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OPIOID HARM REDUCTION POLICYAND NURSING PRACTICE:
Safe Consumption Sites;
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Federal and Provincial level barriers
In the 1980s, Canada was one of the early pioneers of contemporary harm reduction approaches
in response to rising rates of HIV infection among people who inject drugs.
Federal support for harm reduction continued until the mid 2000s and included recognition of HR as a key pillar of federal drug policy, attempts to decriminalize cannabis possession and allowing 2 temporary legal exemptions that allowed the opening of Insite without risk of criminal prosecution as well as the first heroin-assisted treatment clinical trial.
Everything stopped in 2007 when the Conservative government replaced Canada’s Drug Strategy with a new National Anti-drug Strategy and officially eliminated harm reduction from federal policy.
In 2011 the Supreme Court of Canada ruling ordered the Minister of Health to renew Insite’s exemption but this was not without a burdensome process for obtaining an exemption for a supervised injection facility to operate without risk of prosecution
The Canadian government legislated new mandatory minimum sentences for certain drug offenses, rejected the need for syringe distribution programs in federal correctional facilities, and introduced many barriers to legal access to prescription heroin under Health Canada’s Special Access Programme
At present, the federal government and the provinces and territories have shared responsibility over
health.
Access to Canadian harm reduction services remains highly variable across provinces reflecting inconsistent provincial and territorial political support for the approach. The political frameworks have not been sufficiently strong enough to support consistent uptake and scale-up of harm reduction across the country.
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Conservative party leader Stephen Harper made his values clear: “We as a government will not use taxpayers’ money to fund drug use (2021)
Despite the many advantages of MOUD and naloxone, dispensing patterns indicate that patient and community needs are not being met. Why?
Physician Knowledge Gap
Knowledge Gap
This study found that physicians were lacking in knowledge or training in overdose education and naloxone distribution and that physicians felt unprepared to discuss medications for OUD treatment, including buprenorphine and methadone
Physcians were unaware of state laws regarding naloxone, such as standing orders and third-party prescribing substance use services that are available through the Affordable Care Act
Perception Gap
Ethical concerns and fear of of liability as well as the fear of possibly enabling patients to continue misusing opioids, thus inadvertently placing them at a higher risk
belief that addiction should be conceptualized through a disease model framework, and the epidemic itself is a direct result of the actions of the pharmaceutical industry as well as prescribers and
patients.
implicit biases toward patients that may give rise to discomfort when prescribing naloxone/buprenorphine. Perceptions of patients influenced physicians’ attitudes. These findings speak to the role of stigma in harm reduction
This study found varying levels of confidence in prescribing naloxone to patients. Those who felt confident in
identifying individuals at risk for overdose were more likely to initiate dispensing
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System Barriers
Institutional support. Appropriate staffing and a general climate of innovation and continuing education.
Insurance coverage, reimbursement, and general cost constraints impeded harm reduction administration.
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Nurse's Knowledge Gap
Inpatient supervised consumption services: A nursing perspective Access to harm reduction services in hospital reduces overdose, overdose related deaths, untreated pain, withdrawal associated with involuntary discharge, and concealed use in patient care areas (Dong et al., 2020). SCS have been shown to reduce infec-tious disease transmission, public disorder, and contribute to health promotion service referral (Kerr et al., 2017)
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