Interventions to Reduce Opioid Use in Youth At-Risk and in Treatment for Substance Use Disorders: A Scoping Review.

BACKGROUND: Youth and young adults have been significantly impacted by the opioid overdose and health crisis in North America. There is evidence of increasing morbidity and mortality due to opioids among those aged 15-29. Our review of key international reports indicates there are few youth-focused interventions and treatments for opioid use. Our scoping review sought to identify, characterize, and qualitatively evaluate the youth-specific clinical and pre-clinical interventions for opioid use among youth. METHOD: We searched MedLine and PsycInfo for articles that were published between 2013 and 2021. Previous reports published in 2015 and 2016 did not identify opioid-specific interventions for youth and we thus focused on the time period following the periods covered by these prior reports. We input three groups of relevant keywords in the aforementioned search engines. Specifically, articles were included if they targeted a youth population (ages 15-25), studied an intervention, and measured impacts on opioid use. RESULTS: We identified 21 studies that examined the impacts of heterogeneous interventions on youth opioid consumption. The studies were classified inductively as psycho-social-educational, pharmacological, or combined pharmacological-psycho-social-educational. Most studies focused on treatment of opioid use disorder among youth, with few studies focused on early or experimental stages of opioid use. A larger proportion of studies focused heavily on male participants (i.e., male gender and/or sex). Very few studies involved and/or included youth in treatment/program development, with one study premised on previous research about sexual minority youth. CONCLUSIONS: Research on treatments and interventions for youth using or at-risk of opioids appears to be sparse. More youth involvement in research and program development is vital. The intersectional and multi-factorial nature of youth opioid use and the youth opioid crisis necessitates the development and evaluation of novel treatments that address youth-specific contexts and needs (i.e., those that address socio-economic, neurobiological, psychological, and environmental factors that promote opioid use among youth).

When a Child Dies: Racialized Father's Experiences of Objectification During Hospital Care.

Understanding the meaning of loss for racialized immigrant fathers and addressing their experiences in a culturally competent manner is important in an increasingly ethnoculturally diverse country like Canada. Culture, customs and rituals influence fathers' grief and culture impacts how individuals discuss death and dying as well as how they perceive the death of a child. This article is part of a qualitative research project, which examined the experiences of racialized immigrant fathers who experienced the death of a child. Guided by Charmaz's constructivist grounded theory, the methodological aim was to develop a theoretical framework grounded in fathers' experiences of child death within the hospital setting. Findings suggest that for racialized immigrant fathers their migration experience compounds their losses in unexpected ways and that experiences of objectification or 'othering' in hospital and by health care staff were significant.

"It's a Bit of a Double-Edged Sword": Motivation and Personal Impact of Bereaved Mothers' Advocacy for Drug Policy Reform.

North America's overdose crisis is an urgent public health issue that has resulted in thousands of deaths. As the crisis began to take hold across Canada in 2016, bereaved parents, mainly mothers, emerged as vocal advocates for drug policy reform and harm reduction, using their stories to challenge the stigma of drug-related death. In 2017, we launched a qualitative research partnership with leading family organizations in Canada, conducting interviews with 43 mothers whose children had died from substance use, to understand their experiences of drug policy advocacy. Our findings showed that participants' motivations for engaging in advocacy were rooted in their experiences of grief, and that advocacy led to feelings of empowerment and connection to others. Our research suggests that advocacy can be cathartic and associated with healing from grief, but that "going public" in sharing a family story of substance use death can also have a considerable personal cost.

Equipping youth for meaningful policy engagement: an environmental scan.

To better address the mental health and substance use crises facing youth globally, a comprehensive approach, inclusive of mental health promotion is needed. A key component of mental health promotion is policy intervention to address the social and structural determinants of health. Importantly, youth should be engaged in these efforts to maximize relevancy and impact. Yet, while there is growing interest in the inclusion of youth in the policymaking process, there is a paucity of guidance on how to do this well. This environmental scan reports findings from a comprehensive search of academic and grey literature that was conducted using the electronic databases: CINAHL, ERIC, MEDLINE, PsycINFO, Google Scholar, and Google. Search terms included variations of 'youth*', 'educat*', 'engage*', 'policy' and 'policy training'. Thirteen English language training programmes met inclusion criteria. Analysis identified marked differences in programme philosophy and focus by geographic region and highlights the need for enhanced evaluation and impact measurement moving forward. This paper makes a needed contribution to the evidence-base guiding this key mental health promotion strategy, which holds the potential to address critical gaps in approaches to youth mental health and substance use.

