International Journal of Drug Policy 41 (2017) 14–18
Contents lists available at ScienceDirect
International Journal of Drug Policy journal homepage: www.elsevier.com/locate/drugpo
Commentary
Developing national best practice recommendations for harm reduction programmes: Lessons learned from a community-based project Tara Marie Watsona , Carol Strikea,* , Laurel Challacombeb , Geoff Demelc , Diana Heywoodd, Nadia Zurbae a
Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada CATIE, 555 Richmond Street West, Suite 505, Toronto, Ontario, M5V 3B1, Canada c The Works, 277 Victoria Street, Toronto, Ontario, M5B 1W2, Canada d Winnipeg Regional Health Authority, 496 Hargrave Street, Winnipeg, Manitoba, R3A 0X7, Canada e Ontario Harm Reduction Distribution Program, 200 Princess Street, Kingston, Ontario, K7L 1B2, Canada b
A R T I C L E I N F O
Article history: Received 28 June 2016 Received in revised form 9 November 2016 Accepted 16 November 2016 Available online xxx Keywords: Best practice Harm reduction Drug use Stakeholder Community-based research
A B S T R A C T
Through promotion of consistent, evidence-based policy and practice, best practice recommendations can improve service delivery. Nationally relevant best practice recommendations, including guidance for programmes that provide service to people who use drugs, are often created and disseminated by government departments or other national organisations. However, funding priorities do not always align with stakeholder- and community-identified needs for such recommendations, particularly in the case of harm reduction. We achieved success in developing and widely disseminating best practice documents for Canadian harm reduction programmes by bringing together a multi-stakeholder, crossregional team of people with relevant and diverse experience and expertise. In this commentary, we summarise key elements of our experience to contribute to the literature more detailed and transparent dialogue about team processes that hold much promise for developing best practice resources. We describe our project’s community-based principles and process of working together (e.g., regularly scheduled teleconferences to overcome geographic distance and facilitate engagement), and integrate post-project insights shared by our team members. Although we missed some opportunities for powersharing with our community partners, overall team members expressed that the project offered them valuable opportunities to learn from each other. We aim to provide practical considerations for researchers, other stakeholders, and community members who are planning or already engaged in a process of developing best practice recommendations for programmes and interventions that address drug use. © 2016 Elsevier B.V. All rights reserved.
Detailed dialogue about the development of evidence-based best practice recommendations for health-related and prevention programmes, including documents designed for programmes that provide service to people who use drugs (see Burrows (2006); National Institute for Health and Care Excellence [NICE] (2014); NYC Department of Health and Mental Hygiene (2009); Strike et al. (2011); World Health Organization (2007, 2009)), is largely absent from the published literature. In particular, the degree of
* Corresponding author. E-mail address:
[email protected] (C. Strike). http://dx.doi.org/10.1016/j.drugpo.2016.11.008 0955-3959/© 2016 Elsevier B.V. All rights reserved.
community involvement in the development of best practice resources designed for interventions that address drug use is unclear, despite the recognised importance of such involvement (see Jürgens (2008); Schiffer (2011)). In this commentary, we reflect on our own experience of developing national-level best practice recommendations for harm reduction programmes (primarily, needle and syringe programmes) that provide service to people who inject and/or use drugs in other ways. We achieved unprecedented reach with these best practice recommendations, and share our case example from Canada to produce some practical considerations and advice that will benefit international researchers, other stakeholders, and community members interested or
T.M. Watson et al. / International Journal of Drug Policy 41 (2017) 14–18
already engaged in a process of developing similar recommendations. We hope to motivate greater sharing of such team experiences and processes because best practice recommendations promote consistent, evidence-based policy and practice, and can, in turn, improve programmes delivery and address health service disparities that impact marginalised populations. According to a group convened by the European Monitoring Centre for Drugs and Drug Addiction, “best practice”—in this context, applicable to drug demand reduction interventions— means “the best application of available evidence to current activities in the drugs field” (Ferri & Bo, 2013; p. 332). Nationally relevant health-related best practice recommendations are often created and disseminated by government departments or other national organisations. Notable examples related to drug use include guidelines for methadone maintenance treatment and concurrent mental health and substance use disorders developed by Health Canada (2002a, 2002b) and guidance for needle and syringe programmes produced by NICE (2014) in the United Kingdom. Unfortunately, production of such documents may not be a priority for governments and other organisations, especially