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Byles H, Sedaghat N, Rider N, Rioux W, Loverock A, Seo B, Dhanoa A, Orr T, Dunnewold N, Tjosvold L, Ghosh SM. Barriers to calling emergency services amongst people who use substances in the event of overdose: A scoping review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 132:104559. [PMID: 39197374 DOI: 10.1016/j.drugpo.2024.104559] [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: 03/02/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND North America is grappling with an ongoing drug overdose crisis. While harm reduction measures like take-home naloxone kits, and supervised consumption sites, have helped reduce mortality, other strategies to address this public health emergency are required. Good Samaritan Laws (GSLs) offer legal protection for individuals who report overdoses, yet people who use substances (PWUS) may still hesitate to seek help due to concerns about existing legislation. This scoping review explores barriers preventing PWUS from calling emergency services for overdoses, along with potential solutions and facilitators to address this challenge. METHODS PRISMA-ScR was used as a guide to conduct this study. Health sciences librarians searched Medline, Embase, PsychINFO, CINAHL, and SCOPUS to identify relevant articles. Six reviewers contributed to screening and extracting the articles through Covidence. Two reviewers performed thematic analysis using NVivo software to identify key barriers and facilitators. RESULTS An initial search found 6275 articles for title and abstract screening, resulting in 48 studies meeting the inclusion criteria. The primary barrier to calling 911 pertained to concerns about police arrivng with other first responders, especially regarding their presence and involvement at the scene of overdose. This was followed by legal repercussions, including fear of arrest, incarceration, and fear of eviction, amongst others. Some studies noted the lack of knowledge or trust in GSLs as a deterrent to seeking medical assistance. Additional barriers included concerns about privacy and confidentiality, preference to manage an overdose alone/receive help from another peer, confidence in naloxone effectiveness, limited access to cell phones, peer pressure to not call for help, and identifying as Black, Indigenous, or a Person of Colour (BIPOC). Facilitators include increased GSL awareness among PWUS and law enforcement, expanded legal safeguards for 911 callers, reduced police intervention in overdose cases, and enhanced naloxone availability at key access points. CONCLUSION Despite the good intentions of GSLs, PWUS continue to experience significant barriers to calling emergency services in the event of an overdose. Understanding these barriers and key facilitators is necessary to inform future drug policy and advocacy efforts.
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Affiliation(s)
- Hannah Byles
- Department of Pediatrics, University of Calgary, Canada
| | | | - Nathan Rider
- Department of Public Health, University of Calgary, Canada
| | - William Rioux
- Department of Medicine, University of Alberta, Canada
| | | | - Boogyung Seo
- Department of Medicine, University of Calgary, Canada
| | - Avnit Dhanoa
- Department of Medicine, University of Alberta, Canada
| | | | | | | | - S Monty Ghosh
- Department of Medicine, University of Alberta, Canada; University of Calgary, Canada.
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Seo B, Rioux W, Teare A, Rider N, Jones S, Taplay P, Ghosh SM. Perspectives of key interest groups regarding supervised Consumption sites (SCS) and novel virtual harm reduction services / overdose response hotlines and applications: a qualitative Canadian study. Harm Reduct J 2024; 21:141. [PMID: 39068494 PMCID: PMC11282589 DOI: 10.1186/s12954-024-01053-3] [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: 10/13/2023] [Accepted: 07/01/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Supervised consumption sites (SCS) and overdose prevention sites (OPS) have been implemented across Canada to mitigate harms associated with illicit substance use. Despite their successes, they still contend with challenges that limit their accessibility and uptake. Overdose response hotlines and apps are novel virtual technologies reminiscent of informal "spotting" methods that may address some of the limitations. Here, we strove to qualitatively examine the factors that may encourage or deter utilization of these virtual services and SCS. METHODS A total of 52 participants across Canada were recruited using convenience and snowball sampling methods. These included people with lived and living experience of substance use, family members of people with lived experience, healthcare providers, community harm reduction workers, and virtual harm reduction operators. Semi-structured telephone interviews were conducted and inductive thematic analysis was performed to identify the themes pertaining to SCS and virtual harm reduction. RESULTS Participants viewed overdose response hotline and apps as an opportunity to consume substances without being hindered by logistical barriers (e.g., wait times), fear of law enforcement, invasion of privacy, and more. They also noted that these virtual services provided more flexibility for clients who opt for routes of consumption that are not supported by SCS, such as smoking. Overall, SCS was perceived to be better than virtual services at facilitating social connection, providing additional resources/referrals, as well as prompt response to overdose. CONCLUSION In sum, participants viewed SCS and virtual services as filling different needs and gaps. This study adds to a growing body of literature which informs how virtual harm reduction services can serve as useful adjunct to more standard harm reduction methods.
