학술논문
The perspectives of people who use drugs regarding short term involuntary substance use care for severe substance use disorders.
Document Type
Academic Journal
Author
Chau LW; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.; Erickson M; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.; Vigo D; Department of Psychiatry, Faculty of Medicine, University of British Columbia, David Strangway Building, 4th Floor 209, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.; Lou H; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.; Pakhomova T; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.; Winston ML; Morris J. Wosk Centre for Dialogue, Simon Fraser University, 3309-515 West Hastings Street, Vancouver, BC, V6B 5K3, Vancouver, Canada.; MacPherson D; Canadian Drug Policy Coalition, 101-515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.; Thomson E; BC and Yukon Association of Drug War Survivors, 416 Columbia St, New Westminster, BC, V3L 1B1, Canada; Harm Reduction Program, Fraser Health Authority, BC, Canada.; Small W; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada; British Columbia Centre on Substance Use. Electronic address: wsmall@sfu.ca.
Source
Publisher: Elsevier Country of Publication: Netherlands NLM ID: 9014759 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4758 (Electronic) Linking ISSN: 09553959 NLM ISO Abbreviation: Int J Drug Policy Subsets: MEDLINE
Subject
Language
English
Abstract
Background: In the Canadian Province of British Columbia (BC), the BC Mental Health Act permits involuntary care for treating mental disorders. However, the Act has also been applied to provide involuntary care to individuals with a primary substance use disorder, in the absence of specific guidelines and legislation, and with insufficient understanding of perspectives of people who use drugs (PWUD) regarding this approach.
Methods: As part of a larger mixed-methods research project providing an overview of involuntary care for severe substance use disorders in BC, three focus groups were convened with: PWUD, families and caregivers, and Indigenous community stakeholders. This analysis examines perspectives from the focus group of PWUD, consisting of nine participants from local and regional drug user and advocacy organizations regarding involuntary care. A qualitative descriptive approach and thematic analysis were conducted, using a coding framework developed deductively and inductively, and participant perspectives were interpreted drawing on problematization theory.
Results: Participants did not endorse the use of involuntary care, instead emphasizing significant changes were needed to address shortcomings of the wider voluntary care system. When asked to conceptualize what an acceptable involuntary care scenario might look like (under hypothetical and ideal conditions), participants recommended it should include: individual control and autonomy, peer advocacy in decision-making, and elimination of police and criminal justice system involvement from treatment encounters. Participants saw involuntary care to be an inappropriate approach given the shortcomings of the current system, noting also problems inherent in its use to manage severe SUDs and imminent harm, and prioritized alternate approaches to offsetting risks.
Conclusion: Improving voluntary care for substance use, along with addressing the social determinants of health that put individuals at risk of problematic substance use and harm, were prioritized in participant perspectives. Participant comments regarding the use of involuntary care bring forward alternate solutions in the context of the opioid overdose crisis, and a reconceptualization of the 'problem' of managing severe substance use disorders.
Competing Interests: Declarations of Interest None.
(Copyright © 2021. Published by Elsevier B.V.)
Methods: As part of a larger mixed-methods research project providing an overview of involuntary care for severe substance use disorders in BC, three focus groups were convened with: PWUD, families and caregivers, and Indigenous community stakeholders. This analysis examines perspectives from the focus group of PWUD, consisting of nine participants from local and regional drug user and advocacy organizations regarding involuntary care. A qualitative descriptive approach and thematic analysis were conducted, using a coding framework developed deductively and inductively, and participant perspectives were interpreted drawing on problematization theory.
Results: Participants did not endorse the use of involuntary care, instead emphasizing significant changes were needed to address shortcomings of the wider voluntary care system. When asked to conceptualize what an acceptable involuntary care scenario might look like (under hypothetical and ideal conditions), participants recommended it should include: individual control and autonomy, peer advocacy in decision-making, and elimination of police and criminal justice system involvement from treatment encounters. Participants saw involuntary care to be an inappropriate approach given the shortcomings of the current system, noting also problems inherent in its use to manage severe SUDs and imminent harm, and prioritized alternate approaches to offsetting risks.
Conclusion: Improving voluntary care for substance use, along with addressing the social determinants of health that put individuals at risk of problematic substance use and harm, were prioritized in participant perspectives. Participant comments regarding the use of involuntary care bring forward alternate solutions in the context of the opioid overdose crisis, and a reconceptualization of the 'problem' of managing severe substance use disorders.
Competing Interests: Declarations of Interest None.
(Copyright © 2021. Published by Elsevier B.V.)