THE CHALLENGES OF REPLICATING DRUG CONSUMPTION ROOM POLICY IN AUSTRALIA AND CANADA A Comparative Exploration of Policy Transfer _____________________ Vanessa Gstrein BA (Hons) MSc Faculty of Arts, Humanities and Social Sciences Ulster University Submitted for the degree of Doctor of Philosophy May 2019 I confirm that the word count of this thesis is less than 100,000 words ii Table of contents List of Tables ................................................................................................................... iv List of Figures .................................................................................................................. iv Acknowledgements .......................................................................................................... v Abstract ........................................................................................................................... vi List of acronyms ............................................................................................................. vii Chapter one Introduction ............................................................................................. 1 1.1 Introduction ............................................................................................................. 2 1.2 Research aims and objectives .................................................................................. 6 1.3 Drug consumption rooms: background and literature ............................................ 8 1.4 Outline of the thesis .............................................................................................. 17 Chapter two A review of the literature ....................................................................... 22 2.1 Introduction ........................................................................................................... 23 2.2 Evidence-based policy and drug policy scholarship ............................................... 24 2.3 Ideation, social construction and drug policy: a scoping review ........................... 29 2.4 Discussion .............................................................................................................. 54 2.5 Conclusions ............................................................................................................ 57 Chapter three Theoretical framework ........................................................................ 59 3.1 Introduction ........................................................................................................... 60 3.2 Conceptual review ................................................................................................. 61 3.3 Theoretical framework .......................................................................................... 73 3.4 Conclusions ............................................................................................................ 77 Chapter four Methodology ......................................................................................... 78 4.1 Introduction ........................................................................................................... 79 4.2 A critical realist ontology ....................................................................................... 80 4.3 Ontology, the theoretical framework and research design ................................... 83 4.4 Case study methodology: selection and analysis .................................................. 86 4.5 Data sources and methods of collection ............................................................... 89 4.6 Methods of data analysis ....................................................................................... 96 4.7 Ethical issues ........................................................................................................ 100 4.8 Conclusion ........................................................................................................... 100 Chapter five Australian case studies: Sydney and Melbourne .................................. 102 5.1 Introduction ......................................................................................................... 103 5.2 Case study 1: Sydney, Australia ........................................................................... 104 5.3 Case study 2: Melbourne, Australia ..................................................................... 115 iii 5.4 Contextualising the Australian case studies ........................................................ 123 5.5 Findings and conclusions ..................................................................................... 135 Chapter six Canadian case studies: Vancouver and Toronto ..................................... 141 6.1 Introduction ......................................................................................................... 142 6.2 Case study 3: Vancouver, Canada ........................................................................ 143 6.3 Case study 4: Toronto, Canada ............................................................................ 157 6.4 Contextualising the Canadian case studies .......................................................... 165 6.5 Findings and conclusions ..................................................................................... 177 Chapter seven The challenges of replication: empirical findings ............................... 182 7.1 Introduction ......................................................................................................... 183 7.2 Method ................................................................................................................ 183 7.3 Thematic analysis findings ................................................................................... 184 7.4 Theme 1: Problem definition and crisis ............................................................... 186 7.5 Theme 2: Interactions between different levels of government ......................... 191 7.6 Theme 3: Policy conflict between public health and law enforcement approaches to drugs ........................................................................................................................... 194 7.7 Theme 4: Politics and political leadership ........................................................... 198 7.8 Theme 5: Controversy and debate ...................................................................... 202 7.9 Theme 6: The role of evidence ............................................................................ 207 7.10 Conclusions .......................................................................................................... 211 Chapter eight Policy transfer: understanding success and failure ............................. 212 8.1 Introduction ......................................................................................................... 213 8.2 The application of the policy transfer framework ............................................... 214 8.3 Alternative sources of policy change: the role of civil disobedience ................... 238 8.4 Appraising the policy transfer framework ........................................................... 243 8.5 Conclusions .......................................................................................................... 246 Chapter nine Conclusions ......................................................................................... 249 9.1 Introduction ......................................................................................................... 250 9.2 Summary of the main findings ............................................................................. 251 9.3 Contributions of this research ............................................................................. 255 9.4 Limitations ........................................................................................................... 259 9.5 Future research directions ................................................................................... 260 9.6 Conclusions .......................................................................................................... 262 Appendix 1 Ideation, social construction and drug policy scoping review charted data, 2016 ............................................................................................................................. 264 Appendix 2 Interview guides ........................................................................................ 268 List of references .......................................................................................................... 271 iv List of Tables Table 1.1 Research objectives and key research questions Table 1.2 Countries with official drug consumption rooms, 2018 Table 2.1 Search terms and records identified Table 2.2 Topics covered by studies Table 3.1 Multi-level policy transfer analysis Table 4.1 Multiple case study methodology analysis Table 4.2 Key documentary source categories Table 4.3 Recruitment of interview participants Table 4.4 Interview participants by category (role) and site Table 4.5 Phases and processes of thematic analysis Table 4.6 Final themes from thematic analysis Table 5.1 Support for the operation of MSIC in Kings Cross Table 6.1 Approved drug consumption rooms by province, December 2018 Table 7.1 Themes and sub-themes arising from stakeholder interviews in Australia and Canada of the challenges of replicating drug consumption rooms Table 8.1 Key