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In this chapter, the authors consider the relationships between institutional settlements at the field level and the instantiation of logics at the organizational level. The authors present the case of Supervised Consumption Sites (also known as Safe Injection Sites) in Alberta, Canada where a settlement of logics supported by one government was disrupted with the election of a new provincial government in 2015, and then disrupted again after the election of yet another government four years later. The authors use this case to show how different institutional settlements can support or threaten particular types of organizations, and they also show how the instantiation of different settlements in organizations (organizational hybridity) can impact the ways in which organizations present themselves. By analyzing the public justifications provided by key members of Supervised Consumption Sites, they draw attention to connections between institutional settlements at the field level and organizational attempts to manage multiple logics.

This study aims to ask how HIV/AIDS is arranged as a public threat in and through Canadian law, particularly in relation to transmission, and how strategies of capture extend the affective force of criminalization leading to poor health outcomes for persons living with HIV/AIDS.

This is a conceptual paper with a focus on applying affect theorist Jasbir Puar’s work on assemblage and debility. The authors use Puar’s work to frame the conditions that persons with HIV/AIDS experience in the Canadian criminal justice context as debilitating.

The authors found that while HIV transmission is not itself a criminal act in the Canadian criminal justice context, activities where transmission is prevalent or possible have been criminalized, particularly in relation to nondisclosure of health status, sex work and substance use. Further, the authors found that when the activities associated with HIV transmission are criminalized, strategies of capture extend the affective force of criminalization first in the inadequate provision of health-care and pharma-care services, second in state resistance to implement harm reduction measure and third in punitive population management strategies.

Persons living with HIV/AIDS have historically experienced stigmatization, especially intersecting with neoliberal, white supremacist and heteropatriarchal axes of power. This paper uses assemblage theory to shore up how these relations operate in ways that close off possibilities, by constituting the HIV/AIDS assemblage as a criminal – rather than a health phenomenon. This paper, thus, holds Canada to account for debilitating a historically disadvantaged and multiplying marginalized population.

The purpose of this paper is to discuss overdose among those with criminal justice experience and recommend harm reduction strategies to lessen overdose risk among this vulnerable population.

Strategies are needed to reduce overdose deaths among those with recent incarceration. Jails and prisons are at the epicenter of the opioid epidemic but are a largely untapped setting for implementing overdose education, risk assessment, medication assisted treatment, and naloxone distribution programs. Federal, state, and local plans commonly lack corrections as an ingredient in combating overdose. Harm reduction strategies are vital for reducing the risk of overdose in the post-release community.

Therefore, the authors recommend that the following be implemented in correctional settings: expansion of overdose education and naloxone programs; establishment of comprehensive medication assisted treatment programs as standard of care; development of corrections-specific overdose risk assessment tools; and increased collaboration between corrections entities and community-based organizations.

In this policy brief the authors provide recommendations for implementing harm reduction approaches in criminal justice settings. Adoption of these strategies could reduce the number of overdoses among those with recent criminal justice involvement.

Critical analyses of health policies and practices may appear to lack practicality during unprecedented times that demand immediate solutions. This paper aims to use critical social science theories to help improve essential service delivery during a public health crisis.

This study is based on qualitative content analysis of government and scholarly sources between 2008 and 2021 to identify strengths and gaps underlying the Canadian Federal Government’s evidence-based solutions to the opioid death crisis. Key questions examined are: What constitutes best-evidence practices underlying the Canadian Drugs and Substances Strategy?, Is biomedical evidence the only legitimate framework to substantiate feasible interventions? and Because the opioid death crisis affects disproportionately vulnerable populations, what is the potential merit of considering diverse knowledges and practices as valid forms of intervention despite lacking biomedical evidence bases?

While overdose reversing drugs, drug replacement approaches, biologically focused harm reduction options and pharmacological regulatory and surveillance initiatives help reduce premature opioid-related morbidity and mortality across provinces, this study’s findings demonstrate that these individualizing, biomedical magic bullets are temporary solutions, not comprehensive plans to solve a societal problem. This study’s theoretically informed analysis shows that the Canadian Federal Government responses detract attention from issues of social justice, social inequities and the biomedical dominance of health care as broader forces of the opioid death crisis. To address these analytical omissions, broader evidence-based solutions must build upon meaningful intraventions, the insiders’ perspectives or voices of the afflicted communities alongside meaningful interventions – going beyond distal, clinical-based and proximal, home-based interventions.

