‘It's too much, I'm getting really tired of it’: Overdose response and structural vulnerabilities among harm reduction workers in community settings

Kolla, Gillian; Strike, Carol

doi:10.1016/j.drugpo.2019.09.012

Cited by 61 publications

(60 citation statements)

References 45 publications

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“…Although the findings from this research can inform community drug checking implementation, the results also confirm the significant harmful impacts of criminalization of drugs and people who use/sell drugs and how criminalization negatively impacts the implementation of wanted harm reduction responses [57][58][59][60]. As also expressed by Bardwell et al [45], implementation of drug checking is compromised by the criminalization of people who are to access the services and the sample they seek to check.…”

Section: Discussionsupporting

confidence: 54%

What is needed for implementing drug checking services in the context of the overdose crisis? A qualitative study to explore perspectives of potential service users

et al. 2020

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Background: The current illicit drug overdose crisis within North America and other countries requires expanded and new responses to address unpredictable and potentially lethal substances, including fentanyl analogues, in the unregulated drug market. Community-wide drug checking is being increasingly explored as one such public health response. We explored how drug checking could be implemented as a potential harm reduction response to the overdose crisis, from the perspective of potential service users. Methods: The research was guided by the Consolidated Framework for Implementation Research (CFIR). We conducted a qualitative, pre-implementation study to inform development and implementation of drug checking services that are acceptable to people who use substances and meet their needs. University and community researchers conducted 27 in-depth interviews with potential service users at prospective drug checking sites. We inductively developed emerging themes to inform the implementation of drug checking services within the five domains of the CFIR, and identified the most relevant constructs. Results: Implementing community drug checking faces significant challenges within the current context of criminalization and stigmatization of substance use and people who use/sell drugs, and trauma experienced by potential service users. Participants identified significant risks in accessing drug checking, and that confidential and anonymous services are critical to address these. Engaging people with lived experience in the service can help establish trust. The relative advantage of drug checking needs to outweigh risks through provision of accurate results conveyed in a respectful, non-judgemental way. Drug checking should provide knowledge relevant to using and/or selling drugs and informing one's own harm reduction.

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Section: Discussionsupporting

confidence: 54%

What is needed for implementing drug checking services in the context of the overdose crisis? A qualitative study to explore perspectives of potential service users

et al. 2020

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“…Examining the practices of care among PWUD builds off research that has repeatedly documented the mutual aid among PWUD. This includes the ways that PWUD (whether formally employed as "peer workers" or not) support others within harm reduction programs and overdose prevention sites, with more recent research exploring their experiences reversing overdoses in housing and community settings [17,[47][48][49][50][51]. Practices of care range from the provision of sterile injection equipment to the administration of naloxone to reverse a lifethreatening opioid overdose.…”

Section: Practices Of Care In Harm Reductionmentioning

confidence: 99%

“…To do so, they are trained to offer harm reduction services to other PWUD in their social networks, and work primarily from their own homes. The Satellite Sites become community access points for harm reduction equipment and information, overdose education, and naloxone distribution, and, in some sites, monitoring of drug consumption [16,17]. One of the unique elements of the Satellite Site program is that it works directly with people who may move into and out of drug selling; the result is that some of the SSWs are people who sell, or allow drugs to be sold within their sites.…”

Section: Introductionmentioning

confidence: 99%

Practices of care among people who buy, use, and sell drugs in community settings

