Background: People who use drugs (PWUD) are disproportionately burdened by rates of HIV and Hepatitis C, more likely to experience stigma, social exclusion, and as a result, have poorer health outcomes. To mitigate these inequities in health, people with lived experience of drug use are, and should be, included in decisions that affect them. There is evidence that including PWUD in the development and delivery of harm reduction programs, services, and drug policy ensures such initiatives addresses their needs most effectively. As such, the purpose of this thesis is to present the findings of a scoping review of the peer-reviewed literature examining the involvement of people who use drugs (PWUD) in the development and delivery of harm reduction programs, services, and drug policy. Methods: Scoping reviews represent an increasingly popular method used to review the literature of a particular topic. It is a process of summarizing, or ‘mapping’, a range of evidence in order to convey the breadth and depth of a particular field. This scoping review implemented a search strategy focused on three categories: search terms that describe ‘peer engagement’, search terms that describe ‘substance use’ and finally search terms that describe ‘harm reduction programs/services/policy’. Searches of five academic electronic databases were conducted. Peer-reviewed literature published between 2010 and 2020 that discussed the involvement of PWUD in the development and/or delivery of harm reduction programs, services, or drug policy was included in the scoping review. Results: The search strategy produced a total of 1902 references. After duplicates were removed, thirty-two references met the inclusion criteria and were included for analysis. This scoping review identified five characteristics from each study: 1) type of study, 2) location of study, 3) year of publication, 4) type of engagement/participation, and 5) peer roles. Conclusion: One critical finding of this scoping review is the highest level of participation among PWUD was achieved when drug-user organizations were involved. / Graduate

The ongoing overdose problem in the United States, particularly exacerbated by the widespread use of fentanyl, and polydrug use, represents a critical public health challenge. This thesis explores how people who use drugs (PWUD) in Orlando, Florida, are responding to the overdose problem in their community. Drawing on ethnographic research conducted at a syringe services program in Summer 2023, I argue that PWUD in Orlando actively take measures to prevent overdose and overdose deaths but are faced with many obstacles that challenge their overdose prevention efforts. I examine overdose narratives of PWUD to show how factors preventing effective overdose prevention are not just systemic but also cultural. In particular, the prevailing stigma of opioid use hinders the creation of a supportive environment for preventing overdoses and perpetuates the ostracization of PWUD in Orlando. Recognizing the profound influence of stigma towards the PWUD with whom I conducted research, I make the case for reimagining overdose prevention as a comprehensive effort in Orlando to equip PWUD, their families, first responders, and the broader community with the knowledge, skills, and tools to address overdose. Such efforts also have the potential to recalibrate cultural misconceptions and biases toward PWUD. As Florida and the nation continue to experience an overdose problem, understanding local cultural and structural challenges remains pivotal. This project demonstrates that by integrating comprehensive training and combating stigmatization of PWUD, Orlando communities can prevent overdose and save lives more effectively.

Background: People who use illegal drugs are disproportionately affected by HIV and hepatitis C, stigmatization and social exclusion. Health inequities are worsened by drug policy of criminalization, which thwarts health promotion efforts and hinders access to services. To address these inequities, people who use drugs are increasingly included in decisions that affect them by sitting on policy, service delivery and research committees. This study addressed a gap in understanding how power inequities are transformed in committees where people who use drugs are at the table. Methods: In partnership with the Drug Users Advocacy League and the Society of Living Illicit Drugs Users, this participatory critical emancipatory inquiry explored power relations in four committees in Ontario and BC. Data were collected in 2013 through meeting observations, interviews, demographics surveys and document reviews. Data analysis was guided by theoretical frameworks grounded in critical theory and transformative learning theory. Results: Findings confirmed striking socioeconomic inequities between people who use drugs and others at the table. Inconsistent measures were taken by committees to alleviate barriers to inclusion. Despite openness to inclusion, committee members tended to underestimate people who use drugs. The presence of local organizations of people who use drugs ensured a more democratic selection of their representatives to sit on committees. Once at the table, creating a safe space entailed building trust, authentic relationships, relational and reflective dialogue, and skilled facilitation. Democratic practices of negotiated relationships and consensus-based decision-making enhanced meaningful inclusion. A structural environment in which drug policy criminalizes people who use illegal drugs hindered capacity to transform power inequities by feeding stigma, which worsens health and social inequities. Committees were committed to inclusion of people who use drugs though capacity to do so varied due to budgetary and human resources constraints. Study limitations, practice implications and future research directions are offered. / Graduate / 0700 / 0680 / lynnebel@uvic.ca