By highlighting the biomedical and social embeddings of the opioid death crisis, this study underscores structural conditions rather than individuals’ physical bodies as the catalysts for change. A deeper theoretical understanding of why certain issues exists, as they do and how they occur, can provide the basis for prediction of their (re)occurrence and for informing meaningful intervention efforts.

States in the Middle East and North Africa (MENA) have historically leaned towards conservative, reactionary models of drugs policy. The combination of authoritarian forms of government, whether dynastic monarchies (Morocco, Jordan and Persian Gulf countries), semi-military republics (Syria, Egypt and Algeria) or religiously sanctioned republics (Iran), with the strong influence of Islamic law and norms, has signified that the region has enforced strict forms of drug prohibitions. For that matter, the region is home to cultural and social norms that are less permissive than in other regions of the world: for instance, with regard to premarital sex, homosexuality, clothing, alcoholic drinks and freedom of expression. This image of the MENA region is often overplayed by media commentators and Western scholars, especially in the field of drugs policy. The almost total absence of studies of drugs policy or drugs history in the MENA, excluding works in epidemiology, speaks well about the oblivion to which the region has been relegated over the last decades. The chapter provides first a background on the main questions regarding MENA drugs policy, looking at the historical developments in drug regulations and drug trends. Then, it discusses the current policies that operate across the region and, if pertinent, the prospects of policy development. When necessary, the argument refers to contextual elements that have influenced the direction in national and transitional drugs policy. Conscious of the fact that the MENA is as vast and diverse as a continent, I have opted to focus on three paradigmatic cases (Iran, Lebanon and Saudi Arabia), which provide an adequate geographical and thematic coverage of the MENA drugs policy. The three cases cover different aspects of today’s MENA drugs policy spectrum, from draconian repressive measures to progressive harm reduction programmes. Taken in their geographical dimension one can appreciate the variety and difference that exists within the MENA region, therefore supporting one of the key objectives of this chapter, which is to provide a nuanced analysis of drugs policy against the grain of homogenising and culturally reductive approaches.

Psychiatry and other areas of mental healthcare have a limited reach. According to the National Comorbidity Survey in the USA the majority of people with mental illnesses do not get any professional support. The current “acute care focus” treatment paradigm directs funding toward hospitals, medications and institutions. The purpose of this paper is to explore the appropriateness of this approach.

To assess the acute care focus in mental healthcare, the authors will contrast it with an alternative paradigm of harm reduction.

The authors argue that harm reduction principles based on the experiences of addiction medicine may be an added value to the current system of care along with structural reforms regarding early intervention and community-focussed care.

This discussion paper contributes to a growing body of literature recognizing the inefficiencies of the present acute care centered paradigm in healthcare.

The paper examines the historical shifts in policing strategies towards individuals with SMI and vulnerable populations, highlighting the development of co-response models, introducing the concept of “untethered” co-response.

This paper conducts a review of literature to trace the evolution of police responses to individuals with serious mental illness (SMI) and vulnerable populations. It categorizes four generations of police approaches—zero-policing, over-policing, crisis intervention and co-response—and introduces a fifth generation, the “untethered” co-response model exemplified by Project SCOPE in Philadelphia.

The review identifies historical patterns of police response to SMI individuals, emphasizing the challenges and consequences associated with over-policing. It outlines the evolution from crisis intervention teams to co-response models and introduces Project SCOPE as an innovative “untethered” co-response approach.

The research acknowledges the challenges in evaluating the effectiveness of crisis intervention teams and co-response models due to variations in implementation and limited standardized models. It emphasizes the need for more rigorous research, including randomized controlled trials, to substantiate claims about the effectiveness of these models.

The paper suggests that the “untethered” co-response model, exemplified by Project SCOPE, has the potential to positively impact criminal justice and social service outcomes for vulnerable populations. It encourages ongoing policy and evaluative research to inform evidence-based practice and mitigate collateral harms associated with policing responses.

Given the rising interactions between police and individuals with mental health issues, exacerbated by the COVID-19 pandemic, the paper highlights the urgency for innovative, non-policing-driven responses to vulnerable persons.

The paper contributes to the literature by proposing a fifth generation of police response to vulnerable persons, the “untethered” co-response model and presenting Project SCOPE as a practical example.