Everywhere and for everyone: proportionate universalism as a framework for equitable access to community drug checking

Harm Reduction Journal

Research

Thea van Roode¹  Piotr Burek¹  Bernadette Pauly²  Bruce Wallace³  Dennis Hore⁴ 

[1] Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, V8W 2Y2, Victoria, BC, Canada;Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, V8W 2Y2, Victoria, BC, Canada;School of Nursing, University of Victoria, P.O. Box 1700, STN CSC, V8W 2Y2, Victoria, BC, Canada;Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, V8W 2Y2, Victoria, BC, Canada;School of Social Work, University of Victoria, P.O. Box 1700, STN CSC, V8W 2Y2, Victoria, BC, Canada;Department of Chemistry, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC, Canada;Department of Computer Science, University of Victoria, P.O. Box 1700, STN CSC, V8W 2Y2, Victoria, BC, Canada;

关键词: Drug checking;    Harm reduction;    Substance use;    Fentanyl;    Overdose;    Health equity;    Proportionate universalism;    Health quality dimensions;   

DOI  :  10.1186/s12954-022-00727-0

 received in 2022-06-16, accepted in 2022-12-08,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundIllicit drug overdoses have reached unprecedented levels, exacerbated by the COVID-19 pandemic. Responses are needed that address the increasingly potent and unpredictable drug supply with better reach to a wide population at risk for overdose. Drug checking is a potential response offered mainly within existing harm reduction services, but strategies are needed to increase reach and improve equitable delivery of drug checking services.MethodsThe purpose of this qualitative study was to explore how to extend the reach of drug checking services to a wide population at risk of overdose. We conducted 26 in-depth interviews with potential service users to identify barriers to service use and strategies to increase equitable delivery of drug checking services. Our analysis was informed by theoretical perspectives on equity, and themes were developed relevant to equitable delivery through attention to quality dimensions of service use: accessibility, appropriateness, effectiveness, safety, and respect.ResultsBarriers to equitable service delivery included criminalization and stigma, geographic and access issues, and lack of cultural appropriateness that deter service use for a broad population with diverse needs. Strategies to enhance equitable access include 1ocating services widely throughout communities, integrating drug checking within existing health care services, reframing away from risk messaging, engaging peers from a broad range of backgrounds, and using discrete methods of delivery to help create safer spaces and better reach diverse populations at risk for overdose.ConclusionsWe propose proportionate universalism in drug checking as a guiding framework for the implementation of community drug checking as an equity-oriented harm reduction intervention and as a population health response. Both a universal equity-oriented approach and multiple tailored approaches are required to facilitate drug checking services that maximize reach and appropriateness to respond to diverse needs.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 7