The intersectional risk environment of people who use drugs

• Type of Material: Article
• Authors: Alexandra B. Collins, Simon Fraser University; Jade Boyd, University of British Columbia; Hannah Cooper, Emory University; Ryan McNeil, University of British Columbia
• Language: English
• Date: 2019-06-22
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Elsevier Ltd. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.socscimed.2019.112384
• Title of Journal or Parent Work: SOCIAL SCIENCE & MEDICINE
• Volume: 234
• Grant/Funding Information: This research was supported by the US National Institutes of Health (R01DA044181 and R01DA043408) and the Canadian Institute of Health Research (PJT-155943, CBF-362965). Alexandra Collins is supported by a Vanier Canada Graduate Scholarship. Ryan McNeil is supported by a Canadian Institute of Health Research New Investigator Award and a Michael Smith Foundation for Health Research Scholar Award.
• Keywords: intersectionality; risk environment; health outcomes; substance use; health inequities

Abstract

Current conceptual models for examining the production of risk and harm (e.g. syndemics, ‘risk environment’) in substance use research have been fundamental in emphasizing broader environmental factors that shape health outcomes for people who use drugs (PWUD). However, the application of these frameworks in ways that highlight nuance and complexity has remained challenging, with much of this research focusing on select social positions (e.g. race, gender) and social-structural factors (e.g. poverty, drug policies). It is crucial that we move to better accounting for these relations in the context of substance use research to enhance equity in research and ensure understanding of diverse and complex needs. Building on the risk environment framework and complementary approaches, this article introduces the ‘intersectional risk environment’ as an approach to understanding the interconnected ways that social locations converge within the risk environment to produce or mitigate drug-related outcomes. This framework integrates a relational intersectional lens to examine how differential outcomes across populations of PWUD are produced in relation to social location and processes operating across social-structural dimensions. In doing so, the intersectional risk environment highlights how outcomes are products of processes and relations that are embodied, reflected, and challenged while situated within social, historical, and geographic contexts. Incorporating this framework into future research may improve understandings of health outcomes for PWUD and better orient structural interventions and public health approaches to address differential risks and experiences of PWUD.