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Kolla G, Khorasheh T, Dodd Z, Greig S, Altenberg J, Perreault Y, Bayoumi AM, Kenny KS. "Everybody is impacted. Everybody's hurting": Grief, loss and the emotional impacts of overdose on harm reduction workers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104419. [PMID: 38599035 DOI: 10.1016/j.drugpo.2024.104419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/10/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The emotional impacts of witnessing and responding to overdose and overdose-related deaths have been largely overlooked during the drug toxicity overdose crisis in North America. Scarce research has analyzed these impacts on the health and well-being of harm reduction workers, and the broader determinants of harm reduction work. Our study investigates the experiences and impacts of witnessing and responding to frequent and escalating rates of overdose on harm reduction workers in Toronto, Canada. METHODS Using semi-structured interviews, 11 harm reduction workers recruited from harm reduction programs with supervised consumption services in Toronto, Canada, explored experiences with and reactions to overdose in both their professional and personal lives. They also provided insights on supports necessary to help people cope with overdose-related loss. We used thematic analysis to develop an initial coding framework, subsequent iterations of codes and emergent themes. RESULTS Results revealed that harm reductions workers experienced physical, emotional, and social effects from overdose-related loss and grief. While some effects were due to the toll of overdose response and grief from overdose-related losses, they were exacerbated by the lack of political response to the scale of the drug toxicity overdose crisis and the broader socio-economic-political environment of chronic underfunding for harm reduction services. Harm reduction workers described the lack of appropriate workplace supports for trauma from repeated overdose response and overdose-related loss, alongside non-standard work arrangements that resulted in a lack of adequate compensation or access to benefits. CONCLUSIONS Our study highlights opportunities for organizational practices that better support harm reduction workers, including formal emotional supports and community-based supportive care services. Improvement to the socio-economic-political determinants of work such as adequate compensation and access to full benefit packages are also needed in the harm reduction sector for all workers.
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Affiliation(s)
- Gillian Kolla
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada; Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, V8N 5M8, Canada; Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, A1B 3V6, Canada.
| | - Triti Khorasheh
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada
| | - Zoe Dodd
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada
| | - Sarah Greig
- South Riverdale Community Health Centre, Toronto, Ontario, M4M 3P3, Canada
| | - Jason Altenberg
- South Riverdale Community Health Centre, Toronto, Ontario, M4M 3P3, Canada
| | | | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, M5T 3M6, Canada
| | - Kathleen S Kenny
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 0W3, Canada
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Ferguson N, Farrugia A, Moore D, Fraser S. Remaking the 'angry Narcanned subject': Affording new subject positions through take-home naloxone training. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104253. [PMID: 37995551 DOI: 10.1016/j.drugpo.2023.104253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
Naloxone is a medication used to reverse opioid overdose. Alongside its lifesaving effects, it also has a reputation for producing distress, aggression and occasionally violence upon administration. This article analyses how take-home naloxone (THN) training initiatives address naloxone's reputation for producing aggression and conflict, and how new subject positions emerge in the context of this training. While the role of naloxone in producing aggression has been discussed in a range of research, this work emphasises that such conflict is neither inevitable nor even likely because it is contingent on several other issues such as administration practices. Building on this scholarship, we work with Bruno Latour's theorisation of technological 'affordances' to analyse THN as a socially co-produced technology that, rather than either determining or neutrally communicating actions and effects, 'affords' possibilities, capacities and subjects. Analysing data drawn from observations of THN training in Victoria, Australia, and in-depth interviews with training participants, we argue that the issue of conflict upon revival affords a subject position we term the 'angry Narcanned subject'. This subject, we note, has come to hold a powerful position in understandings of naloxone, not least because it tends to accord with stereotypes of antisocial drug users. From here, we argue that a much of THN training is focused on challenging and reframing naloxone's reputation for conflict and questioning related subject positions, especially that of the angry Narcanned subject. We argue that this process of challenging and reframing affords two new subject positions for consumers: the 'capable administrator' and the 'calmer revivee'. We conclude that while THN training affords multiple, potentially positive, subject positions, unless these initiatives are accompanied by broader interventions such as decriminalisation campaigns, they may inadvertently responsibilise people who consume opioids for addressing overdose and erase the role of prohibition, criminalisation and stigmatisation in producing overdose events.
