Vancouver Area Network Of Drug Users Research Articles

The overdose epidemic: a study protocol to determine whether people who use drugs can influence or shape public opinion via mass media

BackgroundWe are currently witnessing an ongoing drug overdose death epidemic in many nations linked to the distribution of illegally manufactured potent synthetic opioids. While many health policy makers and researchers have focused on the root causes and possible solutions to the current crisis, there has been little focus on the power of advocacy and community action by people who use drugs (PWUDs). Specifically, there has been no research on the role of PWUDs in engaging and influencing mass media opinion.MethodsBy relying on one of the longest and largest peer-run drug user advocacy groups in the world, the Vancouver Area Network of Drug Users (VANDU), newspaper articles, television reports, and magazines that VANDU or its members have been directly involved in will be identified via two data bases (the Canadian Newsstream & Google News). The news articles and videos related to the health of PWUDs and issues affecting PWUDs from 1997 to the end of 2020 will be analyzed qualitatively using Nvivo software.DiscussionAs our communities are entering another phase of the drug overdose epidemic, acknowledging and partnering with PWUDs could play an integral part in advancing the goals of harm reduction, treatment, and human rights.

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.

\u201cThey\u2019re always there\u201d: resident experiences of living with rats in a disadvantaged urban neighbourhood

BackgroundThe presence of urban rats in the neighbourhood environment may negatively impact the physical and mental health of residents. Our study sought to describe the experiences with, perceptions of, and feelings towards rats and rat control efforts among a group of disadvantaged urban residents in Vancouver, Canada.MethodsSemi-structured interviews were held with 20 members of the Vancouver Area Network of Drug Users (VANDU) recruited by VANDU staff. Interviews were audio recorded, transcribed, and analyzed using thematic analysis.ResultsParticipants reported daily sightings of rats and close contact during encounters. Participants generally disliked encountering rats, raising issues of health and safety for themselves and the community due to the belief that rats carry disease. Fear of rats was common, and in some cases resulted in avoidance of rats. Effects of rats on participants were particularly pronounced for those living with rats in the home or for homeless participants who described impacts on sleep due to the sounds made by rats. Although rats were viewed as more problematic in their neighbourhood than elsewhere in Vancouver, participants believed there to be a lack of neighbourhood-level control initiatives that angered and disheartened participants. In combination with other community-level concerns (e.g., housing quality and availability), the presence of rats was viewed by some to align with a general disregard for the community and its residents.ConclusionsThis study suggests that the presence of rats in urban centres may have several consequences on the physical and mental health of residents living in close contact with them. These effects may be exacerbated with continued contact with rats and when residents perceive a lack of initiative to control rats in their neighbourhood. As such, research and policies aimed at mitigating the health risks posed by rats should extend beyond disease-related risk and incorporate diverse health outcomes.

Activism and scientific research: 20\xa0years of community action by the Vancouver area network of drug users

BackgroundOver the past several decades, there have been numerous peer-reviewed articles written about people who use drugs (PWUDs) from the Downtown Eastside neighborhood of Vancouver, Canada. While individual researchers have engaged and acknowledged this population as participants and community partners in their work, there has been comparatively little attention given to the role of PWUDs and drug user organizations in directing, influencing, and shaping research agendas.MethodsIn this community-driven research, we examine 20 years of peer-reviewed studies, university theses, books, and reports that have been directed, influenced, and shaped by members of the activist organization the Vancouver Area Network of Drug Users (VANDU). In this paper, we have summarized VANDU’s work based on different themes from each article.ResultsAfter applying the inclusion criteria to over 400 articles, 59 items containing peer-reviewed studies, books, and reports were included and three themes of topics researched or discussed were identified. Theme 1: ‘health needs’ of marginalized groups was found in 39% of articles, Theme 2: ‘evaluation of projects’ related to harm reduction in 19%, and Theme 3: ‘activism’ related work in 42%. Ninety-four percent of co-authors were from British Columbia and 44% of research was qualitative. Works that have been co-authored by VANDU’s members or acknowledged their participations created 628 citations. Moreover, their work has been accessed more than 149,600 times.ConclusionsPeer-based, democratic harm reduction organizations are important partners in facilitating groundbreaking health and social research, and through research can advocate for the improved health and wellbeing of PWUDs and other marginalized groups in their community. This article also recommends that PWUDs should be more respectfully engaged and given appropriate credit for their contributions.

