Downtown Eastside Research Articles

Injecting drugs alone during an overdose crisis in Vancouver, Canada

BackgroundSettings throughout Canada and the USA continue to experience crises of overdose death due to the toxic unregulated drug supply. Injecting drugs alone limits the potential for intervention and has accounted for a significant proportion of overdose deaths, yet the practice remains understudied. We sought to examine the practice of injecting alone among people who inject drugs (PWID) in Vancouver, Canada.MethodsData were derived from two prospective cohorts of people who use drugs between June 2016 and November 2018. This analysis was restricted to participants who, in the previous 6 months, reported any injection drug use. Rates of injecting alone were categorized as always, usually, sometimes, or occasionally. We fit a multivariable generalized linear mixed model to identify factors associated with injecting drugs alone.ResultsAmong 1070 PWID who contributed 3307 observations, 931 (87%) reported injecting alone at least once during the study period. In total, there were 729 (22%) reports of always injecting alone, 722 (21.8%) usually, 471 (14.2%) sometimes, 513 (15.5%) occasionally, and 872 (26.4%) never. In a multivariable model, factors positively associated with injecting drugs alone included male sex (adjusted odds ratio [AOR] 1.69; 95% confidence interval [CI] 1.20–2.37), residence in the Downtown Eastside neighbourhood (AOR 1.43; 95% CI 1.08–1.91), binge drug use (AOR 1.36; 95% CI 1.08–1.72), and experiencing physical or sexual violence or both (AOR 1.43; 95% CI 1.00–2.03). Protective factors included Indigenous ancestry (AOR 0.71; 95% CI 0.52–0.98) and being in a relationship (AOR 0.30; 95% CI 0.23–0.39).ConclusionWe observed that injecting alone, a key risk for overdose mortality, was common among PWID in Vancouver. Our findings underline the need for additional overdose prevention measures that are gender-specific, culturally appropriate, violence- and trauma-informed, and available to those who inject alone.

Picture This: Exploring Photovoice as a Method to Understand Lived Experiences in Marginal Neighbourhoods

Scholars in the social sciences are increasingly turning to research questions that explore everyday lived experiences, using participatory visual methodologies to promote critical reflections on urban challenges. In contrast with traditional research approaches, participatory visual methods engage directly with community participants, foregrounding their daily realities, and working towards collaborative knowledge production of participants’ situated experiences, potentially leading to transformative thinking and action. This participatory turn in research intersects with growing interests in community participation in collaborative planning and effective ways of engaging “unheard voices” in a planning context, particularly in marginalized neighbourhoods, using arts-based methods. This article critically examines the potential of participatory visual methodologies, exploring how the method of photovoice can reveal otherwise obscured perspectives from the viewpoint of communities in marginalised neighbourhoods. Based on a case study in the Downtown Eastside, Vancouver, the research considers whether and how creative participatory approaches can contribute to giving voice to communities and, if so, how these methods can impact a city’s planning for urban futures. The research shows that, potentially, photovoice can provide a means of communicating community perspectives, reimagining place within the framework of participatory planning processes to those who make decisions on the neighbourhood’s future. However, the research also demonstrates that there are limitations to the approach, bringing into sharp focus the ethical dimensions and challenges of participatory visual methodologies as a tool for engaging with communities, in an urban planning context.

The prevalence and social-structural correlates of housing status among women living with HIV in Vancouver, Canada

