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Innovative Approaches to Inform Health and Public Policy
With backgrounds in Public Policy and Interdisciplinary Studies, Simon Fraser University’s School of Public Policy associate professor and Research Scientist with the BC Centre on Substance Use at Providence Health Care, Kora DeBeck is working to improve health amongst vulnerable populations of people who use drugs. Her research evaluates and informs health and policy interventions to reduce health and social harms among people who use drugs, with a particular focus on the prevention of high-risk drug use, infectious diseases, and other health-related harms—particularly amongst street-involved youth.
DeBeck’s research explores the individual, social, economic, and environmental factors that influence the health and well-being of street youth in Vancouver. She has authored more than 150 articles exploring various areas of substance use research and knowledge translation, including injection initiation, addiction treatment, illicit drug policy, drug law enforcement, low-threshold income generation, and emerging risks for HIV infection and transmission among people who use drugs.
The Effects of Criminalizing Drug Use on HIV Outcomes
In one of the first systematic assessments of the effect of laws criminalizing drug use on HIV prevention and treatment outcomes among injection drugs users, DeBeck found that criminalization of drug use had a negative effect on HIV prevention and treatment. In collaboration with Dr. Stefan Baral from Johns Hopkins Bloomberg School of Public Health, this study focused on the effects of such criminalization, including street-level policies, drug paraphernalia laws, and incarceration.
DeBeck and her colleagues analyzed 106 studies published between 2006–14 on the effect of laws criminalizing drug use on HIV prevention and treatment outcomes among people who use injection drugs. Out of the 106 studies reviewed, 91 studies suggested that criminalization undermines HIV prevention while only six studies reported some type of beneficial effect with drug criminalization—but these benefits were minimal at best.
“The evidence was overwhelmingly definitive that drug criminalization has a negative effect on HIV prevention and treatment,” says DeBeck. “Criminalization often results in higher rates of HIV/AIDS, restricts access to clean needles and syringes and prevents people from accessing treatment and health services.”
Prior to joining SFU in 2013, Kora was a CIHR funded post-doctoral fellow with the Division of AIDS in the Department of Medicine at UBC and the Centre for Public Health and Human Rights at Centre for Public Health and Human Rights at Johns Hopkins Bloomberg School of Public Health. She holds a PhD in Interdisciplinary Studies from UBC (2010) and is an SFU Master of Public Policy alumni (2006).
Well-Being of Street Youth
DeBeck is currently the Principal Investigator of the At-Risk Youth Study (ARYS), an ongoing prospective cohort study funded by the US National Institutes of Health involving more than 900 high-risk, street youth who use drugs. Her work at ARYS aims to explore the individual, social, economic, and environmental factors that influence the health and well-being of street youth in Vancouver. Her research is funded by a Michael Smith Foundation for Health Research and St. Paul’s Hospital Foundation–Providence Health Care Career Scholar Award and a Canadian Institutes of Health New Investigator Award.
In March of 2021, DeBeck received federal funding to study the combined impact of the opioid overdose crisis and the COVID-19 pandemic on Vancouver youth who use drugs. British Columbia is struggling to manage simultaneous public health emergencies; the drug overdose crisis declared in April 2016 and the COVID-19 public health emergency declared in March 2020. The funding supports her latest work, which will consist of interviewing ARYS cohort participants to evaluate the impact of the pandemic on the illicit drug supply, overdose risk, access to overdose prevention interventions and the long-term trajectory of addiction treatment engagement and drug use patterns.
Using Indigenous Approaches to Address the Opioid Crises
DeBeck is also a co-investigator for a First Nations Health Authority (FNHA) led project and partnership with SFU. The Research Affiliation Agreement supports the FNHA to manage federal government funds for research into Indigenous health and wellness. A 2017 joint report from the B.C. Coroners Service and the FNHA found that Status First Nations people were five times more likely to experience an overdose, and three times more likely to die from one.
To date, there has been limited literature on Indigenous approaches to harm reduction for opioid use. This innovative project is the first in Canada to use community-based research to gather Indigenous perspectives on health and harm reduction and contributes to reconciliation, recognizing the right of First Nations to control all aspects of the research, information and data that impacts them.
“I want to see a greater recognition that the harms of substance use are directly linked to social inequities, trauma and ongoing colonization. Interventions that my work supports include the City of Vancouver and the Province of British Columbia’s respective proposals to decriminalize drug possession. Both proposals are imperfect but remain important symbolic steps towards a new approach to substance use.
Grassroots movements to address the toxic drug supply through compassion clubs and other innovative models that provide people who use drugs with a regulated supply of drugs are even more critical policy changes that I would like to see continue and which my work underscores the need for. Ultimately, the implementation of public policies that move away from harmful and ineffective models of drug criminalization and interrupt intergenerational trauma is the kind of change that I would like to see as a result of my work.”
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