if the subject area is not seen as within the scope of their work or is regarded as controversial, as is often the case with harm reduction programmes. A major challenge, particularly when the topic area may not be regarded as a current priority, is securing the funding and resources needed to convene a dedicated team that will complete the literature searches and retrieval, evidence syntheses, recommendation development, and eventual dissemination of best practice guidance to a wide audience of service providers and users. We confronted these issues as we began, back in 2009, to bring together a national team to complete a narrative synthesis (e.g., Popay et al., 2006) of evidence derived from research on programmes that serve people who use drugs. Our overarching goals were to develop comprehensive best practice recommendations that address multiple facets of harm reduction programming and disseminate this guidance to applicable programmes across Canada. Despite a stakeholder- and community-identified need, as we note below, for such recommendations, to the best of our knowledge, at the time we started our project the Canadian federal government had shown no intention of preparing or funding best practice guidelines for harm reduction programmes. We initiated and completed our project under an “anti-drug” federal policy climate; that is, in 2007, the former Conservative government launched a National Anti-Drug Strategy that omitted harm reduction as a pillar (DeBeck, Wood, Montaner, & Kerr, 2009). Indeed, securing funding for our project was a time-consuming effort, especially given the competitiveness of national research grant competitions. We sought funding from several sources and eventually secured funding from two, including a competition for HIV-related community-based research (CBR) projects hosted by the federal health research funding body. Next, we describe our project in more detail and integrate postproject insights shared by team members. As we neared project completion in August 2015, we invited all team members— including those who had only been able to participate for short periods and/or were no longer participating—to attend via teleconference an audio-recorded group “debriefing” session that was moderated by an external evaluator. We hoped that by informally collecting this “data”, we would capture valuable, transferable team member insights about the process they were a part of to develop best practice recommendations and any resulting personal and organisational capacity building. National team formation and principles Prior to our project, like many other international jurisdictions (see Stone (2014)), Canada lacked national-level policies and best
15
practice recommendations for harm reduction programmes, although provincial-level recommendations had been developed for two provinces, Ontario (Strike et al., 2006) and British Columbia (Buxton et al., 2008; Chandler, 2008). In 2009, meetings with key stakeholders from across Canada were held to discuss harm reduction programming priorities. Attendees, along with others recruited from varied groups across the country who were known to possess relevant expertise, joined together to meet an objective that arose from these meetings—a call for the development of national best practice recommendations. This multi-stakeholder best practice team, comprised of anglophone and francophone partners, included: people with lived experience of drug use, including a representative from a well-established user-led organisation; managers and workers at harm reduction programmes in each region of the country, most of whom had previous research-team experience; the manager of a provincial harm reduction supply programme; a consultant with a provincial health ministry; a manager at a national organisation that specialises in HIV/hepatitis C treatment and prevention knowledge translation; and researchers with years’ worth of experience investigating the epidemiology of drug use in Canada, harm reduction programmes, blood-borne and other infections, and other relevant topics. Our best practices project unfolded over the course of four years and two major phases, using a CBR approach that entailed a “longterm process and commitment” (Arroyo-Johnson et al., 2015) whereby all team members contributed to project design and implementation. Consensus was a central feature to our project’s terms of reference as we were mindful that in CBR there are often power imbalances between researchers and community members that can render it difficult to incorporate community perspectives (e.g., Banks et al., 2013; Foster et al., 2012; Ross et al., 2010); we thus aimed to achieve team consensus on all project decisions. Also as a team, we agreed on the topics to be covered in the best practice documents (please see Table 1 for chapter topics found in Strike et al. (2013, 2015)); each team member was charged with soliciting input from their regional stakeholders and to report on what content was deemed to be essential for inclusion. The project was also designed to include learning opportunities for the staff and students who reviewed literature and initially drafted best practice recommendations for feedback from the full team, following a core principle of CBR to promote “a co-learning and empowering process” (Israel, Schulz, Parker, & Becker, 1998). Project building and maintenance Geographic dispersion of researchers and stakeholders can lead to high costs—especially