‘It's our safe sanctuary’: Experiences of using an unsanctioned overdose prevention site in Toronto, Ontario

Foreman-Mackey, Annie; Bayoumi, Ahmed M.; Miskovic, Miroslav; Kolla, Gillian; Strike, Carol

doi:10.1016/j.drugpo.2019.09.019

Cited by 57 publications

(31 citation statements)

References 19 publications

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“…Each is integrated within an existing community health agency (CHA), including two comprehensive community health centers and one harm reduction program. SCS were first implemented in Toronto in the summer of 2017 with an unsanctioned site situated in a downtown park, [ 17 ] and the first sanctioned SCS opened in August 2017. Both SCS and overdose prevention sites are herein referred to collectively as SCS, a term we use to reflect that the sites permit consumption by multiple routes.…”

Section: Introductionmentioning

confidence: 99%

The Ontario Integrated Supervised Injection Services Cohort Study of People Who Inject Drugs in Toronto, Canada (OiSIS-Toronto): Cohort Profile

et al. 2021

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The Ontario Integrated Supervised Injection Services cohort in Toronto, Canada (OiSIS-Toronto) is an open prospective cohort of people who inject drugs (PWID). OiSIS-Toronto was established to evaluate the impacts of supervised consumption services (SCS) integrated within three community health agencies on health status and service use. The cohort includes PWID who do and do not use SCS, recruited via self-referral, snowball sampling, and community/street outreach. From 5 November 2018 to 19 March 2020, we enrolled 701 eligible PWID aged 18+ who lived in Toronto. Participants complete interviewer-administered questionnaires at baseline and semi-annually thereafter and are asked to consent to linkages with provincial healthcare administrative databases (90.2% consented; of whom 82.4% were successfully linked) and SCS client databases. At baseline, 86.5% of participants (64.0% cisgender men, median ([IQR] age= 39 [33–49]) had used SCS in the previous 6 months, of whom most (69.7%) used SCS for <75% of their injections. A majority (56.8%) injected daily, and approximately half (48.0%) reported fentanyl as their most frequently injected drug. As of 23 April 2021, 291 (41.5%) participants had returned for follow-up. Administrative and self-report data are being used to (1) evaluate the impact of integrated SCS on healthcare use, uptake of community health agency services, and health outcomes; (2) identify barriers and facilitators to SCS use; and (3) identify potential enhancements to SCS delivery. Nested sub-studies include evaluation of “safer opioid supply” programs and impacts of COVID-19.

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Section: Introductionmentioning

confidence: 99%

The Ontario Integrated Supervised Injection Services Cohort Study of People Who Inject Drugs in Toronto, Canada (OiSIS-Toronto): Cohort Profile

et al. 2021

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“…Promoting the inclusion of people with lived and living experience (PWLLE) of substance use in public health initiatives is central to harm reduction policies and practices [ 4 – 6 ]. There is a long history of grassroots organizing of PWLLE in the harm reduction field which laid the foundation for such inclusion, including grassroots self-organizing among PWLLE for harm reduction and human rights during HIV crises of the 1970–1990s [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Organizational support for frontline harm reduction and systems navigation work among workers with living and lived experience: qualitative findings from British Columbia, Canada

et al. 2021

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Background The inclusion of people with lived and living experience of substance use is essential to effective and client-centered harm reduction services and strategies. The aim of this study is to critically examine and characterize peer worker roles and the definition, recognition, and support for these roles within harm reduction organizations. Methods Fifteen interviews were conducted with peer workers—people with lived and living experience of substance use engaged in harm reduction service delivery—in British Columbia, Canada. An interpretive descriptive approach to data analysis was used to generate themes that best illustrated the roles of peer workers. Findings Two interrelated and overarching themes are presented: (1) peer work in practice; (2) organizational support. Our findings illustrate that peer work is incredibly complex and demanding, requiring peers to be at the forefront of support within their communities while simultaneously navigating the oppressive structures within which they work. While peer workers found a high degree of purpose and meaning in their day-to-day work, their roles lacked definition within organizations, which produced feelings of ineffectiveness and being undervalued. A lack of organizational understanding and recognition of their roles was evident from unclear "peer" role titles, a lack of role communication and expectations, the representation of experiential knowledge, and a lack of role support and training. Conclusions These findings may help harm reduction organizations understand peer work and worker roles which may inform and promote equity in future harm reduction initiatives that include people with living and lived experience of substance use.