BackgroundWomen living with HIV (WLWH) experience numerous social and structural barriers to stable housing, with substantial implications for access to health care services. This study is the first to apply the Canadian Definition of Homelessness (CDOH), an inclusive national guideline, to investigate the prevalence and correlates of housing status among WLWH in Metro Vancouver, Canada.MethodsOur study utilized data from a longitudinal open cohort of cisgender and trans WLWH aged 14 years and older, in 2010–2019. Cross-sectional descriptive statistics of the prevalence of housing status and other social and structural variables were summarized for the baseline visits. Bivariate and multivariable logistic regression analyses were conducted using generalized linear mixed models (GLMM) for repeated measures to investigate the relationship between social and structural correlates and housing status among WLWH.ResultsThe study included 336 participants with 1930 observations over 9 years. Housing status derived from CDOH included four categories: unsheltered, unstable, supportive housing, and stable housing (reference). Evidence suggested high levels of precarious housing, with 24% of participants reporting being unsheltered, 47% reporting unstable housing, 11.9% reporting supportive housing, and 16.4% reporting stable housing in the last six months at baseline. According to the multivariable models, living in the Downtown Eastside (DTES) neighbourhood of Metro Vancouver, hospitalization, physical/sexual violence, and stimulant use were associated with being unsheltered, compared to stable housing; DTES residence, hospitalization, and physical/sexual violence were associated with unstable housing; DTES residence and stimulant use were associated with living in supportive housing.ConclusionComplex social-structural inequities are associated with housing instability among WLWH. In addition to meeting basic needs for living, to facilitate access to housing among WLWH, housing options that are gender-responsive and gender-inclusive and include trauma- and violence-informed principles, low-barrier requirements, and strong connections with supportive harm reduction services are critical.

The practice and embodiment of "goofballs": A qualitative study exploring the co-injection of methamphetamines and opioids.

Polysubstance use is common among people who use drugs, including the co-use of stimulants and opioids. Research suggests the practice of simultaneous co-injection of methamphetamines and opioids, often referred to as "goofballs", is increasing. As a relatively unique drug use practice, little qualitative research currently exists on goofball injecting. This study explores the practice and embodied experiences of goofball injecting. This article draws on in-depth interviews conducted across two qualitative studies undertaken in Vancouver, Canada's Downtown Eastside neighbourhood examining changing dynamics in relation to stimulant use and experiences with an overdose prevention site-based safer supply intervention, respectively. Interviews containing discussions of goofball use (n=29) were extracted from each study and merged into a single qualitative dataset. Data were analysed thematically and focused on the practices and embodied experiences of goofball injection. Our analysis uncovered how goofball injection represented a complex drug use practice driven by the desire to achieve particular embodied experiences not attainable by using either drug individually. We identified three distinct practices of goofball use: 1) to alter or enhance the effects of opioids; 2) to alter or enhance the effects of methamphetamines; and 3) to balance out the effects of both drugs. Our study fills an important gap in the polysubstance use literature specifically exploring the co-injection of methamphetamines and opioids. Our findings highlight the need to implement and expand interventions and services attentive to polysubstance use and the role of pleasure in drug taking practices, including expanding non-medicalized opioid and stimulant safer supply initiatives across North America.

Absent and Problematic: The Representation of Fathers in the Program Policies of Organizations that Provide Family-Centred Services in Vancouver's Downtown Eastside.

Parenting education interventions and parenting programs are important for health promotion efforts among children and families; however, the majority of parenting programs are directed towards and attended by mothers. This is problematic because research has consistently demonstrated that fathers’ active participation in the family can have a positive influence on mothers’ well-being, children’s self-esteem, success in school, and interpersonal relationships. In this paper, using an intersectional poststructuralist framework, document analysis, and Bacchi and Goodwin’s “What’s the problem represented to be” approach (WPR), we analyzed the program policies of 12 organizations that provide family-centred services in the Downtown Eastside of Vancouver, British Columbia, Canada. We identified the following three discourses: organizations strive to be client-centred and provide choices; organizations want to empower their participants; and women need safe place to raise their families. Our analysis revealed that fathers are absent or represented as problems in program policies, and that this has consequences for not only fathers but also mothers and children.

The underground bicycle economy: an exploration of social supports and economic resources that Vancouver’s homeless and variably-housed cyclists utilize

Many people living in poverty ride bicycles and many also participate in informal work such as recycling. A small number of studies have begun to explore homeless cyclists’ experiences with and perspectives on bicycles and recycling. In the current study, we seek to contribute to this emerging area of study, focusing in this case on the social support and informal and formal resources homeless and variably-housed cyclists use in Vancouver. Interviews, including go-along mobile methods, were conducted with five men living in the Downtown Eastside neighbourhood of Vancouver who use bicycles. Findings show that the cyclists, especially recyclers, navigated an ‘underground economy’ of bike-related spaces that allowed them to make money, keep their bicycles in working condition, and cultivate social connections. In particular, a few highly valuable sources and spaces of support existed for participants within a landscape where barriers of many sorts were encountered regularly. These findings bring attention to the needs of and resources considered to be most valuable for some cyclists living in poverty, to the creativity and resilience of an often stigmatised group, and to ways that more inclusive cycling policy might support the efforts of a marginalised group to live a healthy life.

