A Critical Analysis of UK News Media Representations of Proposals To
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International Journal of Drug Policy 68 (2019) 62–74 Contents lists available at ScienceDirect International Journal of Drug Policy journal homepage: www.elsevier.com/locate/drugpo Research Paper ‘We are still obsessed by this idea of abstinence’: A critical analysis of UK T news media representations of proposals to introduce drug consumption rooms in Glasgow, UK ⁎ A.M. Atkinsona, , A. McAuleyb,c, K.M.A. Traynerb,c, H.R. Sumnalla a Liverpool John Moores University, Public Health Institute, Exchange Station, Tithebarn Street, Liverpool. L2 2QP b School of Health of Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, United Kingdom c Health Protection Scotland, NHS National Services Scotland, 5 Cadogan Street, Glasgow G2 6QE, United Kingdom ARTICLE INFO ABSTRACT Keywords: Background: Drug consumptions rooms (DCRs) are a well-established and evidence-based harm reduction re- Drug consumption rooms sponse to drug use. Recently, a consortium led by health services in Glasgow, United Kingdom (UK), proposed Injection facilities piloting a DCR. In this article, we examine how the proposals were represented in news media reporting, and the News media possible effects of such reporting. Agenda setting Methods: A quantitative content and qualitative thematic analysis of UK news media (n = 174 articles) re- Policy making presentations of the proposals to introduce DCRs in the city of Glasgow, UK, was conducted. Analysis was Harm reduction Problematization informed by Bacchi’s (2009, 2012, 2017) approach to policy analysis, ‘What's the problem represented to be?’ Findings: Competing representations of the ‘problem’ of injecting drug use (IDU) were contested by a range of actors with different political visions. The applicability of the ‘evidence base’, potential benefits of DCRstoboth users and the public, and the associated economic costs, were presented in differing ways depending on the underlying assumptions and presumptions of the arguments constructed (e.g. harm reduction vs recovery). As a result, a number of conflicting subject positions were presented that may have implications for the waythat people who inject drugs (PWID) see themselves, and how they are viewed and treated by society. Whilst pro- ponents positioned DCRs within a discourse of public health, an underlying rhetoric of abstinence and recovery underpinned the arguments against DCRs. It was this latter discourse that underpinned the UK Government’s rejection of the proposals, which the Scottish Government were prevented from overruling within the political constraints of their devolved powers, with the lived effect of people who use drugs (PWUD) being denied access to public health services that mitigate harm. Conclusion: We conclude that attempts to introduce and gain public and political support for harm reduction responses such as DCRs through the news media face challenges within the historical and political context of prohibitionist UK drugs policy. Introduction although much of the evidence base is derived from research conducted in facilities operating in a small number of cities in Australia, Canada, Drug consumption rooms (DCRs), also known as safer/supervised Denmark, and Spain (Potier, Laprévote, Dubois-Arber, Cottencin, & injection or consumption facilities, are typically health-care settings Rolland, 2014). Literature reviews and evidence syntheses conclude that allow the consumption of pre-obtained drugs in safer and more that DCRs are successful at attracting the most vulnerable and mar- hygienic conditions, through supervision by medically-trained staff and ginalised people inject use drugs (PWID) (Potier et al., 2014). Research provision of clean injecting equipment (ACMD, 2016; European suggests that DCRs can be effective in preventing overdose morbidity Monitoring Centre for Drug Addiction, 2018; Jauffret-Roustide & and mortality, promoting safer injection conditions and practices, and Cailbault, 2018). Around 100 DCRs have been established worldwide may enhance access to health services (e.g. MacArthur et al., 2014; across Europe, North America, and Australia (EMCDDA, 2018; Jauffret- McNeil & Small, 2014; Potier et al., 2014). By providing a safe and Roustide & Cailbault, 2018; Lloyd, Stöver, Zurhold, & Hunt, 2017), hygienic injecting environment, DCRs may significantly reduce the ⁎ Corresponding author. E-mail address: [email protected] (A.M. Atkinson). https://doi.org/10.1016/j.drugpo.2019.03.010 0955-3959/ © 2019 Elsevier B.V. All rights reserved. A.M. Atkinson, et al. International Journal of Drug Policy 68 (2019) 62–74 sharing of injecting equipment, and as such could potentially reduce In a comparative analysis of policies in Germany, where DCRs have