Drugs, Homelessness & Health: Homeless Youth Speak Out About Harm ReductionThe Shout Clinic Harm Reduction Report Toronto,...
WELCOME<br />Questions: Use the Chat window (bottom right)<br />Technical Issues: Jennifer will try to help<br />Content Q...
Research<br />3<br />Shout Clinic delivers primary, interdisciplinary care to youth ages 16 to 24 years through a trauma i...
About the Study<br />Purpose of the Study<br />Eligibility Criteria<br />Study Activities<br />Community Partners<br />4<b...
Overarching Conclusion<br />Homeless youth run the same high risks as homeless adults<br />It is crucial to provide public...
About Survey Respondents<br />The survey sample of 100 homeless street-involved youth consisted of poly drug users:<br />I...
Principles of Harm Reduction<br />Harm Reduction defines policies, services, practices and approaches that work to reduce ...
Substance Use Practices<br />8<br />
Reasons for Using Drugs<br />To cope with their life circumstances and homelessness<br />To self-medicate: physical and me...
Substance Use History – past 6 months<br />10<br />
11<br />
12<br />
13<br />
14<br />
Average Age of first use<br />Age 12: average age of first use of any substance<br />Age 15-16: average age of first use o...
16<br />
Where youth use drugs<br />While an indoor location was preferred, particularly a private one, all youth at some time had ...
Substance Use Risks and Harms<br />
Locations of use in relation to risks and harms<br />When using outdoors, youth choose to use in hidden places to avoid de...
20<br />“You aren’t somewhere safe, they can grab you.”<br />“Everything comes down to having no safe place to do drugs or...
Drug related harms and risks<br />Needing help to inject, infections, unsafe disposal of used injection equipment<br />Pol...
Sharing drug equipment<br />59% of youth who snorted drugs shared snorting devices<br />21% of IDU’s shared needles<br />3...
23<br />“Night time comes and it all shuts down. And then you don’t have anything so all right… I’ll use yours.”<br />
Specific harms related to meth and crack use:<br />Difficulty breathing<br />Burns, cuts and sores on hands<br />Burns, cu...
Personal Strategies to Reduce Risks<br />Youth have developed strategies to reduce risks and harms related to insufficient...
Emergent Health & Social Issues<br />26<br />
Instability<br />Lack of stability and consistency in all areas of youth’s lives builds and adds to the overall precarious...
Homelessness & Housing<br />44%  of survey respondents experienced homelessness before their 16th birthday<br />42% betwee...
Housing issues<br />Difficult to find and maintain housing due to a number of factors:<br />Homelessness and instability<b...
Poverty and Sources of Income<br />Youth relied on a wide variety of income sources<br />30<br />
Conflicts with the Law<br />Youth had experienced negative and positive interactions with individual police officers<br />...
32<br />
Social Stigma<br />Youth experience social stigma due to:<br />Homelessness, poverty and sources of income<br />Identifica...
Health Issues<br /> A significant portion of youth had either been identified/treated for a health condition or were conce...
Mental health issues<br />27% rated their mental and emotional health as good and 26% as poor<br />37% of survey responden...
Trauma<br />29% of survey respondents reported being physically or sexually assaulted in the past six months<br />48% repo...
Access to health care – past 6 months<br />64% youth reported experiencing barriers when accessing health care<br />57 - 5...
Dependency and Addiction Issues<br />47% of respondents were (in the past 6 months) unsuccessful in trying to cut down or ...
Barriers & Recommendations<br />
40<br />
Barriers<br />Youth experienced a wide range of barriers to accessing services and supports and practicing harm reduction,...
Recommendations<br />Options and choices of programs and services <br />Responsive, comprehensive and flexible services<br...
HarmReductionProfessionals<br />Youth emphasized the importance of protecting youth with accessible, and appropriate harm ...
Harm Reduction Professionals<br />Deliver services where and when youth need them<br />Spread the word – better advertisem...
Addiction and Harm Reduction Professionals<br />Increase options (for treatment and youth specific programs)<br />Easier a...
Mental Health Professionals<br />Tackle social stigma and promote mental health services<br />More responsive services<br ...
Community Health Services<br />No health care card necessary<br />One stop shop<br />Flexible hours and drop-in appointmen...
For Governments (all levels)<br />Secure government funding<br />Increase stability – e.g. through an inter-Ministerial ap...
For the Police<br />Bring police on board<br />Training for police<br />Develop a harm reduction unit as part of TPS<br />...