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Affiliation(s)
- Nyssa Ferguson
- Department of Public Health, La Trobe University, Australia.
| | - Adrian Farrugia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - David Moore
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia
| | - Suzanne Fraser
- Australian Research Centre in Sex, Health and Society, La Trobe University, Australia; Centre for Social Research in Health, University of New South Wales, Australia
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Parkes T, Matheson C, Carver H, Foster R, Budd J, Liddell D, Wallace J, Pauly B, Fotopoulou M, Burley A, Anderson I, Price T, Schofield J, MacLennan G. Assessing the feasibility, acceptability and accessibility of a peer-delivered intervention to reduce harm and improve the well-being of people who experience homelessness with problem substance use: the SHARPS study. Harm Reduct J 2022; 19:10. [PMID: 35120539 PMCID: PMC8815224 DOI: 10.1186/s12954-021-00582-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 12/07/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that the development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing. METHODS The study used mixed methods to assess the feasibility, acceptability and accessibility of a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning, for people experiencing homelessness and problem substance use. Four Peer Navigators were employed to support individuals (n = 68 total, intervention participants). They were based in outreach services and hostels in Scotland and England. Qualitative interviews were conducted with intervention participants, Peer Navigators and staff in services, and observations were conducted in all settings. Quantitative outcomes relating to participants' substance use, physical and mental health, and quality of the Peer Navigator relationship, were measured via a 'holistic health check' with six questionnaires completed at two time-points. RESULTS The intervention was found to be acceptable to, and feasible and accessible for, participants, Peer Navigators, and service staff. Participants reported improvements to service engagement, and feeling more equipped to access services independently. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling trusting, authentic, and meaningful relationships to be developed. Some challenges were experienced in relation to the 'fit' of the intervention within some settings. Among participants there were reductions in drug use and risky injecting practices. There were increases in the number of participants receiving opioid substitution therapy. Overall, the intervention was positively received, with collective recognition that the intervention was unique and highly valuable. While most of the measures chosen for the holistic health check were found to be suitable for this population, they should be streamlined to avoid duplication and participant burden. CONCLUSIONS The study established that a peer-delivered, relational harm reduction intervention is acceptable to, and feasible and accessible for, people experiencing homelessness and problem substance use. While the study was not outcomes-focused, participants did experience a range of positive outcomes. A full randomised controlled trial is now required to assess intervention effectiveness. TRIAL REGISTRATION Study registered with ISRCTN: 15900054.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK.
- Faculty of Social Sciences, University of Stirling, Stirling, UK.
| | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - John Budd
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | - Bernie Pauly
- The Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Maria Fotopoulou
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Tracey Price
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Joe Schofield
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
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Parkes T, Matheson C, Carver H, Foster R, Budd J, Liddell D, Wallace J, Pauly B, Fotopoulou M, Burley A, Anderson I, MacLennan G. A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study. Health Technol Assess 2022; 26:1-128. [PMID: 35212621 PMCID: PMC8899911 DOI: 10.3310/wvvl4786] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing. This study tested the feasibility and acceptability of a peer-delivered intervention, through 'Peer Navigators', to support people who are homeless with problem substance use to address a range of health and social issues. OBJECTIVES The study objectives were to design and implement a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning for people experiencing homelessness and problem substance use, and to conduct a concurrent process evaluation to inform a future randomised controlled trial. DESIGN A mixed-methods feasibility study with concurrent process evaluation was conducted, involving qualitative interviews [staff interviews (one time point), n = 12; Peer Navigator interviews (three or four time points), n = 15; intervention participant interviews: first time point, n = 24, and second time point, n = 10], observations and quantitative outcome measures. SETTING The intervention was delivered in three outreach services for people who are homeless in Scotland, and three Salvation Army hostels in England; there were two standard care settings: an outreach service in Scotland and a hostel in England. PARTICIPANTS Participants were people experiencing homelessness and problem substance use (n = 68) (intervention). INTERVENTION This was a peer-delivered, relational intervention drawing on principles of psychologically informed environments, with Peer Navigators providing practical and emotional support. MAIN OUTCOME MEASURES Outcomes relating to participants' substance use, participants' physical and mental health needs, and the quality of Peer Navigator relationships were measured via a 'holistic health check', with six questionnaires completed at two time points: a specially created sociodemographic, health and housing status questionnaire; the Patient Health Questionnaire-9 items plus the Generalised Anxiety Disorder-7; the Maudsley Addiction Profile; the Substance Use Recovery Evaluator; the RAND Corporation Short Form survey-36 items; and the Consultation and Relational Empathy Measure. RESULTS The Supporting Harm Reduction through Peer Support (SHARPS) study was found to be acceptable to, and feasible for, intervention participants, staff and Peer Navigators. Among participants, there was reduced drug use and an increase in the number of prescriptions for opioid substitution therapy. There were reductions in risky injecting practice and risky sexual behaviour. Participants reported improvements to service engagement and felt more equipped to access services on their own. