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The ever-changing narrative: Supervised injection site policy making in Ontario, Canada

Authors: Isaac Luginaah*, University of Western Ontario, Bianca Ziegler, Department of Geography, The University of Western Ontario, Alexander Wray, Department of Geography, The University of Western Ontario
Topics: Medical and Health Geography
Keywords: Opioids, Supervised injection sites, Land use, Harm reduction, Policy
Session Type: Paper
Presentation File: No File Uploaded

We analyze the ongoing debate surrounding supervised injection sites in Ontario, Canada and the changing policies that impact host communities. Despite a plethora of evidence proving the effectiveness of supervised injection sites as a harm reduction strategy, the topic remains highly controversial with constantly changing rhetoric in the Ontario drug policy landscape. We reviewed government reports, policies, and media sources spanning from prior to the establishment of the first Canadian supervised injection site in 2000 to early 2019, adopting an advocacy coalition framework approach to conduct this policy analysis. Various advocacy coalitions emerge from this analysis, including all three levels of government, law enforcement, health practitioners, and community groups. We describe the narratives constructed by these coalitions, analyzing the supervised injection site model as a harm reduction strategy within a continually shifting socio-political landscape. Emerging from the analysis are competing narratives put forward by various stakeholders within the policy subsystem. We find policy-makers tend to leverage scientific uncertainty as a tool to defend the interests of the most powerful actor in the subsystem. Despite an increase in the number of deaths due to the opioid crisis in Ontario and evidence highlighting the efficacy of supervised injection sites as a tool to reduce harm from controlled substances, various stakeholders are locked in a battle of claims and counter-claims about the appropriate policy response to opioids. These findings have broad implications for drug policy in other contexts.

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