"You can't chain a dog to a porch": a multisite qualitative analysis of youth narratives of parental approaches to substance use.

BACKGROUND: Reducing harms of youth substance use is a global priority, with parents identified as a key target for efforts to mitigate these harms. Much of the research informing parental responses to youth substance use are grounded in abstinence and critiqued as ineffective and unresponsive to youth contexts. Parental provision of substances, particularly alcohol, is a widely used approach, which some parents adopt in an attempt to minimize substance use harms; however, research indicates that this practice may actually increase harms. There is an absence of research exploring youth perspectives on parental approaches to substance use or the approaches youth find helpful in minimizing substance use-related harms. METHODS: This paper draws on interviews with youth aged 13-18 (N = 89) conducted within the Researching Adolescent Distress and Resilience (RADAR) study in three communities in British Columbia, Canada. An ethnographic approach was used to explore youth perspectives on mental health and substance use within intersecting family, social, and community contexts. This analysis drew on interview data relating to youth perspectives on parental approaches to substance use. A multisite qualitative analysis (MSQA) was conducted to examine themes within each research site and between all three sites to understand how youth perceive and respond to parental approaches to substance use in different risk environment contexts. RESULTS: Within each site, youths' experiences of and perspectives on substance use were shaped by their parents' approaches, which were in turn situated within local social, geographic, and economic community contexts. Youth descriptions of parental approaches varied by site, though across all sites, youth articulated that the most effective approaches were those that resonated with the realities of their lives. Zero-tolerance approaches were identified as unhelpful and unresponsive, while approaches that were aligned with harm reduction principles were viewed as relevant and supportive. CONCLUSIONS: Youth perspectives illustrate that parental approaches to substance use that are grounded in harm reduction principles resonate with young people's actual experiences and can support the minimization of harms associated with substance use. Evidence-based guidance is needed that supports parents and young people in adopting more contextually responsive harm reduction approaches to youth substance use.

A Guide to Multisite Qualitative Analysis.

The aims of multisite qualitative research, originally developed within the case study tradition, are to produce findings that are reflective of context, while also holding broader applicability across settings. Such knowledge is ideal for informing health and social interventions by overcoming the limitations of research developed through methodological approaches that either "strip" context, or that hold relevance for a site-specific group or population. Yet, despite the potential benefits of multisite qualitative research, there is a paucity of analytical guidance to support researchers in achieving these yields. In this article, we present an analytical approach for conducting multisite qualitative analysis (MSQA) across various methodologies to maximize the potential of qualitative research, enhance rigor, and support the development of interventions that are tailored to the populations that they are intended to serve.

User-driven conversations about dialysis through Facebook: A qualitative thematic analysis.

AIM: As one of the most popular social networking sites in the world, Facebook has strong potential to enable peer support and the user-driven sharing of health information. We carried out a qualitative thematic analysis of the wall posts of a public Facebook group focused on dialysis to identify some of the major themes discussed. METHODS: We searched Facebook using the word 'dialysis'. A Facebook group (Dialysis Discussion Uncensored) with the highest number of members was selected amongst publicly available forums related to dialysis and operated in English (http://www.facebook.com/groups/DialysisUncensored). Two researchers independently extracted information on features of the group including purpose, group members and the user-generated posts on the group wall. Posts were further analysed to develop major themes. RESULTS: Characteristics of a Facebook group based on its participants and activities are presented. Three themes are described with representative quotations. In a period of 2 weeks, we found 1257 wall posts with total of 31 636 likes and 15 972 comments. All messages were in English, and the majority of the participants were dialysis patients. However, we observed the participation of family members and care providers as well. Posts were categorized into three major themes: sharing information, seeking and providing emotional and social support and sharing experience. CONCLUSION: Findings of this study provide an example of how a social networking platform can enable patients and their families to share information and to encourage peer-based support for managing dialysis-related experiences.

Developing harm reduction in the context of youth substance use: insights from a multi-site qualitative analysis of young people's harm minimization strategies.