Complete the quick survey that will automatically come up at the end of this session<br />Go to www.wellesleyinstitute.com...
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Drugs, Homelessness and Health: Homeless Youth Speak Out About Harm Reduction

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This presentation provides critical insight on homeless youth and harm reduction.

Lorraine Barnaby
Rebecca Penn
Dr. Patricia G. Erickson

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  • This study was conducted by Shout Clinic, a site of Central Toronto Community Health CentresFunded by The Wellesley Institute
  • Purpose: Identify the current substance use, harm reduction and sexual practices and health status of homeless street-involved youth who use substances in the Greater Toronto area (GTA)Identify the needs, gaps, and barriers in current harm reduction services, resources, and the advocacy for community membersAdvocate and influence stakeholders’ response to the emerging issues and needs of community membersDetermine the direction and nature of Shout Clinic’s harm reduction programmingEligibility Criteria: In the past 6 months:16-24 years of age and living in TorontoUsed crack, methamphetamine, a non-prescribed opioidand/or injected any drugAbsolutely homeless, defined as living on the street, in a squat, in a shelter or staying with friends/otherActivities: Used a Peer Researcher Model 100 survey/interviews were carried out from October to December 2008 5 Focus groups were conducted between April to June 2009 Arts Informed activities – In partnership with Sketch - 4 youth created art reflecting the themes of the study The focus of Sketch’s work is to provide creative opportunities for street involved and homeless people ages 15-29, engaging them in the arts in a cross-discipline studio environment.Community partners:Two were community health centres (34 participants), three were youth shelters (28 participants) and 2 were youth drop-in centres (38 participants)
  • Extra vulnerability due to their age
  • Gender Identity:75 young men, 21 young women, and 4 transgendered/transsexual individualsSexual Orientation:61% identified as heterosexual31% identified as GLBTT2S8 % refused, didn’t knowEthno-Racial Background:63% identified as white or Caucasian19% as Aboriginal or First Nations9% as Black or African/Caribbean-Canadian5% as Asian2% as Hispanic or Latin AmericanNine out of ten were Canadian born Educational Background:79% did not complete high school
  • Drug use plays a variety of roles and purposes in youth’s life beyond having fun and socializingWhy and how people used drugs, as well as the types of drugs used were often dependent and reflective of their housing and health status and where they were using and who they were using with. We will expand on this through out the presentation.
  • Other than significantly higher rates by women for oxycontin, Tylenol with codeine and fentanyl, there were only small differences between male and female levels for all other substances
  • 27% of youth named cannabis as their drug of choice12% crack, powder cocaine or amphetamine10% heroin8% alcoholThe remaining participants listed a wide array of substances25% of youth who used crack did so daily19% of youth who used methamphetamine did so daily
  • Initiation ages for first use of drugs are often influenced by factors such as: Drug availability, drug use trends, environment, social networks and motivation of individualAverage age: Alcohol and cannabis were first used around age 12, For many, age of first use was much younger than the overall averageAge of first use (not average) 10 years of age for powdered cocaine; 12 years for Oxycotin/Oxycodone and crack13 years for methamphetamine
  • Of the 33 participants with injection experience, for 18% this occurred when they were 13, 14 or 15 years old. 39% were daily injectors, 21% of which did so 2 – 10 times daily, while the rest did so less frequently (weekly, monthly)The most common drugs injected were heroin and other opioids, cocaine and crack and ketamine.
  • Most commonly used locations (youth were asked to name the 3 most common places they used):Friends place (51%) Parks (35%)Street, alley way and/or parking lot (33%)Their own place (21%)Stairwell (18%)Public or business bathroom (13%)Bathhouse (12%)Shelter/hostel; abandoned building or squat (11%)24% of youth had injected in a correctional facilityDrug Choices and homelessness:Sources of shelter influenced drug choices.Youth living on the streets were more likely to use stimulants and alcohol“I would do ecstasy so I could stay up all night or be warm and functional, not be rolled up in a ball in the middle of winter. At least I’d be walking around, have energy, be with friends.”“When you go to smoke a bowl of meth… the high that it gives you it’s almost like you’re in your own housing.”“If I’m on the street I’m going to be up all night, so I might as well get the drug that keeps me up all night, and if I’m at home I want something that’s more chill, like weed or k [ketamine].”
