Saving lives in our homes: Qualitative evaluation of a tenant overdose response program in supportive, single-room occupancy (SRO) housing

Using alone at home: What’s missing in housing-based responses to the overdose crisis?

“…A peer-witnessed supervised injection intervention implemented in two emergency shelters was found to be effective in facilitating overdose response due to notions of care, trust, and solidarity embedded within the social dynamics of drug-using communities [ 35 ]. Programs in Vancouver, Toronto, and San Francisco that trained dedicated tenant overdose responders in select marginal housing environments found similar results regarding the strengths of peer-based responses in engaging PWUD in harm reduction, and mutual care more broadly, as well as demonstrated the organizing potential in these spaces [ 18 , 24 , 25 , 36 ]. However, these studies also suggest that social–structural contexts of marginal housing environments can act as a barrier to implementation due to, for example, fears of landlord retaliation or prejudicial treatment based on drug use.…”

“…In response to high overdose rates in marginal housing environments, housing-based overdose prevention and response interventions (e.g., housing-based supervised consumption rooms, peer-witnessed injection) are being implemented in some jurisdictions [ 15 , 24 , 25 ]. Such interventions attempt to extend the impacts of SEIs from community- and clinic-based settings into housing environments.…”

“…However, these sites remain rare, with authorities instead encouraging expansion of community distribution of take-home naloxone and drug testing strips rather than explicit housing-based services [ 26 ]. In the USA, housing-based models are in their infancy—a peer-based model was recently implemented in San Francisco, and there are plans to pilot overdose prevention strategies in supportive housing in New York State [ 25 , 27 ].…”

“…However, researchers found that women primarily used the system to alert staff of emergencies in progress (e.g., gender-based violence, other resident actively overdosing) rather than its intended purpose of overdose prevention. Conversely, preliminary reporting from a pilot of the same button alert system implemented in a San Francisco SRO suggests they provided a proactive method for harm reduction, greater privacy during emergencies, as well as other beneficial uses in addition to overdose response (e.g., calling for help in situations of violence or when a visitor would not leave) [ 25 ]. Together these projects demonstrated important and positive, if not alternative, uses for the technology that provide a valuable compliment to other housing-based harm reduction programming (e.g., peer-based responses, naloxone distribution) [ 25 , 39 ].…”

“…Conversely, preliminary reporting from a pilot of the same button alert system implemented in a San Francisco SRO suggests they provided a proactive method for harm reduction, greater privacy during emergencies, as well as other beneficial uses in addition to overdose response (e.g., calling for help in situations of violence or when a visitor would not leave) [ 25 ]. Together these projects demonstrated important and positive, if not alternative, uses for the technology that provide a valuable compliment to other housing-based harm reduction programming (e.g., peer-based responses, naloxone distribution) [ 25 , 39 ]. However, they also highlight the need for additional interventions that target the immediate risks associated with using drugs alone, particularly in the context of a toxic drug supply.…”