BACKGROUND: Youth substance use programming and educational strategies are frequently informed by prevention approaches that emphasize abstinence goals, which often do not resonate with youth in their lack of acknowledgment of young people's social context and how young people perceive positive effects of substance use. Further, approaches to drug prevention have been critiqued as adopting a one-size-fits-all approach and therefore inadequate in addressing substance use in the context of population variation and inequities. In response to the limitations of current approaches to prevention, programming informed by harm reduction principles that aims to minimize harms without requiring abstinence is emergent in school settings. However, youth perspectives informing harm reduction are limited in both research and program development. METHODS: This paper draws on data from the Researching Adolescent Distress and Resilience (RADAR) study, which utilized an ethnographic approach to bring youth voice to the literature on mental health and substance use. Qualitative data collection included individual interviews (n = 86) with young people aged 13-18 across three communities-representing urban, suburban, and rural geographies-in British Columbia, Canada. A multi-site qualitative analysis of interview data was conducted to identify themes across and within each research site. RESULTS: Across all three sites, young people's individual experiences of substance use were shaped by geographic, socio-cultural, and political contexts, with youth describing their use in relation to the nature of substance use in peer groups and in the broader community. To manage their own substance use and reduce related harms, youth employed a variety of ad hoc harm minimization strategies that were reflective of their respective contexts. CONCLUSIONS: The findings from this study suggest the importance of harm reduction approaches that are contextually relevant and responsive to the lived experiences of youth. Youth perspectives in the development of harm reduction programming are needed to ensure that approaches are relatable and meaningful to young people, and effective for promoting the minimization of substance-related harms.

A qualitative content analysis of cigarette health warning labels in Australia, Canada, the United Kingdom, and the United States.

The legislation of health warning labels on cigarette packaging is a major focus for tobacco control internationally and is a key component of the World Health Organization's Framework Convention on Tobacco Control. This population-level intervention is broadly supported as a vital measure for warning people about the health consequences of smoking. However, some components of this approach warrant close critical inspection. Through a qualitative content analysis of the imagery used on health warning labels from 4 countries, we consider how this imagery depicts people that smoke. By critically analyzing this aspect of the visual culture of tobacco control, we argue that this imagery has the potential for unintended consequences, and obscures the social and embodied contexts in which smoking is experienced.

Picture Me Smokefree: a qualitative study using social media and digital photography to engage young adults in tobacco reduction and cessation.

BACKGROUND: Young adults have high rates of tobacco use compared to other subpopulations, yet there are relatively few tobacco interventions specifically targeted to this group. Picture Me Smokefree is an online tobacco reduction and cessation intervention for young adults that uses digital photography and social networking. OBJECTIVE: The main goal of the project was to determine the feasibility of engaging young adults in participating in user-driven, online forums intended to provide peer support and motivate critical reflection about tobacco use and cessation among this high-use, hard-to-reach population. A related aim was to explore the influence of gender-related factors on participation, in order to determine the need for online interventions to be tailored to the specific gender preferences reflecting young men and women's participation styles. METHODS: A total of 60 young adults ages 19-24 years who self-identified as current cigarette smokers or who had quit within the last year were recruited from across British Columbia, Canada, and participated in an online photo group on Facebook over a period of 12 consecutive weeks. A variety of data collection methods were used including tracking online activity, a brief online follow-up survey, and qualitative interviews with study participants. Data analysis involved descriptive statistics on recruitment, retention, and participation and qualitative (eg, narrative analysis, synthesis of feedback) feedback about participant engagement. RESULTS: Findings from this study suggest good potential for Facebook as an accessible, low-cost platform for engaging young adults to reflect on the reasons for their tobacco use, the benefits of quitting or reducing, and the best strategies for tobacco reduction. Young adults' frequent use of mobile phones and other mobile devices to access social networking permitted ease of access and facilitated real-time peer-to-peer support across a diverse group of participants. However, our experience of conducting the study suggests that working with young tobacco users can be accompanied by considerable recruitment, participation, and retention challenges. Our findings also pointed to differences in how young women and men engaged the photo-group intervention that should be considered, bearing in mind that in follow-up interviews participants indicated their preference for a mixed gender and "gender neutral" group format. CONCLUSIONS: Tobacco interventions for youth and young adults should be embedded within the existing social networking platforms they access most frequently, rather than designing a stand-alone online prevention or intervention resource. This subpopulation would likely benefit from tobacco reduction interventions that are gender-sensitive rather than gender-specific.

Gender, smoking and tobacco reduction and cessation: a scoping review.

