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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.

Deux paradigmes se côtoient dans le traitement de la dépendance au Québec. Tout d’abord, il y a le paradigme de l’abstinence avec un modèle d’intervention souvent basé sur les Alcooliques Anonymes. Avec ce modèle, l’alcoolisme (ou la toxicomanie) est défini comme une maladie. En ce qui a trait à la réduction des méfaits, cette dernière vise la réduction des effets néfastes de l’usage de drogues plutôt que l’élimination de leur usage (Brisson, 1997). Nous nous sommes intéressés à une intervention inscrite dans ce paradigme soit le programme de substitution à la méthadone. Cette étude avait comme but de connaître les perceptions de personnes inscrites à ce programme, comprendre comment est vécu le rétablissement à travers la participation au programme et connaître les perceptions de ces personnes en ce qui a trait aux conséquences de la dépendance. Un cadre théorique s’inscrivant dans la perspective de l’interactionnisme symbolique a été choisi. Plus précisément, les processus de transformations normatives de Maria Caiata Zufferey, la théorie de l’étiquetage d’Howard Becker et le concept de stigmate d’Erving Goffman ont été retenus. Ensuite, dix entrevues semi-dirigées auprès d’hommes et de femmes majeures inscrites à un programme de substitution à la méthadone ont été réalisées. En ce qui a trait au chapitre portant sur les résultats, il a mis en lumière différents rapports à la méthadone vécus par les participants. Pour ce faire, trois figures construites à l’aide de l’analyse typologique ont été développées. Il ressort que pour certaines personnes, la méthadone fut décrite comme un substitut nécessaire, pour d’autres, elle correspondait à une aide dont ils veulent se débarrasser et pour une minorité, elle suscitait de l’ambivalence. En définitive, bien que la substitution demeure le traitement de choix pour la dépendance aux opioïdes, il est difficile de parler de sortie du monde de la drogue à l’aide de la méthadone puisque ce traitement apparaît comme étant presque aussi stigmatisé que la dépendance à l’héroïne (Lauzon, 2011). À première vue, la méthadone permet de prendre une distance avec le monde de la drogue (l’argent facile, les vols, la prostitution) et permet de se reconstruire une existence sur la base de repères stables, mais à bien considérer les choses, elle confine les personnes interrogées dans une situation d’ambivalence puisqu’elle les rattache à une identité de toxicomane. Mots-clés : dépendance, programme de substitution à la méthadone, perception, participant, réduction des méfaits, stigmatisation. / Two paradigms are frequent when treating addiction in Quebec. First, there is the paradigm of abstinence with an intervention model often based on Alcoholics Anonymous. With this model, alcoholism (or addiction) is defined as a disease. The second paradigm, harm reduction, is aimed to reduce the harmful effects of drug use rather than eliminating their use (Brisson, 1997). We are particularly interested in an intervention found in this paradigm named methadone maintenance treatment. This research was aimed to identify the perceptions of people enrolled in this treatment, understand their recovery process while participation in this treatment and understanding the perceptions of users of methadone in regards to the consequences of addiction. A theoretical framework found in the symbolic interactionist perspective was selected. More specifically, the process of normative transformations of Maria Caiata Zufferey, the labelling theory of Howard Becker and the stigma theory of Erving Goffman were selected. A qualitative methodology was retained. Ten semi-structured interviews with men and women enrolled in a methadone maintenance treatment were conducted. The chapter that focussed on the results highlighted various reports on how methadone maintenance treatment was experienced by the participants. To do this, three figures constructed using typology analysis were developed. For some people, methadone was described as a necessary substitute, for others, it corresponded to a help that they wanted to eliminate and for a minority, it aroused ambivalence. One thing is certain, although the substitution remains the treatment of choice for opioid dependence, it is difficult to speak of the output of the drug world with the help of methadone because this treatment appears to be almost as stigmatized as the dependence on heroine (Lauzon, 2011). At first glance, the use of methadone can help distance a person from the world of drugs (easy money, theft, prostitution) and can help rebuild their lives on a basis of landmark stability, but to carefully consider, it confines the respondents in a state of ambivalence as it relates to the identity of an addict. Keywords : harm reduction, methadone maintenance treatment, perception, participant, stigma, dependency.

