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Mayer, Samara

University of British Columbia

Background: As part of the response to Canada’s worsening overdose crisis driven by a toxic adulterated drug supply, there has been increased attention to and expansion of drug treatment options, including injectable opioid agonist treatment (iOAT). Many people who access iOAT experience significant social inequities (insecure housing, poverty) and are impacted by multiple and intersecting forms of discrimination (racism, sexism). As this treatment has only recently expanded, there is a gap in research on how iOAT can help alleviate and account for these social inequities in the context of the ongoing adulteration of the illicit drug supply. This dissertation addresses this gap by examining how social and structural factors impact people’s engagement with iOAT to optimize program delivery. Methods: This dissertation draws on critical ethnographic and community-based approaches conducted with people accessing four iOAT programs in Vancouver’s Downtown Eastside neighbourhood from May 2018 to November 2019. Data included in-depth baseline and follow-up interviews and approximately 50 hours of observation fieldwork conducted in one iOAT program and with a subsample of participants in the surrounding neighbourhood. Analysis leveraged a structural vulnerability lens and complementing critical social science theories to characterize the social-structural dynamics that shape people’s engagement with iOAT. Results: This dissertation characterizes why people engage with iOAT and how they navigate its enabling and constraining aspects. Participants accessed iOAT for resources to address social inequities and physical harms (withdrawal, chronic pain, overdose) experienced in the context of the ongoing toxic drug supply. While iOAT provides access to life-saving medication and health and social supports, program operations (e.g., surveillance) can create barriers to engagement. Findings highlight how intersecting structural vulnerabilities, including gendered power dynamics, housing insecurity, poverty, inadequate chronic pain management, and drug use-related stigma, mediate how people engage with iOAT. Conclusion: Drawing attention to structural vulnerability, study findings highlight the diverse and pragmatic ways people engage with iOAT to achieve personal goals and manage their opioid use in a broader socio-political context and worsening overdose crisis. Findings point to the importance and modification of integrating low-threshold, equity-oriented, and patient-centred approaches to iOAT care to meet people’s diverse needs.

Text

2024-10-31

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/86089

Interdisciplinary Studies

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/