title: Living with addiction: the perspectives of drug using and non-using individuals about sharing space in a hospital setting.
abstract: 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.
authors.affiliation: University of Toronto, Dalla Lana School of Public Health, Toronto, Canada. Electronic address: carol.strike@utoronto.ca.
authors.forename: C
authors.initials: C
authors.lastname: Strike
authors.affiliation: University of Toronto, Dalla Lana School of Public Health, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Guta
authors.affiliation: Casey House Hospital, Toronto, Canada.
authors.forename: K
authors.initials: K
authors.lastname: de Prinse
authors.affiliation: University of Toronto, Dalla Lana School of Public Health, Toronto, Canada; Casey House Hospital, Toronto, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Switzer
authors.affiliation: Casey House Hospital, Toronto, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Chan Carusone
mesh_terms: D055030:Drug Users / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy*; D040261:Harm Reduction; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016134:Organizational Policy; D011369:Professional-Patient Relations; D019966:Substance-Related Disorders / Q000453:epidemiology*
keywords: Harm reduction; Hospital; Space; Subjectivity