Les raves sont des événements festifs dédiés à la musique techno et à la danse qui se distinguent des autres lieux de rassemblement tels que les bars et les discothèques notamment par le fait qu’ils se déroulent toute la nuit dans un lieu aménagé pour l’occasion et qu’il n’y a généralement pas de vente d’alcool. La consommation de drogues de synthèse telles que l’ecstasy et les speeds y est toutefois largement répandue. La tenue de ces rassemblements pose une série de problèmes du point de vue des autorités policières, tels que la présence de trafiquants de drogues ainsi que la sécurité des lieux où se déroulent les raves. Dans le contexte particulier de ces événements, les pratiques de contrôle social sont soumises à un certain nombre d’ambiguïtés. Le but général de l’étude est de permettre une compréhension de la façon dont se déterminent et s’appliquent les règles qui visent à encadrer la tenue de ce type de rassemblements. Trois objectifs spécifiques sont poursuivis, soit 1) de comprendre comment on a tenté de réguler ce type d’événements à Montréal, 2) de comprendre comment les différents acteurs responsables de l’organisation et du bon déroulement des événements établissent une série de règles, aussi bien formelles qu’informelles, et négocient leur application dans le cadre de leur pratique, et 3) de comprendre comment ces acteurs identifient certaines situations comme constituant un problème et éventuellement, y réagissent. La principale méthode de recueil des données a consisté à réaliser des entretiens semi-dirigés avec des promoteurs d’événements rave, des agents de sécurité ainsi que d’autres personnes impliquées dans le milieu telles que policier, pompier, artistes de la scène rave et intervenants. L’observation participante lors d’événements rave fut utilisée comme méthode complémentaire. L’étude démontre comment le service de police s’est vu confronté avec les raves à un vide juridique et comment l’encadrement de ce type d’événements s’est plutôt exercé par le service de prévention des incendies. Les autorités ont également tenté d’encadrer le phénomène par des modifications à certaines règlementations, dont celles sur les permis d’alcool. L’étude démontre également de quelle manière et en fonction de quoi les différents acteurs du milieu négocient les règles en cours d’action dans un contexte où la frontière entre le licite et l’illicite est floue. / Raves are festive events dedicated to dance and techno music, different from other places of gathering such as bars and discotheques by the fact that they take place in all night venues converted for the occasion and where there is generally no sale of alcohol. Synthetic drug consumption such as ecstasy and speed is largely widespread in these events. The existence of these gatherings poses a series of problems from the point of view of the police authorities, such as the presence of drug dealers as well as the safety of the venue where the raves are held. In the particular context of these events, social control practices are subjected to a certain number of ambiguities. The general goal of this study is to allow an understanding of the way the rules, that constitute the framework of this type of gathering, are determined and applied. Three specific objectives pursued in this study are 1) to understand how authorities tried to control these types of events in Montreal, 2) to understand how the various actors responsible for the organization of these events establish a series of rules, formal and informal, and negotiate their application within the framework of their practice, and 3) to understand how these actors identify certain situations as problematic and eventually react to them. The main data collection method consisted in carrying out semi-directed interviews with rave Producers, Security Agents, Police Officer, Fire Marshal, Artists of the rave scene and other parties involved. Participating observation in actual events was a complementary method. This study demonstrates how the police service faced a legal void regarding rave events and how the regulatory framework was rather introduced by the fire department. The authorities also tried to control the rave phenomenon by modifying certain regulations, such as those applicable to alcohol licence. The study also demonstrates how and why key stakeholders negotiate the rules in the course of action in this particular context where the frontier between the licit and the illicit is woolly.