  • Conflictswith the law, residents/business groups and community agenciesUnsafe practices due to insufficient lighting and space, poor/no access to clean water, lack of cleanliness and being rushed due to fear of getting caught.
  • Needing assistance to inject: 78% of IDU’s – some time in their life; 34% continued to need helpSocial Networks:Youth used drugs with a variety of people (friends, sex partners, strangers, dealers, family and by themselves).Top three: friends, use alone and regular sex partnersSocial networks can contribute to these risks in a number of ways, such as:Using alone due to isolation and shame/stigma can increase risks and danger of OD’sUsing in groups - increase sharing of equipmentMany youth minimize potential risks due to feelings of trust when using with friendsHomemade/toxic pipes:61% of crack smokers had used a homemade/toxic pipe in past six months40% of meth smokers had used a lightbulb.
  • Risks and sharing practices:Youth reported getting drug use education and equipment from a number of sources besides harm reduction programs (i.e. dealers, friends, pharmacies, etc.)Lack of access:program issues – inconvenient hours and locations, program closed, barred from program, no TTC, no safer meth kits, no NE in prison and NE program understocked, don’t give out full range of supplies and/or give out insufficient quantitiesLack of access:Police confiscation, lost/stolen, no $ to purchase, and pharmacy wouldn’t sell Trust: Lack of knowledge: Unconcerned about risks: Unplanned drug use: Using in a group setting: Kits – drug economyReport contains more specific and detailed stats
  • These can be caused by or exacerbated by:The use of toxic/homemade and damage pipes and other types of drug paraphernalia (railing and snorting devices). These open burns, sores and open cuts increase ones’ risks – Hep C and HIVTolerance and bingingPre-existing mental and physicalconditions
  • Effective: planning ahead and stock piling new and sterile suppliesIneffective: using bleach andburning the end of the pipe to kill germsDangerous:Others revealed a sense of desperation, a lack of knowledge and a considerable amount of misinformation. Attempts to use with people they knew and trusted were repeatedly cited as the main strategy used when they are unable to access needle exchanges or distribution centres.
  • A large portion of youth’s energy and time is directed towards immediate needs rather than towards addressing more long term issuesInstability is a major barrier to accessing services and transforming their lives. In the next series of slides we will examine specific social determinants of health and how instability impacts on them.
  • 1st experience: 37% between ages 13 – 15Sources of shelter ranged from:institutional shelter, non-institutional indoor shelter (independent and relationships), transitional indoor shelter and outdoor shelter.The five most common sources of shelter that survey respondents had used were:  Hostels/shelters (78% past six months, 52% past seven days)   Staying with a girl/boy friend, friend or acquaintance’s place (69% past six months, 40% past seven days)  A place that they rented either alone or with others (53% past six months, 27% past seven days)  Sleeping on the street and in alley ways (52% past six months, 19% past seven days)  Hotels/motels (50% past six months, 14% past seven days) In addition: police stations (47%) parks (46%) stairwells (43%) jails/prisons (35%) abandoned buildings/squats (35%)Safety Issues:Many sources of shelter are unstable, unsafe and expose youth to potential risks33% of those without their own place felt unsafe; compared to those who had their own place (10% of all respondents) - only 10% felt unsafeFG - Safety issues ranged from physical/sexual assaults, theft, verbal abuse, exposure to the elements, police harassment and arrest. Shelters protected youth from police and the elements but youth ran the risk that they would be discharged for being under the influence leading some to avoid shelters when using.
  • Barriers and challenges: Homelessness/instability – difficulty keepings appointments, following up with housing workers and potential landlordsHousing often located in low-income neighbourhoods and buildings that are primarily inhabited by individuals with mental health and substance use issuesDiscrimination due to their age, lack of previous rental experience, substance use, homelessness and unemploymentRisk factors for losing housing:Inability to pay rent due insufficient income to cover rent, food and drugs – low rates of social assistance and lack of employment, as well as binging and addiction issues were a factor.“One bad night, that’s all it takes, is one bad night.”Imprisonment and hospitalizationA lack of proper support when transitioning into housing may put many youth at greater risk of increased social isolation, depression and drug use“You just need help balancing it out. The stress to maintain [housing] can push you back to drugs.” Housing is a foundation for moving forward and making positive changes. It allows youth to focus on other things like enrolling in programs, looking for employment, engaging in self-care activities and receiving harm reduction, counselling and drug treatment services.   “If I have some place to come home to all the time, then I focus on the next step.”
