Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E5031, Baltimore, MD, 21205, USA.
Harm Reduction Innovation Lab, Rhode Island Hospital, 1125 North Main Street, Providence, RI, 02904, USA.
Harm Reduct J. 2024 Feb 15;21(1):40. doi: 10.1186/s12954-024-00955-6.
Overdose prevention centers (OPCs), also known as supervised injection facilities and safe consumption sites, are evidenced-based interventions for preventing overdose deaths and drug-related morbidities. The pathways to legalizing OPCs in the USA have confronted multiple social, political, and legal obstacles. We conducted a multi-site, qualitative study to explore heterogeneities in these pathways in four jurisdictions, as well as to understand stakeholder perspectives on valuable strategies for galvanizing political and public support for OPCs.
From July 2022 to February 2023, we conducted 17 semi-structured, in-depth interviews with OPC policymakers, service providers, advocates, and researchers from California, New York City, Philadelphia, and Rhode Island, where efforts have been undertaken to authorize OPCs. Using inductive thematic analysis, we identified and compared contextually relevant, salient approaches for increasing support for OPCs.
Participants described several strategies clustering around five distinct domains: (1) embedding OPC advocacy into broader overdose prevention coalitions to shape policy dialogs; (2) building rapport with a plurality of powerbrokers (e.g., lawmakers, health departments, law enforcement) who could amplify the impact of OPC advocacy; (3) emphasizing specific benefits of OPCs to different audiences in different contexts; (4) leveraging relationships with frontline workers (e.g., emergency medicine and substance use treatment providers) to challenge OPC opposition, including 'NIMBY-ism,' and misinformation; and (5) prioritizing transparency in OPC decision-making to foster public trust.
While tailored to the specific socio-political context of each locality, multiple OPC advocacy strategies have been deployed to cultivate support for OPCs in the USA. Advocacy strategies that are multi-pronged, leverage partnerships with stakeholders at multiple levels, and tailor communications to different audiences and settings could yield the greatest impact in increasing support for, and diffusing opposition to, future OPC implementation.
过量预防中心（OPC），也被称为监督注射设施和安全消费场所，是预防过量死亡和与毒品相关的发病率的循证干预措施。在美国，使 OPC 合法化的途径面临着多重社会、政治和法律障碍。我们进行了一项多地点、定性研究，以探索四个司法管辖区中这些途径的异质性，以及了解利益相关者对为 OPC 争取政治和公众支持的有价值策略的看法。
从 2022 年 7 月到 2023 年 2 月，我们对来自加利福尼亚州、纽约市、费城和罗得岛州的 OPC 政策制定者、服务提供者、倡导者和研究人员进行了 17 次半结构化的深入访谈，这些地方都在努力授权 OPC。使用归纳主题分析，我们确定并比较了与增加对 OPC 支持相关的具有上下文意义的突出方法。
参与者描述了几种策略，这些策略集中在五个不同的领域：（1）将 OPC 倡导纳入更广泛的过量预防联盟，以塑造政策对话；（2）与可以扩大 OPC 倡导影响力的多种权力经纪人（例如立法者、卫生部门、执法部门）建立关系；（3）根据不同背景下的不同受众强调 OPC 的具体好处；（4）利用与一线工作人员（例如急诊医学和药物使用治疗提供者）的关系来挑战 OPC 的反对意见，包括“邻避主义”和错误信息；以及（5）优先考虑 OPC 决策的透明度，以建立公众信任。
虽然这些策略是针对每个地方的特定社会政治背景量身定制的，但在美国已经部署了多种 OPC 倡导策略来培养对 OPC 的支持。多管齐下、利用与各级利益相关者的伙伴关系以及根据不同受众和环境调整沟通的策略，可能会在增加对未来 OPC 实施的支持和减少反对方面产生最大影响。
