Abstract
BackgroundUsing our research findings, we explore Harm Reduction and Methadone Maintenance Treatment (MMT) using an intersectional lens to provide a more complex understanding of Harm Reduction and MMT, particularly how Harm Reduction and MMT are experienced differently by people dependent on how they are positioned. Using the lens of intersectionality, we refine the notion of Harm Reduction by specifying the conditions in which both harm and benefit arise and how experiences of harm are continuous with wider experiences of domination and oppression;MethodsA qualitative design that uses ethnographic methods of in-depth individual and focus group interviews and naturalistic observation was conducted in a large city in Canada. Participants included Aboriginal clients accessing mainstream mental health and addictions care and primary health care settings and healthcare providers;ResultsAll client-participants had profound histories of abuse and violence, most often connected to the legacy of colonialism (e.g., residential schooling) and ongoing colonial practices (e.g., stigma & everyday racism). Participants lived with co-occurring illness (e.g., HIV/AIDS, Hepatitis C, PTSD, depression, diabetes and substance use) and most lived in poverty. Many participants expressed mistrust with the healthcare system due to everyday experiences both within and outside the system that further marginalize them. In this paper, we focus on three intersecting issues that impact access to MMT: stigma and prejudice, social and structural constraints influencing enactment of peoples' agency, and homelessness;ConclusionsHarm reduction must move beyond a narrow concern with the harms directly related to drugs and drug use practices to address the harms associated with the determinants of drug use and drug and health policy. An intersectional lens elucidates the need for harm reduction approaches that reflect an understanding of and commitment to addressing the historical, socio-cultural and political forces that shape responses to mental illness/health, addictions, including harm reduction and methadone maintenance treatment.
Highlights
Using our research findings, we explore Harm Reduction and Methadone Maintenance Treatment (MMT) using an intersectional lens to provide a more complex understanding of Harm Reduction and MMT, how Harm Reduction and MMT are experienced differently by people dependent on how they are positioned
We focus on harm reduction and methadone maintenance treatment (MMT) to illustrate how social change can be promoted using an intersectional lens to examine harm reduction and MMT and mental health and addictions more broadly
We want to be clear that problematic substance use is not always associated with mental illness, homelessness, Aboriginal identity etc., the issues discussed in this paper represent insights provided by conducting research with Aboriginal people whose lives have been most influenced by these sociopolitical circumstances
Summary
We explore Harm Reduction and Methadone Maintenance Treatment (MMT) using an intersectional lens to provide a more complex understanding of Harm Reduction and MMT, how Harm Reduction and MMT are experienced differently by people dependent on how they are positioned. We focus on three intersecting issues that impact access to MMT: stigma and prejudice, social and structural constraints influencing enactment of peoples’ agency, and homelessness; Conclusions: Harm reduction must move beyond a narrow concern with the harms directly related to drugs and drug use practices to address the harms associated with the determinants of drug use and drug and health policy. We want to be clear that problematic substance use is not always associated with mental illness, homelessness, Aboriginal identity etc., the issues discussed in this paper represent insights provided by conducting research with Aboriginal people whose lives have been most influenced by these sociopolitical circumstances. Substance use can be stable at one point in time and move gradually or rapidly to a different point (p. 8) [15]
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