Bardwell Geoff, Small Will, Lavalley Jennifer, McNeil Ryan, Kerr Thomas
British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada; Centre for Applied Research in Mental Health & Addiction, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.
Soc Sci Med. 2021 Jun;279:113986. doi: 10.1016/j.socscimed.2021.113986. Epub 2021 May 3.
The practice of prescription opioid (PO) diversion remains highly controversial and has been characterized as a source of significant drug-related harm by physicians and public health officials. We critically analyze the "problem" of diversion through an examination of the perspectives of people who divert POs during an overdose epidemic to better understand the practice, including benefits and challenges, as well as how diversion is shaped by structural contexts. Qualitative semi-structured interviews were conducted with 21 participants recruited from ongoing cohort studies involving people who use drugs in Vancouver, Canada. Prohibitive prescribing policies made accessing POs difficult, leading some to smuggle drugs out of clinics. Others would buy POs in bulk or do trades to acquire them. Participants risked having their prescriptions terminated, but rationalized this risk as a protective measure that allows them to provide safer drugs to others (e.g., to prevent overdose or treat withdrawal). Poverty also framed diversion, with some participants diverting their POs to generate income to pay for expenses including food and sometimes illicit fentanyl (perceived as a stronger alternative). However, diversion was shaped by other constraints, including criminalization, negative health impacts from not consistently consuming POs, and supplies running out, which led some participants to rely on other illegal means to generate income. This study highlights the intricate means by which POs are acquired and diverted and how environmental contexts frame how participants negotiated risk and rationalized diversion. Our study provides an alternative perspective on the "problem" of diversion and demonstrate a positive effect in providing a safer drug supply to others during an overdose crisis. Given that drug policy, criminalization, and poverty created challenges, our findings demonstrate the need for strategies that engender greater safety, reduce harm, and alleviate the effects of these constraints, including through policies promoting safer drug supplies, decriminalization, and employment.
处方阿片类药物（PO）的转移使用行为仍极具争议，医生和公共卫生官员将其视为重大药物相关危害的一个源头。我们通过考察在药物过量流行期间转移使用PO的人群的观点，对转移使用这一“问题”进行批判性分析，以更好地理解这种行为，包括其益处和挑战，以及转移使用行为是如何受到结构背景影响的。我们对21名参与者进行了定性半结构化访谈，这些参与者是从加拿大温哥华正在进行的涉及吸毒者的队列研究中招募的。严格的处方政策使获取PO变得困难，导致一些人从诊所偷运药物。其他人则会批量购买PO或进行交易来获取它们。参与者冒着处方被终止的风险，但将这种风险合理化，认为这是一种保护措施，使他们能够向他人提供更安全的药物（例如，预防药物过量或治疗戒断症状）。贫困也促使了转移使用行为，一些参与者转移他们的PO以赚取收入来支付包括食物以及有时非法芬太尼（被视为更强效的替代品）在内的费用。然而，转移使用行为还受到其他限制因素的影响，包括刑事定罪、不持续使用PO对健康产生的负面影响以及药物供应耗尽，这导致一些参与者依赖其他非法手段来赚取收入。本研究突出了获取和转移使用PO的复杂方式，以及环境背景如何影响参与者对风险的权衡和转移使用行为的合理化。我们的研究为转移使用这一“问题”提供了一个不同的视角，并证明了在药物过量危机期间为他人提供更安全的药物供应所产生的积极作用。鉴于药物政策、刑事定罪和贫困带来了挑战，我们的研究结果表明需要制定能够提高安全性、减少危害并减轻这些限制因素影响的策略，包括通过促进更安全药物供应、非刑事化和就业的政策。