for CBR projects that would benefit from having close or face-to-face interaction among team members—as well as logistical (e.g., travel and time-zone differences) and engagement challenges (Foster et al., 2012; Isler et al., 2015). Funding is again a key issue, as funders do not always provide enough resources for large teams to meet in person. Given that we faced such a constraint yet wanted all team members to be actively included in all stages of the project, we had to find a cost-effective way to engage a national team; these were our reasons for choosing teleconferences as our primary method of communication and tool to work collaboratively on best practice development. We met by teleconferences to discuss each chapter and evidence summary as they were drafted, giving team members multiple opportunities to report on their feedback (either on the calls and/or over email), with emphasis on the wording, consistency, and usefulness of the drafted best practice recommendations. While teleconference meetings might intuitively seem impersonal or limited, in our case service providers and other team members found that our model was well-coordinated, efficient,
16
T.M. Watson et al. / International Journal of Drug Policy 41 (2017) 14–18
Table 1 Topics covered in the best practice recommendations for Canadian harm reduction programmes. Best practices part 1 (Strike et al., 2013)
Best practices part 2 (Strike et al., 2015)
Needle and syringe distribution
Programme delivery models (fixed-site NSPs, mobile NSPs, pharmacy-based distribution and purchase, peer-based outreach, and needle/syringe vending machines) Needle distribution for anabolic steroid injection, hormone injection, piercing and/or tattooing Foil distribution Safer crystal methamphetamine smoking equipment distribution Injection-related complications—prevention, assessment and treatment Testing services for HIV, hepatitis C, hepatitis B, and tuberculosis Vaccination services for hepatitis A and B, pneumococcal pneumonia, influenza, tetanus, and diphtheria HIV and/or hepatitis C treatment referrals
Cooker distribution Filter distribution Ascorbic acid distribution Sterile water distribution Alcohol swab distribution Tourniquet distribution Safer crack cocaine smoking equipment distribution Handling and disposal of used drug use equipment Safer drug use education Overdose prevention: education and naloxone distribution
Substance use treatment referrals Mental health services referrals Housing services referrals Relationships with law enforcement Education and other services for the prison context
and actually facilitated engagement. During the debriefing session, numerous team members said that the teleconferences were a productive way in which to discuss the large amount of material being reviewed, synthesised, and distilled into practical, evidencebased recommendations. Although some team members said that they would have liked face-to-face meetings to get to know others on the team, they recognised that in-person meetings would have been logistically difficult and costly; moreover, these same team members stated that the teleconferences worked well enough to keep up project momentum. To ensure that we used a “cyclical and iterative process” (see again Arroyo-Johnson et al. (2015); Israel et al. (1998)), teleconferences were regularly scheduled and followed a common structure. We aimed for monthly meetings, although there were longer breaks depending on the time of year or chapter-writing progress. Some team members acknowledged that their project participation waxed and waned at times due to competing work demands or schedule conflicts, and thus offered appreciation for the multiple opportunities offered to review all drafted material and provide feedback. Several team members also noted that the value placed on consensus was evident during the teleconferences, and described the overall process as “more of a conversation back and forth” that involved working together to ensure that everyone’s perspective was heard and incorporated into the final chapters as much as possible. If and when any disagreements arose, there was a commitment to have as much discussion as needed to resolve the disagreement or to revise any disputed content, for example, and resend to the team for later discussion. Teleconferences were led by the principal investigator (Strike) or on occasion by the research coordinator (Watson). A smaller sub-team including these two team members, a frontline worker from the larger team, hired research staff, and graduate students drafted chapters and evidence summaries. We searched six databases for literature related to each topic of interest and adapted an evidence-appraisal approach based on NICE (2012) methods that fit with the scope of the project (for more details about the evidence review and synthesis methods we used, please see the method appendices in Strike et al. (2013, 2015)). Every draft chapter produced was reviewed and revised by the principal investigator and research coordinator, then sent to the larger team for review. We found that this division of labour was efficient and respected other team members’ daily work commitments and level of comfort with the material and research writing methods. Near the end of each phase of our project, once we had complete drafts of each best practice document, team members were provided with a package containing all revised chapters and summaries for final review and approval.