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Affiliation(s)
- Boogyung Seo
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Adrian Teare
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nathan Rider
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada.
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
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Sedaghat N, Seo B, Rider N, Rioux W, Ghosh SM. Perspectives of Canadian Healthcare and Harm Reduction Workers on Mobile Overdose Response Services: A Qualitative Study. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:506-514. [PMID: 38525593 DOI: 10.1177/29767342241237169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Supervised consumption sites (SCS) are an evidence-based intervention proven effective for preventing drug overdose deaths. Obstacles to accessing SCS include stigma, limited hours of operation, concerns about policing, and limited geographic availability. Mobile overdose response services (MORS) are novel technologies that provide virtual supervised consumption to help reduce the risk of fatal overdoses, especially for those who use alone. MORS can take various forms, such as phone-based hotlines and mobile apps. The aim of this article is to assess the perceptions of MORS among healthcare and harm reduction staff to determine if they would be comfortable educating clients about these services. METHODS Twenty-two healthcare and harm reduction staff were recruited from Canada using convenience, snowball, and purposive sampling techniques to complete semistructured interviews. Inductive thematic analysis informed by grounded theory was used to identify main themes and subthemes. RESULTS Four themes were identified: (1) increasing MORS awareness among healthcare providers was seen as useful; (2) MORS might lessen the burden of drug overdoses on the healthcare system but could also increase ambulance callouts; (3) MORS would benefit from certain improvements such as providing harm reduction resources and other supports; and (4) MORS are viewed as supplements for harm reduction, but SCS were preferred. CONCLUSIONS This research provides valuable perspectives from healthcare and harm reduction workers to understand their perception of MORS and identifies key areas of potential improvement. Practical initiatives to improve MORS implementation outcomes exist.
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Affiliation(s)
- Navid Sedaghat
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Boogyung Seo
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nathan Rider
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - William Rioux
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Dunham K, Hill K, Kazal H, Butner JL, Hull I, Sue K, Li L, Doneski K, Dinges B, Rife-Pennington T, Kung S, Thakarar K. In Support of Overdose Prevention Centers: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education and Research in Substance Use and Addiction). SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:328-336. [PMID: 38747578 DOI: 10.1177/29767342241252590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Given increasing rates of fatal overdoses in the United States and the rapidly changing drug supply, overdose prevention centers (OPCs; also known as safe consumption sites) have been identified as a vital, evidence-based strategy that provide people who use drugs (PWUD) the opportunity to use drugs safely and receive immediate, life-saving overdose support from trained personnel. In addition to providing a safe, supervised space to use drugs, OPCs can house further essential harm reduction drop-in services such as sterile supplies, social services, and medical care. There are established national and international data demonstrating the lifesaving services provided by OPCs, inspiring a groundswell of advocacy efforts to expand these programs in the United States. Thus, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) endorses OPCs, in addition to other harm reduction strategies that protect PWUD. Ultimately, it is imperative to increase access to OPCs across the United States and support key policy changes at the local, state, and federal levels that would facilitate urgent expansion.