Considerations of how gender-related factors influence smoking first appeared over 20 years ago in the work of critical and feminist scholars. This scholarship highlighted the need to consider the social and cultural context of women's tobacco use and the relationships between smoking and gender inequity. Parallel research on men's smoking and masculinities has only recently emerged with some attention being given to gender influences on men's tobacco use. Since that time, a multidisciplinary literature addressing women and men's tobacco use has spanned the social, psychological and medical sciences. To incorporate these gender-related factors into tobacco reduction and cessation interventions, our research team identified the need to clarify the current theoretical and methodological interpretations of gender within the context of tobacco research. To address this need a scoping review of the published literature was conducted focussing on tobacco reduction and cessation from the perspective of three aspects of gender: gender roles, gender identities, and gender relations. Findings of the review indicate that there is a need for greater clarity on how researchers define and conceptualize gender and its significance for tobacco control. Patterns and anomalies in the literature are described to guide the future development of interventions that are gender-sensitive and gender-specific. Three principles for including gender-related factors in tobacco reduction and cessation interventions were identified: a) the need to build upon solid conceptualizations of gender, b) the importance of including components that comprehensively address gender-related influences, and c) the importance of promoting gender equity and healthy gender norms, roles and relations.

The Influences of Health Beliefs and Identity on Adolescent Marijuana and Tobacco Co-Use.

Among youth, the co-use of marijuana and tobacco is highly prevalent, yet a considerable gap remains in the drug-prevention literature pertaining to such co-use. In particular, the prevention field lacks research exploring how adolescents understand the health implications of smoking these two substances in combination. In this article, we draw on qualitative interviews with adolescents from three communities in British Columbia, Canada, and describe the health beliefs and social identities that they associated with smoking marijuana and tobacco. We argue that smoking prevention and cessation initiatives targeting adolescents must address both marijuana and tobacco. Such initiatives must also be designed to identify and address how adolescents frame the potential health harms associated with smoking these substances.

Designing Tailored Messages about Smoking and Breast Cancer: A Focus Group Study with Youth.

The purpose of this study was to design an approach to supporting the development of gender- and Aboriginal-specific messages regarding the link between tobacco exposure and breast cancer, drawing on youth perspectives. Focus groups were held with 18 girls (8 First Nations and Métis) and 25 boys (12 First Nations and Métis) to solicit advice in the design of messages. Transcribed data were analyzed for themes. Girls preferred messages that included the use of novel images, a personal story of breast cancer, and ways to avoid secondhand smoke. Boys endorsed messages that were "catchy" but not "cheesy" and had masculine themes. First Nations and Métis participants confirmed the use of Aboriginal symbols in messages as signalling their relevance to youth in their communities. The results can be used as a guide in developing tailored health promotion messages. Challenges in developing gender-appropriate messages for youth are described.

Notre étude visait à mettre au point une approche propice à la création de messages axés sur le lien entre l'exposition au tabac et le cancer du sein, qui s'adresseraient aux jeunes Autochtones de chaque sexe et s'inspireraient de leurs perspectives. Nous avons tenu des groupes de discussion formés de 18 filles (issues de huit Premières nations et du peuple métis) et de 25 garçons (issus de 12 Premières nations et du peuple métis), dans le but d'obtenir leur avis sur cette question. Les données transcrites ont été analysées pour en dégager les thèmes principaux. Chez les filles, on préfère des messages qui proposent des images originales, une histoire personnelle sur le cancer du sein et des conseils sur les façons d'éviter de s'exposer à la fumée secondaire. Les garçons préfèrent quant à eux des messages « accrocheurs ¼, qui ne sont pas « de mauvais goût ¼ et comportent des thèmes masculins. Tous et toutes ont jugé que le recours à des symboles autochtones dans les messages était pertinent pour les jeunes de leurs communautés. Ces résultats pourront servir de guide en vue de créer des messages ciblés axés sur la promotion de la santé. On explique les difficultés que présente la formulation de messages adaptés en fonction du sexe des jeunes.

Reconceptualizing cannabis use risks in the context of health and social inequities: Insights from a qualitative study with young people in Canada.