  • Youth engaged in a variety of activities to earn money, many of which are unstable and come with certain risks.Selling/running drugs, sex work, boosting/stealing and fraudPanhandling, squeegeeing, $CAS, family and friendsPNA - $3.90/dayOW – basic rate for single person approx. $548/month for housed – majority of which goes to rent, leaving very little (if any) for food and other expensesODSP - $979Barriers to employment and other higher sources of income:Lack of education - 79% of youth did not complete high schoolHomelessness and instabilityDifficulty managing ODSP application:Low rates of ODSP despite many youth being eligible (37% have been diagnosed/treated for a mental health condition)The impact of this was that youth found it extremely stressful and difficult to:Find employment even with employment supports, such as a counsellor balance the multiple economic demands they faced, such as rent, food and paying for drugs. 41% of youth used drugs to cope with illegal and legal workFeelings of shame and frustration due to unemployment and sources of incomeSecuring stable and safe sources of income, such as legal employment and government assistance is an important resource which has the potential to enhance youth’s ability to secure and maintain housing, increase self-esteem and decrease social isolation.
  • Interactionswith individual police officers:Having their drug use equipment taken/destroyed 45%Being assaulted or threatened with physical and/or sexual violence 48 – 53%Target policing and being given tickets/fines 55%Aggressive and discriminatory behaviour and harassment 70 – 85%Being treated with respect and kindness 45 %Offered information, assistance or protection 43 – 30 %FG voiced tremendous frustration, hopelessness and injustice in regards to their attempts to submit an official complaint against individual police officersYouth feel that they do not have recourse when they have been mistreatedYouth are fearful of retaliation51% of all survey respondents were in a jail, prison or other type of correctional facility in past year33% (of the 51%) had stays longer than a week24% - one time16% 2 -3 times7% 4 -5 times4% 6 or more timesCurrent drug detection practices (random urinalysis) have inadvertently created an environment in which injection drug use has become more commonplace leading some youth to engage in risky drug use behaviours while imprisoned (i.e. sharing injection equipment). Pros and Cons (PASAN report 2002)24% of survey respondents had injected while in a correctional facility
  • FG made the following comments in regards to other people’s attitudes about them:We’re no good. Street trash. We should all be put in jailScum of the earthEveryone has human rights but we’re drug addicts so we don’t have shitNot trustworthy. Not respectfulThey think: ‘ you’ve made your bed’You’re stupid… dirty… uselessOther areas of their lives: race, ethnic background, sexual orientation, gender identity, age, history of imprisonment, levels of education and family history.Impact of social stigma: Poor self-image, self-esteem and self-care; and increased risk-taking activities Difficulty forming trusting relationships; fear of opening up and self-disclosure; and reluctance to seek out professional help; sense of hopelessness Internalized negative stereotypes Some hardened themselves against the discrimination and abuse they are met with by trying to not care what other people think and by isolating themselves “Makes me angry if I start to think a worker thinks negatively. They’re supposed to be open-minded and respectful. It’s kind of degrading… It makes you kind of angry.” “We don’t want society or the community to look down on us so we just don’t’ reach out for the help.”
  • Health Issues: Respiratory illnesses 23%HIV/AIDS, STI’s, and Hepatitis C -Only 13% of respondents reported that they always used a condom or other type of latex barrier. Greater use among men with male sex partners than with female sex partners. 76% rated their knowledge of safer sex as excellent or goodChronic pain (16% diagnosed, 27% concerned) - Foot pain, headaches. 68% used drugs to cope with chronic painDental problems Learning disabilities 33% Attention Deficit Disorder, 16% concerned but not diagnosed. 20% other learning disorderPoor nutrition and food security (52% had gone hungry in the past 7 days due to poverty)Sleep disorders (19%) and exhaustion. 59% used drugs to sleepMental health, trauma and stress
  • Depression was the most common mental health issue reported; followed by bi-polar disorder; anxiety; and schizophrenia41% of all respondents reported using drugs to cope with mental health issues and symptoms. 81% used drugs to cope with emotional painStress:28% of respondents rated the level of stress in their daily lives as being extremely stressful32% rated as quite a bit stressful36% rated it as a bit stressfulSources of stress:poverty, homelessness, conflicts with the law, discrimination and stigma, interpersonal relationships, substance use issues, violence, trauma, and being young86% of all survey respondents reported using drugs to cope with stress and 74% to escape
  • Homeless and street involved youth often have experienced trauma/abuse prior to being homeless and are at a greater risk of further trauma and abuse once they become homelessMany vulnerable homeless youth experience trauma and abuse in the form of sexual exploitationYouth see violence at the hands of police inherently different than other forms of abuse due to their position of power and authorityBarriers to reporting trauma and accessing support: shame, not wanting to appear weak, abuser is part of social network and in a position of authority (i.e. police), fear of police involvement“Some people are scared, they don’t want people to know they were vulnerable, they let someone take advantage of them without fighting back, they don’t want to feel like they’re are weak… so they don’t talk about it.”
