Political Action and Democracy Collective (CAPED), Department of Political Sciences, University of Montreal, Pavillon Lionel-Groulx, Bureau, C-3114 Quebec, Canada.
Int J Drug Policy. 2022 Jun;104:103694. doi: 10.1016/j.drugpo.2022.103694. Epub 2022 Apr 21.
While much has been written about the positive individual and collective effects of Supervised injection services (SIS), notably on health and drug-related harm, little research focuses on their operational context and constraints. Building on Lascoumes and Le Gales's "public policy instrument and instrumentation" framework (2007), this article analyzes the implementation of Montreal SIS and discusses how the organizational aspects of SIS produce the contexts for drug injection.
Using an ethnographic approach, this article draws on three types of data: 10 months of participant observation in a SIS (700 h); 19 semi-structured interviews with staff members (social workers, peers, heads of staff, management); and analysis of organizational documents (protocols, staff notebooks).
First, this article examines how political context and advocacy coalitions produced Montreal SIS as a public policy instrument, affecting both the philosophy and the implementation of the service. It shows that Montreal SIS were developed under a health care network blueprint rather than a community organization harm reduction framework. Then, it analyzes how SIS as a policy instrument defines what constitutes appropriate injection practices, trying to supervise injection as an individual and technical act, rather than a broader social practice composed of pleasure, rituals, routines, and group dynamics.
Montreal SIS were conceptualized under a "health banner" and through alliances between regional public health administration and local well-known community organizations. They were then developed mostly under a health care administration blueprint, although operated at a ground-level by local community organizations. It created tensions between the logics of "zero risk" and "harm reduction", and ambiguity about how injection should be supervised and what parts of drug use could be managed.
虽然已有大量文献探讨监督注射服务（SIS）对个人和集体的积极影响，尤其是在健康和与毒品相关的危害方面，但很少有研究关注其运营背景和限制。本文以 Lascoumes 和 Le Gales 的“公共政策工具和工具化”框架（2007 年）为基础，分析了蒙特利尔 SIS 的实施情况，并讨论了 SIS 的组织方面如何产生药物注射的背景。
本文采用民族志方法，利用三种类型的数据：在 SIS 中进行了 10 个月的参与式观察（700 小时）；与工作人员（社会工作者、同伴、工作人员负责人、管理人员）进行了 19 次半结构化访谈；以及对组织文件（协议、工作人员笔记本）的分析。
首先，本文考察了政治背景和倡导联盟如何将蒙特利尔 SIS 作为一种公共政策工具产生，这影响了服务的理念和实施。它表明，蒙特利尔 SIS 是在医疗保健网络蓝图下开发的，而不是在社区组织减少伤害框架下开发的。然后，本文分析了 SIS 作为一种政策工具如何定义适当的注射实践，试图将注射监督作为个人和技术行为，而不是由乐趣、仪式、常规和群体动态组成的更广泛的社会实践。
蒙特利尔 SIS 是在“健康旗帜”下，通过区域公共卫生管理局和当地知名社区组织之间的联盟构想的。然后，它们主要是在医疗保健管理局蓝图下开发的，尽管是由当地社区组织在基层运营的。这在“零风险”和“减少伤害”的逻辑之间产生了紧张关系，并且对于应该如何监督注射以及可以管理哪些部分的药物使用存在歧义。
