Department of Geography, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; Health Hazards and Environment Lab, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
Department of Geography, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; Human Environments Analysis Lab, Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
Int J Drug Policy. 2019 Dec;74:98-111. doi: 10.1016/j.drugpo.2019.09.006. Epub 2019 Oct 3.
We analyze the ongoing debate surrounding supervised injection sites in Ontario, Canada and changing policies that impact host communities. Despite a plethora of evidence proving the effectiveness of supervised injection sites on harm reduction strategy, the topic remains highly controversial with constantly changing rhetoric in the Ontario drug policy landscape.
We reviewed government reports, policies, and media sources spanning from prior to the establishment of the first Canadian supervised injection site in 2000 to early 2019, adopting an advocacy coalition framework approach to this policy analysis. Various advocacy coalitions emerge from this analysis, including all three levels of government, law enforcement, health practitioners, and community groups. We describe the narratives constructed by these coalitions, analyzing the supervised injection site model as a harm reduction strategy within a continually shifting socio-political landscape.
Emerging from the analysis are competing narratives put forward by various stakeholders within the policy subsystem. We find policy-makers tend to leverage scientific uncertainty as a tool to defend the interests of the most powerful actor in the subsystem. Despite an increase in the number of deaths due to the opioid crisis and evidence highlighting the efficacy of supervised injection sites as a harm reduction tool, various stakeholders are locked in a battle of claims and counter-claims about the appropriate policy response to opioids.
These findings have broad implications for drug policy in other contexts. Our case study demonstrates the strength of stopgap measures, like supervised injection, to reduce harm from controlled substances.
我们分析了加拿大安大略省围绕监督注射点的持续争论以及影响宿主社区的政策变化。尽管有大量证据证明监督注射点在减少伤害策略方面的有效性，但由于安大略省毒品政策领域的言论不断变化，该话题仍然极具争议性。
我们回顾了从 2000 年加拿大第一个监督注射点建立之前到 2019 年初的政府报告、政策和媒体资料，采用倡导联盟框架方法对这一政策进行分析。从这项分析中出现了各种倡导联盟，包括三级政府、执法部门、医疗从业者和社区团体。我们描述了这些联盟构建的叙述，分析了监督注射点模式作为一个在不断变化的社会政治环境中的减少伤害策略。
分析中出现了政策子系统内各利益相关者提出的相互竞争的叙述。我们发现政策制定者倾向于利用科学不确定性作为保护子系统中最强大行为者利益的工具。尽管由于阿片类药物危机导致的死亡人数增加，并且有证据强调监督注射点作为减少伤害工具的有效性，但各利益相关者仍陷入了一场关于应对阿片类药物的适当政策反应的主张和反驳的斗争。
这些发现对其他背景下的毒品政策具有广泛的影响。我们的案例研究表明，监督注射等权宜之计在减少受控物质造成的伤害方面具有强大的作用。
