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309 n16309 NOV 16.docx

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Robb Travers

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SOC309 NOV 16, 2012 HARM REDUCTION DISERTTATION HOW COMM MANAGE CONTRO IN NEEDLE EXHNAGE FOR AIDS IN ONTARIO OUTCOMES OF STUDIES DONE BY POLICY MAKERS OR IGNORED BC CONTROVERSIAL Handful of experts eva harm reduction and cuts out political rhetoric I don’t want tax dollars pay inefficiently Associate prof dalla lana school public health and engaging lecture Outline - Wasy to stereotype people who use drugs - These are two stories could reflect people who use drugs Typical- - Illegal drug use is personal failing or lack of strength get it together pull up socks - Ignores context or origin in which drug use occurs - And they are criminals and undeserving of social services and poorly treated - People are stigmitizrd and marginalized and told get clkean or sober or go to jail Nect - Think about Casandra - Injection nno injection 2 years most get hiv or hep c - 50 percent get hep c injection drug use Andy nd - System fired from family doctor and 2 sent to methadone clinnc - Couch surfing no place to live sleeps couches - 30 thou methadone 1900 to 30 thou easy gget methadone - Not get in buy oxy on street - Oxy d listed - Heroin come back to replace oxy in rural areas - Loses house - Opiates deleiverd by injection mre efficient then swallowing - Arrested Substance abuse - Embedded within process - Sometimes case bad kid not always bad case - Bio more develeop dependence - Embedded in pyshcosocial process - Hisotricla norms and values - Andy in diffent place wouldn’t get fired - Someone from pain to addiction by doctor to drug dealer - Most people consume psy act once in life - Increasing student drug survry - Alc cann and persp drugs and ill Ritalin goes over 70 percent once in highschooll Social responses Imp - Prevention not prevent most try drugs - Not help minority who develop problems - Treatment not available to all who want it - U need several instances of treatment need many tries - Used to smoke tobacco - Stop and start Is normal - Evidence of mandated treatment not true for all people - May look for adolescents but not work for everyone and is expensive - Enforcement not elim drug problems - Mexico change nature of society despite resources putting put in enforcement and the like - Some people not stop using despite consequences - Some people may like using - In Ontario treatment is free, not available - Addiction system paid partly health system and not – some see social service - More people then spots - Methadone not on drug benfit program have to pay for self or insurance - Question what do out treatment pop - Tret prev enf not work Harm red - 4 pillar - Treat prev enfo harm red elimate harm reduction - Definition top of page - Not reducing consumption - Distinguish from purely ansitnance approach - Understsanfing clients use drugs - Harm reduction as a safety net Principles - Evidence based - Incremental approach not all or nothing - Someone less drugs less often - Smaller steps over time - Dignity for people who use drugs - Univderalty and interdependce of rights, drugs not forfeit med ben - Advocates transparency Types of harm - Hiv and hep c - Injection related harm - Injection to hiv is contaminated needles and drug prep method - Re use of needles lead to hiv and hep c - Non inject – stem for smoke crack - People share pipes risk hep c link to hiv is less clear Other drig realted hardms - None to mild to severe - Drugs lead to other problems - Ass psychosis and smokng large qaunttites of pot - Cassandra 20 years of age and infected hiv not finish school no job and boosting stealing stuff and sex work - Hits 40 or 50 she will recover probably - No job skills or ed - Coming out of treatment what have to do to do good prod life why would bother work tim hortons Harms for families - Mexico breakdown of society widespread prod and trafficking Canada - Not national harm reduction stragety - 93 countries - 14 – opotate suppsitition is oct Hiv stbbi - Challenge prevent transmission of hiv and other blood borned infection bc multiple risk nto just drug but sexual as well - Risk changes over time - Risk transmission changes over time - Mult risk and risk changes how effective program be - Research assumes people are rational actors and if give people information will change - Research assumes don’t change worthy of blame more complex process leads to onset and continuutation of drug use, say stop not casuse stop Mutli fact - Harm red change env and behaviours - Need to focus on indi behavior - Indi component need to be understood in context Examples - Needle exchange - Suprivised injection - Prescription heroin programs really rare - Safe crack smoking Needel and syringe - Wet shelters managed alc programs - Research needle progemas long time Inject drug prep - Risk injection durg use - Need a cooker - Add water and filter looks like cotton ball - Drug eroin need heat - Used needle before and now mixing drug - Buy drug in groups first person goes into cooker tip on filter - Both needles used before and cooker most likely used but in this case clean this scenario - Clean site, push needle in blood goes in bc find vein and push down - If have hep c first - If material exposed contaninmats lead to trans of hiv and hep and damage veins Frequency - 35 percent injected daily and numenr fo days 16 and range of 1 to 31 days - Everyday depend how many per day depend on drug - Opiate 2 3 times a day coke or crack 10 20 times - Number use potential risk or trans Nsp - Needles syringe programs - In 1980s and 1970s in England reduce hep b virus bc injectors get hep b - And people on drugs start it - Never needle in Canada if not for hiv - Pilot programs in 80s and eval in who in Toronto funded by fed pro and local - Needel and syringe programs ess to hiv policy - 1000 hits in research and small number neg finds still criticed Nsp in ont goals - Bigger programs food clot shouing Mandated - Demonstrated problem must have needle exchange Outcome - Attend high risk inectors high risk behavior hard to change - Ass with reduced trans of hiv hb b not c - Trying to catch early is for hep c - Evidence reduced discarded needles in commnuites - Comm. Finding needles - Some programs not attend to it - Programs only point of contact and one programs cost less of tresating someone for hiv over lifetime and not encourage people to start using Impl - Every province and terr and every continent not available in prisons - Jails high risk - Needles in prson ball point pens shave down - Needle fraction sharpend with match pack - Someone suing fed gov not prviding needle exchange Suprived - Study carrels with mirrors behinf - Nurse stand behind buckets and 12 spots - 3 to 12 spots - Europe look less clinical Sur - Indoor acquired outside - All equipmen privded and education if want and overdose care - Intro proper tech - Use drugs by injection cant or wont so have - Facilities van not allow help even boyfirieds - Some places allow - Max number of 12 - Chill out room - Short term rested beds - Vanc 2 excempt from criminal code not arrested for possession of drugs - Before facility open agreement with police invisible barrier police wont do survelance indi police officers violate - Crusier sitting outside people not use it - Emergency medi care - Physician may come in and have primary care clinic -
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