Beyond co-production: The construction of drug checking knowledge in a Canadian supervised injection facility

Drug-checking is an ensemble of different harm reduction techniques providing people the ability to test illegally purchased drugs for strength, the presence of particular substances, and possible adulterants. Drug-checking research has primarily focused on nightlife and festival communities of people who use drugs and has overlooked how it functions as a knowledge forming process, particularly by people whose drug use is more stigmatized. The implementation of Fourier-Transform Infrared Spectroscopy (FTIR) in Vancouver, Canada's Downtown Eastside in response to the overdose crisis has made it possible for people who use drugs to receive information about the drugs that they are consuming. Using insights developed from the ‘ontological turn’ and approaches to co-production from public health and science and technology studies, we explore the multiple relations that come to produce and contest drug-checking knowledge in this setting. We look at how knowledge is produced by and for people who use drugs, including people who use drugs operating the FTIR. Using rapid ethnographic assessment and semi-structured interviews, participants were recruited from a low-barrier supervised injection facility to explore their experience of drug-checking. Data were coded in NVivo 12 using an initial coding scheme, as well as an iterative coding scheme as the data were explored. We find that the traditional demarcation between lay and expert, or peer and professional, which co-production idioms often rely on, creates barriers to seeing the different knowledge formations of drug-checking knowledge, and instead offer up a new idiom, trans-production, to explore how knowledge and harm reduction services are mutually enacted.

Characterizing stimulant overdose: A qualitative study on perceptions and experiences of "overamping".

The dominant focus of North America's current overdose crisis has been opioids, resulting in considerable research and harm reduction efforts to address opioid-related overdose risks. Less attention has been paid to people who use stimulants (PWUS) despite recent increases in stimulant use and stimulant-involved overdoses (i.e., "overamping"). Stimulant users' definitions, risk factors and experiences of, and responses to, overamping are poorly understood, thereby putting PWUS at heightened risk of adverse health outcomes. This study explores how PWUS understand, experience, and respond to overamping. In-depth qualitative interviews were conducted with 61 PWUS in Vancouver, Canada's Downtown Eastside neighbourhood. Thematic analysis of interviews focused on contextualizing stimulant overdoses, including how PWUS understand, define, experience, and respond to overamping. Participants associated overamping experiences with commonly identified signs and symptoms, such as rapid onset, elevated heart rate, incontinence, and audiovisua hallucinations, but also reported more serious indicators of overamping, such as unconsciousness, cardiac arrests and seizures. Our findings demonstrate that, among PWUS, there was no unified understanding of overamping such as with opioid overdose and individual experiences had substantial variation in severity and presentation. This impacted the ability to adequately respond to stimulant overdoses, which were primarily self-managed through methods including stabilizing breathing, polysubstance use, and cold showers. Given the growing role of stimulants in North America's overdose crisis, there is an urgent need to improve the identification of stimulant overdoses in real world settings. Our findings identify a gap in current understandings of stimulant overdose, and demonstrate the need for public health and harm reduction interventions to better address overamp risk among PWUS, including harm reduction campaigns to disseminate information regarding identifying signs of, and proper responses to, overamping.

Different spokes for different folks: experiences with cycling and the bicycle from the perspective of variably-housed cyclists in Vancouver

ABSTRACT Bicycling is celebrated for being sustainable, healthy, and economical, and it has become popularised among urbanites in many cities. Literature on mobility and urban development tends to reflect these values, as do policies on transportation and sustainability in cities like Vancouver – where the bicycle’s role as a sustainable leisure activity and commuting strategy is commonly promoted. Often unrecognised in this literature and in policy are the many people experiencing homelessness, who sometimes cycle as their only transportation option, and who may ride bicycles for reasons that do not fit neatly in a leisure-commuter dichotomy. Responding to this gap, the study reported in this paper was concerned with discovering what cycling means to variably-housed people who ride bicycles in Vancouver’s Downtown Eastside neighbourhood, and how these meanings align (or do not align) with common depictions of cycling and cyclists in existing research and policy. Drawing from a set of in-depth (and sometimes ‘ride-along’) interviews, results indicated that participants cycled for a variety of reasons, including for informal work (recycling) and for personal mobility when walking proved difficult. Interviewees focused on the value of the bicycle for personal mobility and as a health aid, while expressing little attachment to their bicycles due to theft. By focusing on cycling-related practices and identities that exist outside the leisure-commuter dichotomy and with unique relationships with this dichotomy, this study informs literature concerning cycling and (in)equity, while highlighting the need for policy developments that account for the range of cycling identities.

