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ID: HR19-592

Presenting author: Ryan McNeil

Presenting author biography:

Ryan McNeil, PhD, is a Research Scientist with the BC Centre on Substance Use and Assistant Professor in the Department of Medicine at the University of British Columbia. His research examines social, structural, and environmental influences on risk, harm, and health care access among people who use drugs.

Scaling up supervised consumption services in response to the overdose crisis: Lessons from a rapid ethnographic study of overdose prevention site implementation in Vancouver, Canada

Ryan McNeil, Samara Mayer, Alexandra Collins, Mary Clare Kennedy, Sandra Czechaczek, Jade Boyd

BACKGROUND: North America is experiencing an unprecedented overdose epidemic, driven by fentanyl and fentanyl-adulterated drugs. In 2016, British Columbia (BC), Canada declared a public health emergency due the overdose epidemic and later supported the rapid implementation of low-threshold supervised consumption facilities, termed Overdose Prevention Sites (OPS). OPS provide people with spaces to consume drugs under the supervision of peer and support workers, and be administered naloxone in the event of overdose. This study examined the implementation and impacts of OPS in Vancouver, BC's Downtown Eastside neighbourhood, home to more than 5000 people who use drugs (PWUD) and an existing supervised injection facility (Insite).

METHODS: Between December 2016 and April 2017, we conducted a rapid ethnographic study of the implementation of OPS involving approximately 200 hours of ethnographic observation at four OPS and in-depth interviews with 72 PWUD. Data were analyzed using deductive and inductive methods.

FINDINGS: The rapid scale-up of OPS addressed implementation gaps in harm reduction programming to enhance the overdose response. The implementation of OPS across multiple locations and in close proximity to drug scene areas minimized geographic barriers to services, and ensured access among homeless PWUD. Moreover, OPS promoted the effective and equitable delivery of supervised consumption services by enabling individual sites to implement diverse operating models, including peer-based models and the accommodation of a wider range of drug use practices (e. g., smoking, assisted injections). These approaches enabled uptake of overdose-focused interventions among populations not served by Insite due to its operational capacity, location, and restrictions stemming from federal drug laws (e.g., prohibition of assisted injections).

CONCLUSIONS: Findings demonstrate the feasibility of the rapid scale-up of low-threshold supervised consumption services in response to a public health emergency, and these measures should be considered in regions affected by the overdose epidemic.