Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Subst Use Addctn J. 2024 Oct;45(4):682-689. doi: 10.1177/29767342241253663. Epub 2024 May 28.
Federal, state, and municipal governments in the United States have been reluctant to authorize overdose prevention centers (OPCs), which are evidence-based approaches for preventing overdose deaths and blood-borne pathogen transmission.
From July 2022 to February 2023, we explored how stigma manifests in OPC policymaking by conducting in-depth interviews with 17 advocates, legislators, service providers, and researchers involved with OPC advocacy and policymaking in Rhode Island, California, Pennsylvania, and New York.
We found that although jurisdictions differed in their OPC policymaking experiences, stigma manifested throughout the process, from planning to authorization. Participants described OPCs as a tool for destigmatizing overdose and substance use, yet confronted institutionalized stigma and discriminatory attitudes toward people who use drugs (PWUD) and harm reduction from multiple sources (eg, politicians, media, and members of the public). Opposition toward OPCs and harm reduction approaches more broadly intersected with public discourse on crime, homelessness, and public disorder. Employed stigma-mitigation strategies included humanizing PWUD, publicizing the benefits of OPCs to the wider community, and strategically engaging media.
These findings illustrate the importance of understanding stigma at different stages of the policymaking process to better facilitate authorization and eventual implementation of OPCs in the United States.
美国的联邦、州和市政府一直不愿意批准过量预防中心 (OPC)，而 OPC 是预防过量死亡和血源性病原体传播的循证方法。
从 2022 年 7 月到 2023 年 2 月，我们通过对罗德岛、加利福尼亚州、宾夕法尼亚州和纽约参与 OPC 倡导和政策制定的 17 名倡导者、立法者、服务提供者和研究人员进行深入访谈，探讨了污名化如何在 OPC 政策制定中表现出来。
我们发现，尽管司法管辖区在 OPC 政策制定方面的经验不同，但污名化在整个过程中都表现出来，从规划到授权。参与者将 OPC 描述为消除对过量用药和药物使用的污名化的工具，但面临着来自多个来源（如政治家、媒体和公众成员）的针对吸毒者 (PWUD) 和减少伤害的制度化污名化和歧视性态度。反对 OPC 和更广泛的减少伤害方法与关于犯罪、无家可归和公共秩序的公众讨论相交织。采用的污名化缓解策略包括将 PWUD 人性化、向更广泛的社区宣传 OPC 的好处以及有策略地与媒体接触。
这些发现说明了在政策制定过程的不同阶段了解污名化的重要性，以更好地促进美国 OPC 的授权和最终实施。