Protocol: A mixed methods evaluation of an IPS program to increase employment and well-being for people with long-term experience of complex barriers in Vancouver’s downtown and DTES

BackgroundEmployment improves mental health and well-being by providing financial security, daily structure, a sense of identity and purpose, and social engagement. However, securing and sustaining employment is exceptionally challenging for vulnerable populations who experience persistent and multiple barriers, such as mental illness, homelessness, food and housing insecurity, and marginalization. Evidence-based supported employment programs, most notably individual placement and support (IPS) are becoming a more common approach for addressing the needs of these high-risk individuals. The aim of this paper is to outline the protocol for evaluating an IPS program in Vancouver’s downtown and Downtown Eastside (DTES).Methods and designThis prospective quasi-experimental study of persons with persistent and multiple barriers to employment will use a mixed-methods approach for evaluating a novel IPS program. The evaluation will consist of survey packages and interviews that will capture outcomes related to employment and well-being, as well as the experiential process of receiving individualized and integrated supports through the IPS program. A mixed-methods approach is appropriate for this study as quantitative data will provide an objective assessment of program impacts on employment and well-being outcomes over time, while qualitative data will provide an in-depth understanding of continued barriers and experiences.DiscussionThe results from this evaluation will contribute evidence within a local British Columbian (BC) context that may increase access to meaningful employment for those with long-term experience of complex barriers to employment. Further, the findings will support continued improvements, and guide decision-making around practices and policy for future implementation of IPS and employment supports across BC.

BC's Five Years of Drug Failure, Visualized: The anniversary of the province's overdose emergency declaration is nothing to celebrate

Since the start of the opioid epidemic in 2016, the Downtown Eastside community of Vancouver, Canada, has lost many pioneering leaders, activists and visionaries to the war on drugs. The Vancouver Area Network of Drug Users (VANDU), the Western Aboriginal Harm Reduction Society (WAHRS), and the British Columbia Association People on Opiate Maintenance (BCAPOM) are truly concerned about the increasing overdose deaths that have continued since 2016 and have been exacerbated by the novel coronavirus (SARS-COVID-19) despite many unique and timely harm reduction announcements by the British Columbia (BC) government. Some of these unique interventions in BC, although in many cases only mere announcements with limited scope, are based on the philosophy of safe supply to illegal street drugs. Despite all the efforts during the pandemic, overdose deaths have spiked by over 100% compared to the previous year. Therefore, we urge the Canadian federal government, specifically the Honorable Patty Hajdu, the federal Minister of Health, to decriminalize simple possession immediately by granting exemption under the Controlled Drugs and Substances Act. The Canadian federal government has a moral obligation under Sect. 7 of the Canadian Charter of Rights and Freedoms to protect the basic human rights of marginalized Canadians.

"I Used to be Scared to Even Like Stand Beside Somebody Who Had It": HIV Risk Behaviours and Perceptions among Indigenous People Who Use Drugs