  • Primary Health Care: other sources of medical attention included walk-in clinics, family doctors’ offices, Aboriginal health centre and alternative health providerUse of mental health services:23% had seen a psychiatrist16% accessed mental health care at CAMHFG reported receiving support from service providers at community agencies, outreach services, CHC, NE programs, drop-in centres and from shelter staff
  • FG acknowledged that substance use had cost them in many ways: loss of friends, family and children, illnesses and infections, imprisonment, exploitation and violence, hunger, homelessness, physical and mental health problems. Addiction named as a major source of stress in their livesAccess to services: 21% had not accessed any services.Of those that did (multiple responses were permitted):12% had accessed a detox centre, methadone13% traditional counselling, 13% harm reduction counselling and 9% drug-free counselling9% mental health facility (i.e. CAMH); 6% twelve step program; and 5% residential treatment programYouth also accessed emergency medical services, acupuncture and traditional healersSome tried to quit on their own, going “cold turkey”, relying on self-help and/or the support of family and friends
  • Youth acknowledged what’s working well in regards to services and supports, and identified a number of barriers and gapsPolicy Barriers: Lack of funding and support for harm reductionZero tolerance policiesRestrictive eligibility criteria Structural Barriers: Limited and inconvenient hours of operation Limited and inconvenient locations of service delivery Lack of transportation resources Waiting times and waiting lists Lack of program options and the power to choose No health card or health care coverage Attitudinal Barriers: Social stigma and discrimination Social networks Staffing and interpersonal relationships Knowledge Barriers: Lack of knowledge of services and support Lack of knowledge and concern for risks Complex and Multi-Dimensional Barriers: Homelessness and instability Fear of police
  • Common Theme:Youth friendly, non-judgmental, low-threshold and flexible approach to program design, ideally delivered by people with lived experience of issues youth are experiencing (peer workers), which are provided with others in accessible locationsOptions and choices of programs and services that are relevant to youth:Access to transportation resources Safe, affordable and appropriate housing options (youth, harm reduction, transitional, supportive housing options) Maintain and develop innovative programs that are geared towards the complex and diverse realities of street-involved youth. Comprehensive and high-quality discharge plans  
  • #1:After hour services and non-downtown areas, shelters, drop-ins, CHCs and areas where youth use and hang out.#3: Greater access to existing supplies and meth, snorting and drug testing kits#4: Expansion of existing NE, outreach and mobile servicesVending machinesPrograms designed for specific groups (i.e. LGBT)Peer and mentoring programs Individual and political advocacy supportHarm reduction: support groups for people living with mental health issues, HIV/AIDS, and Hepatitis C counselling and crisis intervention supportive housing, shelters and hostels for youth who use drugs #5:A variety of educational mediums (i.e. verbal, internet, brochures, etc)Strong visuals and accessible languageYouth involvement in design/production#6:The list of reasons given by youth for why this is an needed resource is detailed in the report. Research regarding Insite supports this recommendation.
  • Increase options:   Youth-specific programs and treatment options (youth-only detoxification centres or at minimum, youth-specific beds within the current system). Options of residential or out-patient programs, and group or individual counselling. Range in program options that include abstinence as well as harm reductionA holistic approach to supporting youth in reducing or quitting substance use; and in the delivery of after-care need to expand to include assisting youth in re-integrating into the community by securing housing, income, primary health care, and linking youth with employment, educational and recreational opportunitiesEasier Access: Reducing waiting time and increasing the flexibility of programs and services Youth-friendly intake procedures, self-referrals, informal assessments, drop-in services, and flexible hours More local services and programs availableLived Experience:Youth described feeling more comfortable talking about their use of substances and other issues with someone who has been through similar experiences themselves.