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“…Qualitative research on 'peer' employment in harm reduction services, including overdose prevention and response, reveal similar benefits, in particular the effectiveness of peer-led models of care. In reaching vulnerable communities, however, they also detail the particular struggles experienced in their efforts to care for others who use illicit drugs, including material and pay inequities that factor into negotiation and navigation of the invisible boundaries that demark what constitutes a 'peer, ' and frought workplace policies regarding drug use/abstinence, as described by our study participants, and which remain unresolved [1,4,9,28,37,38]. Significantly, the involvement of people with lived experience of drug use has also resulted in increased diversity within many of these service settings, with socially and economically marginalized women and Indigenous people who use(d) drugs taking a particularly prominent role in emerging programming [31,[39][40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Having a voice and saving lives: a qualitative survey on employment impacts of people with lived experience of drug use working in harm reduction

Austin

Boyd

2021

Harm Reduct J

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Background Ongoing legal and social discrimination, and stigmatization of people with lived experience of drug use (PWLE) continues to contribute to overdose-related deaths in Canada. The involvement of PWLE working in harm reduction services has proven effective in decreasing drug-related harms among PWLE; however, there exist unintended negative impacts. PWLE working in harm reduction services risk overextending themselves beyond employment parameters (e.g., emotional labor) with few systems in place (e.g., employment advocacy) for support. While meaningful participation of PWLE in harm reduction programs is critical to addressing the overdose crisis, their labor in Canada’s overdose response commands further investigation and recognition. This paper examines some of the benefits and negative aspects of working in harm reduction among PWLE. Methods Fifty qualitative surveys were completed by PWLE working in harm reduction services from across Canada at the National 2018 Stimulus conference held in Edmonton, Alberta. The surveys focused on the benefits and negatives of ‘peer’ employment and recommendations for organizational transformation through short answer written sections. Surveys were analyzed thematically using NVivo, informed by critical perspectives on substance use, with attention to key re-occurring themes on employment equity. Results While participants described multiple benefits of working in harm reduction services, such as the valuing of their expertise by fellow ‘peers,’ growing skill sets, countering stigma, and preventing overdose deaths, issues of workplace equity were significantly identified. Stigma, tokenism, workplace discrimination, including power and pay inequities, as well as lack of worker compensation and benefits were identified as key factors persisting in the everyday experiences of participants. Conclusion Continued exposure to stigma, workplace discrimination, and/or power imbalances, combined with the impact of high stakes employment (e.g., dealing with overdose deaths), can have significant consequences for PWLE working in harm reduction, including burn out. Policy recommendations include large-scale structural changes that address inequities of hierarchical ‘peer’ employment for PWLE, including increased leadership roles for diverse PWLE, pay equity and benefits, unionization, as well as more supportive working environments attentive to the intersecting social-structural factors (poverty, criminalization, racism, gendered violence) impacting the everyday lives of PWLE working in harm reduction.

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‘It's our safe sanctuary’: Experiences of using an unsanctioned overdose prevention site in Toronto, Ontario

Cited by 57 publications

References 19 publications

The Ontario Integrated Supervised Injection Services Cohort Study of People Who Inject Drugs in Toronto, Canada (OiSIS-Toronto): Cohort Profile

The Ontario Integrated Supervised Injection Services Cohort Study of People Who Inject Drugs in Toronto, Canada (OiSIS-Toronto): Cohort Profile

Organizational support for frontline harm reduction and systems navigation work among workers with living and lived experience: qualitative findings from British Columbia, Canada

Having a voice and saving lives: a qualitative survey on employment impacts of people with lived experience of drug use working in harm reduction

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