Objectives: In Canada, and elsewhere, Indigenous people who use illicit drugs and/or alcohol (WUID/A) experience a disproportionate burden of HIV-related harm. This study examined HIV risk perceptions and behaviours among Indigenous people WUID/A living in the Downtown Eastside (DTES) and the policies and practices that shape inequities and vulnerabilities for them in HIV testing and treatment. Further, we aimed to situate the vulnerabilities of Indigenous people WUID/A in HIV care within the context of wider structural inequality and generate recommendations for culturally relevant and safe HIV treatment options. Methods: This research employed an Indigenous-led community-based participatory approach using talking circles to explore experiences of Indigenous people living with HIV. Under the participatory research framework, community researchers led the study design, data collection, and analysis. Talking circles elicited participants’ experiences of HIV knowledge, testing, and treatment, and were audio-recorded and transcribed. Data were coded line-by-line and codes were organized into themes. Results: Five key themes were identified via the talking circles: evolving HIV risk perceptions (e.g., HIV knowledge and testing, and “intentional exposure”); research as an avenue for HIV testing; HIV treatment and discussions about grief and loss; HIV-related stigma and discrimination; and the importance of culturally-relevant and safe HIV treatment options for Indigenous people WUID/A. Discussion: Our work reveals that Indigenous people WUID/A do not have adequate access to HIV knowledge and education, often limiting their ability to access HIV testing and supports. Participant stories revealed both internalized and community stigma and discrimination, which at times compromised connection with participants' home communities. Further, our findings point to a failure in the public health system to deliver accessible HIV information to Indigenous Peoples, hence, many participants have solely relied on participation in community-based research studies in the Downtown Eastside (DTES) for HIV education and knowledge. There is an urgent need for accessible, culturally safe, and community-based education and treatment options for Indigenous people WUID/A within HIV care.

Social-Structural Predictors of Fentanyl Exposure among Street Involved Youth

ABSTRACT ObjectiveThe emergence of synthetic fentanyl has been a main contributor to North America’s rising overdose death rates. While increasing attention has been given to drug-related harm among youth, little is known about how social-structural conditions influence their risk of fentanyl exposure. Therefore, we evaluated potential relationships between social-structural conditions and fentanyl exposure among youth who use illicit drugs in Vancouver, BC. Methods: Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort study. The ARYS cohort involves street-involved youth, who use illicit substances in Vancouver, Canada. A multivariable logic regression analysis model was used to identify social factors associated with recent fentanyl exposure as determined through urine drug screening. Results: Overall, 423 participants were included in this analysis, with 380 (38.23%) testing positive for recent fentanyl exposure. In a multivariable relative risk analysis, living in Vancouver’s Downtown Eastside in the last six months (RR = 1.16, 95% CI: 1.03-1.32) and daily heroin injection drug use (RR = 1.31, 95% CI: 1.15 − 1.50) were positively associated with fentanyl exposure. As a secondary measure, we found that within the encounters who denied using fentanyl (92.25% of total encounters), 321 (35.05%) still tested positive. Conclusions: We found that youth residing in Vancouver’s Downtown Eastside was positively associated with being exposed to fentanyl. Our findings highlight the need to support youth in finding secure housing outside of Vancouver’s drug use epicenter to reduce fentanyl exposure.

MAKING PROPERTY OUTLAWS: Law and Relegation

AbstractDrawing from community‐based research in the Downtown Eastside, the poorest part of Vancouver, Canada, a neighbourhood long demonized as an ‘outlaw zone’, we suggest that what may appear to be illegal property practices in the area's infamous Single Room Occupancy (SRO) hotels are, in fact, harder to detach from formal legality than supposed. We characterize the state's withdrawal of tenancy law from SRO in the 1970s as productive of property outlaws. A form of legal relegation, outlawry places SRO residents in a space of lesser protection, stripping them of rights. A space of decades of systematic legal relegation, the outlaw zone is a product of law, not its antithesis, predicated on organized forms of devaluation and discrimination.

Effect of COVID-19 on Pet Food Bank Servicing: Quantifying Numbers of Clients Serviced in the Vancouver Downtown Eastside, British Columbia, Canada.

