Background Despite the implementation and expansion of public health and harm reduction strategies aimed at preventing and reversing overdoses, rates of overdose-related events and fatalities continue to rise in British Columbia. The COVID-19 pandemic created a second, concurrent public health emergency that further exacerbated the illicit drug toxicity crisis, reinforced existing social inequities and vulnerabilities, and highlighted the precariousness of systems in place that are meant to protect the health of communities. By exploring the perspectives of people with recent experience of illicit substance use, this study sought to characterize how the COVID-19 pandemic and associated public health measures influenced risk and protective factors related to unintentional overdose by altering the environment in which people live and use substances, influencing the ability of people who use substances to be safe and well. Methods One-on-one semi-structured interviews were conducted by phone or in-person with people who use illicit substances (n = 62) across the province. Thematic analysis was performed to identify factors shaping the overdose risk environment. Results Participants pointed to factors that increased risk of overdose, including: [1] physical distancing measures that created social and physical isolation and led to more substance use alone without bystanders nearby able to respond in the event of an emergency; [2] early drug price spikes and supply chain issues that created inconsistencies in drug availability; [3] increasing toxicity and impurities in unregulated substances; [4] restriction of harm reduction services and supply distribution sites; and [5] additional burden placed on peer workers on the frontlines of the illicit drug toxicity crisis. Despite these challenges, participants highlighted factors that protected against overdose and substance-related harm, including the emergence of new programs, the resiliency of communities of people who use substances who expanded their outreach efforts, the existence of established social relationships, and the ways that individuals consistently prioritized overdose response over concerns about COVID-19 transmission to care for one another. Conclusions The findings from this study illustrate the complex contextual factors that shape overdose risk and highlight the importance of ensuring that the needs of people who use substances are addressed in future public health emergency responses.
Background British Columbia (BC) has been in a state of public health emergency since 2016, due to the unprecedented numbers of fatal and non-fatal drug toxicity (i.e. overdose) events. Methamphetamine detection in illicit drug toxicity deaths increased from 14% in 2012 to 43% in 2020 suggesting a concerning trend of concurrent methamphetamine and opioid use in BC, consistent with rising patterns identified across North America. People who use methamphetamine concurrently with opioids face an elevated risk of harm. This study aimed to identify behaviours for survival and wellness practiced by people who concurrently use methamphetamine and opioids. Methods One-on-one semi-structured interviews were conducted by peer research assistants in person and by telephone. Thematic analysis was carried out to identify patterns in behaviours participants described as important to their safety in the context of concurrent use of methamphetamine and opioids. Results Participants (n = 22) were distributed across the province with at least four participants from each of the five geographic health regions: 64% self-identified as men, and 50% self-identified as Indigenous. Daily methamphetamine use was reported by 72.7% of participants, and 67.3% reported using alone either often or always. Participants made several considerations and adaptations in order to balance the perceived benefits and risks of their use of methamphetamine with opioids. Two overarching themes were identified to describe how participants adapted their use for survival and wellness. The first was personal safety behaviours which included self-regulation and self-care behaviours. The second was interpersonal safety behaviours which included using alongside peers, and engaging with peer-led services (e.g. community outreach organizations) and public health-led services (e.g. overdose prevention sites) to reduce the risk of harm. Participants identified many gaps in available services to meet their diverse needs. Conclusions This manuscript identified diversity in participants’ methamphetamine and opioid use (i.e. frequency, route of administration), and a range of behaviours that were performed to improve wellness and survival while using methamphetamine and opioids. Harm reduction and treatment responses must be robust and adaptable to respond to the diversity of patterns of substance use among people who use methamphetamine and opioids concurrently, so as to not perpetuate harm and leave people behind.
Background: British Columbia has been in a state of public health emergency since 2016, due to the unprecedented numbers of overdoses and overdose deaths. Methamphetamine (MA) detection in illicit drug toxicity deaths increased from 14% in 2012 to 43% in 2020 suggesting a concerning trend of concurrent MA and opioid use in BC that reflects rising patterns identified across North America. People who use MA concurrently with opioids face an elevated risk of harm. This study aimed to identify behaviours of people who concurrently use MA and opioids practice to be safe.Methods: One-on-one semi-structured interviews were conducted by Peer Research Assistants in person and by telephone. Each interview lasted approximately 30-90 minutes and were recorded and later transcribed. Thematic analysis was carried out to identify patterns in the behaviours participants described as important to their safety in the context of concurrently using MA and opioidsResults: Participants (n=22) were distributed across the province with at least four participants from each of the five geographic health regions; 64% self-identified as men, and 50% self-identified as Indigenous. Daily MA use was reported by 72.7% of participants, and 67.3% reported using alone either often or always. From the data, we identified that participants made several considerations and adaptations in order to balance the perceived benefits and risks of their use of MA with opioids. Two overarching themes were identified to describe how participants adapted their use for survival and wellness: 1) Personal safety behaviours, and 2) interpersonal safety behaviours.Conclusions: This manuscript identified diversity in participants’ MA and opioid use (i.e. frequency, route of administration), and a subsequent range of behaviours that were performed to improve wellness and survival while using MA and opioids. Some of participants’ behaviours were practiced individually, while others relied peer support, or public health service provision. Participants identified many gaps in available services to meet their diverse needs. Harm reduction and treatment responses must be robust and adaptable to respond to the diversity of patterns of substance use among people who use opioids and MA concurrently, so as to not perpetuate harm and leave people behind.
Background: British Columbia (BC) has been facing a public health emergency of overdose since 2016, with rural regions of the province facing the highest rates of death. Peers (in this case, people with lived experience of substance use) are known to be effective patient navigators in health system and can play a role in connecting patients to care and reducing overdose risk. Case Presentation: We outline a peer-led program focused on opioid agonist treatment and safe supply medication delivery at a clinic in rural BC that began in March 2020. The peer takes an Indigenous harm reduction approach and is focused on meeting the needs of the whole person. The peer has regular contact with approximately 50 clients and navigates medication delivery and appointments for approximately 10-15 people each day. Clients have been retained on the medication, and experienced improvement in other outcomes, including securing housing, employment and managing other health issues. The peer has established contact with clients since March 2020 to support engagement with health care and continuity of medication access. This program highlights the importance and value of peer-led work and need for further investments in peer-led programs to respond to the overdose crisis Conclusions: This peer-led intervention is a promising approach to engaging people who remain disconnected from health services in care in a rural community. This model could be adapted to other settings to support patient contact with the health system and medication access and continuity, with the ultimate goal of reducing overdose risk.
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