Abstract This paper explores elements of the relationships that develop between people who use illicit drugs and people who provide services to them. It focuses on expectations people who use drugs ...and service providers have of health and social care relationships for harm reduction, as well as facilitators and barriers to effective and ineffective interactions, and to what governments might better do to help strengthen interactions. Prior to Canada's inaugural national harm reduction conference, informal discussion groups were organized to source local views regarding policy reform for harm reduction. One component of these discussion groups focused upon improving health and social care relationships for harm reduction. Community-based organizations providing services for harm minimisation were consulted to help develop themes and questions. Discussion groups conducted in French or English were held in 10 cities across Canada. Groups were audio-recorded, transcribed and thematically analysed. Disjuncture between understandings of the nature of health and social care relationships for harm reduction were found. Interpersonal and structural factors functioned both for and against the development of effective interactions. Differences in expectation sets held by illicit drug users and service providers may reflect the fluid experience of boundaries as a population on society's margins moves between harm-causing and harm-reducing behaviours and identities. The research described in this paper targeted those most directly involved in receiving, developing and delivering harm reduction programmes across a very diverse nation. It did so by including representatives of those most directly involved in utilizing and providing services within the research process itself. By incorporating a process that was community-based, user-driven, and which strived to be non-judgmental, the research was able to explore suggestions for improving health and social care relationships for harm reduction proffered by professionals actively providing services, as well as a variety of users, including some isolated or structurally excluded from service access by geography, illiteracy and/or street-involvement.
The authors examine the organizational transformation of Prevention Point, the San Francisco-based syringe exchange program. Their purposes are to explore the processes of organizational change, ...focus on the impact of formalization on members and organizational goals, and contextualize these in light of belonging to an underground organization. They highlight the volunteers’ motivation and commitment, and their responses to the organizational changes. Drawing on qualitative interviews with 56 service providers, conducted from 1993 to 1995, the authors document the changes in the organization and the members’ perceptions of it as it moved from an illegal, deviant group to a socially sanctioned service organization. This transition is shown to have ultimately undermined much of the basis for volunteer commitment, reinforcing the shift in responsibility from the membership to a new management structure. These findings have implications for the larger problem of maintaining volunteer engagement in volunteer work.
This article examines illicit drug use from a decision-making perspective using data collected during 2000-2002 from 51 current and ex-users of marijuana in a large urban city in the ...central/southwest United States. A qualitative inductive approach based on grounded theory guided the analyses. We find that prior to experimentation and use, decision-making processes are general and nonspecific. In the later stages of drug involvement, decision-making processes become drug-specific. Individuals consider a number of different types of factors when making decisions about illicit drug use involvement. The study's implications and limitations are discussed and future research suggested.
Harm reduction is part of a comprehensive approach to dealing with the harms of drug use. Although the evidence to support implementation of harm reduction strategies for illicit drug use is ...abundant, it is unlikely that scientific knowledge alone will be enough to facilitate the adoption of harm reduction strategies in many health-care settings. The authors examine the ethical, legal and social context of harm reduction as it pertains to illicit drug use to assist nurses in providing safe, competent and ethical care. Included is an examination of values and accompanying responsibility statements from the Canadian Nurses Association's Code of Ethics for Registered Nurses that can guide nurses in their ethical reflection and provide insights into ethical practice.
. This paper presents a review of the recent economics literature in the area of illicit drug use. Particular attention is paid to the economics of addiction and the rational addiction model, the ...welfare economics framework for analysing the social costs of drug use, and the attempts that have been made by economists to evaluate recent or proposed policy interventions. A dominant theme in this review is the problem of poor data availability. This is particularly true when it comes to implementing the Rational Addiction model, but it is also apparent in the literature on estimating the costs of illicit drug use to society as a whole. One of the main conclusions of this review is that until recently public policy has not been particularly influenced by research carried out by economists. It is not clear whether this is because economists have had to grapple with inadequate data, and hence their conclusions are couched in uncertainty, or whether it is because drugs researchers have assumed a very limited role for economists in their analysis.
This cross-sectional study of adult (137 male, 128 female), urban, community dwelling users and nonusers of illicit drugs evaluated associations of demographic, medical, and drug factors with body ...composition. The population was 49% HIV-positive and 94% African-American. In multivariate analysis, there were no body composition differences among males based on drug use. Among females, the highest tertile of drug use had less fat (12.3 vs.19.9 kg, p = .01) and lower body mass index (21.9 vs. 25.1, p = .01) versus less frequent or nonusers. These data suggest a sex difference in body composition associated with drug use.
Pulmonary hypertension has been associated with ingestion of theappetite suppressant aminorex. A similar compound, 4-methyl-aminorex(street names, “U-4-E-uh” pronounced euphoria or “ice”), isa ...“designer” drug with central stimulant activity. This drug wasdiscovered on the property of three individuals with diagnoses ofpulmonary hypertension. The association between “recreational”aminorex manufacture and ingestion and the development of pulmonaryhypertension is described.
Illicit drug use is an important public health problem with broad social costs. The low effectiveness of prevention efforts leaves treatment of drug dependence as one of the most powerful means of ...fighting illicit drug use. Treatment reduces drug use and crime and increases individuals' functioning. However, programs that treat drug dependence have high dropout rates and low completion rates. In addition, some individuals continue to use drugs while in treatment, and relapse is common. Furthermore, only a fraction of those who need treatment receive it. Recently, there have been important innovations that reduce barriers and increase effectiveness of treatment. These innovations include new pharmacological agents, novel counseling strategies, promising ways to motivate, and treatment in new settings. This paper describes standard treatments and recent innovations designed to increase (a) effectiveness of treatment, (b) motivation to seek care, (c) access, (d) retention, and (e) cost-effectiveness. We provide criteria on how these innovations should be evaluated in order to determine which should be adopted, funded, and transferred to existing and future treatment programs.
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