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Many young people who use drugs are structurally vulnerable to policing powers given the ongoing criminalization of drug possession. Police authority limits and the expression of that authority may play a significant role in police encounters among young people who use drugs. This qualitative study explores the views of young people who use drugs toward police power and authority in their recent encounters with police officers. Interviews were conducted with 38 young people who recently used illegal drugs in British Columbia, Canada. We found five interrelated themes related to perceptions of police authority: (1) skepticism and distrust toward authority; (2) paternalism and authority over drug use; (3) officer use of force; (4) police as power-hungry; and (5) officers above the law. Participants described police authority as limitless, unpredictable, untethered, easily abused, and lacking accountability. Participants feared holding police officers accountable to power abuses in a criminal justice system that they saw as stacked against them. Moving forward, institutional reforms may consider and account for the expression, limits, and use of police authority among young people who use drugs and other structurally vulnerable communities.

Youth who use drugs (YWUD) are likely to encounter the police and experience victimization within those encounters. Negative experiences of police among youth can dramatically undermine youths’ trust in police, making them unlikely to ask for help when they need it. In this article, we use Rance and Fraser’s concept of “accidental intimacies” between staff and people who inject drugs arising in encounters within supervised consumption sites. Their exploration of Sarah Ahmed’s work on the social productivity of emotions argues that new subjectivities that counter or transform stigma and shame surrounding drug use can occur from the space between individuals. For Ahmed “emotions do things, and work to align individuals with collectives—[linking] bodily space with social space—through the very intensity of their attachments.” During 2017–2018, 38 youth (aged 16–30 years) who use drugs in three cities in British Columbia, Canada, were interviewed to explore their encounters (both positive and negative) with police and how these influenced their perceptions of police. In this article, we assert that the dynamic of “we” and “them,” of the YWUD and police, is constituted in part through the powerful emotions created and confirmed by negative bodily encounters where the bodies of youth and police collide through physical and/or verbal contact. The repetition of emotions and objectification through stigma within their communities force some youth to repeatedly confront harmful subjectivities. Rance and Fraser’s work provides possibilities for shifting these stigmatizing subjectivities. For change to occur, addressing the historical and present realities that impact YWUD will help facilitate and enhance more respectful communication and interactions between YWUD and police. Bodily encounters may also present opportunities for both YWUD and police to reflect on the subjectivities that reinforce and are shaped by their negative interactions with one another. Incremental change may be possible as we find new meanings in youths’ understanding of and compassion for police and their work.

Background:In Canada, nursing programs have not kept pace with the growing rates and changing patterns of substance use.Method:To get a sense of the current state of substance use education in nursing programs, we conducted a survey of nursing students.Results:Our findings indicate that (a) substance use education is minimal, 1 to 5 hours (43%) or none (20%); (b) students had more working knowledge of legal and prescribed substances than illegal ones; (c) of 22 content areas deemed essential for practice, only seven were covered; (d) students were able to identify statements consistent with a harm reduction philosophy despite limited substance use education; and (e) the majority of students wrongfully believed that illegal substances are more harmful than legal substances.Conclusion:Our findings demonstrate that substance use education in nursing programs is largely insufficient and not keeping up with current issues. Our findings demonstrate that substance use education in nursing programs is largely insufficient and not keeping up with current issues. [[J Nurs Educ. 2020;59(9):510–513.]

Setting: There is a multitude of health equity tools but little guidance on how to effectively use these tools in public health nursing practice. In BC, public health nurses who are certified in sexually transmitted infection care utilize guidelines authorized by the nursing regulatory body. Intervention: As part of the Equity Lens in Public Health (ELPH) research project, an assessment of the nursing guideline, Sexually Transmitted Infection (STI) Assessment Decision Support Tool, was undertaken using the Assessing Equity in Clinical Practice Guidelineshealth equity assessment tool. The chosen tool is intended for use by health care providers, is broadly applicable to clinical practice guidelines, can be used retrospectively, and falls within the category of equity checklists and audits. Outcomes: Overall, the tool wasuseful in assessing the inclusion and omission of an equity focus in the guideline. However, there were several challenges: the identification of an appropriate health equity tool; the absence of an evaluation of the chosen tool; the tool’s focus on chronic disease versus communicable disease; and the difficulty of obtaining client perspectives. Implications: For an improved equity lens in the STI Assessment Decision Support Tool, future revisions should be equity focused and include perspectives from affected populations, an emphasis on the determinants of health that perpetuate inequities for populations who experience a disproportionate burden of STI, information on provincially available resources, and service delivery models that improve timely and equitable access to treatment and care.