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling the development of trusting, authentic and meaningful relationships. The relationship with the Peer Navigator was measured as excellent at baseline and follow-up. Some challenges were experienced in relation to the 'fit' of the intervention within some settings and will inform future studies. LIMITATIONS Some participants did not complete the outcome measures, or did not complete both sets, meaning that we do not have baseline and/or follow-up data for all. The standard care data sample sizes make comparison between settings limited. CONCLUSIONS A randomised controlled trial is recommended to assess the effectiveness of the Peer Navigator intervention. FUTURE WORK A definitive cluster randomised controlled trial should particularly consider setting selection, outcomes and quantitative data collection instruments. TRIAL REGISTRATION This trial is registered as ISRCTN15900054. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - John Budd
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | - Bernie Pauly
- The Canadian Institute for Substance Use Research, University of Victoria, Greater Victoria, BC, Canada
| | - Maria Fotopoulou
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Adam Burley
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
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Walker S, Dietze P, Poznyak V, Campello G, Kashino W, Dzhonbekov D, Kiriazova T, Nikitin D, Terlikbayeva A, Nevendorff L, Busse A, Krupchanka D. More than saving lives: Qualitative findings of the UNODC/WHO Stop Overdose Safely (S-O-S) project. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 100:103482. [PMID: 35042142 DOI: 10.1016/j.drugpo.2021.103482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Stop Overdose Safely (S-O-S) initiative-developed in compliance with WHO guidelines-aims to prevent opioid overdose deaths. Under the umbrella of this initiative a multi-country project was implemented in Kazakhstan, Kyrgyzstan, Tajikistan, and Ukraine, that involved overdose recognition and response training, including the provision of take-home naloxone (THN). More than 14,000 potential overdose witnesses were trained and more than 16,000 THN kits were distributed across the participating countries. This paper reports on the qualitative component of an evaluation aiming to understand the views and experiences of S-O-S project participants. METHODS Data were drawn from focus group discussions with 257 project participants from across all four countries, including people who use and inject drugs, and others likely to witness an opioid overdose. Data were analysed thematically. RESULTS Findings revealed how past experiences of trauma and loss related to overdose death were common, as was appreciation and gratitude for the opportunity to participate in the S-O-S training. Participants described how they shared knowledge and skills with others. Empowerment and destigmatising narratives featured prominently, and highlighted how for people who use drugs, feeling valued and cared about-not only by families and friends, but by health care providers, and sometimes police-was a positive outcome of their participation. Nevertheless, findings also revealed how real experiences of fear regarding police intervention was a barrier to carrying naloxone and intervening when faced with an overdose situation. CONCLUSION Our analysis found that the S-O-S project produced positive outcomes that go well beyond saving lives. Despite identifying barriers to THN uptake, our findings support a growing body of evidence that broad access to THN as part of a continuum of care can enhance the health and wellbeing of people who use drugs and their communities, in low- to middle-income countries.
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Affiliation(s)
- Shelley Walker
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia; National Drug Research Institute, Faculty of Health Sciences, Curtin University, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia.
| | - Paul Dietze
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne Victoria, 3004, Australia; National Drug Research Institute, Faculty of Health Sciences, Curtin University, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia
| | - Vladimir Poznyak
- Alcohol, Drugs and Addictive Behaviours Unit, Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Giovanna Campello
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | - Wataru Kashino
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | | | - Tetiana Kiriazova
- Ukrainian Institute on Public Health Policy, 5 Biloruska Street, Office 20, 27, Kyiv, 04050, Ukraine
| | - Danil Nikitin
- Global Research Institute (GLORI) Foundation, 125 Suyumbaev Street Bishkek, 720011, Kyrgyzstan
| | - Assel Terlikbayeva
- Global Health Research Center of Central Asia (GHRCCA), 38B Shashkina Street, Almaty, Kazakhstan
| | - Laura Nevendorff
- Burnet Institute, Behaviours and Health Risks Program, 85 Commercial Road, GPO Box 2284, Melbourne, Victoria, 3004, Australia
| | - Anja Busse
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, P.O. Box 500, A-1400 Vienna, Austria
| | - Dzmitry Krupchanka
- Alcohol, Drugs and Addictive Behaviours Unit, Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland
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Wallace B, MacKinnon K, Strosher H, Macevicius C, Gordon C, Raworth R, Mesley L, Shahram S, Marcellus L, Urbanoski K, Pauly B. Equity-oriented frameworks to inform responses to opioid overdoses: a scoping review. JBI Evid Synth 2021; 19:1760-1843. [PMID: 34137739 DOI: 10.11124/jbies-20-00304] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this scoping review was to systematically identify and describe literature that uses a health equity-oriented approach for preventing and reducing the harms of stigma or overdose for people who use illicit drugs or misuse prescription opioids. INCLUSION CRITERIA To be included, papers had to both: i) use a health equity-oriented approach, defined as a response that addresses health inequities and aims to reduce drug-related harms of stigma or overdose; and ii) include at least one of the following concepts: cultural safety, trauma- and violence-informed care, or harm reduction. We also looked for papers that included an Indigenous-informed perspective in addition to any of the three concepts. METHODS An a priori protocol was published and the JBI methodology for conducting scoping reviews was employed. Published and unpublished literature from January 1, 2000, to July 31, 2019, was included. The databases searched included CINAHL (EBSCOhost), MEDLINE (Ovid), Academic Search Premier (EBSCOhost), PsycINFO (EBSCOhost), Sociological Abstracts and Social Services Abstracts (ProQuest), JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews, PROSPERO, Aboriginal Health Abstract Database, First Nations Periodical Index, and the National Indigenous Studies Portal. The search for unpublished studies included ProQuest Dissertations and Theses, Google Scholar, and targeted web searches. Screening and data extraction were performed by two reviewers using templates developed by the authors. Data extraction included specific details about the population, concepts, context, and key findings or recommendations relevant to the review objectives. RESULTS A total of a total of 1065 articles were identified and screened, with a total of 148 articles included. The majority were published in the previous five years (73%) and were from North America (78%). Most articles only focused on one of the three health equity-oriented approaches, most often harm reduction (n = 79), with only 16 articles including all three. There were 14 articles identified that also included an Indigenous-informed perspective. Almost one-half of the papers were qualitative (n = 65; 44%) and 26 papers included a framework. Of these, seven papers described a framework that included all three approaches, but none included an Indigenous-informed perspective. Recommendations for health equity-oriented approaches are: i) inclusion of people with lived and living experience; ii) multifaceted approaches to reduce stigma and discrimination; iii) recognize and address inequities; iv) drug policy reform and decriminalization; v) ensure harm-reduction principles are applied within comprehensive responses; and vi) proportionate universalism. Gaps in knowledge and areas for future research are discussed. CONCLUSIONS We have identified few conceptual frameworks that are both health equity-oriented and incorporate multiple concepts that could enrich responses to the opioid poisoning emergency. More research is required to evaluate the impact of these integrated frameworks for action.
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Affiliation(s)
- Bruce Wallace
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
| | - Karen MacKinnon
- School of Nursing, University of Victoria, Victoria, BC, Canada
- Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Affiliated Group, University of Victoria, Victoria, BC, Canada
| | - Heather Strosher
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
| | - Celeste Macevicius
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
| | - Carol Gordon
- Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Affiliated Group, University of Victoria, Victoria, BC, Canada
- Library Service, University of Victoria, Victoria, BC, Canada
| | - Rebecca Raworth
- Library Service, University of Victoria, Victoria, BC, Canada
| | - Lacey Mesley
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
| | - Sana Shahram
- School of Nursing, University of British Columbia: Okanagan campus, Kelowna, BC, Canada
| | - Lenora Marcellus
- School of Nursing, University of Victoria, Victoria, BC, Canada
- Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Affiliated Group, University of Victoria, Victoria, BC, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
- School of Nursing, University of Victoria, Victoria, BC, Canada
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Orkin AM, Rao S, Venugopal J, Kithulegoda N, Wegier P, Ritchie SD, VanderBurgh D, Martiniuk A, Salamanca-Buentello F, Upshur R. Conceptual framework for task shifting and task sharing: an international Delphi study. HUMAN RESOURCES FOR HEALTH 2021; 19:61. [PMID: 33941191 PMCID: PMC8091141 DOI: 10.1186/s12960-021-00605-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/21/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Task shifting and sharing (TS/S) involves the redistribution of health tasks within workforces and communities. Conceptual frameworks lay out the key factors, constructs, and variables involved in a given phenomenon, as well as the relationships between those factors. Though TS/S is a leading strategy to address health worker shortages and improve access to services worldwide, a conceptual framework for this approach is lacking. METHODS We used an online Delphi process to engage an international panel of scholars with experience in knowledge synthesis concerning TS/S and develop a conceptual framework for TS/S. We invited 55 prospective panelists to participate in a series of questionnaires exploring the purpose of TS/S and the characteristics of contexts amenable to TS/S programmes. Panelist responses were analysed and integrated through an iterative process to achieve consensus on the elements included in the conceptual framework. RESULTS The panel achieved consensus concerning the included concepts after three Delphi rounds among 15 panelists. The COATS Framework (Concepts and Opportunities to Advance Task Shifting and Task Sharing) offers a refined definition of TS/S and a general purpose statement to guide TS/S programmes. COATS describes that opportunities for health system improvement arising from TS/S programmes depending on the implementation context, and enumerates eight necessary conditions and important considerations for implementing TS/S programmes. CONCLUSION The COATS Framework offers a conceptual model for TS/S programmes. The COATS Framework is comprehensive and adaptable, and can guide refinements in policy, programme development, evaluation, and research to improve TS/S globally.