We concede that while the teleconference moderation, literature reviews, and drafting work were excellent opportunities for power-sharing and capacity-building for our community members on the team (i.e., service providers and people with lived experience of drug use), we missed some opportunities by having these tasks completed by those who already possessed experience with research methods and writing. Nonetheless, of critical importance during the chapter-development stages in the process were the team teleconference discussions about the quality of the reviews and the wording and relevance of the best practice recommendations that opened each chapter. In particular, the feedback from people with lived experience of drug use was invaluable as they often spoke about emerging drug-use practices that were localised, presented new challenges and opportunities for programmes, and were often not yet known to service providers. These team members were from different provinces (Ontario, Alberta, and British Columbia) and brought their own unique histories that varied in terms of, among other features, type(s) of drug use and involvement as peer workers; these experiences likely shaped their opinions regarding what practices should be recommended (see Lancaster, Santana, Madden, and Ritter (2015)). Feedback from the service providers was also crucial, especially since early in the process we decided as a team that the best practice recommendations would be aimed at programmes and staff. “Practice-research collaborations” become complicated when research methods are not seen by service providers as relevant to their real-life practice and/or when researchers warily receive the knowledge and experience shared by service providers (Secret, Abell, & Berlin, 2011). Fortunately, during the debriefing session team members, including the community members, expressed that our project offered them important opportunities to learn from each other, especially through hearing different perspectives and about different practices from stakeholders across the country. It was also noted during the debriefing session that everyone on the team had the same “amount of credibility” and mutual respect in the process. According to a person with lived experience who attended the debriefing, project participation was a very positive experience and involved strong, non-judgemental communication and a sense of inclusion. Upon deeper reflection, we further concede that we should have modified our communication strategy throughout the project to better engage people with lived experience of drug use. Attending teleconferences may not always be feasible for this population, especially when working across different time zones (our regular teleconference start time was 12 p.m. Eastern Standard Time, but for those in British Columbia, for example, this meant 9 a.m.). People
T.M. Watson et al. / International Journal of Drug Policy 41 (2017) 14–18
who use drugs and are at risk of health-related harms often experience low income, unstable housing, unstable employment, marginalisation and stigma, and numerous other social-structural challenges in their lives (e.g., Corneil et al., 2006; Grinman et al., 2010; Lloyd, 2013; Stein & Friedman, 2002). When we started the project, we had three community members with lived experience on the team and varied supports were put in place to assist them (e.g., pairing with a local harm reduction programme manager for assistance with printing materials, telephone access, and meeting reminders; honoraria for participation). However, we observed much greater participation from people with lived experience during the first half of the project than during the second half. More effort could have been made to locate additional team members with lived experience and check in with all of our existing community partners regarding their understanding and comfort with the material, especially for the clinical chapters (e.g., on testing services, vaccination services) that we developed during the project’s second phase. Involving people who use drugs not only benefits best practice research and development due to the important and diverse insights they can contribute, insights that may reflect “interconnected (and sometimes conflicted)” knowledge about effective interventions and lived experiences of stigmatisation (Lancaster et al., 2015), but may also enhance these team members’ personal knowledge and capacity for related work, volunteering, advocacy, and other opportunities (Boyd & Boyd, 2014; Schiffer, 2011). It is therefore essential to employ multiple ways of engaging and checking in with such community members. Our project—and likely other best practice projects addressing drug use interventions—would have surely benefited from greater built-in involvement of and training opportunities for people who use drugs. Best practice dissemination and moving forward We produced two accessible and widely-used best practice documents (Strike et al., 2013, 2015) and accompanying materials (e.g., chapter summaries, webinar presentations), and all team members were acknowledged as authors on the final documents. In collaboration with team members, we developed a multipronged dissemination strategy to ensure that the best practice recommendations would reach programmes across Canada as well as a much wider audience. Our dissemination efforts, an “essential element” of CBR (May & Law, 2008), included having all content hosted and promoted online by our main knowledge exchange partner, CATIE (see www.catie.ca/en/programming/best-practices-harm-reduction), national webinars that introduced each document, and presentations at regional, national, and international conferences. Additionally, we secured funding to have the best practice documents translated into French and followed a similar dissemination strategy in collaboration with francophone partners. We feel confident that our recommendations have indeed reached many stakeholders to date. According to CATIE, for instance, the first full instalment of the best practice recommendations and chapter summaries, launched in late 2013, had been downloaded 21,217 and 31,712 times, respectively (these totals include both English and French downloads), by May 2016. Drawing on the above summary of our experience, we present what we believe are general steps for successful best practice development and dissemination in harm reduction and other drug-use related fields: Convene a national team of diverse stakeholders and ensure that everyone has opportunities to contribute to project design and development, including the refinement and revision of best practice recommendations. Commit to consensus decision-making, including as much team discussion as needed to address any contentious issues.
