respondent driven sampling with community based participatory action research in these settings and compare the attributes and social networks of PWSD in two British Columbia cities with different harm reduction programs. METHODS: Using community-based participatory action research (CBPAR) and respondent-driven sampling (RDS), individuals with lived drug experiences were employed from communities in Abbotsford and Vancouver as peer researchers to interview ten contacts from their social networks. Contacts completed a questionnaire about their harm reduction behaviours and interactions. RESULTS: We found that PWSD residing in Abbotsford were more likely to report engaging in harm-promoting behaviours, such as sharing, reusing, or borrowing crack pipes. However, PWSD in the Downtown East side Community of Vancouver were more likely to report engaging in harm-reducing activities, such as being trained in naloxone use and CPR. We found no differences in network sizes between the two communities, despite the population differences and harm reduction programs CONCLUSION: The high participation rates and interactions between researchers, and peer researchers enriched the study implementation and successfully informed our results. The fact that there were no differences in network size suggests that people have similar support in Vancouver as in Abbotsford, and that drug use practices differ mainly due to availability of harm reduction programming and resources.

Social network support and harm reduction activities in a peer researcher-led pilot study, British Columbia, Canada.

BACKGROUND: People who smoke drugs (PWSD) are at high risk of both infectious disease and overdose. Harm reduction activities organized by their peers in the community can reduce risk by providing education, safer smoking supplies, and facilitate access to other services. Peers also provide a network of people who provide social support to PWSD which may reinforce harm reducing behaviors. We evaluated the numbers of supportive network members and the relationships between received support and participants' harm-reducing activities. METHODS: Initial peer-researchers with past or current lived drug use experience were employed from communities in Abbotsford and Vancouver to interview ten friends from their social networks who use illegal drugs mainly through smoking. Contacts completed a questionnaire about people in their own harm reduction networks and their relationships with each other. We categorized social support into informational, emotional, and tangible aspects, and harm reduction into being trained in the use of, or carrying naloxone, assisting peers with overdoses, using brass screens to smoke, obtaining pipes from service organizations and being trained in CPR. RESULTS: Fifteen initial peer researchers interviewed 149 participants who provided information on up to 10 people who were friends or contacts and the relationships between them. People who smoked drugs in public were 1.46 (95% CI, 1.13-1.78) more likely to assist others with possible overdoses if they received tangible support; women who received tangible support were 1.24 (95% CI; 1.02-1.45) more likely to carry and be trained in the use of naloxone. There was no relationship between number of supportive network members and harm reduction behaviors. CONCLUSIONS: In this pilot study, PWSD who received tangible support were more likely to assist peers in possible overdoses and be trained in the use of and/or carry naloxone, than those who did not receive tangible support. Future work on the social relationships of PWSD may prove valuable in the search for credible and effective interventions.

Correction to: COVID-19 and people who use drugs: a call for action.

This article was updated was to correct the spelling of Dave Hamm's name: it is correct as displayed here.

Research 101: A process for developing local guidelines for ethical research in heavily researched communities.

BACKGROUND: Marginalized communities often attract more than their share of research. Too often, this research benefits researchers disproportionately and leaves such communities feeling exploited, misrepresented, and exhausted. The Downtown Eastside (DTES) neighborhood of Vancouver, Canada, has been the site of multiple public health epidemics related to injection drug use as well as the site of much community-led resistance and struggle that has led to the development of cutting-edge harm reduction interventions (e.g., North America's first supervised injection facility, Insite) and a strong sense of community organization. This background has made the DTES one of the most heavily researched communities in the world. Amidst ongoing experiences of unethical or disrespectful research engagement in the neighborhood, a collaboration between local academic researchers and community representatives developed to explore how we could work together to encourage more respectful, community-responsive research and discourage exploitative or disrespectful research. METHODS: We developed a series of six weekly workshops called "Research 101." These workshops brought together approximately 13 representatives from peer-based organizations in the DTES with a variety of experiences with research. Research 101 created space for community members themselves to discuss the pitfalls and potential of research in their neighborhood and to express community expectations for more ethical and respectful research. RESULTS: We summarized workshop discussions in a co-authored "Manifesto for Ethical Research in the Downtown Eastside." This document serves as a resource to empower community organizations to develop more equitable partnerships with researchers and help researchers ground their work in the principles of locally developed "community ethics." Manifesto guidelines include increased researcher transparency, community-based ethical review of projects, empowering peer researchers in meaningful roles within a research project, and taking seriously the need for reciprocity in the research exchange. CONCLUSIONS: Research 101 was a process for eliciting and presenting a local vision of "community ethics" in a heavily researched neighborhood to guide researchers and empower community organizations. Our ongoing work involves building consensus for these guidelines within the community and communicating these expectations to researchers and ethics offices at local universities. We also describe how our Research 101 process could be replicated in other heavily researched communities.

Exploring what shapes injection and non-injection among a sample of marginalized people who use drugs.

BACKGROUND: Few studies have specifically explored what influences people who use drugs to consume them in certain ways (i.e., smoking, injecting). While a great deal of research has examined the transition from non-injection to injection routes of drug administration, less is known about people who use drugs (PWUD) but have never injected or have stopped injecting. This paper draws on actor-network theory to explore what moves people to inject or not, among both people who currently smoke/sniff drugs (PWSD) and people who currently inject drugs (PWID), to better understand factors that shape/influence methods of drug consumption. METHODS: Two-stage interviews (a quantitative survey followed by a qualitative interview) were conducted with 26 PWSD and 24 PWID. Interviews covered a range of topics related to drug use, including reasons for injecting drugs, never injecting, and stopping injecting. Data were analysed by drawing on actor-network theory to identify forces involved in shaping drug consumption practices. RESULTS: We present three transformative drug use events to illustrate how specific methods of drug consumption are shaped by an assemblage of objects, actors, affects, spaces and processes. Rather than emphasising the role of broad socio-structural factors (i.e., poverty, drug policy) participant narratives reveal how a variety of actors, both human and non-human, assembled in unique ways produce drug consumption events that have the capacity to influence or transform drug consumption practices. CONCLUSION: Actor-network theory and event analysis provide a more nuanced understanding of drug consumption practices by drawing together complex material, spatial, social and temporal aspects of drug use, which helps identify the variety of forces involved in contexts that are thought to shape substance use. By attending to events of drug consumption we can better understand how contexts shape drug use and related harms. With greater insight into the transformative capacity of drug use events, strategies may be better tailored to prevent drug use-related harms.