Use of safer smoking facilities within a supervised consumption service shaped by socio-structural factors: A qualitative study.

BACKGROUND: Safer smoking facilities provide an important alternative for supervised consumption service (SCS) clients who wish to lower certain health risks associated with injecting or who wish to smoke in the safety of the SCS rather than on the street. In 2018, the first regulated safer smoking facility in North America opened as part of a new supervised consumption site in a Western Canadian city. The purpose of this research project was to understand the interplay of factors in SCS clients choosing to use safer smoking rooms instead of injecting in booths. METHOD: Using a phenomenological approach, this research was guided by the question, "What personal, social and environmental factors influence SCS clients' consumption methods?" To answer this question we interviewed both clients and staff at the SCS. Participants were recruited through purposive sampling. Data was analysed using thematic analysis. RESULTS: The findings of this study suggest that the mode of consumption is affected by personal (personal history and preference that clients had previously pre-contemplated and established pertaining to the substances of choice), social (the desire to be with friends) and environmental (space limitations in the SCS) factors. CONCLUSIONS: While many clients described self-determined rules around how they will consume various substances, these rules were fluid and changing depending on personal, social and environmental factors. Ensuring sufficient capacity of smoking rooms is a critical consideration in SCS and an important potential site of harm reduction.

Peer-assisted injection as a harm reduction measure in a supervised consumption service: a qualitative study of client experiences.

BACKGROUND: Peer assistance is an emerging area of study in injection drug use. When Canada's first supervised consumption site (SCS) opened in 2003 in Vancouver, Canada, clients were prohibited from injecting their peers; only recently has this practise been introduced as a harm reduction measure at these sites. In 2018, Health Canada granted federal exemption to allow peer-assisted injection at certain SCS sites, under the Controlled Drugs and Substances Act. Literature pertaining to peer-assisted injection addresses several topics: interpersonal relationships between the injection provider and recipient; the role of pragmatism; trust and expertise; and gender relations. METHODS: In this qualitative study, participants (n = 16) were recruited to be interviewed about their experiences in a peer-assisted injection program (PAIP) at one SCS regulated by Health Canada. Interview data were transcribed and thematically analyzed. Quantitative administrative data were used to provide context and to describe the study population, comprised of people in the PAIP (n = 248). RESULTS: PAIP clients made up 17.4% of all SCS clients. PAIP clients were more likely to be female and Indigenous. Injection providers expressed being moved by compassion to help others inject. While their desire to assist was pragmatic, they felt a significant burden of responsibility for the outcomes. Other prominent factors related to the injection provider-recipient relationship were social connection, trust, safety, social capital, and reciprocity. Participants also made suggestions for improving the PAIP which included adding more inhalation rooms so that if someone was unable to inject they could smoke in a safe place instead. Additionally, being required by law to divide drugs outside of the SCS, prior to preparing and using in the site, created unsafe conditions for clients. CONCLUSIONS: Regular use of the SCS, and access to its resources, enabled participants to lower their risk through smoking and to practice lower-risk injections. At the federal level, there is considerable room to advocate for allowing clients to divide drugs safely within the SCS, and to increase capacity for safer alternatives such as inhalation.

Supervised inhalation is an important part of supervised consumption services.

SETTING: The first regulated supervised inhalation site (safer smoking room) in North America has opened in Lethbridge, Alberta, as part of a supervised consumption site addressing all routes of consumption. When designing the service, we felt it was important to accommodate not just injection drug use but also inhalation because (1) it is not the method of drug use that kills but the drug itself, (2) all people who use drugs deserve service regardless of their mode of use, and (3) people who use drugs should have the opportunity to use the method with the lowest risk. INTERVENTION: We received approval from Health Canada to offer supervised inhalation services in addition to supervised injection services. Based on a European model, we worked with a local commercial heating, cooling, and ventilation (HVAC) company to create rooms with ventilation systems that complied with Canadian health and safety regulations. OUTCOME: People who use drugs by inhalation have repeatedly told us that they want to use indoors and will do so given the option. Since opening the supervised consumption service at the end of February 2018, the response has been overwhelming and both of the inhalation rooms are constantly in use. IMPLICATIONS: Supervised inhalation services provide an alternative to public drug use and an opportunity for people who use drugs to engage with harm reduction services. Other supervised consumption services in Canada may also wish to pursue exemptions for this service.

Fitness Equipment in Public Parks: Frequency of Use and Community Perceptions in a Small Urban Centre.

BACKGROUND: Providing freely accessible exercise facilities may increase physical activity at a population level. An increasingly popular strategy is outdoor fitness equipment in urban parks. Few studies have evaluated the effectiveness of this intervention in smaller cities. This study examined fitness equipment use, perceived effectiveness, and ways to increase use in a city of 100,000 people in 2015. METHODS: Two parks with fitness equipment and 4 without were directly observed. Interviews with 139 adults in active parks or living nearby were also conducted. RESULTS: Only 2.7% of adult park users used the fitness equipment over 100 hours of observation across 3 seasons. In contrast, 22.3% of adults interviewed reported monthly or more use of the equipment, highlighting the limitations of self-report methods. Adults interviewed perceived the equipment as potentially beneficial and suggested strategies to increase public use, including increased advertising, the introduction of programming to teach and encourage use, improved equipment quality, and improved maintenance of the equipment and surrounding area. CONCLUSIONS: In a low density city, park fitness equipment may not be an effective public health practice without additional efforts to market, introduce programming, and maintain these sites.

Mycobacterium avium intracellulare complex causing olecranon bursitis and prosthetic joint infection in an immunocompromised host.

CASE: A 73-year-old immunocompromised male presented with recurrent left elbow swelling due to Mycobacterium avium intracellulare complex (MAC) olecranon bursitis. 3 years after completing MAC treatment, he underwent right total knee arthroplasty (TKA). 1 year later, he developed TKA pain and swelling and was diagnosed with MAC prosthetic joint infection (PJI). He underwent TKA resection, reimplantation, and 12 months of anti-MAC therapy. This patient is the seventh case report of MAC olecranon bursitis and the third case report of MAC PJI. He is the only report of both MAC olecranon bursitis and PJI occurring in the same patient. INFORMED CONSENT: This patient was informed and agreed to the publication of this material.

Desulfovibrio legallii prosthetic shoulder joint infection and review of antimicrobial susceptibility and clinical characteristics of Desulfovibrio infections.

We describe a case of shoulder hemiarthroplasty infection with Desulfovibrio legallii. Antimicrobial susceptibilities of 36 Desulfovibrio isolates are presented. Metronidazole and carbapenems exhibited reliable activity, although piperacillin-tazobactam did not. Eleven previous cases of Desulfovibrio infection are reviewed; most arose from a gastrointestinal tract-related source.

Mycobacterium arupense flexor tenosynovitis: case report and review of antimicrobial susceptibility profiles for 40 clinical isolates.

We describe a case of chronic tenosynovitis in the hand of a 58-year-old cattle farmer. Surgical biopsy specimens grew Mycobacterium arupense. The patient responded to surgery and antimicrobial therapy based on in vitro susceptibility testing. The antimicrobial susceptibility profiles of the isolate from this patient and 39 additional clinical isolates are presented.