British Columbia Centre on Substance Use, 717 East Hastings St. Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, 170-6371 Crescent Road, Vancouver, BC V6T 1Z2, Canada.
British Columbia Centre on Substance Use, 717 East Hastings St. 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.
Int J Drug Policy. 2023 Jul;117:104054. doi: 10.1016/j.drugpo.2023.104054. Epub 2023 May 14.
Injectable opioid agonist treatment (iOAT) has recently been expanded in some geographical contexts in Canada as part of a response to the escalating overdose crisis. Complex gendered dynamics, including power differentials, violence, and social norms, shape the overdose crisis and drug treatment programs which can adversely impact women's experiences. This qualitative study examines how social (e.g., gender, income, housing) and structural factors (e.g., program policies) impact women's experiences of iOAT.
Qualitative interviews were completed with 16 women enrolled in four iOAT programs in Vancouver, Canada. Approximately 50 hours of ethnographic observations were conducted. Interview transcripts and ethnographic fieldnotes were analyzed using a critical feminist lens by applying the concepts of embodiment, relationality, and social control to understand women's engagement and self-reported treatment outcomes.
Initial iOAT engagement was a relational process, including initiating treatment with a partner and engaging with iOAT to (re)build personal relationships. Relationships with iOAT providers, including flexibility and support with medication administration, were important to women, providing an affirming embodied experience and a greater sense of agency. However, program operations (e.g., mandated daily attendance, program crowding) incompatible with women's needs (e.g., employment) could undermine these positive experiences. Women's reported outcomes highlight a tension between achieving more agency and the constraints of intensive and stigmatized treatment.
This study highlights how iOAT is both a source of care and control for women from a relational and embodied perspective. Findings underscore the need for gender-attentive and flexible drug treatment services to meet the varied needs of women and the importance of providing relational care for women accessing iOAT.
作为应对不断升级的过量用药危机的一部分，最近在加拿大的一些地理区域扩大了注射阿片类激动剂治疗（iOAT）。复杂的性别动态，包括权力差异、暴力和社会规范，影响了过量用药危机和药物治疗项目，这些因素可能对女性的体验产生不利影响。这项定性研究考察了社会（如性别、收入、住房）和结构性因素（如项目政策）如何影响女性接受 iOAT 的体验。
对加拿大温哥华的四个 iOAT 项目中的 16 名女性进行了定性访谈。进行了大约 50 小时的民族志观察。使用批判女性主义视角，通过应用体现、关系和社会控制的概念来理解女性的参与和自我报告的治疗结果，对访谈记录和民族志实地记录进行了分析。
最初的 iOAT 参与是一个关系过程，包括与伴侣一起开始治疗，并与 iOAT 合作（重新）建立个人关系。与 iOAT 提供者的关系，包括药物管理方面的灵活性和支持，对女性很重要，为她们提供了肯定的体验和更大的代理权。然而，与女性需求（如就业）不兼容的项目运营（如强制性的每日出勤、项目拥挤）可能会破坏这些积极体验。女性报告的结果强调了在实现更多代理权和强化且污名化的治疗的限制之间的紧张关系。
本研究从关系和体现的角度强调了 iOAT 既是女性护理的来源，也是控制的来源。研究结果强调了需要提供性别敏感和灵活的药物治疗服务，以满足女性的各种需求，以及为接受 iOAT 的女性提供关系护理的重要性。