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Affiliation(s)
- Katherine Dunham
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katherine Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Hannah Kazal
- Division of Addiction Medicine, Department of Family Medicine, Maine Medical Center, Portland, ME, USA
| | - Jenna L Butner
- Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Ilana Hull
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kimberly Sue
- Department of General Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Li Li
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin Doneski
- Harm Reduction Program/Needle Exchange, Portland Public Health, Portland, ME, USA
| | - Beth Dinges
- Pharmacy Service, Veteran Affairs Illiana Healthcare System, Danville, IL, USA
| | - Tessa Rife-Pennington
- Pharmacy Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- School of Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Sunny Kung
- Mass General Brigham Community Physicians, Haverhill, MA, USA
| | - Kinna Thakarar
- Center for Interdisciplinary Population and Health Research/Maine, Portland, ME, USA
- Department of Medicine, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
- Maine Medical Partners Adult Infectious Diseases, South Portland, ME, USA
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Mocanu V, Viste D, Rioux W, Ghosh SM. Accessibility gaps of physical supervised consumption sites in Canada motivating the use of overdose response technology/phone based virtual overdose response services: a retrospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100770. [PMID: 38798948 PMCID: PMC11127238 DOI: 10.1016/j.lana.2024.100770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Background Overdose response technology or virtual overdose response services are an evolving complementary harm reduction intervention which may overcome certain accessibility barriers of physical supervised consumption sites (SCS) and overdose prevention sites (OPS). We sought to characterize SCS/OPS accessibility barriers among clients accessing a nationwide overdose response phone-based hotline in Canada. Methods We performed a retrospective cohort analysis using anonymized call logs of the National Overdose Response Service (NORS) between December 2020 to July 2023. De-identified caller locations were cross-referenced with the locations, policies and operational hours of existing physical SCS/OPS. The primary outcome was accessibility of physical SCS/OPS defined hierarchically according to alignment with caller postal code, substance use routes reported, and calling times. Findings Our cohort comprised 4501 calls from 331 unique clients. Despite always having nearby SCS/OPS open and supporting substance use routes of choice, 100 clients (30.2%) preferentially utilized NORS. Among 191 clients (57.7%) who never had access to physical SCS/OPS at time of calling, 92 (27.8%) lacked a nearby site, 58 (17.5%) called outside of operational hours, and 41 (12.4%) would not be permitted to smoke on premises. Secondary analyses identified correlations between accessibility and the urbanicity and geographical region of callers within Canada. Interpretation Overdose response technology or virtual overdose response services are a novel complementary harm reduction strategy both for clients with access barriers to physical SCS/OPS and those who prefer virtual services. System-level correlates of client location urbanicity and inter-provincial variation indicate actionable targets for expanding harm reduction services both physical and virtual to better engage with people who use drugs. Funding Health Canada Substance Use and Addictions Program, Canadian Institutes of Health Research, and Grenfell Ministries.
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Affiliation(s)
- Victor Mocanu
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Dylan Viste
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta T6G 2R7, Canada
| | - S. Monty Ghosh
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 2J2.00 Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta T6G 2R7, Canada
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Rioux W, Taplay P, Morris-Miller L, Ghosh SM. Implementing Canada's first national virtual phone based overdose prevention service: lessons learned from creating the National Overdose Response Service (NORS). Harm Reduct J 2024; 21:102. [PMID: 38807227 PMCID: PMC11131261 DOI: 10.1186/s12954-024-01017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/06/2024] [Indexed: 05/30/2024] Open
Abstract
The opioid epidemic remains one of the largest public health crises in North America to date. While there have been many diverse strategies developed to reduce the harms associated with substance use, these are primarily concentrated within a few large urban centers. As a result, there have been increased calls for equitable access to harm reduction services for those who cannot or choose not to access in-person harm reduction services. In December 2020, Canada's National Overdose Response Service (NORS) a telephone based overdose response hotline and virtual supervised consumption service, was established in collaboration with various agencies and people with lived and living experience of substance use (PWLLE) across Canada to expand access to harm reduction services using novel Opioid Response Technology. In this manuscript we explore the lessons learned from the establishment and continued operation of the service exploring topics related to the initial establishment of the service, securing a phone line, routing technology, EMS dispatch solutions, peer and volunteer recruitment, legal and ethical support, policy and procedure development, securing funding, and marketing. Furthermore, we detail how this service has grown and changed in response to the various needs of service users.
