Peer involvement in low-threshold supervised consumption sites in the context of an overdose epidemic in Vancouver, Canada


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    <p>ID: HR19-745</p>

    <p><i>Presenting author:</i>
                                    Mary Clare Kennedy                        </p>

    <h4 class="My(0)">Presenting author biography:</h4>
            Mary Clare Kennedy is a PhD student in the School of Population and Public Health at the University of British Columbia and a Research Associate at the British Columbia Centre on Substance Use in Vancouver, Canada. Her research primarily focuses on supervised consumption services, including health impacts and programme innovations.    
    <h1 class="Fz(1.3rem)">Peer involvement in low-threshold supervised consumption sites in the context of an overdose epidemic in Vancouver, Canada</h1>

    <p>Mary Clare Kennedy, Jade Boyd, Samara Mayer, Alex Collins, Sandra Czechaczek, Ryan McNeil</p>

    <p>Background: Low-threshold supervised consumption facilities, known as overdose prevention sites (OPS), have been widely 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 involvement in OPS programming and how this shapes service dynamics and related health and social outcomes among PWUD. <br />
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Methods: 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 hours of observational fieldwork at OPS and 72 in-depth qualitative interviews with PWUD. Data were analyzed thematically, with a focus on peer involvement at OPS and related outcomes.</p><p>Results: OPS implementation and operations depended on peer involvement and thus allowed for recognition of peer capacities developed through roles that peers were already undertaking through local collective action initiatives and programming for PWUD. Peer involvement at OPS enhanced feelings of comfort and trust and facilitated engagement with OPS among PWUD. These dynamics and appreciation of peer expertise enabled communication with peer staff in ways that fostered harm reduction practices and promoted health benefits. However, many peers 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.</p><p>Discussion: Our findings illustrate the feasibility of involving peers as staff at OPS and how this can enhance service engagement and promote the reduction of harms among PWUD. Amidst an ongoing overdose epidemic, the expansion of formalized peer 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, social and emotional supports.</p>
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