Previous research has focused on the benefits and difficulties of pet ownership in people, who are experiencing homelessness. However, many pet services, such as pet food banks, serve a more varied population of people. Furthermore, the effect of the COVID-19 pandemic has not been documented within the context of pet food banks. Vancouver's Downtown Eastside (DTES) population comprises a notable proportion of the city's overall population and has a high density of people who are experiencing financial hardships, but some of whom do not always experience homelessness. The purpose of this study was to gain an understanding of the number of clients and pets that are being serviced by a pet food bank, whether that has changed over time, and if it was impacted by the COVID-19 pandemic. We analyzed available attendance and service records from The British Columbia Society for the Prevention of Cruelty to Animals pet food bank between 2013 and 2020. We found that a median of 100 clients attended the food bank each week and that most of the companion animals serviced were cats (72.5%), then followed by dogs (25.2%), and rats (1.2%). Servicing was not consistent over time, with a weekly pattern of decreased attendance every fourth week of the month, which coincided with income assistance payments. This suggests that either servicing needs are decreased with income assistance or that the week of the month may present an access to care challenge. We also observed a decrease in the clientele attending in 2020 compared to previous years, suggesting an effect of COVID-19. Specifically, this trend was present for cats, rats, rabbits, and “other” companion animals, but not for dogs; the number of dog owners receiving services did not change in 2020, suggesting a difference between needed services in dog vs. other pet owners. The yearly trends shed light on the impact of COVID-19 on vulnerable populations, highlighting the need for additional support through times of crisis. Overall, the data show a complex relationship between pet service provision and other community issues and highlight the need to consider pet food banks within the greater social services networks.

A drug-related Good Samaritan Law and calling emergency medical services for drug overdoses in a Canadian setting

BackgroundPeople who use drugs (PWUD) are known to fear calling emergency medical services (EMS) for drug overdoses. In response, drug-related Good Samaritan Laws (GSLs) have been widely adopted in the USA and Canada to encourage bystanders to call emergency medical services (EMS) in the event of a drug overdose. However, the effect of GSLs on EMS-calling behaviours has been understudied. We sought to identify factors associated with EMS-calling, including the enactment of the Canadian GSL in May 2017, among PWUD in Vancouver, Canada, a setting with an ongoing overdose crisis.MethodsData were derived from three prospective cohort studies of PWUD in Vancouver in 2014–2018. Multivariable logistic regression was used to determine factors associated with EMS-calling among PWUD who witnessed an overdose event. An interrupted time series (ITS) analysis was employed to assess the impact of GSL on monthly prevalence of EMS-calling.ResultsAmong 540 eligible participants, 321 (59%) were males and 284 (53%) reported calling EMS. In multivariable analysis, ever having administered naloxone three or more times (adjusted odds ratio [AOR] 2.00; 95% confidence interval [CI] 1.08–3.74) and residence in the Downtown Eastside (DTES) neighbourhood of Vancouver (AOR 1.96; 95% CI 1.23–3.13) were positively associated with EMS-calling, while living in a single occupancy hotel (SRO) was negatively associated with EMS-calling (AOR 0.51; 95% CI 0.30–0.86). The post-GSL enactment period was not associated with EMS-calling (AOR 0.81; 95% CI 0.52–1.25). The ITS found no significant difference in the monthly prevalence of EMS-calling between pre- and post-GSL enactment periods.ConclusionWe observed EMS being called about half the time and the GSL did not appear to encourage EMS-calling. We also found that individuals living in SROs were less likely to call EMS, which raises concern given that fatal overdose cases are concentrated in SROs in our setting. The link between many naloxone administrations and EMS-calling could indicate that those with prior experience in responding to overdose events were more willing to call EMS. Increased efforts are warranted to ensure effective emergency responses for drug overdoses among PWUD.

A new quantitative drug checking technology for harm reduction: Pilot study in Vancouver, Canada using paper spray mass spectrometry.

IntroductionDrug checking services for harm reduction and overdose prevention have been implemented in many jurisdictions as a public health intervention in response to the opioid overdose crisis. This study demonstrates the first on‐site use of paper spray mass spectrometry for quantitative drug checking to address the limitations of current on‐site drug testing technologies.MethodsPaper spray mass spectrometry was used to provide on‐site drug checking services at a supervised consumption site in the Downtown Eastside of Vancouver, British Columbia, Canada during a 2‐day pilot test in August 2019. The method included the targeted quantitative measurement of 49 drugs and an untargeted full scan to assist in identifying unknown/unexpected components.ResultsDuring the pilot, 113 samples were submitted for analysis, with 88 (78%) containing the client expected substance. Fentanyl was detected in 45 of 59 expected fentanyl samples, and in 50 (44%) samples overall at a median concentration of 3.6% (w/w%). The synthetic precursor of fentanyl, 4‐anilino‐N‐phenethyl‐piperidine (4‐ANPP), was found in 74.0% of all fentanyl samples at a median concentration of 2.2%, suggesting widespread poor manufacturing practices. Etizolam was detected in 10 submitted samples anticipated to be fentanyl at a median concentration of 2.5%. No clients submitting these samples expected etizolam or a benzodiazepine in their sample. In three instances, it was co‐measured with fentanyl, and in seven cases it was detected alone.Discussion and ConclusionsThe quantitative capabilities and low detection limits demonstrated by paper spray mass spectrometry offer distinct benefits over existing on‐site drug checking methods and harm reduction services.