  • Social stigma:Anti-stigma initiatives are recommended to decrease resistance to acknowledging mental health issues and increase willingness to get help. Increased promotion of mental health service Increase understanding of what to expect from the mental health system, how it works, and what rights individuals have when they access mental health servicesResponsive services: Reduce/eliminate waiting lists and the need for professional referrals Increase in outreach services and greater flexibility in the referral process,hours and appointments. “Sooner response times… The problem is now.” Program options: Increase in availablelife skills and stress management programs Individual or group counsellingPositive relationships: Consistent and long-term working relationship with one worker in order to buildtrust and rapport  
  • Nation-wide health care coverage Integrate social services into primary health care settings (i.e. CHC model) and bring primary health care (including mental health and dental services) to shelters, drop-ins and supportive/public housingYouth want to be treated as a whole person and in a holistic mannerGreater adoption of harm reduction approaches by health professionals
  • Funding bodies mustprovide agencies with ongoing and sufficient funding in order to properly staff and manage existing as well as new programs and resources for youth. Linked up services and programs and continuity of care (across government and service sectors, as well as disciplines) For example, comprehensive discharge planning from the jail or detention centres or from treatment centres into the community; responsive housing support workers; flexibility and support for youth who are transitioning from the youth sector to the adult sector.
  • Policing issues was consistently named as an important issue for youth in the interviews and focus group Bring police on board in regards to harm reduction – four pillar approach Training for police: on working with homeless and street-involved youth and harm reduction Policy reform: police will not confiscate or destroy harm reduction supplies Complaints process – educate youth and service providers re: new independent police complaint process (OIPRD)
  • Drugs, Homelessness and Health: Homeless Youth Speak Out About Harm Reduction

    1. 1. Drugs, Homelessness & Health: Homeless Youth Speak Out About Harm ReductionThe Shout Clinic Harm Reduction Report Toronto, 2010<br />Research Team:<br />Lorraine Barnaby, Principal Investigator (Health Promoter, Shout Clinic), Patricia G. Erickson, Co-Investigator (Senior Scientist, Centre for Addiction and Mental Health), Tara Fidler, Data Analyst (University of Toronto), Val Fuhrmann, Peer Researcher (Shout Clinic), Matt Johnson, Peer Researcher (Shout Clinic).<br />Authors:Lorraine Barnaby, Rebecca Penn and Dr Patricia G. Erickson<br />
    2. 2. WELCOME<br />Questions: Use the Chat window (bottom right)<br />Technical Issues: Jennifer will try to help<br />Content Questions / Comments will be addressed at the end of the seminar<br />Feedback<br />During the session: 2 quick polls to share your viewpoint<br />After the session: An exit poll to tell us what you think<br />The session will be recorded so we can address any missed questions offline<br />2<br />
    3. 3. Research<br />3<br />Shout Clinic delivers primary, interdisciplinary care to youth ages 16 to 24 years through a trauma informed and harm reduction philosophy.<br />The Wellesley Institute advances urban health through rigorous research, pragmatic policy solutions, social innovation, and community action.<br />Conducted by<br />Funded by<br />
    4. 4. About the Study<br />Purpose of the Study<br />Eligibility Criteria<br />Study Activities<br />Community Partners<br />4<br />
    5. 5. Overarching Conclusion<br />Homeless youth run the same high risks as homeless adults<br />It is crucial to provide public health services geared to this vulnerable population of youth<br />Protecting youth with harm reduction services rather than punishing them should be the priority for future programs<br />5<br />
    6. 6. About Survey Respondents<br />The survey sample of 100 homeless street-involved youth consisted of poly drug users:<br />In the past six months:<br />71 had used crack<br />51 had used methamphetamine<br />53 had used a opioid that was not medically prescribed<br />33 had injected drugs<br />Age:<br />15% were 16-8 years of age<br />39% were 19-21 years of age<br />42% were 22-24 years of age<br />4% were 25 years of age (24 years of age within the last 6 months)<br />6<br />
    7. 7. Principles of Harm Reduction<br />Harm Reduction defines policies, services, practices and approaches that work to reduce substance related harms and risks to individuals, communities and society without requiring abstinence<br />Harm Reduction recognizes:<br />The right for comprehensive, non-judgemental medical and social services and the fulfillment of basic needs of all individuals and communities <br />The competency of individuals to make their own choices and changes in their lives, and provides options to support this competency<br />7<br />