behaviours that increase the risk of blood-borne virus transmission. been established, and the UK, Lloyd et al. (2017) discussed a number of Modelling studies suggest DCRs could be cost-effective, with the short- barriers to implementation. These included legal challenges, assumed term cost of funding DCRs offset by long-term savings made from pre- lack of public tolerance, fear of the political consequences of introdu- venting infections and other morbidities among people who inject drugs cing unpopular policy, lack of police support, concerns over the quality (PWID) (Des Jarlais, Arasteh, & Hagan, 2008). Although one of the of the evidence base, associated costs, the possibility of low level street main objections to DCRs is that they might increase crime in sur- drug sales around DCR sites, and a general lack of prioritisation of drug rounding areas, primary studies suggest that crime (including drug policy by government. As discussed in relation to the implementation of dealing) does not increase and implementation of DCRs has been as- DCRs in France, tensions also arose when attempting to implement sociated with reductions in street-based drug use and discarded drug harm reduction policies in a context of drug prohibition (Jauffret- paraphernalia (Potier et al., 2014). There is less research on the social Roustide & Cailbault, 2018). Negative popular news media reporting acceptability of DCRs, and the impact of such facilities on public order has also been highlighted as a key influencing factor (Jauffret-Roustide (Jauffret-Roustide & Cailbault, 2018). & Cailbault, 2018), with governmental fear of being accused of opening The introduction of DCRs in the UK has been recommended on a ‘drug dens’ playing an important role in their rejection (Lloyd et al., number of occasions by a range of important policy actors, including 2017). the Advisory Council on the Misuse of Drugs (ACMD, 2016), yet no Whilst research highlights the influence of the media on the policy facilities are currently operational. A number of areas of the UK have making process, policy preference and formation is far from a linear proposed introducing DCRs (e.g. Cardiff, Brighton, West Midlands), the process. It involves a complex range of actors, ideologies, and structures most recent being the Scottish city of Glasgow. Scotland is one of four including constructions of problems and the identification of solutions, countries (i.e. England, Wales, Scotland, Northern Ireland) in the UK and opportunities for action; political and power relationships; ad- and has its own devolved government with responsibilities for a vocacy, lobbying and consensus building; availability and interpreta- number of devolved issues including health and criminal justice, whilst tion of evidence through knowledge brokers; election cycles and out- other areas such as drug policy are retained by the UK Government. comes, and development of community support and political will (e.g. PWID in Glasgow are a particularly vulnerable population. For ex- Cairney, 2016; Gornall, 2014; Kingdon, 2003; Oliver & de Vocht, 2015; ample, in 2009/10 this population experienced a large outbreak of Ritter, Hughes, Lancaster, & Hoppe, 2018; Sabatier, 1988). News media anthrax (Ramsay et al., 2010), which was followed in 2015 by the influences public opinion and policy making through an agenda setting largest documented outbreak of wound botulism in Europe (Trayner role by framing a particular perspective in order to tell audiences what et al., 2018). More recently, an increase of HIV infection among PWID to think about, how to think about it, and how it should be responded to was detected, with Glasgow currently experiencing its largest docu- by ‘putting a particular slant on issues’ (Bacchi, 2009: xvii; Lancaster, mented outbreak (Ragonnet-Cronin et al., 2018). These outbreaks of Hughes, Spicer, Matthew-Simmons, & Dillon, 2011; Lancaster, Duke, & acute infectious disease have occurred against a backdrop of increasing Ritter, 2015; Lancaster, Seear, & Treloar, 2015). In their discussion of drug-related deaths in Scotland, with rates higher than any other UK English drug policy ‘constellations’ Stevens and Zampini (2018) identi- country and amongst the highest in Europe (Millar & McAuley, 2017). fied the media as important actors in exerting influence andre- In response to accumulating evidence of poor health and social presenting asymmetric social powers through editorial position, re- outcomes for PWID, a needs assessment focussing on drug use in public presentation of evidence and norms, and providing privileged actors places in Glasgow city centre was published by the local health board in platforms and access to decision makers. Moreover, the extent to which June 2016 (NHS Greater Glasgow and Clyde (NHSGCC, 2016). This the news