The thesis explores chronic leg ulceration experienced by young people who inject drugs (PWID). The applied health research study, in two phases, used a sequential explanatory mixed methods design. Phase 1 involved a survey of 200 people who injected drugs to investigate the prevalence of skin problems and leg ulceration, together with the identification of risk factors for ulceration. Phase 2 involved a series of fifteen qualitative semi-structured interviews that explored the results relating to risk factors with a sample of PWID who had experienced leg ulceration, and investigated participants’ perceptions of appropriate harm reduction methods. Main findings There were three research questions in this study: 1) What is the extent of skin problems and chronic leg ulceration in young people who inject drugs? The study identified a high prevalence of leg ulceration as 15%. 60% of the sample had experienced a skin problem. Each reported skin complication is clearly defined. 2) What causes chronic leg ulceration in young people who inject drugs? Leg ulceration experienced by PWID in this study was directly linked to deep vein thrombosis (DVT), as well as injecting in the groin and the leg. DVT was strongly associated with groin and leg injecting. The acceptance amongst injectors of the groin and leg as a site of choice has occurred with a lack of awareness of the long-term consequences of damage to the limb. 3) What are appropriate harm reduction measures in young people who inject drugs? Harm reduction methods related to the development of leg ulceration have been absent across schools and drug services. Training for healthcare workers which enables them to identify risk factors should be developed, and harm reduction information related to leg ulceration should be included in drug education within schools, and instigated within drugs services. This applied health research has led to a number of practice-focused recommendations surrounding clinical care including early detection of venous insufficiency and accessible services to prevent, assess, and treat venous disease in PWID. The original contribution to knowledge is three-fold: 1. Leg ulcers have been found to be highly prevalent in young people who inject drugs. 2. Ulceration is predominantly caused by venous thrombosis due to injecting in the legs or groin. 3. Harm reduction related to the development of venous disease has lacked impact and effect.

The aim of this study was to explore how harm reduction methods are perceived by Swedish social workers working with treatment of substance abuse. In doing so, qualitative research method with semi-structured interviews was conducted with five social workers practicing within the social services adult unit from three different municipalities in mid-Sweden. The gathered data was analyzed through the perspective of the two related theoretical frameworks of social constructionism and discourse theory. The result revealed diverse perceptions and perspectives regarding harm reduction methods which both were conflicted between participants and within the participants. Methods practiced in Sweden were to a large degree perceived as positive. Perceptions regarding methods outside of Sweden were to a large degree split between an overall negative perception and a conflicted perception between negative views on the legitimization of drugs and positive perceptions regarding preventive positive outcomes. From the chosen theoretical framework, The participating social workers’ perceptions appeared to be influenced by experience, social context, and a prohibitionist discourse on drug abuse that has since long been predominant in Sweden.

À luz da teoria interacionista do desvio esta pesquisa tem como objetivo estudar as representações de psicóloga(o)s que trabalham em CAPSad em relação ao uso de álcool e outras drogas. Partimos da hipótese de que as psicóloga(o)scontratadas na instituição teriam como representação o uso abusivo de drogas como comportamento desviante e o usuário como doente. O método de pesquisa escolhido foi entrevistas semiestruturadas realizadas em quatro CAPSad. A pesquisa foi dividida em duas partes, sendo a primeira delas realizada como projeto piloto em um município que contava apenas com aquela unidade e teve a participação de duas psicóloga(o)s e a segunda realizada em três unidades do CAPSad numa mesma região na cidade de São Paulo que teve como participação cinco psicóloga(o)s. Para levantamento destas representações consideramos as políticas de saúde mental na área de álcool e outras drogas, a influência da Reforma Psiquiátrica e o Conceito de redução de danos, além da história das drogas e do proibicionismo no Brasil e no mundo / Through the deviance interactionist theory this research aims to study the representation of CAPSad psychologists regarding the use of alcohol and other drugs. We set out the hypothesis that the psychologists contracted in the institution would have representation the abusive use of drugs such as deviant behavior and the user as a sick. The method chosen was semi-structured interviews carried out in four CAPSad. The survey was divided into two parts, the first of them performed as a pilot project in a city that there is only one unit and had the participation of two psychologists and the second held in three CAPSad units in the same region in the city of São Paulo that had the participation of five psychologists. To identify these representations we consider mental health policies in the area of alcohol and other drugs, the influence of the psychiatric reform and the concept of harm reduction, beyond the story of drugs and the prohibition in Brazil and in the world

