International Journal of Drug Policy - 2014

Volume 25 Issue 3 May 2014

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International Journal of Drug Policy 25 (2014) 640–649 Contents lists available at ScienceDirect International Journal of Drug Policy j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o Research paper Living with addiction: The perspectives of drug using and non-using individuals about sharing space in a hospital setting C. Strike a,∗ , A. Guta a , K. de Prinse b , S. Switzer a,b , S. Chan Carusone b a University of Toronto, Dalla Lana School of Public Health, Toronto, Canada b Casey House Hospital, Toronto, Canada a r t i c l e i n f o Article history: Received 18 April 2013 Received in revised form 13 February 2014 Accepted 18 February 2014 Keywords: Harm reduction Hospital Space Subjectivity a b s t r a c t Hospitals seem to be places where harm reduction approaches could have great benefit but few have responded to the needs of people who use drugs. Drawing on recent theoretical contributions to harm reduction from health geography, we examine how the implementation of harm reduction is shaped by space and contested understandings of place and health. We examine how drug use and harm reduction approaches pose challenges and offer opportunities in hospital-based care using interview data from people living with HIV and who were or had recently been admitted to a hospital with an innovative harm reduction policy. Our data reveal the contested spatial arrangements (and the related practices and corporeal relations) that occur due to the discordance between harm reduction and hospital regulatory policy. Rather than de-stigmatising drug use at Casey House Hospital, the adoption of the harm reduction policy sparked inter-client conflict, reproduced dominant discourses about health and drug users, and highlights the challenges of sharing space when drug use is involved. The hospital setting produces particular ways of being for people who use and those who do not use drugs and the demarcation of space in a drug using context. Moving forward, harm reduction practice and research needs to consider more than just interactions between drug users and healthcare providers, or the role of administrative policies; it needs to position ethics at the forefront of understanding the collisions between people, drug use, place, and space. We raise questions about the relationship between subjectivity and spatial arrangements in mediating the success of harm reduction. © 2014 Elsevier B.V. All rights reserved. Introduction Increasingly, harm reduction is included as a constituent ele- ment of international, national and local drug policies (Stoicescu, 2012) with implementation of interventions in community sett- ings across the world (Marlatt & Witkiewitz, 2010). However, harm reduction has yet to reach most hospital settings. This is concern- ing because people who consume drugs in problematic ways are admitted to hospital and emergency departments more frequently than the general population (French, McGeary, Chitwood, & McCoy, 2000; Haber, Demirkol, Lange, & Murnion, 2009; Kerr et al., 2005; Palepu et al., 2001). Within hospitals, people who use substances encounter significant barriers to accessing care (McCreaddie et al., 2010; Monks, Topping, & Newell, 2012). They are often labelled as being 'challenging, manipulative, drug-seeking and demanding' by healthcare workers (Ford, 2011; N. S. Miller, Sheppard, Colenda, & ∗ Corresponding author at: 155 College Street, Toronto, ON M5T 3M7, Canada. Tel.: +1 416 978 6292; fax: +1 416 978 2087. E-mail address: (C. Strike). Magen, 2001), encounter stigma and receive substandard care, and frequently leave hospitals against medical advice (Chan et al., 2004; Pecoraro et al., 2013; Ray et al., 2013; Saitz, 2002). For people living with HIV/AIDS (PLHIV), having access to care is essential for their health and survival (Cunningham, Crystal, Bozzette, & Hays, 2005; Cunningham et al., 1998). Those able to access care are living longer and have improved health thanks to antiretroviral medications. However, with this increased lifespan, PLHIVs are experiencing chronic episodes of acute HIV-related and other types of illness that can require hospitalisation and/or supportive care arrangements. These medical needs can be compli- cated by substance use. Research suggests as many as 70% of people living with HIV/AIDS (PLHIVs) used illicit drugs or reported haz- ardous alcohol use in the previous year (Korthuis et al., 2008; Sohler et al., 2007). Illicit drug use is associated with negative outcomes for PLHIVs, including: lower adherence to antiretroviral therapy, poor immune suppression, disease progression, and mortality (Balsa, French, Maclean, & Norton, 2009; Brubacher et al., 2008; French et al., 2000; Haber et al., 2009; Kerr et al., 2005; Neblett et al., 2011; Palepu et al., 2001). A Vancouver-based study found that, when accessing hospital-based care, PLHIVs who injected drugs had high 0955-3959/© 2014 Elsevier B.V. All rights reserved.

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