17
Offer team members across regions opportunities to learn from each other regarding topics directly related to the project as well as emergent issues in local practice. Regularly scheduled teleconferences are a simple yet useful tool for such collaboration. Commit to multipronged dissemination efforts and encourage team members to present the best practices to their local stakeholders/regions. Our project is a unique success story in best practice development, especially since we worked together outside of government or a national organisation during a time when federal drug policy in our country was not highly supportive of harm reduction. We have shared our experience in the hopes of inspiring other teams internationally to use CBR-informed approaches and basic technologies to overcome geographic distances and facilitate engagement, and to build in greater opportunities for people with lived experience, in pursuit of developing much-needed, evidencebased best practice recommendations designed to reduce the many potential harms associated with drug use. Acknowledgements We are deeply grateful to the following staff and team members who contributed their time and expertise to the best practices project: Ashraf Amlani, Camille Arkell, Jane Buxton, Hemant Gohil, Natalia Gutiérrez, Shaun Hopkins, Hugh Lampkin, Jenny Lebounga Vouma, Pamela Leece, Lynne Leonard, Lisa Lockie, Peggy Millson, Miroslav Miskovic, Carole Morissette, Diane Nielsen, Darren Petersen, Samantha Robinson, Despina Tzemis, and Sara Young. The project would not have been possible without their invaluable insights. This work was supported by the AIDS Bureau, Ontario Ministry of Health and Long-Term Care; and the Canadian Institutes of Health Research [grant number CBR-127101]. Conflict of interest None declared. References Arroyo-Johnson, C., Allen, M. L., Colditz, G. A., Ali Hurtado, G., Davey, C. S., Thompson, V. L. S., . . . Goodman, M. S. (2015). A tale of two community networks program centers: Operationalizing and assessing CBPR principles and evaluating partnership outcomes. Progress in Community Health Partnerships: Research, Education, and Action, 9(Suppl), 61–69. Banks, S., Armstrong, A., Carter, K., Graham, H., Hayward, P., Henry, A., . . . Strachan, A. (2013). Everyday ethics in community-based participatory research. Contemporary Social Science, 8(3), 263–277. Boyd, J., & Boyd, S. (2014). Women’s activism in a drug user union in the Downtown Eastside. Contemporary Justice Review, 17(3), 313–325. Burrows, D. (2006). High coverage sites: HIV prevention among injecting drug users in transitional and developing countries: Case studies. Geneva: Joint United Nations Programme on HIV/AIDS. Buxton, J. A., Preston, E. C., Mak, S., Harvard, S., Barley, J., & BC Harm Reduction Strategies and Services Committee (2008). More than just needles: An evidence-informed approach to enhancing harm reduction supply distribution in British Columbia. Harm Reduction Journal, 5, 37. Chandler, R. (2008). Best practices for British Columbia’s harm reduction supply distribution program. Vancouver: BC Harm Reduction Strategies and Services Committee. Corneil, T. A., Kuyper, L. M., Shoveller, J., Hogg, R. S., Li, K., Spittal, P. M., . . . Wood, E. (2006). Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Health and Place, 12(1), 79–85. DeBeck, K., Wood, E., Montaner, J., & Kerr, T. (2009). Canada’s new federal ‘National Anti-Drug Strategy’: An informal audit of reported funding allocation. International Journal of Drug Policy, 20(2), 188–191. Ferri, M., & Bo, A. (2013). Best practice promotion in Europe: A web-based tool for the dissemination of evidence-based demand reduction interventions. Drugs: Education, Prevention and Policy, 20(4), 331–337. Foster, J. W., Chiang, F., Burgos, R. I., Cáceres, R. E., Tejada, C. M., Almonte, A. T., . . . Heath, A. (2012). Community-based participatory research and the challenges of qualitative analysis enacted by lay, nurse, and academic researchers. Research in Nursing and Health, 35(5), 550–559.
