School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Int J Drug Policy. 2022 Oct;108:103805. doi: 10.1016/j.drugpo.2022.103805. Epub 2022 Jul 27.
Health risks associated with drug use are concentrated amongst structurally vulnerable people who use illegal drugs (PWUD). We described how Canadian policy actors view structural vulnerability in relation to harm reduction and policymaking for illegal drugs, and what solutions they suggest to reduce structural vulnerability for PWUD.
The Canadian Harm Reduction Policy Project is a mixed-method, multiple case study. The qualitative component included 73 semi-structured interviews conducted with harm reduction policy actors across Canada's 13 provinces and territories between November 2016 and December 2017. Interviews explored perspectives on harm reduction and illegal drug policies and the conditions that facilitate or constrain policy change. Our sub-analysis utilized a two-step inductive analytic process. First, we identified transcript segments that discussed structural vulnerability or analogous terms. Second, we conducted latent content analysis on the identified excerpts to generate main findings.
The central role of structural vulnerability (including poverty, unstable/lack of housing, racialization) in driving harm for PWUD was acknowledged by participants in all provinces and territories. Criminalization, in particular, was seen as a major contributor to structural vulnerability by justifying formal and informal sanctions against drug use and, by extension, PWUD. Many participants expressed that their personal understanding of harm reduction included addressing the structural conditions facing PWUD, yet identified that formal government harm reduction policies focused solely on drug use rather than structural factors. Participants identified several potential policy solutions to intervene on structural vulnerability including decriminalization, safer supply, and enacting policies encompassing all health and social sectors.
Structural vulnerability is salient within Canadian policy actors' discourses; however, formal government policies are seen as falling short of addressing the structural conditions of PWUD. Decriminalization and safer supply have the potential to mitigate immediate structural vulnerability of PWUD while policies evolve to advance social, economic, and cultural equity.
与吸毒相关的健康风险集中在使用非法药物的结构性弱势群体（PWUD）中。我们描述了加拿大政策制定者如何看待与减少伤害和非法药物政策相关的结构性脆弱性，以及他们为减少 PWUD 的结构性脆弱性提出了哪些解决方案。
加拿大减少伤害政策项目是一个混合方法、多案例研究。定性部分包括 2016 年 11 月至 2017 年 12 月期间在加拿大 13 个省和地区对 73 名减少伤害政策制定者进行的 73 次半结构化访谈。访谈探讨了对减少伤害和非法药物政策的看法，以及促进或限制政策变革的条件。我们的子分析利用了一个两步归纳分析过程。首先，我们确定了讨论结构性脆弱性或类似术语的谈话片段。其次，我们对确定的摘录进行潜在内容分析，以生成主要发现。
所有省份和地区的参与者都承认结构性脆弱性（包括贫困、不稳定/缺乏住房、种族化）在推动 PWUD 伤害方面的核心作用。特别是，刑事定罪被视为造成结构性脆弱性的主要因素，因为它为针对吸毒和 PWUD 的正式和非正式制裁提供了依据。许多参与者表示，他们对减少伤害的个人理解包括解决 PWUD 面临的结构性条件，但他们认为，政府正式的减少伤害政策只关注吸毒问题，而不关注结构性因素。参与者确定了一些潜在的政策解决方案，以干预结构性脆弱性，包括非刑事化、安全供应以及制定涵盖所有卫生和社会部门的政策。
结构性脆弱性在加拿大政策制定者的话语中很突出；然而，政府正式政策被认为没有解决 PWUD 的结构性条件。非刑事化和安全供应有可能减轻 PWUD 的即时结构性脆弱性，同时政策也在发展，以促进社会、经济和文化公平。