BACKGROUND: Cannabis became legal in Canada in 2018. Since then, calls for research to evaluate the impact of legalization on youth have been at the forefront of public and academic discussions. Research addressing these calls has largely focused on issues of risk and harm, with limited attention to the role of social context in shaping youth cannabis use. This paper presents the findings of a study that centered youth perspectives on cannabis use in the context of health and social inequities. METHODS: Between 2021 and 2022, we undertook an exploratory and critical qualitative interview study with 56 youth from across Canada who use cannabis and who reported experiences with health or social struggles, broadly self-defined. Our analysis followed a reflexive thematic approach and leveraged theoretical perspectives from critical drug studies to interrogate youths' variegated cannabis use risks and risk environments, whilst facilitating inquiry into their interface with overlapping forms of hardship and inequity. FINDINGS: We developed three interconnected themes: (i) cannabis use risks as contextually situated; (ii) cannabis use as a practice of care; and (iii) cannabis use as a survival tool in connection with trauma and violence. Findings within and across these themes centre on the nexus of intentionality and agency in youth narratives of using cannabis and situates their cannabis use in connection with, and in response to, intersecting health and social inequities. CONCLUSION: This study underscores opportunities for a reconsideration or reconceptualization of risks in the context of youth cannabis use, so that approaches to supporting youth who use cannabis are more resonant and credible with those who experience health and social inequities. Findings offer direction for youth cannabis policy and programming, including to decenter individual pathology, support harm reduction goals, and further consider relationships between cannabis use and context, marginalization, and oppression.

Expectancies of the Effects of Cannabis Use in Individuals with Social Anxiety Disorder (SAD).

Previous research has indicated that anticipating positive effects from cannabis use may be linked with increased frequency of cannabis consumption, yet these expectancies remain poorly understood in adults with social anxiety disorder (SAD). Thus, our study aimed to investigate the expectancies of the effects of cannabis use in 26 frequently using adults with SAD (age: 27.9 ± 7.3 years; 54% female) and 26 (age: 27.4 ± 6.7 years; 50% female) without. While no between-group differences were observed, both groups reported expecting tension reduction and relaxation (F = 0.001; p = 0.974), cravings, and physical effects (F = 1.10; p = 0.300), but denied global negative effects (F = 0.11; p = 0.744). The trajectory of cannabis use perceptions (further investigated in 12/26 participants/group) also showed no between-group differences. Before the initial use, positive perceptions may have led to initial and continuous cannabis consumption, while the symptoms of cannabis use disorder may have contributed to repeated use. Our data indicate that, regardless of psychiatric history, frequent cannabis-using adults are more likely to report positive expectancies, which are often associated with increased patterns of cannabis consumption. Psychoeducational programs and openly discussing the risks of cannabis may be beneficial in preventing and/or reducing cannabis use in people with SAD.

Defining a public health approach to substance use: Perspectives from professionals and practitioners across Canada.

BACKGROUND: While increasingly referenced in the literature and policy discussions, a "public health approach" (PHA) to substance use has been inconsistently defined or remained undefined. As part of a larger project on building the capacity to implement a PHA to substance use, we aimed to understand how professionals and practitioners across Canada who work with or whose work directly impacts the lives of people who use substances conceptualize a PHA. METHODS: We conducted a cross-sectional national online survey of public health professionals, public safety professionals, health and social service providers, and other relevant professionals and practitioners. The survey contained closed- and open-ended questions designed to gauge familiarity and comfort with application of a PHA to substance use, and perspectives on an organizational definition of such an approach. Survey recruitment was active between May and July 2021. Data analysis included descriptive statistics and thematic analysis. RESULTS: A total of 1041 surveys were completed. Most respondents (76 %) reported having heard of a PHA to substance use, as it was defined. Over half (54 %) indicated a high level of comfort with applying such an approach within their work. In relation to defining a PHA to substance use, the following thematic suggestions emerged from respondent's open-ended answers: explicitly recognize people with lived/living experience of substance use; incorporate trauma-informed understanding and acknowledge the varied underlying reasons for substance use; decolonize approaches to substance use and empower communities; and consider a more critical appraisal of a PHA and the terminology in its definition. CONCLUSION: Empirically unpacking multi-stakeholder understandings of a PHA to substance use can help to inform a more cohesive definition and build the consensus needed for more effective, coordinated, and community-led responses to substance use. Future work, especially qualitative research, will provide richer and more practical understandings of a PHA to substance use.

Beyond struggle: A strengths-based qualitative study of cannabis use among queer and trans youth in Québec.