The perspectives of structurally vulnerable people who use drugs on volunteer stipends and work experiences provided through a drug user organization: Opportunities and limitations

BackgroundWhile drug user organizations (DUO) have received public health attention as a means to potentially reduce the harms associated with drug use, there is a lack of research on the compensation and structural forces that promote or inhibit participation in DUO. Against the backdrop of structural vulnerability experienced by people who use drugs (PWUD), we examined the impact of monetary ‘volunteer stipends’ provided through a DUO and explore their role in providing low-threshold employment opportunities and shaping participation in DUO. MethodsParticipants were purposively sampled to reflect a range of perspectives and experiences volunteering at Vancouver Area Network of Drug Users (VANDU) and receiving stipends. Semi-structured qualitative interviews were conducted with 23 members of VANDU. Interview transcripts were coded in Atlas.ti 7 for key a priori themes and emergent categories from the data and analyzed thematically. ResultsStipends provided participants with symbolic and material recognition of the time, effort, and expertise they contribute to the organization, and functioned to facilitate ongoing participation. Payments that rewarded, skills, labour and drug-related knowledge reduced participant’s perception of stigma against PWUD. Paid work in VANDU further provided participants with non-material benefits commonly attributed to regular employment, including social connections and a sense of purpose. Participants also identified the low level of pay as a limitation of VANDU’s paid participation program. The daily demands of survival (accessing shelter, food, and drugs) posed more complex structural vulnerabilities to participate in VANDU, as small stipends were not sufficient to address these needs. ConclusionLow threshold employment opportunities within DUO may provide significant individual and public health benefits. However, these benefits are constrained by the small size of stipends. Therefore, to ensure better inclusion of PWUD, our findings recommend the development and expansion of equitable, accessible, well-paying employment programs for PWUD.

(Re)visualizing women who use drugs

This article explores a collaborative, community-based project that fuses both arts-based feminist and visual sociological perspectives through a collaboration with five women in leadership roles in a drug user union, Vancouver Area Network of Drug Users (VANDU). VANDU is situated in the Downtown Eastside of Vancouver, British Columbia, in Canada’s poorest urban neighbourhood. Through writing, photography and collage-making, participants in this study resisted dominant representations of women who use criminalised drugs by focusing on activism, family, friends and the spaces they live and work in. This paper contributes to a growing body of critical and feminist scholarship interested in using creative and visual methodologies and collaborative community artworks as tools for developing alternate perspectives about the lives of marginalised women.

Exploring the role of an unsanctioned, supervised peer driven injection facility in reducing HIV and hepatitis C infections in people that require assistance during injection

BackgroundSupervised consumption rooms or supervised injection facilities (SIFs) are venues that have reduced the risk of needle sharing and deaths caused by drug overdose among people who inject drugs (PWID). As a result of such a decline in the mortality rate, numerous studies have been able to illustrate its cost-effectiveness. However, studies have neglected to examine the same phenomena for unsanctioned SIFs that are run by peer drug users and provide assisted injections.MethodsThe current study will determine whether the former unsanctioned SIF, that provided assisted injection and was operated by the grass root organization called Vancouver Area Network of Drug Users (VANDU), cost less than the health care consequences of not having such a program in Vancouver, Canada. By analyzing data gathered in 2013, this paper relies on two mathematical models to estimate the number of new HIV and HCV infections prevented by the former unsanctioned facility in Vancouver’s Downtown Eastside.ResultsA conservative estimate indicates that the SIF location that provided assisted injections has a benefit-cost ratio of 33.1:1 due to its low operational cost. At the baseline sharing rate, the facility, on an average, reduced 81 HCV and 30 HIV cases among PWID each year. Such reductions in blood borne infections among PWID resulted in annual savings worth CAN$4.3 million dollars in health care expenditure. In addition to this, the current paper relies on a sensitivity analysis based on different needle sharing rate scenarios.ConclusionsThe sensitivity analysis and the baseline rates indicate that funding SIF facilities operated by peer drug users that facilitate assisted injection appear to be an efficient and effective use of financial resources in the public health domain since they lead to a significant decline in the rate of mortality within a vulnerable population.

