@article{ref1,
title="Between zero risk and harm reduction: an ethnography of Montreal supervised injection services as a public policy instrument",
journal="International journal on drug policy",
year="2022",
author="Paumier, Romain",
volume="104",
number="",
pages="103694-103694",
abstract="BACKGROUND: While much has been written about the positive individual and collective effects of Supervised injection services (SIS), notably on health and drug-related harm, little research focuses on their operational context and constraints. Building on Lascoumes and Le Gales's &quot;public policy instrument and instrumentation&quot; framework (2007), this article analyzes the implementation of Montreal SIS and discusses how the organizational aspects of SIS produce the contexts for drug injection. <br><br>METHODS: Using an ethnographic approach, this article draws on three types of data: 10 months of participant observation in a SIS (700 h); 19 semi-structured interviews with staff members (social workers, peers, heads of staff, management); and analysis of organizational documents (protocols, staff notebooks). <br><br>RESULTS: First, this article examines how political context and advocacy coalitions produced Montreal SIS as a public policy instrument, affecting both the philosophy and the implementation of the service. It shows that Montreal SIS were developed under a health care network blueprint rather than a community organization harm reduction framework. Then, it analyzes how SIS as a policy instrument defines what constitutes appropriate injection practices, trying to supervise injection as an individual and technical act, rather than a broader social practice composed of pleasure, rituals, routines, and group dynamics. <br><br>CONCLUSION: Montreal SIS were conceptualized under a &quot;health banner&quot; and through alliances between regional public health administration and local well-known community organizations. They were then developed mostly under a health care administration blueprint, although operated at a ground-level by local community organizations. It created tensions between the logics of &quot;zero risk&quot; and &quot;harm reduction&quot;, and ambiguity about how injection should be supervised and what parts of drug use could be managed.<p /> <p>Language: en</p>",
language="en",
issn="0955-3959",
doi="10.1016/j.drugpo.2022.103694",
url="http://dx.doi.org/10.1016/j.drugpo.2022.103694"
}