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Affiliation(s)
- Aaron M Orkin
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Toronto, Canada.
| | - Sampreeth Rao
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Natasha Kithulegoda
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | | | - Stephen D Ritchie
- School of Kinesiology and Health Sciences, Faculty of Health, Laurentian University; Sudbury, Toronto, Canada
| | - David VanderBurgh
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Alexandra Martiniuk
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Ross Upshur
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Antoniou T, Pritlove C, Shearer D, Martins D, Tadrous M, Munro C, Gomes T. A qualitative study of a publicly funded pharmacy-dispensed naloxone program. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103146. [PMID: 33568317 DOI: 10.1016/j.drugpo.2021.103146] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/28/2022]
Abstract
AIMS To characterize the experiences of individuals accessing pharmacy-based naloxone and relate these experiences to the risk environments and discourses in which they are embedded. METHODS We conducted a qualitative study using in-depth interviews of 37 adults aged 18 years and over who had accessed pharmacy-dispensed naloxone. Participants were recruited from across Ontario, Canada, and comprised individuals taking opioids for chronic pain, those taking opioids for reasons other than chronic pain, and individuals acquiring naloxone to act as bystanders in an opioid overdose setting. We drew upon risk environment theory to interpret participants' accounts. RESULTS Following analysis and interpretation, we generated five theoretically-informed themes characterizing the experiences of individuals accessing pharmacy-dispensed naloxone: 'intersection of naloxone narrative with pharmacy environment', 'individual risk environment and pharmacy-dispensed naloxone uptake', 'safe spaces: creating an enabling environment for pharmacy-dispensed naloxone', 'individuation: becoming a first responder' and 'beyond naloxone: the macro risk environment'. Specifically, participants described how judgement and stereotyping associated with the broader naloxone narrative can be amplified in the space of the pharmacy, leading to fears of reprisals and strategies to mitigate social risk. In addition, the social construction of naloxone as a drug for 'problematic' opioid use and a lack of pharmacist awareness regarding the risk environments in which opioid use occurs was perceived to limit opportunities for optimizing naloxone distribution and training. Finally, participants described approaches that could create enabling environments in the space of the pharmacy while remaining cognizant of the structural changes required in the macro risk environments of people who take opioids. CONCLUSIONS Despite increasing the availability of naloxone, participants characterized several social and environmental factors that could limit the accessibility of the drug from pharmacies. Strategies to address these factors could create enabling environments within pharmacies that optimize the reach and impact of pharmacy-dispensed naloxone.
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Affiliation(s)
- Tony Antoniou
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, Unity Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Cheryl Pritlove
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Dana Shearer
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Diana Martins
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Mina Tadrous
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
| | - Charlotte Munro
- Ontario Drug Policy Research Network, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Ontario, Canada; Ontario Drug Policy Research Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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9
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Costa T, Zhang M. The innovative role of an "opioid overdose prevention pharmacist" at a mental health teaching hospital. Am J Health Syst Pharm 2021; 78:292-296. [PMID: 33471052 DOI: 10.1093/ajhp/zxaa407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tianna Costa
- Centre for Addiction and Mental Health Toronto, Canada
| | - Maria Zhang
- Leslie Dan Faculty of Pharmacy University of Toronto Toronto, Canada
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10
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Olding M, Boyd J, Kerr T, McNeil R. "And we just have to keep going": Task shifting and the production of burnout among overdose response workers with lived experience. Soc Sci Med 2021; 270:113631. [PMID: 33418149 DOI: 10.1016/j.socscimed.2020.113631] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/13/2023]
Abstract
Overdose response programs in North America increasingly employ task shifting-shifting overdose response tasks to less specialized workers-to increase effectiveness and promote involvement of people with lived/living experience of drug use (PWLE). In Canada, task shifting has occurred through community-driven implementation of overdose response programs staffed primarily by PWLE. The implications of this task shifting on workers' well-being and service delivery has received little scholarly consideration, despite reports of widespread burnout among frontline responders. This study examines experiences and drivers of burnout among PWLE working at low-barrier supervised consumption sites ("Overdose Prevention Sites" or OPSs) in Vancouver, Canada. Between December 2016 and March 2020, we conducted ethnographic fieldwork at four OPSs, including in-depth interviews with 23 overdose response workers, three site-based focus groups with 20 additional workers, and 150 h of naturalistic observation. Data were analyzed to explore how working conditions, labour arrangements, economic insecurity and social disadvantage shaped burnout. We found that overdose response workers commonly reported burnout, which they attributed to the precarious and demanding nature of their work. While casual positions offered low-barrier employment, PWLE often lacked the wages and benefits enjoyed by other frontline workers, with limited supports and opportunities for advancement. Due to their social position within drug-using networks, PWLE's work encompassed hidden care work that participants felt was constant and undervalued. The scarcity of permanent full-time positions, alongside barriers to transitioning into formal employment, prevented many PWLE from earning livable wages or taking time off to 'recharge.' This study highlights how the devaluing and casualization of overdose response labour, compounded by other dimensions of structural vulnerability, are central to burnout among overdose response workers with lived experience. Interventions to address burnout within this setting must extend beyond individual-level interventions (e.g. counselling, self-care) to also strengthen working conditions and economic security of PWLE.
