The Dr. Peter Centre (DPC), an HIV care facility, provides integrated health care services incorporating harm reduction strategies as part of service provision. These services include a “Harm Reduction Room” for those members who inject drugs, to do so in a supervised environment. In this thesis, I explore the perspectives of DPC members on the harm reduction approach as part of a larger study titled A mixed Method Evaluation of the Impact of the Dr. Peter Centre on Health Care Access and Outcomes for Persons Living with HIV/AIDS who use Illicit Drugs. Thirty DPC members were recruited as part of the qualitative portion of the larger mixed-method study. One-on-one in depth interviews were conducted with each participant and audio-recorded and then transcribed verbatim. Participant narratives reflected positive experiences with nurses and other staff, and with the harm reduction philosophy at the DPC. Narratives from both participants who inject drugs and participants who do not inject drugs indicated support for the harm reduction room because of the safety it provides. Safety was related to reducing the direct harmful effects of injection drugs such as infection and overdose, and also to the refuge from the street and freedom from stigma of drug use that the DPC provides. Participant accounts expressed a sense of acceptance and belonging as a part of the community at the DPC highlighting the role of DPC in shifting drug use patterns. This thesis emphasizes that the harm reduction philosophy and the provision of harm reduction services at the DPC contributes to the overall health and well being of participants. / Graduate

Supervised injection sites (SISs) have become subject to much political and social controversy in Canada since the late 1990s. Since the implementation of North America’s first SIS, Insite, in 2003 in Vancouver, the controversy has reached new levels. Despite the increasing evidence base available regarding the effectiveness of SISs as a harm reduction strategy trans-nationally, the implementation of this intervention in Canada prevails within public and parliamentary debates. Guided by the theoretical contributions of Joel Best (2008) on claims-making and the construction of social problems, this thesis explores the SIS debate in Canada and the assertions advanced with respect to the implementation of SISs. Building on the available literature, the author identifies numerous types of claims advanced by proponents and opponents of SISs through a qualitative content analysis of 164 newspaper documents from The Vancouver Sun, The Ottawa Sun and The Ottawa Citizen. It was determined that claimsmakers often present the intervention as a solution to the ‘drug problem’ or part in parcel of the problem. Opponents in particular attempt to construct the intervention as harmful for the community in that the implementation of a SIS would exacerbate various aspects of the ‘drug problem’ including drug abuse and crime. Very rarely, however, claimsmakers suggest the SIS is merely one strategy to addressing public health issues related to injection drug use and that there is ‘no easy fix’ to this ‘drug problem’. Further, the author applies the findings from this analysis to make sense of the Canadian federal government’s proposed policy response, The Respect for Communities Act, towards the establishment of SISs.

The current opioid crisis has, among other things, resulted in soaring rates of fatal overdose across Canada, prompting officials to turn to harm reduction in hopes of combatting the epidemic. The Coroners Service of British Columbia issued a statement in March 2017 reporting an 80% increase in the number of deaths resulting from illicit drug use in 2016 from 2015 (Coroners Service of British Columbia, 2017). Despite the abundance of evidence demonstrating the effectiveness of supervised injection services (SIS) in Canada and worldwide, the implementation of this intervention has remained highly controversial, particularly in Ottawa. Guided by Michel Foucault’s theory of governmentality, this thesis explores the obstacles hindering the implementation of supervised injection services in Ottawa, Ontario. Through eight qualitative semi-structured interviews with front-line workers of harm reduction programs, this thesis identifies and explores several obstacles to the implementation of SIS, primarily bureaucratic obstacles stemming from the enactment of the Respect for Communities Act (2015).

