It's powerful to gather : a community-driven study of drug users' and illicit drinkers' priorities for harm reduction and health promotion in British Columbia, Canada

It is essential that the autonomy and dignity of people who use illicit substances be respected by meaningfully involving them in research into their needs and priorities. This dissertation reports on two projects in which substance users were involved in planning and conducting qualitative research in British Columbia, Canada. In the first phase of the research, a province-wide series of 17 workshops, facilitated by drug users, was held to identify health and harm reduction priorities for this population. I found that drug users in British Columbia identified clear priorities to improve their well-being: improving interactions with health professionals, promoting access to a range of housing options, improving treatment by police, ensuring harm reduction best practices are followed everywhere, improving social assistance, supporting drug users' organizations, and engaging new and existing allies. These were based on the values of collectivity, activity, freedom from surveillance, and accountability. An unexpected finding of this research was identifying a need and opportunity for drug users to collaborate with illicit drinkers (defined as people who consume non-beverage alcohol (e.g. mouthwash) and people who consume beverage alcohol in highly criminalized ways (e.g. homeless drinkers)) based on their shared priorities, values, and polysubstance use. In response to this conclusion, the second phase of this research involved a series of 14 town hall meetings with illicit drinkers in Vancouver’s Downtown Eastside to research their perceptions of the harms they face from illicit drinking, the strategies they currently use to reduce these harms, and their ideas for additional harm reduction initiatives. These meetings were planned and facilitated with a steering committee of drug users and illicit drinkers. I found that the harms illicit drinkers experience and some of the strategies they suggest (particularly safe spaces and managed alcohol programs) can usefully be interpreted as examples of structural, everyday, and symbolic violence. This work has led to several positive outcomes for drug users and illicit drinkers, including deeper involvement of substance users in planning provincial harm reduction services and the formation of an activist group for illicit drinkers.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat