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Int J Drug Policy. 2019 Jan 30. pii: S0955-3959(18)30323-2. doi: 10.1016/j.drugpo.2018.12.014. [Epub ahead of print]

Principles, practice, and policy vacuums: Policy actor views on provincial/territorial harm reduction policy in Canada.

Author information

1
School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada; Inner City Health and Wellness Program, B818 Women's Centre, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, Alberta, T5H 3V9, Canada. Electronic address: ehyshka@ualberta.ca.
2
School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada.
3
School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada; Inner City Health and Wellness Program, B818 Women's Centre, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, Alberta, T5H 3V9, Canada.
4
Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, Room 273, Victoria, British Columbia, V8P 5C2, Canada.
5
College of Social and Applied Human Sciences, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
6
Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, Room 273, Victoria, British Columbia, V8P 5C2, Canada; School of Nursing, University of Victoria, HSD Building A402A, Victoria, British Columbia, V8W 2Y2, Canada.
7
Dalla Lana School of Public Health, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada.
8
Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, 4th Floor, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada.
9
Department of Sociology, University of Saskatchewan, 9 Campus Drive, 1109 Arts Building, Saskatoon, Saskatchewan, S7N 5A5, Canada.
10
Alberta Health, Government of Alberta, 10024 Jasper Avenue, Edmonton, Alberta, T5J 1S6, Canada.
11
British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, Canada.

Abstract

INTRODUCTION:

Canada is experiencing a new era of harm reduction policymaking and investment. While many provinces and territories are expanding access to these services, harm reduction policy and policymaking varies across the country. The present study, part of the Canadian Harm Reduction Policy Project (CHARPP), described policy actors' views on formal harm reduction policies in Canada's 13 provinces and territories.

METHODS:

As part of CHARPP's mixed-method, multiple case study, we conducted qualitative interviews with 75 policy actors, including government officials, health system leaders, senior staff at community organizations, and advocates with self-identified lived experience of using drugs. Interviews were conducted in English or French, and recorded and transcribed verbatim. We used latent content analysis to inductively code the data and generate main findings. NVivo 11 was used to organize the transcripts.

RESULTS:

Participants expressed divergent views on formal provincial/territorial policies and their impact on availability of harm reduction programs and services. While some identified a need to develop new policies or improve existing ones, others resisted bureaucratization of harm reduction or felt the absence of formal policy was instead, advantageous. Instances where harm reduction was advanced outside of formal policymaking were also described.

DISCUSSION:

Previous CHARPP research documented wide variability in quantity and quality of formal harm reduction policies across Canada, and characterized official policy documents as serving largely rhetorical rather than instrumental functions. The present findings highlight diverse ways that actors used their discretion to navigate these weak policy contexts. Participants' views and experiences sometimes referred to strengthening policy support, but institutionalization of harm reduction was also resisted or rejected. Results suggest that actors adopt a range of pragmatic strategies to advance harm reduction services in response to policy vacuums characteristic of morality policy domains, and challenge assumptions about the utility of formal policies for advancing harm reduction.

KEYWORDS:

Canada; Harm reduction; Key informant interviews; Opioid crisis; Policymaking; Qualitative research

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