Love & hate in the Downtown Eastside of Vancouver: features of an unusual drug scene

Purpose According to conventional research and political conceptions, illicit drug scenes are often characterised by cultures of crime, violence and deceit and customarily met by repressive law enforcement. However, a growing body of research demonstrates the very diverse nature of drug subcultures. This paper aims to explore this diversity and thereby investigates the psychosocial and socio-spatial features people selling and/or using drugs in the Downtown Eastside of Vancouver (DTES) attribute to the local drug scene. Design/methodology/approach Qualitative in-depth interviews were conducted with 23 persons with drug selling and/or using experiences in the DTES. Interviews were analysed and interpreted according to grounded theory. Findings Participants represent the social fabric of the DTES drug scene as comprising complexly interwoven facets and structures including frequent, brutal violence on the one hand and sincere, heart-rending compassion, care and even love on the other. Originality/value Police and social and health services can cooperate constructively with the overriding aim of individual and social harm reduction. Thereby, the existing social network and prosocial orientations of a drug scene can be used in effective approaches such as participatory policy strategies and peer-driven interventions.

Migration Patterns from an Open Illicit Drug Scene and Emergency Department Visits among People Who Use Illicit Drugs in Vancouver, Canada

Background People who use illicit drugs (PWUD) experience various adverse health outcomes leading to increased healthcare service utilization. PWUD are also a highly mobile population which poses challenges to healthcare delivery. The objective of this study was to identify migration patterns from the Downtown Eastside (DTES), an urban illicit drug scene in Vancouver and to estimate the impact of different migration patterns on two outcomes: a) emergency department (ED) visits and b) ED visits resulting in inpatient admission among PWUD. Methods Three prospective cohorts of PWUD in Vancouver were linked with regional ED data. We defined the optimal number of trajectory groups that best represented distinct patterns of migration from Vancouver’s DTES using a latent class growth analysis. Then, generalized estimating equations were used to estimate the effect of migration patterns on the two ED outcomes. Results Four distinct migration trajectory patterns were identified among the 1210 included participants: PWUD who consistently lived in the DTES, those who migrated out of DTES early, those who migrated out of DTES late, and those who frequently revisited the DTES. Participants who frequently revisited the DTES had higher odds of an ED visit (adjusted odds ratio = 1.62; 95% confidence interval: 1.28–2.06). There was no significant association between migration patterns and inpatient admission. Conclusions We found that PWUD who frequently revisited the DTES were more likely to have utilized the ED, suggesting that there may be a subgroup of PWUD who are at increased risk of experiencing negative health outcomes. Supplemental data for this article is available online at 10.1080/10826084.2021.1958849

"Every One of Us Is a Strand in That Basket": Weaving Together Stories of Indigenous Wellness and Resilience From the Perspective of Those With Lived and Living Experience With HIV/Hepatitis C Virus.

This article primarily focuses on the stories shared by Indigenous women with living and/or lived experiences of HIV/hepatitis C virus from the Vancouver Downtown East Side who attended the “Awakening our Wisdom” retreat. Weaving together the story of an Indigenous approach to research that informed the design of the retreat and the findings that emerged, a basket is formed that highlights the ways settler-colonialism within Canada has produced a system of health care that has neglected the Indigenous experience. The emerging themes of Connection, Disconnection, and Reconnection offers teachings for Indigenous journeys of resilience and wellness for those living with HIV/hepatitis C virus. These findings may help health care practitioners identify health care places and spaces that are in need of decolonization and offer, from an Indigenous perspective, the next steps forward for a health care system that promotes Indigenous engagement and retention in care.