This paper explores the discourse surrounding the introduction of supervised injection facilities (SIF) in New York City following their recent introduction in November 2021.  The contemporary debate surrounding SIF in New York is more diverse than may be assumed, even within a seemingly liberal city in the United States, as there are many competing perspectives which make broad categorizations of the discourse difficult. Nevertheless, supporters of SIF have continued to emphasize the efficacy of this program and its potential to prevent overdoses in a largely uniform manner.  In contrast, critics of SIF in NYC have demonstrated a multiplicity of oppositional narratives, which take the forms of traditional abstinence perspectives, localism/not in my backyard rhetoric, law and order beliefs, and social justice evaluations that question the equality of such programs. Nearly all sentiments regarding SIF are founded in the individual perceptions of addiction, specifically whether the individual views it as a disease or a moral failing.        The United States is slowly continuing to adopt more dynamic approaches to substance abuse and move away from the punitive policies established through the War on Drugs strategies advanced throughout the previous decade.  This pilot program can be viewed as a continuation of existing harm reduction policies such as syringe exchange programs.  While the introduction of SIF signifies a substantial evolution of the existing harm reduction policies and provides the basis for national expansion of the program, the current socio-political environment does not prove conducive to its evolution.  Overall, this study explores the diverse range of narratives surrounding SIF, their informing ideology, and attempts to situate these opinions within their broader sociological and historical backgrounds, providing the basis for further research regarding this subject.

Supervised Injection Facilities (SIFs) for the medical supervision of illicit drug use exist in Europe, Canada, and Australia to reduce infectious disease transmission, overdose deaths, and other harms of drug use. They have been shown to reduce rates of needle sharing by 69% and local overdose mortality by 35% without increasing rates of drug use or related crime. In light of increasing rates of illicit opioid use and overdose death in Massachusetts, the Massachusetts Medical Society recently endorsed opening a SIF in Boston. This thesis proposes a study of the Boston SIF with the hypothesis that higher SIF utilization will be associated with decreased incidence of fatal overdose, HIV seroconversion, and HCV seroconversion during the study period. I propose evaluating this hypothesis prospectively by following clients of the SIF at 6 month intervals and comparing the rates of overdose death and HIV or HCV seroconversion among frequent and infrequent clients of the SIF. Based on data reported from previous SIFs and projections of the population of people who inject drugs (PWID) in Boston, a study with this design should detect a significant difference in these three primary endpoints between people using the SIF frequently and those using it infrequently within five years. A positive finding would confirm the efficacy of SIFs in harm reduction and secondary prevention for Opioid Use Disorder (OUD), potentially leading to broader adoption in other hotspots of opioid use in the United States.

This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.

This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.

This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.

This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.

This research project aimed to conduct a strategic analysis of the implementation of a supervised injecting facility (SIF) in Montérégie. Using a mixed design, we first completed a portrait of the injection drug user (IDU) population. We then explored the perceptions of IDU and stakeholders with regard to the relevance of implementing a SIF in the region. Although some similarities were found with the IDU populations of Montreal and the province of Quebec, this population in Montérégie is characterized by a lower frequency of injections in public, less homeless people and lower rates of HIV and HCV infections. Despite these differences, the IDU population in Montérégie was found to have important physical and psychosocial needs. Although the relevance of a SIF in Montérégie is undeniable, improvements regarding the accessibility, continuity and appreciation of the actual services dedicated to IDU remain a priority. / Ce projet de recherche visait à réaliser une analyse stratégique de l’implantation d’un service d’injection supervisée (SIS) en Montérégie. Utilisant un devis mixte, son premier volet consistait à tracer un portrait de la population usagère de drogues par injection (UDI) montérégienne, alors que le second explorait les perceptions des UDI et des acteurs stratégiques œuvrant auprès d’eux quant à l’implantation d’un SIS dans la région. Bien que similaire aux populations UDI montréalaise et du Québec, celle de la Montérégie s’en distingue par le fait qu’elle s’injecte moins souvent dans des lieux publics, qu’elle soit sans domicile fixe à moindre proportion et par ses taux inférieurs d’infection au VIH et au VHC. Elle présente toutefois des besoins physiques et psychosociaux importants. Bien qu’un SIS soit jugé pertinent en Montérégie, une amélioration de l’accessibilité, de la continuité et de l’appréciation de l’offre de services actuelle dédiés aux UDI est considérée comme prioritaire.