BACKGROUND: Queer and trans (QT) youth report higher rates of cannabis use than their cisgender and heterosexual peers. Explanations for this have overwhelmingly focused on the difficulties QT youth face, while little research has examined how cannabis use can relate to QT youth's strengths. We sought to explore how cannabis use could be involved in the experiences of QT youth from a strengths-based perspective. METHODS: We conducted a QT youth-led, community-based study composed of 27 semi-structured interviews with QT young adults aged 21-25 years and living in Québec who use(d) cannabis regularly. Through reflexive thematic analysis (Braun & Clarke, 2019), we used a strengths-based lens informed by the Minority Strengths Model (Perrin et al., 2020) to explore how cannabis use featured in participants' efforts to survive and thrive. RESULTS: We generated three themes representing how cannabis featured in participants' efforts to survive and thrive. First, cannabis was used to facilitate the production of an authentic QT self, a process that involved self-discovery, introspection, exploration, awareness, and expression. Cannabis supported, accompanied, and/or complicated this process. Second, cannabis use (and non-use) was involved in building QT community and connection, which constituted a crux of participants' wellbeing. Third, cannabis was used to face adversity, such as marginalization, QT oppression, mental health challenges, and structural under-resourcing. This adversity contrasted experiences of QT identities themselves, which were described as a source of joy and pride. CONCLUSION: Our analysis illustrates many ways in which cannabis use (and non-use) features in QT youth's efforts to survive and thrive. As a result, we encourage loved ones, clinicians, researchers and policy makers to adopt a view of QT cannabis use that is expansive and inclusive of QT youth's strengths.

Engaging families and parent advocates in research on substance use and drug policy reform: Guiding principles from a Canadian community-academic partnership.

Canada is in the midst of a public health emergency in drug poisoning (overdose) deaths. In this context parents, and especially mothers, of those who have died from drug poisoning have mobilised to advocate for urgent responses and drug policy reforms. To document this emerging women-led advocacy, we initiated a community-academic research partnership with three parent groups representing families in Canada bereaved by drug-related deaths. In this commentary, we describe four guiding principles we developed during the course of this project, to ensure an ethical and equitable approach to conducting our research partnership. In particular, we emphasise how we navigated parents' roles as vocal advocates for addressing drug stigma and expanding harm reduction while actively working to avoid eclipsing the need to centre the perspectives of people who use drugs. Meaningful and collaborative partnerships between academics and community groups may facilitate greater understandings of how families and communities can be allied in drug policy reforms urgently needed to prevent drug poisoning deaths.

Flawed reports can harm: the case of supervised consumption services in Alberta.

Supervised consumption services have been scaled up within Canada and internationally as an ethical imperative in the context of a public health emergency. A large body of peer-reviewed evidence demonstrates that these services prevent poisoning deaths, reduce infectious disease transmission risk behaviour, and facilitate clients' connections to other health and social services. In 2019, the Alberta government commissioned a review of the socioeconomic impacts of seven supervised consumption services in the province. The report is formatted to appear as an objective, scientifically credible evaluation of these services; however, it is fundamentally methodologically flawed, with a high risk of biases that critically undermine its authors' assessment of the scientific evidence. The report's findings have been used to justify decisions that jeopardize the health and well-being of people who use drugs both in Canada and internationally. Governments must ensure that future assessments of supervised consumption services and other public health measures to address drug poisoning deaths are scientifically sound and methodologically rigorous. Health policy must be based on the best available evidence, protect the right of structurally vulnerable populations to access healthcare, and not be contingent on favourable public opinion or prevailing political ideology.

RéSUMé: Les services de consommation supervisée ont été établis au Canada et à l'étranger en tant qu'impératif éthique dans le contexte d'une urgence de santé publique. Un grand nombre d'études rigoureuses démontrent que ces services préviennent les décès par empoisonnement, réduisent les comportements à risque de transmission de maladies infectieuses, et facilitent les liens avec d'autres services sociaux et de santé. En 2019, le gouvernement de l'Alberta a commandé un examen des impacts socioéconomiques de sept services de consommation supervisée dans la province. La présentation du rapport donne l'impression que l'évaluation de ces services est objective et scientifiquement crédible; cependant, il présente des faiblesses importantes au plan méthodologique, notamment en raison de la présence de biais qui compromet l'évaluation des preuves scientifiques. Ses conclusions ont été utilisées pour justifier des décisions qui mettent en péril la santé et le bien-être des personnes qui consomment des drogues, tant au Canada qu'à l'étranger. Les gouvernements doivent s'assurer que les futures évaluations des services de consommation supervisée et d'autres mesures de santé publique pour lutter contre les décès par empoisonnement dû aux drogues sont scientifiquement fondées. Les politiques en matière de santé doivent être basées sur les meilleures données disponibles, protéger les droits des populations structurellement vulnérables à accéder aux soins de santé, et ne pas dépendre de l'opinion publique ou d'une idéologie politique dominante.