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ID: HR19-470

Presenting author: Gillian Kolla

Presenting author biography:

Gillian Kolla is a Phd candidate in Public Health at the University of Toronto. Her research explores ways to deliver health and social services within the spaces where people gather to use illicit drugs. She is also a member of the coordinating committee of the Toronto Overdose Prevention Society.

The complicated work of overdose response by harm reduction workers in community settings

Gillian Kolla, Carol Strike

Background: Due to the overdose epidemic in Canada, people who use drugs are responding to more overdoses than ever before. This study explores the impact of repeated exposure to overdoses on the health, wellbeing, and housing status of harm reduction workers who offer services from their homes.

Methodology: Data are drawn from an ethnographic study of “Satellite Sites”, where people who use drugs are employed by a community health centre to operate harm reduction programs within their homes. Observations within Satellite Sites and interviews (n=20) with Satellite Site workers, clients and managers of the program were conducted in Toronto in 2016-2017. Thematic analysis was used to explore the impacts of repeated exposure to overdose.

Results:  The Satellite Site model of community-based harm reduction service provision was designed and implemented before the onset of the overdose epidemic. Some offer friends, family and clients space to inject drugs. In the past, Satellite Site workers frequently responded to overdose, but the scale of the overdose crisis is unprecedented. Satellite Site workers are responding to more overdoses, and despite availability of naloxone for overdose reversal, workers report being exhausted by the emotional burden. Stress is compounded by hesitation to call 911 due to histories of negative experiences with police, and reports of evictions due to multiple 911 calls for overdose. Some Satellite Sites have responded by allowing fewer people to inject onsite.

Conclusion: The overdose crisis has complicated the work of Satellite Sites. Current responses to the overdose crisis are woefully inadequate, and the persistence of stigma and criminalization of drug use renders overdose response advice inadequate to the realities of workers on the ground, and may endanger their housing. Provision of trauma supports to people repeatedly intervening in overdoses in community settings are crucial, as are changes to the policy and legal environments.