In recent years, cities in North America have declared public health emergencies in response to opioid–related overdoses and fatalities. Municipalities are reacting with various interventions and degrees of urgency, whereas harm reduction organizations coordinate the street–level fight against death. Though drug use has long been concentrated in urbanized and downtown areas, these neighborhoods are being addressed with new national attention. This article draws on qualitative interviews with participants in the Downtown Eastside (DTES) in Vancouver and the Tenderloin in San Francisco. I highlight two interconnected themes: (1) the legacy of distrust between municipal officials and drug users and (2) the disconnection between “epidemics” as narrowly constructed public health emergencies and the needs of communities. Findings show ongoing struggles with “progressive” urban agendas. San Francisco minimized fatalities thanks to the early introduction of unregulated naloxone; however, new anti–homelessness legislation and police–led initiatives continue to create social upheaval for drug users. In comparison, the rollout of Vancouver's naloxone program arrived 10 years too late. Organizations are attempting to amplify access to safe injection and overdose prevention sites in the DTES. Using interurban analysis, overdose epidemics can be conceptualized as sociospatial fields of power, providing greater insight into urban marginality and health inequalities.

中文翻译：

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“中间地带”：城市治理与过量流行病的空间化

近年来，北美城市已宣布突发公共卫生事件，以应对与阿片类药物相关的过量用药和死亡事件。市政当局正在以各种干预措施和紧急程度做出反应，而减少伤害组织则协调街道层面的与死亡的斗争。虽然吸毒长期以来一直集中在城市化和市中心地区，但这些社区正受到新的国家关注。本文借鉴了对温哥华市中心东区 (DTES) 和旧金山 Tenderloin 参与者的定性访谈。我强调两个相互关联的主题：（1）市政官员和吸毒者之间的不信任遗留问题；（2）“流行病”作为狭义的突发公共卫生事件与社区需求之间的脱节。调查结果显示，与“进步”城市议程的持续斗争。由于早期引入不受管制的纳洛酮，旧金山将死亡人数降至最低；然而，新的反无家可归立法和警察主导的举措继续为吸毒者带来社会动荡。相比之下，温哥华纳洛酮计划的推出晚了 10 年。组织正试图扩大对 DTES 中安全注射和过量预防站点的访问。使用城市间分析，药物过量流行可以被概念化为社会空间权力领域，提供对城市边缘性和健康不平等的更深入的了解。新的反无家可归立法和警察主导的举措继续为吸毒者带来社会动荡。相比之下，温哥华纳洛酮计划的推出晚了 10 年。组织正试图扩大对 DTES 中安全注射和过量预防站点的访问。使用城市间分析，药物过量流行可以被概念化为社会空间权力领域，提供对城市边缘性和健康不平等的更深入的了解。新的反无家可归立法和警察主导的举措继续为吸毒者带来社会动荡。相比之下，温哥华纳洛酮计划的推出晚了 10 年。组织正试图扩大对 DTES 中安全注射和过量预防站点的访问。使用城市间分析，药物过量流行可以被概念化为社会空间权力领域，提供对城市边缘性和健康不平等的更深入的了解。