Side event: Facilitating Access To Evidence-Based Demand Reduction Services For Marginalized Populations

Organized by Canada with the support of Finland, Malta, Mexico, the Netherlands, Norway, Paraguay, Portugal, Switzerland, the United Kingdom, the United States, Uruguay and the European Union

Welcoming and Opening Remarks

Carol Anne Chénard – Director, Office of Controlled Substances, Health Canada: Canada is very happy to sponsor today’s side events on facilitating access to evidence based Demand Reduction Services for marginalized populations. We’d like to thank you for taking the time to be with us today. The Government of Canada has sponsored this important side event to continue the discussion following resolution 64 Dash five on facilitating access to comprehensive scientific evidence based drug Demand Reduction Services and related measures including for people impacted by social marginalization. This resolution was adopted last year at CMD and co sponsored by 14 Member States, several of which are co sponsors for today’s event. Canada believes everyone should have voluntary access to demand reduction services, regardless of race, gender, ethnicity, culture or sexual orientation. A key step in facilitating access to demand reduction services and to help inform decision policy initiatives is to hear from a variety of perspectives within this field. This includes people who are socially marginalized, those that work with marginalized populations, individuals that have focused their research in this area and policy approaches by government. We are fortunate to gather the spectrum of expertise on our panel today. I’d like to thank our panel for their participation in today’s session, and I’m looking forward to learn more about each of their unique perspectives and experiences. I would also like to thank the Government of Israel, Malta, Uruguay and Switzerland in their efforts to identify panelists from their respective countries.

 

 Jeffrey Copenace – Chief of the Ojibways of Onigaming First Nation: speaking to you from Ojibways of Onigaming, and Winnipeg, Canada today, actually at a national day wellness conference taking place on recovery and addiction program for First Nations people. We’re currently in a state of emergency for suicides and for mental illness. We’ve been under the state of emergency since 2014. Almost all of the issues related to the state of emergency are drug and alcohol related. And today I’ll be speaking about the need to invest directly in indigenous communities given the disproportionate disproportionate number of overdose overdoses in our community, as well as, again the dramatic needs of our people in addiction. But today I’m just honored to be again the indigenous representative for Canada today. Honored to be the elected chief. And one last point is I’ve lived this experience. This Sunday. I’ll be five years sober since my last drink of alcohol. I’ve battled alcoholism most of my life and have managed to again become sober and become the elected chief and focused on again the state of emergency that we’re in. I’ll be the moderator today, and I’ll hand over to Hagit Bonny-Noah, she’ll be discussing the ethnographic study conducted in the largest open drug scene in Israel and presenting some main conclusions from that.

Panel

Hagit Bonny- Noach (Israel)  Senior Lecturer, Department of Criminology Ariel University & Board Member of the Israeli Society of Addiction Medicine (ILSAM): I would like to present our ethnographic study in the Israeli largest open drug scene and our main conclusions to suggest to Israel to establish the first safe consumption site. So etnographic research is a particularly well suited method for understanding open drug scences. But when we talk about the term open drug scene, it describes a setting where drugs are used and trained in public. So limited research attention has been given to the largest open drug scene in Israel, that located in the streets around the old central bus station in the city of Tel Aviv, in south of Tel Aviv. The police described this area as a crime hub hotspot, because the place is widely known  to be the marketplace for illegal substances and high level of violence. place where people who inject drugs gather homelessness drug dealers, sex workers, thieves, undocumented migrants or refugee from Africa. We were exposed to chaotic filled with sensitive topics that include everyday violence, illegal activities, and a lot of victimization. The population that we meet in this area is what we call hard to reach populations. Sometimes they call it hidden population. Because that population are not accessible, unknown. Sometimes they do not have fixed address. They are not under the spotlight of research. The live and make the living from the streets they drop out run away from home and police with mental disorders addiction also behavioral addiction disorder and substance addiction. Some have infection disease engage in deviance and crime. This population they are very great challenge in collecting data from them. n our finding we saw that there is associate jury in this place, problem relation, gender violence and victimization. And we can see here the man the Man’s Corner, nullity, violence and dominate the man is dominant. After that we saw this transgender that most of them were a sex worker and marginalized men and in the bottom it was the marginalized woman. So the marginalized people hit rock bottom of the society they are in poor physical and mental conditions. And we saw their homelessness and people who use drugs and treat says sex workers. All of them were from the very lowest level of the society in a very poor physical and mental condition. So the marginal people describe the place is held as lowest place in Israel, a trash can of violence, everything. So as a researcher we wonder so why do we come to place that they describe it so so like held so we understand that the place offers something that they cannot get from a society at large

Marilyn Clark (Malta) – Associate Professor, Faculty for Social Wellbeing, University of Malta & Psychologist: Marginalized populations include those groups that experience discriminate discrimination, and exclusion, because of unequal power relations and women and non binary persons whose drugs clearly fall in this category, I think are also exposed. So gender intersects also with another a number of structuring variables such as age, ethnicity, socio economic status, to exacerbate the difficult experiences of some women or non binary persons who use drugs. For example, homeless people, sex workers, these people have little voice and little social capital. So understanding gender is a critical requirement for developing effective policy and practice responses to substance use. Women or non binary persons have different addiction career trajectories, so they start using drugs for different reasons. And the reasons for resistance obviously different. They also have different experiences within the criminal justice system. And all of this poses particular intervention challenges. So epidemiological data clearly indicates that in some countries and for some populations, most of the youth populations, the gender gap in substance use is narrowing. However, despite this recent change in epidemiological data, we still see disproportionate over representation of males in in substance use prevalence data, especially problematic substance use, and unfortunately, this disproportionate representation has resulted in drug policy and practice taking a predominantly male lens. I’ll be talking about prevention, treatment and reintegration on the criminal justice system. So zooming in on prevention, prevention has rarely been designed so far. To be gender sensitive or gender specific. More recently, we are seeing some evidence surfacing on how we can be gender specific in our consideration of prevention efforts. So for example, we know that risk and protective factors operate differently from Boys Girls or non binary persons at different stages of the addiction career. With regards to treatment, and reintegration women specifically present present with very complex needs. So we see women’s addiction careers as punctuated by trauma often exacerbated by poverty and sex where and we also see that women often present with disproportionate substance use of health related consequences and this often is a result of a phenomenon we know as telescoping. So we see that women progress very quickly from initiation of substances to more problematic use. And this accelerated disease progression often results in heightened health risks

 

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