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Affiliation(s)
- Michelle Olding
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, V6Z 1Y6, BC, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, V6Z 1Y6, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, V6Z 1Y6, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, V6Z 1Y6, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Yale School of Medicine, New Haven, CT, United States; Yale School of Public Health, New Haven, CT, United States; Department of Anthropology, Yale University, New Haven, CT, United States.
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11
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Tran T, Ball J, Bratberg JP, DeSimone EM, Franko TS, Hill LG, Sharp CPKK, Palombi L, Ventricelli D, Farrell D, Gandhi N, Moore T. Report of the 2020 Special Committee on Substance Use and Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:8421. [PMID: 34283760 PMCID: PMC7712728 DOI: 10.5688/ajpe8421] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
EXECUTIVE SUMMARYThe 2020 Special Committee on Substance Use and Pharmacy Education was charged to update the work of the 2010 Special Committee on Substance Abuse and Pharmacy Education Report (SAPER) specifically with recommendations on core curricular content and delivery processes on substance misuse and substance use disorder (SUD). This report provides information on the committee's process to address the charges, background information and resources pertaining to the charges, and rationale for SUD being a critical topic for curriculum at colleges and schools of pharmacy. This committee offers several recommendations to the Association of Colleges of Pharmacy (AACP) pertaining to the committee charges.
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Affiliation(s)
- Tran Tran
- Midwestern University Chicago, College of Pharmacy, Downers Grove, Illinois
| | - Jennifer Ball
- South Dakota State University, College of Pharmacy and Allied Health Professions, Brookings, South Dakota
| | | | - Edward M DeSimone
- Creighton University, School of Pharmacy and Health Professions, Omaha, Nebraska
| | | | - Lucas G Hill
- The University of Texas at Austin College of Pharmacy, Austin, Texas
| | | | - Laura Palombi
- University of Minnesota, College of Pharmacy, Duluth, Minnesota
| | | | - Dorothy Farrell
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Nidhi Gandhi
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Terri Moore
- American Association of Colleges of Pharmacy, Arlington, Virginia
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12
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Jozaghi E. The Opioid Epidemic: Task-Shifting in Health Care and the Case for Access to Harm Reduction for People Who Use Drugs. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 52:261-268. [PMID: 32268811 DOI: 10.1177/0020731420914820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We are sadly experiencing unprecedented levels of overdose mortalities attributed to the increased availability of synthetic opioids in illegal markets. While the majority of attention in North America has focused on preventing drug overdose cases through the distribution and administration of naloxone, in addition to stricter regulations of opioid prescriptions and greater law enforcement in illegal markets, little attention has been given to other alternative models and treatments for people who use drugs that are tailored specifically to the health care needs of this marginalized population. Through this analysis, the implications of task-shifting in health care via the distribution of naloxone for an already marginalized population are discussed. Alternatively, the role of pioneering harm-reduction programs - such as supervised injection/consumption sites, a variety of opioids maintenance therapies, and social-structural interventions - are highlighted as crucial interventions in the current ongoing opioid crisis. Moreover, people with lived experiences of illegal drug use are discussed as having a pivotal role but being ultimately overshadowed by public health partners.