ObjectiveTo determine the effect of opioid and stimulant Risk Mitigation Guidance (RMG) dispensations on mortality and acute care visits during the dual public health emergencies of overdose and covid-19.DesignPopulation based retrospective cohort study.SettingBritish Columbia, Canada.Participants5882 people with opioid or stimulant use disorder who received RMG prescriptions for opioids (n=5356) and/or stimulants (n=1061) (535 received both) from 27 March 2020 to 31 August 2021.Main outcome measuresAll cause and overdose specific mortality and acute care visits in the week after RMG opioid or stimulant dispensation. RMG recipients were matched 1:1 with controls through use of high dimensional propensity score matching. Marginal structural models, executed on weekly time steps, were used to measure the effect of dispensations on outcomes.ResultsRMG opioid dispensations of one day or more were associated with reduced all cause mortality (adjusted hazard ratio 0.39, 95% confidence interval 0.25 to 0.60) and overdose related mortality (0.45, 0.27 to 0.75) in the subsequent week. Dispensations of RMG stimulants (≥1 days) were not significantly associated with reduced all cause mortality (adjusted hazard ratio 0.50, 0.20 to 1.23) or overdose related mortality (0.53, 0.18 to 1.56). The protective effect of RMG opioid dispensations increased with the number of days the medications were dispensed in a given week. People who received four or more days of RMG opioid dispensations had reduced all cause mortality (adjusted hazard ratio 0.09, 0.04 to 0.21) and overdose related mortality (0.11, 0.04 to 0.32) compared with the control group. Opioid RMG dispensations did not significantly modify the odds of all cause or overdose related acute care visits. Dispensations of RMG stimulants were associated with a significant decrease in the odds of acute care visits for any cause but did not affect the odds of overdose related acute care visits.ConclusionsRMG opioid dispensations were associated with reduced overdose related and all cause mortality among a sample of people with opioid use disorder. Pharmaceutical alternatives to the illegal drug supply are promising interventions to reduce mortality in people with opioid use disorder.

Globally, engaging people who have used drugs, or peers, in decision-making has been increasingly touted as a best practice approach to developing priorities, programs, and policies. Peer engagement ensures decisions are relevant, appropriate, and effective to the affected community. However, ensuring that inclusion is accessible and equitable for those involved remains a challenge. In this study, we examined the perspectives of people who use or have used illicit drugs (PWUD) on peer engagement in health and harm reduction settings across British Columbia (BC), Canada. The Peer Engagement and Evaluation Project used a participatory approach to conducting 13 peer-facilitated focus groups (n= 83) across BC. Focus group data were coded and analyzed with five peer research assistants. Themes about the nature of peer engagement were generated. From this analysis, peer engagement barriers and enablers were identified. Barriers to peer engagement included individual, geographical, systemic, and social factors. Issues related to stigma, confidentiality, and mistrust were intensely discussed among participants. Being “outed” in one’s community was a barrier to engagement, particularly in rural areas. Participants voiced that compensation, setting, and the right peoplehelp facilitate and motivate engagement. Peer networks are an essential ingredient to engagement by promoting support and advocacy. PWUD are important stakeholders in decisions that affect them. This cross-jurisdictional study investigated how PWUD have experienced engagement efforts in BC, identifying several factors that influence participation. Meaningful engagement can be facilitated by attention to communication, relationships, personal capacity, and compassion between peers and other professionals. À l’échelle mondiale, le dialogue avec les personnes ayant consommé de la drogue (les « pairs ») à la prise de décisions est de plus en plus considéré comme une pratique exemplaire pour l’élaboration de priorités, de programmes et de politiques. Le dialogue avec les pairs mène à des décisions pertinentes, appropriées et efficaces dans la communauté touchée. Il demeure toutefois difficile d’assurer l’accessibilité et l’équité de l’intégration des personnes en cause. Dans cette étude, nous avons examiné les points de vue de personnes consommant ou ayant consommé de la drogue (PCACD) au sujet du dialogue avec les pairs dans les milieux de la santé et de la réduction des méfaits en Colombie-Britannique, au Canada. Ce projet de participation des pairs et d’évaluation a fait appel à une démarche participative pour mener 13 groupes de discussion animés par des pairs (n= 83) en Colombie-Britannique. Les données des groupes de discussion ont été codées et analysées avec cinq pairs adjoints à la recherche. Des thèmes sur la nature du dialogue avec les pairs sont ressortis. L’analyse a permis de cerner les éléments qui entravent ou qui favorisent le dialogue avec les pairs. Les éléments qui entravent le dialogue avec les pairs étaient des facteurs individuels, géographiques, systémiques et sociaux. La stigmatisation, la confidentialité et la méfiance ont été des questions chaudement discutées entre les participants. Le fait d’être révélé dans son propre milieu comme étant consommatrice ou consommateur de drogue constituait un obstacle au dialogue, surtout en zone rurale. Les participants ont exprimé l’avis que la rémunération, le lieu et les « bonnes personnes » facilitent le dialogue et motivent les gens à s’impliquer. Les réseaux de pairs sont un ingrédient essentiel du dialogue, car ils favorisent l’entraide et la défense des intérêts. Les PCACD sont d’importants acteurs dans les décisions qui les concernent. Cette étude à l’échelle intergouvernementale a porté sur la perception par des PCACD vivant en Colombie-Britannique des démarches visant à les faire participer; plusieurs facteurs influant sur le dialogue ont été recensés. Un dialogue sérieux peut être favorisé par une attention à la communication, aux relations, aux capacités individuelles et à la compassion entre les pairs et les autres professionnels.