A concept mapping study of service user design of safer supply as an alternative to the illicit drug market

Pauly, Bernadette; McCall, Jane; Cameron, Fred; Stuart, H.; Hobbs, Heather; Sullivan, Ginger; Ranger, C.; Urbanoski, Karen

doi:10.1016/j.drugpo.2022.103849

Cited by 16 publications

(15 citation statements)

References 45 publications

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“…” (2654). During the program development phase, key elements of effective safer supply identified by service users included the importance of the right drug and right dose as part of effective safer supply [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

“…Early implementation focused on nurse-led outreach to people who use substances and living in city parks to connect them with a prescriber while consulting with services providers, and other stakeholders to inform program development [ 20 ]. The emerging SAFER team collaborated with a local drug user organization (SOLID Outreach) and academic researchers to conduct a study of the perspectives of people who use drugs on effective safer supply [ 24 ]. Further, the SAFER program utilized emerging data from their evaluation processes to rapidly implement program changes to better serve their clients.…”

Section: Introductionmentioning

confidence: 99%

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Prescribed safer supply during dual public health emergencies: a qualitative study examining service providers perspectives on early implementation

McCall,

Hobbs,

Ranger

et al. 2024

Subst Abuse Treat Prev Policy

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Background Within North America and worldwide, drug related overdoses have increased dramatically over the past decade. COVID-19 escalated the need for a safer supply to replace unregulated substances and to reduce toxicity and overdoses. Service providers play an integral role in the delivery of safer supply but there is little empirical evidence that conceptualizes effective safer supply from their perspectives. This study explored early implementation and impacts of a safer supply program, capturing the perspectives of an interdisciplinary team of service providers on tensions and issues encountered in the development of the SAFER program. Methods Using a community-based participatory approach, we conducted individual interviews with program providers (n = 9). The research team was composed of researchers from a local drug user organization, a local harm reduction organization, and academic researchers. The Consolidated Framework for Implementation Research (CFIR) informed the interview guide. Data was analyzed using thematic analysis. Results There are six themes describing early implementation: (1) risk mitigation prescribing as context for early implementation; (2) developing SAFER specific clinical protocols; (3) accessibility challenges and program innovations; (4) interdisciplinary team and wraparound care; (5) program tensions between addiction medicine and harm reduction; (6) the successes of safer supply and future visions. Conclusion Early implementation issues and tensions included prescriber concerns about safer supply prescribing in a highly politicized environment, accessibility challenges for service users such as stigma, encampment displacement, OAT requirements, program capacity and costs, and tensions between addiction medicine and harm reduction. Navigating these tensions included development of clinical protocols, innovations to reduce accessibility challenges such as outreach, wraparound care, program coverage of medication costs and prescribing safer supply with/without OAT. These findings contribute important insights for the development of prescribed safer supply programs.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prescribed safer supply during dual public health emergencies: a qualitative study examining service providers perspectives on early implementation

McCall,

Hobbs,

Ranger

et al. 2024

Subst Abuse Treat Prev Policy

Self Cite

View full text Add to dashboard Cite

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“…This finding supports previous work from our setting and elsewhere which demonstrates that negative experiences with prescribers can lead to periods of disengagement from care among YPWUD ( Hargreaves et al, 2015 ; Pilarinos et al, 2022 ). Regardless of whether they continued to access hydromorphone prescriptions, in the absence of a safe supply of the drugs they were actively using – that is, pharmaceutical-grade fentanyl – all of the YPWUD in this study continued to access fentanyl via the illicit, highly toxic drug market ( Pauly et al, 2022 ).…”

Section: Discussionmentioning

confidence: 98%

Risk mitigation guidance and safer supply prescribing among young people who use drugs in the context of COVID-19 and overdose emergencies

Giang¹,

Charlesworth²,

Thulien³

et al. 2023

International Journal of Drug Policy

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“…Concept mapping has been employed in several settings, including domestic violence, end-of-life initiatives, and substance use (Crawford-Browne & Kaminer, 2012 ; Rao et al, 2005 ; Windsor, 2013 ). Of the concept mapping studies related to substance use and criminal legal involvement, each focuses on only one of these topics or a different connection (e.g., incarceration and HIV) (Antoniou et al, 2019 ; Pauly et al, 2022 ; Urbanoski et al, 2020 ). It is, however, underutilized in understanding the relationship between criminal legal involvement and overdoses.…”

Section: Introductionmentioning

confidence: 99%

Identifying structural risk factors for overdose following incarceration: a concept mapping study

Nall,

Jurecka,

Ammons

et al. 2024

Health Justice

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Background Currently, there are more than two million people in prisons or jails, with nearly two-thirds meeting the criteria for a substance use disorder. Following these patterns, overdose is the leading cause of death following release from prison and the third leading cause of death during periods of incarceration in jails. Traditional quantitative methods analyzing the factors associated with overdose following incarceration may fail to capture structural and environmental factors present in specific communities. People with lived experiences in the criminal legal system and with substance use disorder hold unique perspectives and must be involved in the research process. Objective To identify perceived factors that impact overdose following release from incarceration among people with direct criminal legal involvement and experience with substance use. Methods Within a community-engaged approach to research, we used concept mapping to center the perspectives of people with personal experience with the carceral system. The following prompt guided our study: “What do you think are some of the main things that make people who have been in jail or prison more and less likely to overdose?” Individuals participated in three rounds of focus groups, which included brainstorming, sorting and rating, and community interpretation. We used the Concept Systems Inc. platform groupwisdom for our analyses and constructed cluster maps. Results Eight individuals (ages 33 to 53) from four states participated. The brainstorming process resulted in 83 unique factors that impact overdose. The concept mapping process resulted in five clusters: (1) Community-Based Prevention, (2) Drug Use and Incarceration, (3) Resources for Treatment for Substance Use, (4) Carceral Factors, and (5) Stigma and Structural Barriers. Conclusions Our study provides critical insight into community-identified factors associated with overdose following incarceration. These factors should be accounted for during resource planning and decision-making.

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A concept mapping study of service user design of safer supply as an alternative to the illicit drug market

Cited by 16 publications

References 45 publications

Prescribed safer supply during dual public health emergencies: a qualitative study examining service providers perspectives on early implementation

Prescribed safer supply during dual public health emergencies: a qualitative study examining service providers perspectives on early implementation

Risk mitigation guidance and safer supply prescribing among young people who use drugs in the context of COVID-19 and overdose emergencies

Identifying structural risk factors for overdose following incarceration: a concept mapping study

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