UBC Theses and Dissertations

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UBC Theses and Dissertations

Injection settings and drug-related harm in Vancouver, Canada Small, William


Ecological approaches to addressing injection-related risk seek to reduce drug-related harm by identifying and removing environmental barriers to risk-reduction. While the settings where drugs are injected represent a key location for these efforts, further knowledge regarding the role of injection settings is required to understand and address context-specific barriers to risk-reduction. This thesis sought to employ the risk environment framework and use ethnographic methods to examine two key types of injection settings, public injection venues and a local supervised injection facility (SIF), in the Downtown Eastside (DTES) of Vancouver, Canada. Ethnographic fieldwork, including naturalistic observation of activity within drug use settings and 50 in-depth interviews with local injection drug users (IDUs), generated information regarding local public injection settings and the SIF. Generating detailed descriptions of the settings investigated, and the use of analytical approaches drawing on the risk environment framework, permitted identification of the influence of various ecological forces upon risk production/reduction in relation to these settings. In Vancouver, public injecting often occurs in spaces characterized by unsanitary conditions and a lack of adequate amenities for hygienic injecting, where the threat of street violence or arrest impedes individual ability to employ safer injecting practices. While the SIF fosters risk-reduction by addressing many of these contextual features which pose barriers to safer injecting, the perspectives of IDUs emphasise that they inject at the facility because it addresses multiple salient risk priorities, including health concerns as well as “everyday risks” associated with injecting. A contextualised understanding of the operation of Insite highlights how the interactions between macro-level forces (e.g., regulatory mechanisms), operational features of the facility, and the local drug using context shape utilisation of the SIF by local IDUs. This work highlights the importance of developing contextualized understandings of injection settings in order to identify barriers to risk-reduction, and inform the development of safer injecting environments. While initiatives fostering injection safety within existing injection settings must be pursued, these should be complemented by efforts to remove barriers to accessing SIFs.

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