MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada.
Elizabeth Fry Society Toronto, 215 Wellesley Street East, Toronto, ON, M4X 1G1, Canada.
Subst Abuse Treat Prev Policy. 2021 Mar 20;16(1):26. doi: 10.1186/s13011-021-00360-3.
Amid increasing opioid overdose deaths in Canada since 2010 and a changing naloxone access landscape, there is a need for up-to-date research on Canadian women's experiences with opioids. Studies on Canadian take-home naloxone programs are promising, but research beyond these programs is limited. Our study is the first to focus on women's experiences and perspectives on the opioid crisis in Ontario, Canada's most populous province, since the opioid crisis began in 2010.
Our objective was to address research knowledge gaps involving Canadian women with criminal justice involvement who use opioids, and identify flaws in current policies, responses, and practices. While the opioid overdose crisis persists, this lack of research inhibits our ability to determine whether overdose prevention efforts, especially involving naloxone, are meeting their needs.
We conducted semi-structured, qualitative interviews from January to April 2018 with 10 women with experience of opioid use. They were recruited through the study's community partner in Toronto. Participants provided demographic information, experiences with opioids and naloxone, and their perceptions of the Canadian government's responses to the opioid crisis. Interviews were transcribed verbatim and inductive thematic analysis was conducted to determine major themes within the data.
Thematic analysis identified seven major concerns despite significant differences in participant life and opioid use experiences. Participants who had used illicit opioids since naloxone became available over-the-counter in 2016 were much more knowledgeable about naloxone than participants who had only used opioids prior to 2016. The portability, dosage form, and effects of naloxone are important considerations for women who use opioids. Social alienation, violence, and isolation affect the wellbeing of women who use opioids. The Canadian government's response to the opioid crisis was perceived as inadequate. Participants demonstrated differing needs and views on ideal harm reduction approaches, despite facing similar structural issues surrounding stigma, addiction management, and housing.
Participants experienced with naloxone use found it to be useful in preventing fatal overdose, however many of their needs with regards to physical, mental, and social health, housing, harm reduction, and access to opioid treatment remained unmet.
自 2010 年以来，加拿大阿片类药物过量死亡人数不断增加，纳洛酮获取途径也发生了变化，因此需要对加拿大女性的阿片类药物使用经验进行最新研究。关于加拿大带离纳洛酮计划的研究很有前景，但超出这些计划的研究有限。我们的研究是自 2010 年阿片类药物危机开始以来，首次关注加拿大人口最多的省份安大略省女性对阿片类药物危机的经验和看法。
我们的目的是解决涉及有犯罪司法记录的使用阿片类药物的加拿大女性的研究知识空白，并确定当前政策、应对措施和做法中的缺陷。虽然阿片类药物过量危机仍在持续，但这种缺乏研究的情况限制了我们确定预防过量的努力，特别是涉及纳洛酮的努力，是否满足了他们的需求。
我们于 2018 年 1 月至 4 月期间，通过多伦多的研究社区合作伙伴，对 10 名有阿片类药物使用经验的女性进行了半结构式定性访谈。参与者提供了人口统计信息、阿片类药物和纳洛酮使用经验，以及他们对加拿大政府应对阿片类药物危机的反应的看法。访谈记录被逐字转录，并进行了归纳主题分析，以确定数据中的主要主题。
尽管参与者的生活和阿片类药物使用经验存在显著差异，但主题分析确定了七个主要关注点。自 2016 年纳洛酮在加拿大非处方销售以来，曾使用过非法阿片类药物的参与者对纳洛酮的了解要多于仅在 2016 年之前使用过阿片类药物的参与者。纳洛酮的便携性、剂型和效果是使用阿片类药物的女性的重要考虑因素。社会孤立、暴力和隔离影响了使用阿片类药物的女性的健康。加拿大政府对阿片类药物危机的应对被认为是不足的。尽管参与者面临着围绕污名化、成瘾管理和住房等结构性问题存在相似的需求和观点，但他们对理想的减少伤害方法的需求和看法存在差异。
有纳洛酮使用经验的参与者发现它在预防致命性过量方面很有用，但他们在身体、心理和社会健康、住房、减少伤害和获得阿片类药物治疗方面的许多需求仍未得到满足。