A cost-benefit/cost-effectiveness analysis of an unsanctioned supervised smoking facility in the Downtown Eastside of Vancouver, Canada.

BackgroundSmoking crack involves the risk of transmitting diseases such as HIV and hepatitis C (HCV). The current study determines whether the formerly unsanctioned supervised smoking facility (SSF)—operated by the grassroot organization, Vancouver Area Network of Drug Users (VANDU) for the last few years—costs less than the costs incurred for health-care services as a direct consequence of not having such a program in Vancouver, Canada.MethodsThe data pertaining to the attendance at the SSF was gathered in 2012–2013 by VANDU. By relying on this data, a mathematical model was employed to estimate the number of HCV infections prevented by the former facility in Vancouver’s Downtown Eastside (DTES).ResultsThe DTES SSF’s benefit-cost ratio was conservatively estimated at 12.1:1 due to its low operating cost. The study used 70% and 90% initial pipe-sharing rates for sensitivity analysis. At 80% sharing rate, the marginal HCV cases prevented were determined to be 55 cases. Moreover, at 80% sharing rate, the marginal cost-effectiveness ratio ranges from $1,705 to $97,203. The results from both the baseline and sensitivity analysis demonstrated that the establishment of the SSF by VANDU on average had annually saved CAD$1.8 million dollars in taxpayer’s money.ConclusionsFunding SSFs in Vancouver is an efficient and effective use of financial resources in the public health domain; therefore, Vancouver Coastal Health should actively participate in their establishment in order to reduce HCV and other blood-borne infections such as HIV within the non-injecting drug users.

“People Knew They Could Come Here to Get Help”: An Ethnographic Study of Assisted Injection Practices at a Peer-Run ‘Unsanctioned’ Supervised Drug Consumption Room in a Canadian Setting

People who require help injecting are disproportionately vulnerable to drug-related harm, including HIV transmission. North America's only sanctioned SIF operates in Vancouver, Canada under an exemption to federal drug laws, which imposes operating regulations prohibiting assisted injections. In response, the Vancouver Area Network of Drug Users (VANDU) launched a peer-run unsanctioned SIF in which trained peer volunteers provide assisted injections to increase the coverage of supervised injection services and minimize drug-related harm. We undertook qualitative interviews (n = 23) and ethnographic observation (50 h) to explore how this facility shaped assisted injection practices. Findings indicated that VANDU reshaped the social, structural, and spatial contexts of assisted injection practices in a manner that minimized HIV and other health risks, while allowing people who require help injecting to escape drug scene violence. Findings underscore the need for changes to regulatory frameworks governing SIFs to ensure that they accommodate people who require help injecting.