Desde a entrada do crack no cenário mundial, pesquisas nesta área geralmente tendem a focar no uso problemático, visto como resultado da perda de controle do uso da substância com interferência para vida social e privada do usuário. Vários estudos são desenvolvidos com pessoas que estão em tratamento ambulatorial ou internados. Outros focam nas cenas de uso público, como a Cracolândia, mas sem dissociar: uso da substância, e, viver em situação de rua (que, por si só, tal situação traz grandes prejuízos à saúde). Tendo isso em conta, a perspectiva desse estudo é de colocar em discussão a afirmação de que o uso do crack se daria sem nenhum controle por parte dos envolvidos nesta prática. Deste modo, propõe-se a investigar a existência de padrões de controle e autocuidados no contexto desse uso e os significados a ele atribuídos. Visa, também, examinar em que medida os usos problemáticos (associados às cenas de uso públicos), e, a produção de discursos morais e estigmatizantes performam as experiências dos usuários de crack de uso não visível. Identificar os diferentes padrões de uso e as estratégias desenvolvidas para um uso controlado, tendo em consideração o conhecimento construído pelos usuários, é importante para o desenvolvimento de políticas públicas mais eficazes e que respeitem os direitos e a autonomia dos usuários quer tenham desenvolvido problemas com o uso ou não / Since the worldwide appearance of crack, research in this area generally tends to focus on problematic crack use, as seen as a result of the loss of control of the use of the substance with interference to the users social and private life. A variety of studies is done with people who are in outpatient or inpatient treatment. Other studies focus on scenes of public use, such as Cracolândia, but without dissociating the use of the substance from living in a street situation that in itself causes great harm to health. Taking this into account, the perspective of this study is to put in discussion the assertion that the use of crack would occur without any control on the part of those involved in this practice. In this way, it proposes to do research on the existence of control and self-care patterns in the context of this use and the meanings assigned to it. It also aims to examine the extent to which problematic uses, associated with public use scenes, and the production of moral and stigmatizing discourses, perform the experiences of crack users of non-visible use. Identifying the different usage patterns and developed controlled use strategies, thereby taking into account the knowledge built up by the users, is important for the development of public policies that are more effective and that respect the rights and autonomy of users regardless of whether or not they have developed drug using problems

Este estudo trouxe o debate sobre a Política de Combate às Drogas no Brasil sob o enfoque metodológico da Criminologia Crítica, utilizando autores de referência como Alessandro Baratta e Salo de Carvalho. A crítica vai ao sentido de questionar o proibicionismo, perspectiva que embasa as políticas de combate às drogas no mundo, com grande influência no Brasil. Do ponto de vista histórico é evidente que o proibicionismo não tem evitado o consumo das drogas, muito menos tem contribuído para minimizar os efeitos deletérios sobre a questão social que o tráfico ocasiona, arrebanhando em suas práticas ilícitas uma série de crimes que afetam toda a sociedade, particularmente, nas franjas mais pauperizadas da classe trabalhadora. Nessa perspectiva, a atual Política de Combate às Drogas, por não diferenciar o traficante do usuário apenas contribui para o superencarceramento de jovens das camadas populares. No Brasil o fenômeno do superencarceramento fere os Direitos Humanos. A descriminalização da maconha, nesse sentido, poderá ter forte impacto para evitar a prisão cautelar de jovens usuários ou que portem pequena quantidade da droga. Enquanto a descriminalização não ocorre, mediante amplo debate social, o Estado pode atuar frente à problemática, adotando procedimentos que auxiliam nas decisões judiciais, como a Justiça Restaurativa, a Justiça Terapêutica e a Audiência de Custódia, que se constituem alternativas à prisão cautelar. Por fim, o presente estudo procura trazer algumas reflexões teóricas sobre a política de redução de danos que é uma tendência mundial, adotada por países que aderiram à descriminalização das drogas. / This text brings in the discussion about the drug dealing combat policy