    8. 8. Substance Use Practices<br />8<br />
    9. 9. Reasons for Using Drugs<br />To cope with their life circumstances and homelessness<br />To self-medicate: physical and mental health issues<br />To escape and disconnect<br />To deal with boredom and hopelessness<br />When they are expecting or wanting to have sex<br />As part of their social networks and street culture<br />9<br />
    10. 10. Substance Use History – past 6 months<br />10<br />
    11. 11. 11<br />
    12. 12. 12<br />
    13. 13. 13<br />
    14. 14. 14<br />
    15. 15. Average Age of first use<br />Age 12: average age of first use of any substance<br />Age 15-16: average age of first use of most stimulants and some party drugs<br />Age 17-18: average age of first use of crack, methamphetamine, heroin, morphine, oxy’s, Ketamine, GHB and poppers<br />15<br />
    16. 16. 16<br />
    17. 17. Where youth use drugs<br />While an indoor location was preferred, particularly a private one, all youth at some time had smoked, snorted or injected drugs:<br />Outdoors (i.e. a park, street, stairwell or squat)<br />In a public location (i.e. a club, public bathroom or a place to buy/use drugs)<br />In aninstitution (i.e. hostel, community agency or correctional facility)<br />17<br />
    18. 18. Substance Use Risks and Harms<br />
    19. 19. Locations of use in relation to risks and harms<br />When using outdoors, youth choose to use in hidden places to avoid detection.<br />These locations contribute to:<br />Conflicts<br />Wide range of unsafe drug practices:<br />Sharing drug use equipment<br />Unhygienic injections<br />Overdoses<br />Unprotected sex<br />19<br />
    20. 20. 20<br />“You aren’t somewhere safe, they can grab you.”<br />“Everything comes down to having no safe place to do drugs or buy drugs. You’re out on the street.”<br />
    21. 21. Drug related harms and risks<br />Needing help to inject, infections, unsafe disposal of used injection equipment<br />Poly drug use and overdoses (20% of survey respondents had O.D. in past 6 months)<br />Use of homemade/toxic pipes<br />“… I always shared my crack pipe ‘cause I thought it was safe… I thought I couldn’t get sick from sharing a crack pipe and then I got Hepatitis C.”<br />21<br />
    22. 22. Sharing drug equipment<br />59% of youth who snorted drugs shared snorting devices<br />21% of IDU’s shared needles<br />36% shared other injection equipment<br />81% of methamphetamine smokers shared pipes; as did 61% of crack smokers<br />22<br />
    23. 23. 23<br />“Night time comes and it all shuts down. And then you don’t have anything so all right… I’ll use yours.”<br />
    24. 24. Specific harms related to meth and crack use:<br />Difficulty breathing<br />Burns, cuts and sores on hands<br />Burns, cuts and sores on the lips and tongue<br />Burns and cuts on and in the nose<br />Open cuts and sores due to picking and digging<br />Drug-induced psychosis, paranoid delusions and hallucinations (audio and visual)<br />Seizures<br />24<br />
    25. 25. Personal Strategies to Reduce Risks<br />Youth have developed strategies to reduce risks and harms related to insufficient access to safer drug use equipment<br />Strategies ranged from highly effective, to less effective, to ineffective, inaccurate, and potentially dangerous<br />“Desperate Times Call for Desperate Measures.”<br />25<br />
    26. 26. Emergent Health & Social Issues<br />26<br />
    27. 27. Instability<br />Lack of stability and consistency in all areas of youth’s lives builds and adds to the overall precariousness of their existence<br />The ability to move forward and establish stability in any one area is hampered by the stress emanating from another<br />27<br />
    28. 28. Homelessness & Housing<br />44% of survey respondents experienced homelessness before their 16th birthday<br />42% between the ages of 16 - 18<br />Sources of Shelter - Past 6 Months<br />Reliance on a wide range of sources of shelter<br />Safety issues were a major concern for youth<br />Use of drugs to cope with and escape from homelessness, to feel safe and to stay up all night<br />28<br />
    29. 29. Housing issues<br />Difficult to find and maintain housing due to a number of factors:<br />Homelessness and instability<br />Poverty<br />Limited and poor quality of available affordable housing<br />Discrimination<br />Substance use<br />29<br />
    30. 30. Poverty and Sources of Income<br />Youth relied on a wide variety of income sources<br />30<br />
    31. 31. Conflicts with the Law<br />Youth had experienced negative and positive interactions with individual police officers<br />High rates of imprisonment<br />Detention centres, jails and prisons names as sources of shelter<br />Poor health care and discharge planning<br />Continued use of drugs while incarcerated<br />31<br />
    32. 32. 32<br />
