Safety and danger: Perceptions of the implementation of harm reduction programs in two communities in Nova Scotia, Canada.

People who use substances (PWUS), and specifically individuals who use injection drugs and/or smoke crack cocaine, experience risks which harm reduction programmes can help reduce. Prior to implementing harm reduction programmes, however, it is critical to understand how programme users and others in the community perceive the programmes as their perceptions may influence implementation. A mixed-methods study asked PWUS and key informants about their perceptions of implementing five harm reduction programmes in their communities, including perceptions of the advantages of the programmes, where best to locate them, and community support. Questionnaires were administered to 160 PWUS, and qualitative interviews were conducted with 11 purposefully sampled key informants. Data were collected in one medium-size and one small-size community/municipality in Nova Scotia, Canada, during 2017-2018. SPSS was used to generate descriptive statistics and means from the quantitative data, and the qualitative data were analysed for key themes using thematic analysis. Both PWUS and key informants perceived numerous advantages of the harm reduction programmes, but some key informants suggested that there might be potential opposition to the implementation of additional needle distribution and disposal programmes in some locations and potential opposition to safer consumption sites. Further research is needed to understand why these programmes were viewed as potentially generating opposition, but findings suggest that a key factor is the association of the programmes with 'danger' because the programmes are directly linked with criminalized drug use. In contrast, the three other programmes are linked to 'safety' because naloxone saves lives, peer navigation programmes support access to existing programmes and detoxification programmes are associated with safety through the reduction/elimination of drug use. Legalization/decriminalization of drugs might help to change the association of some programmes with 'danger' and therefore help support the implementation of harm reduction programmes that appear to be perceived by some as linked to danger.

Peer helpers' struggles to care for "others" who inject drugs.

BACKGROUND: Users who access needle exchanges are sometimes recruited to act as secondary distributors in an effort to reach a broader range of individuals who inject drugs. Although evaluations have demonstrated the efficiency of such approaches, more recent research has begun to uncover particular challenges associated with assuming these intermediary roles. METHODS: This article provides insights drawn from four focus-group sessions with 17 volunteers, termed natural helpers, who have between 1 and 14 years experience acting as secondary distributors for an Atlantic Canadian needle exchange. RESULTS: From the perspective of the natural helpers involved in this research, medical professionals consider those who inject drugs to be undeserving of the care accorded to more "responsible" patients. As a consequence of such disenfranchisement, natural helpers find themselves drawn into many forms of informal "doctoring" that extend far beyond their official roles as secondary distribution agents. In addition to providing syringes, training new users in safe injection procedures and promoting the use of sterile equipment, natural helpers try to dissuade people from starting to inject, act as first responders for overdoses, test drug potency, administer first aid, share prescription drugs such as antibiotics, offer temporary housing, counsel on emotional/psychological issues, and support those who are striving to reduce their drug consumption. CONCLUSION: The practices that have arisen in response to the distancing from professional health care experienced by those who inject drugs pose serious dilemmas and risks for not only users and natural helpers but also the general public.