A legal and policy ethnography of toxic drug overdose among people who use drugs

The objectives of the research are twofold. (1) To appraise the place occupied by people who use drugs who are also involved in drug distribution, why they’re absent from debates on drug policy liberalization, and how they can be better enlisted in policies oriented toward the mitigation of health disparities and overdose mortality. (2) To chart and appraise the contradictory shifts in the policies and practices of criminal-legal institutions responses to toxic drug overdose, that have included both punitive and rehabilitative/supportive toward people who use drugs.

Fieldwork has been completed, and analysis is currently underway. Preliminary outcomes point to how many of the drug distribution and trafficking practices in which people who use drugs are engaged are motivated by efforts to mitigate overdose risks and other drug-related harms. These include: purchasing for friends, selling a less toxic or safer supply, communicating information regarding potency, and operating as an in-between to mitigate exposure to exploitation or violence. Many of the social practices exhibited by participants are articulated as a form of compensation for deficiencies of formal healthcare services, including eligibility barriers, resource constraints, as well as stigma and discrimination excluding people who use drugs from care. Outcomes will also explore the nature of social and economic relations within the drug trade, specifically, between individuals selling drugs and those purchasing drugs. Accounts suggest a form of “negotiated safety” at play between drug sellers and customers including the communication of potency and composition, the distribution of sterile drug use supplies and naloxone, an opioid overdose antidote. Such accounts stand in stark contrast to dominant legal and cultural modes that regard drug sellers as inherently predatory and as unconcerned with the health and well-being of their customers. 

Outcomes will explore the relationship articulated among participants between the management of health-related risks (e.g. overdose risk, risk of infectious disease transmission, risk of withdrawal) and management of legal risks (e.g. risk of arrest, risk of confiscation of drugs by police, risk of incarceration). In this respect, the analysis will interrogate how the legal environment comes to bear on the uptake of risk reduction behaviours, access to health services, and experiences of drug-related harms. 

Stepping beyond individual and micro-level analyses and reflecting on meso-level questions of institutional policy and practice, the project outcomes will include a critical appraisal of recent criminal legal reforms. These recent reforms include a prosecutorial guideline in 2020 restricting the prosecution of simple possession charges to the most serious manifestations of the offense, a measure often referred to as “de-facto decriminalization”, an initiative implemented to address recognized health-related harms of over-criminalization. 

Stepping beyond meso-level considerations of institutional policy, broader questions of the relationship between therapeutic and punitive governance, outcomes of the project will seek to trouble the notion of a therapeutic or punitive “turn”, and instead insist on the ways in which the two are intertwined and operate in relation to one another. Punitive measures can be found to be embedded in medico-therapeutic settings, including forcible / compulsory treatment, or involuntary discontinuation from opioid agonist treatment for illicit drug use. The inverse is also true: rehabilitative measures are also found to be embedded in criminal-legal settings, as evidenced through measures such as prison needle exchange.