Kolla

Strike

2020

Harm Reduct J

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Background: Popular perception of people who sell drugs is negative, with drug selling framed as predatory and morally reprehensible. In contrast, people who use drugs (PWUD) often describe positive perceptions of the people who sell them drugs. The "Satellite Sites" program in Toronto, Canada, provides harm reduction services in the community spaces where people gather to buy, use, and sell drugs. This program hires PWUD-who may move into and out of drug selling-as harm reduction workers. In this paper, we examine the integration of people who sell drugs directly into harm reduction service provision, and their practices of care with other PWUD in their community. Methods: Data collection included participant observation within the Satellite Sites over a 7-month period in 2016-2017, complemented by 20 semi-structured interviews with Satellite Site workers, clients, and program supervisors. Thematic analysis was used to examine practices of care emerging from the activities of Satellite Site workers, including those circulating around drug selling and sharing behaviors. Results: Satellite Site workers engage in a variety of practices of care with PWUD accessing their sites. Distribution of harm reduction equipment is more easily visible as a practice of care because it conforms to normative framings of care. Criminalization, coupled with negative framings of drug selling as predatory, contributes to the difficultly in examining acts of mutual aid and care that surround drug selling as practices of care. By taking seriously the importance for PWUD of procuring good quality drugs, a wider variety of practices of care are made visible. These additional practices of care include assistance in buying drugs, information on drug potency, and refusal to sell drugs that are perceived to be too strong. Conclusion: Our results suggest a potential for harm reduction programs to incorporate some people who sell drugs into programming. Taking practices of care seriously may remove some barriers to integration of people who sell drugs into harm reduction programming, and assist in the development of more pertinent interventions that understand the key role of drug buying and selling within the lives of PWUD.

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“…Previous studies have found that oppression of individuals or groups is often based on their social positioning, which affects their "structural vulnerability" [30]. Substance use is one such factor that generates marginalization of individuals to both drug and health related harms [28]. This stigma is deeply embedded in the long history of drug prohibition in Canada which continues to criminalize substance use [50,51] Our ndings indicate that nancial insecurity is one of the most prominent stressors in experiential workers' lives.…”

Section: Discussionmentioning

confidence: 99%

“…Experiential workers not only work in a stressful environment, but often live the same reality too [24][25][26]. Like other PWUD, experiential workers are in a vulnerable position, subject to societal stigma, poverty, poor living conditions, and illness [27][28][29]. These experiences of oppression that harm and constrain individuals or groups based upon their social positioning, is termed "structural vulnerability" [30] and affects the mental health of experiential workers.…”

Section: Introductionmentioning

confidence: 99%

“An Emotional Roller-Coaster:" Stressors Faced by Peer Workers in Overdose Response Settings

Mamdani

McKenzie

Pauly

et al. 2020

Preprint

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Background Experiential workers or ‘peers’ (workers with past or present drug use experience) are at the forefront of overdose response initiatives and their role is essential in creating safe spaces for people who use drugs (PWUD). Working in overdose response settings has benefits for experiential workers but is also stressful, with lasting emotional and mental health effects. Yet, little is known about the stressors experiential workers face and what interventions can be implemented to support them in their roles. Methods This project used a community-based mixed methods research design. Eight experiential worker-led focus groups (n = 31) were conducted between November 2018 and March 2019 to assess needs of experiential workers. The transcripts were thematically coded and analyzed using interpretative description. These results informed a survey which was conducted (n = 50) in September 2019 to acquire quantitative data on experiential workers’ perception of health, quality of life, working conditions and stressors. Frequency distributions were used to describe characteristics of participants. X2 distribution values with Yates correction were conducted to check for association between variables. Results Five themes emerged from the focus groups that point to stressors felt by experiential workers: (1) Financial insecurity; (2) lack of respect and recognition at work; (3) poor living conditions; (4) inability to access and/or refer individuals to resources; and (5) constant exposure to death and trauma. Consistent with this, the top four factors that survey participants picked as one of the “top three stressors” included financial situation, work situation, housing, and caring for others. Conclusion Experiential workers are faced with a diversity of stressors in their lives which often reflect societal stigmatization of drug use. Recognition of these stressors is critical in designing interventions to ease the emotional, physical and financial burden faced by experiential workers.

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‘It's too much, I'm getting really tired of it’: Overdose response and structural vulnerabilities among harm reduction workers in community settings

Cited by 61 publications

References 45 publications

What is needed for implementing drug checking services in the context of the overdose crisis? A qualitative study to explore perspectives of potential service users

What is needed for implementing drug checking services in the context of the overdose crisis? A qualitative study to explore perspectives of potential service users

Practices of care among people who buy, use, and sell drugs in community settings

“An Emotional Roller-Coaster:" Stressors Faced by Peer Workers in Overdose Response Settings

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