Harm reduction Narratives

Overdose prevention sites or supervised consumption facilities are a public health, harm reduction strategy to address the health needs of persons who use drugs (PWUD). 

• These are sites where people can consume their own substances in a safe environment within the presence of harm reduction staff, medical supervision, and peer workers.
•  Narratives are a co-creation of knowledge by collecting the participants’ stories using semi-structured interviews and photographs taken by them. 
• all types of changes including behaviors, relationships, interactions with others, feelings, and perceptions of self and others. 
• deepen our understanding of the experiences of individuals who use such sites and the role of these sites in the community.
• Research has shown that the primary users of supervised injection services are those who are most marginalized 
• effective at meeting their public health objectives of mitigating overdose-related mortality; reducing substance-related risk behaviors such as syringe sharing, syringe reuse, injecting outdoors, and rushed injections; and facilitating uptake of addiction treatment and other health care services 
•  the review suggests improvements in public order outcomes such as reduced public injecting, reduced publicly discarded syringes, and reduced injection-related litter without increasing substance-related crime

key benefits of injection sites as perceived by PWUD are “safe place”, “safety”, and “education”

• comfortable engaging with staff about their needs. It has been suggested that this supportive environment comes about because the sites have “disrupted stigmatization processes and improved trust in program staff 
• Tis fostered trust facilitates acceptance of other supports such as food, shelter, and broader medical and social supports
• deeply understand how a local overdose prevention site had influenced the lives of site users, their relationships, interactions with others, and perceptions of self. Critical narrative inquiry allowed for a space for participants to construct their life story and their realities in ways that made sense for them

Narratives

• The overall goal of analysis was to generate a core narrative supported by key themes. A core narrative aims to produce explanations regarding the accounts and patterns of behavior that are relevant and problematic to those involved. Te intent is to generate explanations of experiences around core categories
• core categories emerged through thematic analysis, where the focus was to explicate the meaning of the text, emphasizing what was being said, rather than how it was being said, and narrative analysis
• A critical component of narrative analysis is the articulation of a core narrative, the story that combines and underpins all the participant stories. 
• The core narrative here is a chronological process. 
•  four themes: Enduring, Accessing Safety, Connecting and Belonging, and Transforming. 
• Conclusions
• physical safety was improved through an “unrushed” injection process free from the fear of being arrested or assaulted. 
• participants clearly conveyed “feeling safe” at the site. (a stigma-free environment of acceptance, connection, and belonging)
• The care participants received at the site was in direct contrast to their experiences of stigmatization, marginalization, violence, and unpredictability that they endured elsewhere in the community.
• caring relationships are an intervention in and of themselves and that these relationships contribute to transformation that extends far beyond the public health outcomes of disease reduction. 
• These caring relationships at the site begin to address existing social barriers to achieving health and well-being experienced by the site users.
• The site played an important role in bringing stability to participants’ lives, such sites are more than just disease prevention facilities. 
• The site has become a refuge and safe-haven from the daily chaos participants face in their lives. 
• The site became part of their daily routine, especially for those site users experiencing homelessness. 
• As participants started caring for themselves, that caring has extended to the community in which they live.
• Stigma
•  It is important to explore how intersecting social identities influence health outcomes and enhance health disparities. 
• Previous research has noted that these intersecting social identities play an influential role in perpetuating health disparities among disadvantaged groups of people. 
• Stigma resulting from addiction to drugs can be further exasperated when it intersects with other forms of bias such as racism and sexism.