Jurisdictional Justice, Democracy and the Story of Insite

Insite, North America’s first legally sanctioned safe injection site, opened its doors in 2003. It did so after several years of political struggle by a network of community groups in Vancouver’s Downtown Eastside (DTES), the neighbourhood it serves. The grassroots movement secured support at municipal, provincial, and federal levels of government. The latter expressed its approval by granting an exemption that protected Insite staff and patients from prosecution for possession of illegal substances under the federal Controlled Drugs and Substances Act (CDSA ). The remarkable political consensus in favour of Insite came apart in 2008 when the federal government, after the election of the Harper Conservatives, declined to extend the exemption. As a consequence, Vancouver Area Network of Drug Users (VANDU) and the Portland Hotel Community Services Society (PHS), the non-profit that operates Insite, along with two Insite clients, brought an action against the federal government in the B.C. Supreme Court. The provincial government intervened.2 The key arguments were that either the CDSA is inapplicable (and therefore the exemption is unnecessary) because primary jurisdiction over health resides with the province, or that the application of the provisions prohibiting possession in the federal statute violates the section 7 Charter rights3 of clients seeking treatment at Insite.

The Injection Support Team: A Peer-Driven Program to Address Unsafe Injecting in a Canadian Setting

In 2005, members of the Vancouver Area Network of Drug Users (VANDU) formed the Injection Support Team (IST). A community-based research project examined this drug-user-led intervention through observation of team activities, over 30 interviews with team members, and 9 interviews with people reached by the team. The IST is composed of recognized “hit doctors,” who perform outreach in the open drug scene to provide safer injecting education and instruction regarding safer assisted-injection. The IST represents a unique drug-user-led response to the gaps in local harm reduction efforts including programmatic barriers to attending the local supervised injection facility.

Kerr and Wood Respond

We thank Drach et al. for their interest in our study and for sharing evidence from their intervention study focused on secondary syringe exchange. Consistent with the findings of their study is a large and growing body of evidence pointing to the important role injection drug users can play in enhancing HIV prevention efforts among their peers. Fairly early on in the HIV epidemic, studies from Europe and the United States demonstrated that involving drug users in the delivery of HIV prevention efforts, including syringe exchange programs (SEPs), could help extend the reach, coverage, and effectiveness of these programs.1–3 These findings were likely, in part, a reflection of the fact that too many injection drug users remained marginalized and did not have access to conventional public health programs. The peer-to-peer model of using drug users as peer educators appears to address this barrier by providing a service that is more acceptable to drug users than professional-led programs.4 In our recent study,5 an important aspect of the change in syringe distribution policy that led to large declines in syringe borrowing and lending was the creation of peer-driven SEPs. Recently, we have evaluated both the mobile and fixed syringe distribution activities of a local drug user organization—the Vancouver Area Network of Drug Users (VANDU). An examination of the fixed exchange showed that the drug user–led program was attracting a population of injectors who possessed several markers of heightened vulnerability to HIV infection.6 Surprisingly, despite being frequent injectors, the population using the VANDU fixed exchange was also less likely to report unsafe syringe disposal. More recently, we evaluated the VANDU outreach-based syringe distribution program and found similar results.7 This program was reaching high-risk injectors while helping to reduce syringe reuse. Drach et al. are correct in pointing out that transforming US syringe exchange programs will require changes in political acceptance. Given the evidence concerning the important role that drug users can play in enhancing SEP delivery, a part of this political change must be growing acceptance that this population can and will work effectively to support prevention efforts if given the opportunity.

An external evaluation of a peer-run outreach-based syringe exchange in Vancouver, Canada

Objective Vancouver, Canada has been the site of an epidemic of human immunodeficiency virus (HIV) amongst injection drug users (IDU). In response, the Vancouver Area Network of Drug Users (VANDU) initiated a peer-run outreach-based syringe exchange programme (SEP) called the Alley Patrol. We conducted an external evaluation of this programme, using data obtained from the Vancouver Injection Drug Users Study (VIDUS). Methods Using generalised estimating equations (GEE) we examined the prevalence and correlates of use of the SEP amongst VIDUS participants followed from 1 December 2000 to 30 November 2003. Results Of 854 IDU, 233 (27.3%) participants reported use of the SEP during the study period. In multivariate GEE analyses, service use was positively associated with living in unstable housing (adjusted odds ratio [AOR] = 1.83, 95% confidence interval [CI]: 1.39–2.40), daily heroin injection (AOR = 1.31, 95% CI: 1.01–1.70), daily cocaine injection (AOR = 1.34, 95% CI: 1.03–1.73), injecting in public (AOR = 3.07, 95% CI: 2.32–4.06), and negatively associated with needle reuse (AOR = 0.65, 95% CI: 0.46–0.92). Conclusion The VANDU Alley Patrol SEP succeeded in reaching a group of IDU at heightened risk for adverse health outcomes. Importantly, access to this service was associated with lower levels of needle reuse. This form of peer-based SEP may extend the reach of HIV prevention programmes by contacting IDU traditionally underserved by conventional syringe exchange programmes.