in Brazil, under the emphasis of Criticism Criminology. The work is based on authors like Alessandro Baratta and Salo de Carvalho. The argumentation goes on questioning prohibitionism, witch is the bases of the combat policies over the entire world, including Brazil. Under a historical point of view, it´s obvious that prohibiotionism hasn´t been effective in avoiding drug consumption growth, let alone minimizing the deleterious effects over the social issue generated by the drug market, involving in itself a great amount of crimes that affect all the society, in special, the working masses with low incomes.Under this radar, the current combat policy, while not sorting out drug dealers from consumers, contributes itself for the prision population growth. In Brazil particularly, this phenom hurts Human Rights. The Marijuana regulamentation, in this direction, might be a strong factor to avoid the arrest of young users caught with a small amount of the drug. While the decriminalization is still on debate, the government can face the problem with paleactive procedures that would help justice, like Restaurative Justice, Therapeutic Justice and the Custody Audience, for instance. All of them alternatives for the arrest. Lastly, this study brings some theorical insights over the Damage Reduction Policy, a global tendency adopted by many countries that has joined the idea of drug discriminalization.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-07-18T11:46:22Z No. of bitstreams: 1 Renata da Silva Winning.pdf: 1184277 bytes, checksum: ab6391c3808e396e6cbdf3d2f7c771d2 (MD5) / Made available in DSpace on 2018-07-18T11:46:22Z (GMT). No. of bitstreams: 1 Renata da Silva Winning.pdf: 1184277 bytes, checksum: ab6391c3808e396e6cbdf3d2f7c771d2 (MD5) Previous issue date: 2018-04-27 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The relation of the human being with drugs has not always been protected by the State. Since the nineteenth century, paradigmatic changes have occurred in relation to drugs that culminated in the creation of specific policies to problems related to its consumption. The theoretical study developed here brought articulations between the psychoanalytic clinic and the harm reduction strategy by analysing its implantation in the Unified Health System (SUS). From that point, it was made a dialogue between the psychoanalytic propositions concerning the drug compulsive use phenomenon and its treatment as well as possible approximations with the harm reduction logic. We have debated, throughout this study, in which ways the discursive turns formalized by Jacques Lacan accompanied the historical, political and economic changes involving the use of drugs; we analysed the proposal of harm reduction; developed questions that guide psychoanalytic clinic; illustrated the divergences between the treatment direction within the institutional context concerning the harm reduction and abstinence simultaneously to the pre-condition and treatment aim. By presenting a logic that considers the autonomy, the bond and the general life context as the motto of its actions, disregarding the idea that drugs is the main problem to be treated and making abstinence more flexible as an ideal of cure. The strategies of harm reduction favor articulations with the psychoanalytic work, that, in turn, contributes to the particularity of the listening clinic and intervention from the subject of the unconscious / A relação do ser humano com as drogas nem sempre foi atividade tutelada pelo Estado. A partir do século XIX ocorreram mudanças paradigmáticas em relação às drogas que culminaram na criação de políticas específicas para problemas relacionados ao seu consumo. O estudo teórico aqui desenvolvido trouxe articulações entre a clínica psicanalítica e a estratégia de redução de danos por meio da análise de sua implantação no Sistema Único de Saúde (SUS). A partir daí foi traçado um diálogo entre as proposições psicanalíticas acerca do fenômeno do uso compulsivo de drogas e de seu tratamento bem como suas possíveis aproximações com a lógica de redução de danos. Discutimos, ao longo deste estudo, de que maneira os giros discursivos formalizados por Jacques Lacan acompanham as mudanças históricas, políticas e econômicas envolvendo o uso de drogas; analisamos a proposta de redução de danos; desenvolvemos questões que norteiam a clínica psicanalítica; ilustramos as divergências entre a direção do tratamento em contexto institucional no que se refere à redução de danos em simultaneidade às propostas de abstinência como precondição e meta do tratamento. Ao apresentar uma lógica que considera a autonomia, o vínculo e o contexto geral de vida como mote de suas ações – descaracterizando-se da ideia de que a droga é o principal problema a ser tratado e flexibilizando, portanto, a exigência da abstinência enquanto ideal de cura –; as estratégias de redução de danos ora perscrutadas permitem articulações com o trabalho psicanalítico que, por sua vez, tem a contribuir com a particularidade de sua clínica de escuta e de intervenção a partir do sujeito do inconsciente