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Affiliation(s)
- Ehsan Jozaghi
- The School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Selfridge M, Greer A, Card KG, Macdonald S, Pauly B. “It's like super structural” – Overdose experiences of youth who use drugs and police in three non-metropolitan cities across British Columbia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 76:102623. [DOI: 10.1016/j.drugpo.2019.102623] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 01/01/2023]
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14
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Thylstrup B, Hesse M, Jørgensen M, Thiesen H. One opioid user saving another: the first study of an opioid overdose-reversal and naloxone distribution program addressing hard-to-reach drug scenes in Denmark. Harm Reduct J 2019; 16:66. [PMID: 31805969 PMCID: PMC6896775 DOI: 10.1186/s12954-019-0328-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background Overdose education and naloxone distribution programs decrease opioid overdose deaths. However, no studies of such programs have been carried out in Denmark. The aim of this study was to evaluate the feasibility and the effect of a broader “training-the-trainers” model in low-threshold settings after participation in the “Danish Save Lives” [SL] program. Methods Between May 2013 and November 2015, 552 participants from four municipalities took part in the SL program. The program is built on the train-the-trainers model where a central trainer trains others (trainers), who in turn train others (helpers). Participants were 30 police officers (5%), 188 people who use opioids (34%), 23 significant others (4%), and 217 social workers (39%). Ninety-four participants could not be classified (17%). At follow-up, participants were interviewed to determine the number and outcomes of opioid overdoses. Logistic regression was used to assess predictors of treating an overdose. Results In all, 37 (7%) participants had intervened in 45 opioid overdose events (two trainers and 35 helpers). Detailed descriptions of the overdose event were available from 32 follow-up interviews (70%). In 16 cases, the person who intervened was already present at the site when the overdose occurred, and in 17 cases, the overdose victim recovered without complications. All overdose victims survived except one. People who used opioids were more likely to have treated an overdose than other participants (adjusted odds ratio [AOR] = 8.50, p = 0.001), and the likelihood of treating and overdose declined over time AOR = 0.37 (0.13, 0.93), p = 0.034). Conclusions Prevention programs that target people who use opioids are more likely to be effective than programs that target professionals, especially in high-risk settings that can be hard for paramedics to reach. A future goal is to explore how prevention programs can be adapted to new user groups. Trial registration The Danish Data Protection Agency, 2015-57-0002, Aarhus University, 2016-051-000001, 184, retrospectively registered
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Affiliation(s)
- Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Bartholins Allé 10, 8000, Aarhus C, Denmark.
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Bartholins Allé 10, 8000, Aarhus C, Denmark
| | - Marian Jørgensen
- HealthTeam for Homeless, Save Lives Program, Sundholmsvej 18, 2300, København S, Denmark
| | - Henrik Thiesen
- HealthTeam for Homeless, Save Lives Program, Sundholmsvej 18, 2300, København S, Denmark
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15
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Parkes T, Matheson C, Carver H, Budd J, Liddell D, Wallace J, Pauly B, Fotopoulou M, Burley A, Anderson I, MacLennan G, Foster R. Supporting Harm Reduction through Peer Support (SHARPS): testing the feasibility and acceptability of a peer-delivered, relational intervention for people with problem substance use who are homeless, to improve health outcomes, quality of life and social functioning and reduce harms: study protocol. Pilot Feasibility Stud 2019; 5:64. [PMID: 31164989 PMCID: PMC6489271 DOI: 10.1186/s40814-019-0447-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/09/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While people who are homeless often experience poor mental and physical health and problem substance use, getting access to appropriate services can be challenging. The development of trusting relationships with non-judgemental staff can facilitate initial and sustained engagement with health and wider support services. Peer-delivered approaches seem to have particular promise, but there is limited evidence regarding peer interventions that are both acceptable to, and effective for, people who are homeless and using drugs and/or alcohol. In the proposed study, we will develop and test the use of a peer-to-peer relational intervention with people experiencing homelessness. Drawing on the concept of psychologically informed environments, it will focus on building trusting and supportive relationships and providing practical elements of support such as access to primary care, treatment and housing options. METHODS A mixed-method feasibility study with concurrent process evaluation will be conducted to explore the feasibility and acceptability of a peer-delivered, relational intervention for people with problem substance use who are homeless. Peer Navigators will be based in homelessness outreach and residential services in Scotland and England. Peer Navigators will work with a small number of participants for up to 12 months providing both practical and emotional support. The sample size for the intervention is 60. Those receiving the intervention must be currently homeless or at risk of homelessness, over the age of 18 years and self-report alcohol/drug problems. A holistic health check will be conducted in the first few months of the intervention and repeated towards the end. Health checks will be conducted by a researcher in the service where the Peer Navigator is based. Semi-structured qualitative interviews with intervention participants and staff in both intervention and standard care settings, and all Peer Navigators, will be conducted to explore their experiences with the intervention. Non-participant observation will be conducted in intervention and standard care sites to document similarities and differences between care pathways. DISCUSSION The SHARPS study will provide evidence regarding whether a peer-delivered harm reduction intervention is feasible and acceptable to people experiencing homelessness and problem substance use in order to develop a definitive trial. TRIAL REGISTRATION SRCTN registry ISRCTN15900054, protocol version 1.3, March 12, 2018.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - John Budd
