Abstract
We described public views toward harm reduction among Canadian adults and tested a social exposure model predicting support for these contentious services, drawing on theories in the morality policy, intergroup relations, addiction, and media communication literatures. A quota sample of 4645 adults (18+ years), randomly drawn from an online research panel and stratified to match age and sex distributions of adults within and across Canadian provinces, was recruited in June 2018. Participants completed survey items assessing support for harm reduction for people who use drugs (PWUD) and for seven harm reduction interventions. Additional items assessed exposure to media coverage on harm reduction, and scales assessing stigma toward PWUD (α = .72), personal familiarity with PWUD (α = .84), and disease model beliefs about addiction (α = .79). Most (64%) Canadians supported harm reduction (provincial estimates = 60% - 73%). Five of seven interventions received majority support, including: outreach (79%), naloxone (72%), drug checking (70%), needle distribution (60%) and supervised drug consumption (55%). Low-threshold opioid agonist treatment and safe inhalation interventions received less support (49% and 44%). Our social exposure model, adjusted for respondent sex, household income, political views, and education, exhibited good fit and accounted for 17% of variance in public support for harm reduction. Personal familiarity with PWUD and disease model beliefs about addiction were directly associated with support (βs = .07 and -0.10, respectively), and indirectly influenced public support via stigmatized attitudes toward PWUD (βs = 0.01 and -0.01, respectively). Strategies to increase support for harm reduction could problematize certain disease model beliefs (e.g., “There are only two possibilities for an alcoholic or drug addict–permanent abstinence or death”) and creating opportunities to reduce social distance between PWUD, the public, and policy makers.
Highlights
IntroductionA substantial evidence base supports the population benefits and cost-effectiveness of harm reduction interventions (e.g., needle distribution, supervised drug consumption) for people who use drugs (PWUD) [1,2,3]
A substantial evidence base supports the population benefits and cost-effectiveness of harm reduction interventions for people who use drugs (PWUD) [1,2,3]
Two studies confirmed that policies were largely produced for rhetorical rather than instrumental purposes, as revealed in documents that avoided clear governance statements, and failed to name or support specific harm reduction interventions or key international tenets of harm reduction [13, 14]
Summary
A substantial evidence base supports the population benefits and cost-effectiveness of harm reduction interventions (e.g., needle distribution, supervised drug consumption) for people who use drugs (PWUD) [1,2,3]. The literature on morality policy is helpful for understanding this disconnection between evidence and haphazard implementation of harm reduction services [9, 10] Scholars in this area propose that when decision makers must reconcile conflicting public values over the legitimacy of providing health or social services to target populations, they strategically downplay instrumental support in favor of policy designed to serve rhetorical, symbolic functions [11, 12]. Volume of coverage tracked major events (e.g., Canada’s opioid emergency, legal challenges to Vancouver’s safe injection programming) but dramatically overemphasized supervised drug consumption and naloxone programs at the expense of other harm reduction services This limited sense of ‘newsworthiness’ may have perpetuated a morality policy environment for harm reduction by reducing public awareness of the full range of evidence-supported harm reduction services that could benefit PWUD [16]
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