    33. 33. Social Stigma<br />Youth experience social stigma due to:<br />Homelessness, poverty and sources of income<br />Identification as drug users, including type of drugs and methods of use <br />Mental and physical health conditions<br />Other areas of their lives<br />Social stigma negatively impacts youth internally and externally<br />33<br />
    34. 34. Health Issues<br /> A significant portion of youth had either been identified/treated for a health condition or were concerned about one<br />Only (52%) of survey respondents rated their physical health as excellent or good<br />25% of all survey respondents reported self-medicating with drugs in order to feel healthy<br />34<br />
    35. 35. Mental health issues<br />27% rated their mental and emotional health as good and 26% as poor<br />37% of survey respondents disclosed that they had been diagnosed and/or treated for a mental health condition<br />30% were concerned but had not been diagnosed<br />35<br />
    36. 36. Trauma<br />29% of survey respondents reported being physically or sexually assaulted in the past six months<br />48% reported being assaulted by police<br />Only 34% of those who had been assaulted received any medical support or counselling<br />36<br />
    37. 37. Access to health care – past 6 months<br />64% youth reported experiencing barriers when accessing health care<br />57 - 53% had been to a hospital emergency room, Community Health Centres or saw a nurse at a shelter, drop-in centre, or health bus<br />Low use of mental health services despite high rates of mental health issues<br />37<br />
    38. 38. Dependency and Addiction Issues<br />47% of respondents were (in the past 6 months) unsuccessful in trying to cut down or quit their drug of choice; 37% were not interested<br />50% of respondents used drugs to avoid withdrawal symptom<br />Low use of drug treatment services<br />38<br />
    39. 39. Barriers & Recommendations<br />
    40. 40. 40<br />
    41. 41. Barriers<br />Youth experienced a wide range of barriers to accessing services and supports and practicing harm reduction, such as:<br />Policy<br />Structural<br />Attitudinal<br />Knowledge<br />Complex & Multi-dimensional<br />41<br />
    42. 42. Recommendations<br />Options and choices of programs and services <br />Responsive, comprehensive and flexible services<br />Friendly faces and friendly places<br />Youth speak out about receiving respect and fair treatment<br />Target social stigma<br />Treatment instead of jail<br />42<br />
    43. 43. HarmReductionProfessionals<br />Youth emphasized the importance of protecting youth with accessible, and appropriate harm reduction services and approaches, rather than punishing them for their drug use.<br />90% of survey respondents think that harm reduction is an appropriate and useful approach to substance use issues. <br />43<br />
    44. 44. Harm Reduction Professionals<br />Deliver services where and when youth need them<br />Spread the word – better advertisement of services<br />Provide supplies that youth need and will use<br />Relevant program options that are appealing to youth<br />Provide greater access to educational materials and resources<br />A safe place to use – safe injection and consumption sites<br />44<br />
    45. 45. Addiction and Harm Reduction Professionals<br />Increase options (for treatment and youth specific programs)<br />Easier access<br />Peer-workers and people with lived experience<br />“There’s a lot of red tape to get into a treatment centre: orientation, waiting list, appointment here, appointment there, it’s too many walls.”<br />45<br />
    46. 46. Mental Health Professionals<br />Tackle social stigma and promote mental health services<br />More responsive services<br />Program options<br />Positive relationships<br />46<br />
    47. 47. Community Health Services<br />No health care card necessary<br />One stop shop<br />Flexible hours and drop-in appointments<br />Address discrimination by educating health professionals<br />47<br />
    48. 48. For Governments (all levels)<br />Secure government funding<br />Increase stability – e.g. through an inter-Ministerial approach in order to address the different social determinants of health operating here<br />48<br />
    49. 49. For the Police<br />Bring police on board<br />Training for police<br />Develop a harm reduction unit as part of TPS<br />Policy reform<br />Effective complaint process and greater police accountability<br />49<br />
    50. 50. Complete the quick survey that will automatically come up at the end of this session<br />Go to www.wellesleyinstitute.com<br />To get your copy of the full Shout Clinic report, as well as the presentation you just watched<br />To register for our next Wellesley Webinar on Mar 9 – Seeing the Possibilities: The Need for a Mental Health Focus Amongst Street-Involved Youth<br />To arrange a presentation of the Shout Clinic report, contact Lorraine Barnaby at lbarnaby@ctchc.com or 416-927-8253 ext 15<br />50<br />

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