Harm reduction by a “user-run” organization: A case study of the Vancouver Area Network of Drug Users (VANDU)

The Downtown Eastside of Vancouver has experienced ongoing epidemics of HIV infection and illicit drug overdoses since the mid 1990s. In 1997, in response to the emerging health crisis among injection drug users (IDU) and government inaction, individuals gathered in Vancouver to form a drug user-run organization. This group eventually became known as the Vancouver Area Network of Drug Users (VANDU). Because of the growing interest in drug user organizations, this case study was conducted to document the genesis, structure, and activities of VANDU. In accordance with VANDU's philosophy of “user involvement and empowerment,” we employed a community-based case study methodology to achieve these aims. The findings demonstrate that through years of activism, advocacy, and public education, VANDU has repeatedly voiced the concerns of drugs users in public and political arenas. VANDU has also performed a critical public health function by providing care and support programmes that are responsive to immediate needs of their peers. This study indicates that greater efforts should be made to promote the formation of drug user organizations, and that health authorities and policy makers should explore novel methods for incorporating the activities of drug user organizations within existing public health, education, and policy making frameworks.

Harm reduction by a ?user-run? organization: a case study of the Vancouver Area Network of Drug Users (VANDU)

Harm reduction by a ?user-run? organization: a case study of the Vancouver Area Network of Drug Users (VANDU)

An external evaluation of a peer-run "unsanctioned" syringe exchange program.

In Vancouver, British Columbia, Canada, difficulty accessing syringes at night has been shown to be strongly associated with human immunodeficiency virus (HIV) risk behavior among the city's injection drug users (IDUs). On September 1, 2001, the Vancouver Area Network of Drug Users (VANDU) initiated an unsanctioned all-night needle-exchange program on a street corner in the heart of the neighborhood where many of the city's IDUs are concentrated. An external evaluation of the population reached by the VANDU exchange was performed through the Vancouver Injection Drug User's Study, a prospective cohort study of IDUs begun in 1996. Persons accessing syringes through the exchange were compared to those active injectors who acquired their syringes from other sources, including the city's fixed site exchange, which closes at 8:00 PM. Overall, 587 active IDUs were seen during the period September 2001 to June 2002; of these individuals, 165 (28.1%) reported using the VANDU exchange. In multivariate analyses, participants who used the VANDU table were more likely to frequently inject cocaine (adjusted odds ratio [AOR]=1.56; 95% confidence interval [CI]=1.00-2.44), inject in public (AOR=2.71; 95% CI=1.62-4.53), and require help injecting (OR=2.13; 95% CI=1.33-3.42). Interestingly, use of the table was also independently associated with safer syringe disposal (AOR=2.69; 95% CI=1.38-5.21). Results indicate that the unsanctioned exchange appears to have reached those IDUs at highest risk of HIV infection. Although the cross-sectional nature of the study design warrants caution, we also found that use of the nighttime exchange was strongly associated with higher rates of safe syringe disposal. The data suggest that drug user organizations can play a major role in reducing harm among their peers by reaching the highest risk drug users with harm reduction services. The findings also suggest that other forms of syringe-exchange programs should consider the benefits of offering fixed site nighttime service.