18
T.M. Watson et al. / International Journal of Drug Policy 41 (2017) 14–18
Grinman, M. N., Chiu, S., Redelmeier, D. A., Levinson, W., Kiss, A., Tolomiczenko, G., . . . Hwang, S. W. (2010). Drug problems among homeless individuals in Toronto, Canada: Prevalence, drugs of choice, and relation to health status. BMC Public Health, 10, 94. Health Canada (2002a). Best practices: Concurrent mental health and substance use disorders. Ottawa: Health Canada. Health Canada (2002b). Best practices: Methadone maintenance treatment. Ottawa: Heath Canada. Isler, M. R., Miles, M. S., Banks, B., Perreras, L., Muhammad, M., Parker, D., & CorbieSmith, G. (2015). Across the miles: Process and impacts of collaboration with a rural community advisory board in HIV research. Progress in Community Health Partnerships: Research, Education, and Action, 9(1), 41–48. Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of communitybased research: Assessing partnerships approaches to improve public health. Annual Review of Public Health, 19, 173–202. Jürgens, R. (2008). Nothing about us without us—Greater, meaningful involvement of people who use illegal drugs: A public health, ethical, and human rights imperative, international edition. Toronto: Canadian HIV/AIDS Legal Network, International HIV/AIDS Alliance, Open Society Institute. Lancaster, K., Santana, L., Madden, A., & Ritter, A. (2015). Stigma and subjectivities: Examining the textured relationship between lived experience and opinions about drug policy among people who inject drugs. Drugs: Education, Prevention and Policy, 22(3), 224–231. Lloyd, C. (2013). The stigmatization of problem drug users: A narrative literature review. Drugs: Education, Prevention and Policy, 20(2), 85–95. May, M., & Law, J. (2008). CBPR as community health intervention: Institutionalizing CBPR within community based organizations. Progress in Community Health Partnerships: Research, Education, and Action, 2(2), 145–155. National Institute for Health and Care Excellence (2012). Methods for the development of NICE public health guidance, 3rd ed. Retrieved from https:// www.nice.org.uk/process/pmg4/chapter/introduction. National Institute for Health and Care Excellence (2014). Needle and syringe programmes. London: National Institute for Health and Care Excellence. NYC Department of Health and Mental Hygiene (2009). Recommended best practices for effective syringe exchange programs in the united states: Results of a consensus meeting. New York: NYC Department of Health and Mental Hygiene. Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., . . . Duffy, S. (2006). Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC methods programme. Lancaster: Lancaster University.
Ross, L. F., Loup, A., Nelson, R. M., Botkin, J. R., Kost, R., Smith, G. R., & Gehlert, S. (2010). Challenges of collaboration for academic and community partners in a research partnership: Points to consider. Journal of Empirical Research on Human Research Ethics, 5(1), 19–31. Schiffer, K. (2011). ‘Nothing about us, without us’: Participation and involvement of drug users in health services and policy making. Amsterdam: Correlation Network. Secret, M., Abell, M. L., & Berlin, T. (2011). The promise and challenge of practiceresearch collaborations: Guiding principles and strategies for initiating, designing, and implementing program evaluation research. Social Work, 56 (1), 9–20. Stein, M. D., & Friedman, P. (2002). Need for medical and psychosocial services among injection drug users: A comparative study of needle exchange and methadone maintenance. American Journal on Addictions, 11(4), 262– 270. Stone, K. (2014). The global state of harm reduction 2014. London: Harm Reduction International. Strike, C., Hopkins, S., Watson, T. M., Gohil, H., Leece, P., Young, S., . . . Zurba, N. (2013). Best practice recommendations for Canadian harm reduction programs that provide service to people who use drugs and are at risk for HIV, HCV, and other harms: Part 1. Toronto: Working Group on Best Practice for Harm Reduction Programs in Canada. Strike, C., Leonard, L., Millson, M., Anstice, S., Berkeley, N., & Medd, E. (2006). Ontario needle exchange programs: Best practice recommendations. Toronto: Ontario Needle Exchange Coordinating Committee. Strike, C., Watson, T. M., Gohil, H., Miskovic, M., Robinson, S., Arkell, C., . . . Zurba, N. (2015). Best practice recommendations for Canadian harm reduction programs that provide service to people who use drugs and are at risk for HIV, HCV, and other harms: Part 2. Toronto: Working Group on Best Practice for Harm Reduction Programs in Canada. Strike, C., Watson, T. M., Lavigne, P., Hopkins, S., Shore, R., Young, D., . . . Millson, P. (2011). Guidelines for better harm reduction: Evaluating implementation of best practice recommendations for needle and syringe programs (NSPs). International Journal of Drug Policy, 22(1), 34–40. World Health Organization (2007). Guide to starting and managing needle and syringe programmes. Geneva: World Health Organization. World Health Organization (2009). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva: World Health Organization.
