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Mot de présentation : DSS hors thème

Christophe Huỳnh

Revaloriser la place des femmes dans les conférences sur les jeux de hasard et d’argent : le rôle des communautés francophones pour une recherche plus équitable

Adèle Morvannou, Eva Monson, Annie-Claude Savard and Andrée-Anne Légaré

Addiction et accès aux soins : une enquête qualitative auprès de femmes consommatrices de substances

Sarah El Guendi
This article looks at how gender affects access to healthcare and harm reduction services for women who use drugs and are seeking treatment in Belgium. Unlike many earlier studies, which tend to focus on men’s experiences or rely on standard approaches, this research takes a more grounded and context-based perspective. Using grounded theory, the aim is to better understand how women experience addiction, how they make sense of it, and what specific barriers they face when trying to access appropriate support.The article is based on qualitative research involving fifteen women aged between 19 and 55, interviewed in three Belgian cities: Liège, Charleroi, and Brussels. Data were collected through semi-structured interviews and analysed using an approach inspired by grounded theory.The results reveal, on the one hand, the diversity of these women’s relationships with their consumption, marked by identity issues, and, on the other hand, the meanings they attribute to the obstacles they encounter in services: moral judgements, gendered expectations, experiences of rejection. The analysis highlights the convergence of several intersectional issues that reinforce stigma and complicate women’s access to harm reduction services.In conclusion, this paper highlights the need to rethink policies and practices by considering women’s specific paths and the overlapping vulnerabilities (poverty, mental health problems, homelessness, minority status, or ethnic background) that make access more unequal.

Caractéristiques des victimes de surdose accidentelle et utilisation des services en Montérégie

Marianne Bouvrette, Julie Loslier and David-Martin Milot
The overdose crisis represents a major public health issue. In Quebec, 2375 deaths were linked to suspected opioid or other drug poisoning between 2018 and 2022, with Montérégie being the second most affected region. By better understanding the characteristics of victims and their use of services, recommendations can be proposed to improve interventions to prevent overdose deaths. A descriptive design was used with a retrospective analysis of coroner’s reports on accidental overdose deaths occurring between 2018 and 2022 among adults with an address associated with a primary residence in Montérégie (n=222). Accidental overdose death rates for this period are higher in certain municipalities or communities. Witnesses to the poisoning are often present (n=99; 45%). Problems with substance use (n=183; 82%), physical health (n=120; 54%) and mental health (n=103; 46%) are often reported. The 218 toxicological analyses show the presence of opioids (n=115; 53%), benzodiazepines (n=86; 39%), antidepressants (n=85; 39%), antipsychotics (n=57; 26%) and alcohol (n=52; 24%). Half of the people had contact with the health and social services network (n=112; 50%), including several in the year (n=93; 42%), the month (n=47; 21%) or the week (n=31; 14%) preceding the death. Mortality by overdose is a complex, multifactorial and avoidable phenomenon. Several aspects related to the phenomenon make it possible to identify avenues of intervention that can help prevent fatal overdoses. For example, witnesses should recognize the signs and symptoms of an overdose and intervene quickly following best practices. Interventions should target not only opioid use, but also prescription drugs and alcohol. The significant use of services before death suggests opportunities for intervention related to the different comorbidities present.

Le trouble concomitant selon une perspective syndémique : une étude de cas multiples

Isabelle St-Pierre and Liette St-Pierre
Introduction: Dual disorder is complex and optimally requires integrated services delivery. However, current management strategies remain fragmented, with limited attention given to the role of social determinants of health, making challenging access to appropriate services. A syndemic approach, which adopts a holistic perspective, has the potential to improve care delivery and access, but remains underexplored in the context of dual disorder.Objective: To explore the syndemic perspective of dual disorder through a multiple-case study, focusing on emergency department care pathways and transitions to outpatient services.Methods: This study was conducted in Quebec, using medical records from three individuals who were frequent users of emergency services. Data included a 12-month review of emergency department visits, referrals to outpatient mental health and addiction services, and interventions performed by mental health and addiction liaison nurses as well as social workers.Results: Findings revealed service utilization patterns aligning with a syndemic perspective. The individual’s diverse needs, often linked to social determinants of health, frequently required coordination across outpatient services. The involvement of nurses and social workers varied in frequency and intensity across the three cases.Conclusion: A syndemic approach could enhance the management of individuals with dual disorder by facilitating access to complementary and integrated services. Nurses and social workers are well-positioned to play a pivotal role in assessing needs and guiding individuals toward appropriate care. Strengthening their involvement presents numerous opportunities for optimizing care delivery and addressing the complex interplay of factors affecting this population.

Engagement de personnes utilisatrices de drogues dans une recherche participative

Lucie Fradet and Sophie Dupéré
Introduction. The stigmatization of people who use drugs (DU) is a major barrier to reducing the harm associated with drug use. To counter this, meaningful participation in decisions affecting them is recommended. In particular, DU people advocate for their involvement in research to ensure they truly benefit from the findings. Yet the few studies on their involvement in participatory research (PR) report that they often play limited roles. To examine how a committee composed mostly of DU people participates in PR, this article documents their contributions and experiences in research, artistic creation and knowledge mobilization processes. Methodology. The article is based on a longitudinal qualitative study of a corpus comprising recordings of PR committee meetings and individual interviews with its six DU members. An interactional analysis is conducted using a conceptual bricolage structured according to The Rubicon Model of Action Phases and participatory and artistic research-specific scientificity criteria. Results. This study reveals that DU members are active participants in the project’s implementation across the studied processes. They apply several participatory and artistic scientific criteria. They adopt a scientific, artistic and persuasive objectives to achieve the project’s goals. They reflect on the best strategies to reach these goals, execute them rigorously, and provide feedback on their achievements. Conclusion. The study shows that participation in the realization of PR is substantial in the areas allocated to them in this context. This study shows that DU people can be reliable, have the intellectual capacity to carry out PR with rigor and the ability to act in a collective mode despite the prejudices often conveyed against them.