- Edinburgh Access Practice, NHS Lothian, 22-24 Spittal Street, Edinburgh, EH3 9DU UK
| | - Dave Liddell
- Scottish Drugs Forum, 91 Mitchell Street, Glasgow, G1 3LN UK
| | - Jason Wallace
- Scottish Drugs Forum, 91 Mitchell Street, Glasgow, G1 3LN UK
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, Technology Enterprise Facility, University of Victoria, Room 273, Victoria, British Columbia V8P 5C2 Canada
| | - Maria Fotopoulou
- Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Adam Burley
- The Access Point, 17/23 Leith Street, Edinburgh, EH1 3AT UK
| | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
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16
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Kennedy MC, Boyd J, Mayer S, Collins A, Kerr T, McNeil R. Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada. Soc Sci Med 2019; 225:60-68. [PMID: 30798157 DOI: 10.1016/j.socscimed.2019.02.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 01/05/2023]
Abstract
Overdose prevention sites (OPS) are a form of supervised consumption facility that have been implemented in Vancouver, Canada as an innovative response to an ongoing overdose epidemic. OPS are primarily staffed by peers - people who use(d) drugs (PWUD) - trained in overdose response. We sought to characterize peer worker involvement in OPS programming, including how this shapes service dynamics and health outcomes among PWUD. Data were drawn from a rapid ethnographic study examining the implementation, operations and impacts of OPS in Vancouver from December 2016 to April 2017. We conducted approximately 185 h of observational fieldwork at OPS and 72 in-depth qualitative interviews with PWUD. Data were analyzed thematically, with a focus on peer worker involvement at OPS and related outcomes. OPS implementation and operations depended on peer worker involvement and thus allowed for recognition of capacities developed through roles that peers were already undertaking through local programming for PWUD. Peer involvement at OPS enhanced feelings of comfort and facilitated engagement with OPS among PWUD. These dynamics and appreciation of peer worker expertise enabled communication with staff in ways that fostered harm reduction practices and promoted health benefits. However, many peer workers received minimal financial compensation and experienced considerable grief due to the emotional toll of the epidemic and lack of supports, which contributed to staff burnout. Our findings illustrate the specific contributions of task shifting OPS service delivery to peer workers, including how this can enhance service engagement and promote the reduction of harms among PWUD. Amidst an ongoing overdose epidemic, expanding formalized peer worker involvement in supervised consumption programming may help to mitigate overdose-related harms, particularly in settings where peers are actively involved in existing programming. However, efforts are needed to ensure that peer workers receive adequate financial support and workplace benefits to promote the sustainability of this approach.
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Alexandra Collins
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
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Farrugia A, Fraser S, Dwyer R, Fomiatti R, Neale J, Dietze P, Strang J. Take-home naloxone and the politics of care. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:427-443. [PMID: 30710415 DOI: 10.1111/1467-9566.12848] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
'Take-home naloxone' refers to a life-saving intervention in which a drug (naloxone) is made available to nonmedically trained people for administration to other people experiencing an opioid overdose. In Australia, it has not been taken up as widely as would be expected, given its life-saving potential. We consider the actions of take-home naloxone, focusing on how care relations shape its uses and effects. Mobilising Science and Technology Studies insights, we suggest that the uses and effects of naloxone are co-produced within social relations and, therefore, this initiative 'affords' multiple outcomes. We argue that these affordances are shaped by a politics of care, and that these politics relate to uptake. We analyse two complementary case studies, drawn from an interview-based project, in which opioid consumers discussed take-home naloxone and its uses. Our analysis maps the ways take-home naloxone can afford (i) a regime of care within an intimate partnership (allowing a terminally ill man to more safely consume opioids) and (ii) a political process of care (in which a consumer takes care of others treated with the medication by administering it 'gently'). We conclude by exploring the political affordances of a politics of care approach for the uptake of take-home naloxone.
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Affiliation(s)
- Adrian Farrugia
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
| | - Suzanne Fraser
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Dwyer
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Vic, Australia
| | - Renae Fomiatti
- Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia
| | - Joanne Neale
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul Dietze
- Behaviours and Health Risks Programs, Burnet Institute, Melbourne, Vic, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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18
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Silva DS, Forlini C, Meurk C. Public Mental Health Ethics: Helping Improve Mental Health for Individuals and Communities. Public Health Ethics 2018. [DOI: 10.1093/phe/phy011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Cynthia Forlini
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney
| | - Carla Meurk
- School of Public Health, The University of Queensland, Policy and Epidemiology Group, Queensland Centre for Mental Health Research
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