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Affiliation(s)
- William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | | | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Rioux W, Teare A, Rider N, Jones S, Ghosh SM. Preference for hotline versus mobile application/countdown-based mobile overdose response services: a qualitative study. Harm Reduct J 2024; 21:31. [PMID: 38317194 PMCID: PMC10840257 DOI: 10.1186/s12954-024-00944-9] [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: 10/08/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND In response to the exacerbated rates of morbidity and mortality associated with the overlapping overdose and COVID-19 epidemics, novel strategies have been developed, implemented, operationalized and scaled to reduce the harms resulting from this crisis. Since the emergence of mobile overdose response services (MORS), two strategies have aimed to help reduce the mortality associated with acute overdose including staffed hotline-based services and unstaffed timer-based services. In this article, we aim to gather the perspectives of various key interest groups on these technologies to determine which might best support service users. METHODS Forty-seven participants from various interested groups including people who use substances who have and have not used MORS, healthcare workers, family members, harm reduction employees and MORS operators participated in semi-structured interviews. Transcripts were coded and analyzed using a thematic analysis approach. RESULTS Four major themes emerged regarding participant perspectives on the differences between services, namely differences in connection, perceived safety, privacy and accessibility, alongside features that are recommended for MORS in the future. CONCLUSIONS Overall, participants noted that individuals who use substances vary in their desire for connection during a substance use session offered by hotline and timer-based service modalities. Participants perceived hotline-based approaches to be more reliable and thus potentially safer than their timer-based counterparts but noted that access to technology is a limitation of both approaches.
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Affiliation(s)
- William Rioux
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Adrian Teare
- College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
| | - Nathan Rider
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | | | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
- Department of Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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Rioux W, Kilby K, Jones S, Joshi P, Vandenberg S, Ghosh SM. Perspectives of healthcare workers on the integration of overdose detection technologies in acute care settings. Addict Sci Clin Pract 2024; 19:4. [PMID: 38217056 PMCID: PMC10785401 DOI: 10.1186/s13722-023-00433-7] [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: 06/05/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND People who use drugs (PWUD) face disproportionately high rates of hospitalizations and patient-initiated discharge (leaving against medical advice), explained by a combination of stigma, withdrawal, judgment, blame, and improper pain management. In addition, evidence has shown that despite abstinence-based policies within healthcare settings, PWUD continue to use their substances in healthcare environments often hidden away from hospital staff, resulting in fatalities. Various novel overdose detection technologies (ODTs) have been developed with early adoption in a few settings to reduce the morbidity and mortality from risky substance use patterns within healthcare environments. Our study aimed to gain the perspectives of healthcare workers across Canada on implementing ODTs within these settings. METHOD We used purposive and snowball sampling to recruit 16 healthcare professionals to participate in semi-structured interviews completed by two evaluators. Interview transcripts were analyzed using thematic analysis to identify key themes and subthemes. RESULTS Participants recognized ODTs as a potentially feasible solution for increasing the safety of PWUD in healthcare settings. Our results suggest the mixed ability of these services to decrease stigma and build rapport with PWUD. Participants further highlighted barriers to implementing these services, including pre-established policies, legal recourse, and coordination of emergency responses to suspected overdoses. Lastly, participants highlight that ODTs should only be one part of a multifaceted approach to reducing harm in healthcare settings and could currently be integrated into discharge planning. CONCLUSION Healthcare professionals from across Canada found ODTs to be an acceptable intervention, but only as part of a larger suite of harm reduction interventions to reduce the harms associated with illicit drug use in healthcare settings. In contrast, participants noted institutional policies, stigma on behalf of healthcare workers and leadership would present significant challenges to their uptake and dissemination.
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Affiliation(s)
- William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kyle Kilby
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Calgary, Calgary, AB, Canada
| | | | - Pamela Joshi
- Provincial Perinatal Substance Use Program, BC Women's Hospital & Health Center, Provincial Health Services Authority, Vancouver, Canada
| | | | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
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