Overdose Prevention and Housing: a Qualitative Study Examining Drug Use, Overdose Risk, and Access to Safer Supply in Permanent Supportive Housing in Vancouver, Canada

Abstract

The majority of overdose deaths in British Columbia (BC) occur among people using illicit substances alone in private residences. Some supportive housing in BC includes on-site access to a variety of health and substance use–related services. More recently, a number of supportive housing locations have started offering prescribed safer supply medications to people at high overdose risk, though these remain limited and under-evaluated. In this study, we describe the drug use practices — including access to and use of on-site supervised consumption, OAT, and prescribed safer supply medications — of study participants living in permanent supportive housing with integrated primary care, substance use treatment services, and supervised consumption spaces. Qualitative interviews were conducted with 30 residents of a permanent supportive housing site in Vancouver, Canada. Data were analyzed using a sequential process to identify both a priori (e.g., low-barrier substance use treatment, pandemic effects on service access) and emerging themes (e.g., using alone). Most ( N = 27) study participants reported using alone in their rooms, despite having access to an on-site supervised consumption area. Reasons for using alone include the following: preference for being alone, discretion/stigma, and restrictive housing policies. Less than half ( N = 12) of the study participants accessed on-site prescribed safer supply medications. Participants receiving on-site prescribed safer supply described positive benefits including reduced use of illicit opioids, and less reliance on illicit income generation activities. On-site prescribed safer supply programs within supportive housing environments are an important tool in addressing overdose risk.

Safer opioid supply via a biometric dispensing machine: a qualitative study of barriers, facilitators and associated outcomes

“…Our findings add to a small but emerging body of research on safer supply programs in Canada that reports how these programs have the potential to reduce overdose risk by limiting illicit opioid exposure, 3 , 15 , 29 – 31 with 1 study reporting no opioid-related deaths among program participants 3 and another reporting 0 overdoses among program participants. 31 As most participants in this study reported using fewer illicit drugs and described reductions in overdose risk since enrolling in MySafe, our findings provide further support of the potential that safer supply programs may offer to address overdose risk.…”

“…Currently, we know of no programs in Canada that allow youth to enroll and, overall, access to safer supply remains limited nationally. Several models of safer supply programs have been implemented in select cities across Canada, including overdose prevention site-and clinic-based witnessed dosing programs; 4 , 12 , 13 programs that provide take-away doses; 3 , 14 those integrated within supportive housing, with on-site primary care clinics that provide delivery to participants’ rooms for nonwitnessed use; 15 and programs that provide take-away doses via biometric opioid dispensing machines; 5 we focus on the latter in this study.…”

The POP (Permanent Supportive Housing Overdose Prevention) Study: protocol for a hybrid type 3 stepped-wedge cluster randomized controlled trial

“…The majority of related studies have been conducted in PSH and SROs in Vancouver, Canada. There, researchers have conducted qualitative interviews with PSH residents identifying overdose risks related to using drugs alone in their rooms and potential benefits of safer supply medications [ 28 ]; qualitative interviews examining a tenant-led naloxone training and distribution intervention in SROs [ 21 ]; and qualitative interviews assessing use of overdose response buttons in a women-only PSH building [ 27 ]. These studies suggested risk factors and a few potentially promising interventions to prevent overdose in PSH and SROs, yet overall there remains a large gap in the literature related to effective interventions to prevent overdose deaths in these settings.…”

“…One study suggested that training and practice facilitation positively impacted PSH staff knowledge and attitudes toward harm reduction, and was met with high satisfaction [ 26 ]. Researchers in Vancouver, Canada, conducted qualitative research examining overdose risk and selected overdose prevention interventions (overdose response buttons and peer-led naloxone training and distribution) in PSH and SROs [ 21 , 27 , 28 ]. However, overall there is a paucity of high-quality evidence related to harm reduction in PSH [ 29 ] and there remains a significant gap in the evidence related to the effective implementation of overdose prevention practices in these settings.…”

Disease-related stigma among people who inject drugs in Toronto amidst the COVID-19 pandemic

“…In our setting [Toronto], a citywide task force found that staff of shelter-hotels had difficulty dually upholding overdose response and COVID-19 precautions ( web page ). The task force, along with findings from other areas in Canada ( MacKinnon et al., 2020 ; Hyshka et al., 2020 ), recommended expanding and scaling up harm reduction housing approaches such as integrating onsite primary healthcare, pharmacy, managed alcohol programs, facilitating virtual healthcare visits, implementing SCS & peer spotting/witnessing interventions, and enhanced staff training ( Bardwell et al., 2017 , 2019 ; Ivsins et al., 2022 ; web page ). Many of these strategies were implemented in COVID-19 recovery hotels, and along with access to private bathroom and television, were noted by residents to be a positive and dignified experience ( Kolla et al., 2021 ).…”