Bruce Wallace1, Katrina Barber2, Bernadette Bernie Pauly3. 1. School of Social Work, Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada. Electronic address: barclay@uvic.ca. 2. Social Dimensions of Health, Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada. Electronic address: kbarber@uvic.ca. 3. School of Nursing, Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada. Electronic address: bpauly@uvic.ca.
Abstract
BACKGROUND: The current opioid overdose crisis in North America is heightening awareness of the need for and the challenges of implementing harm reduction, notably within complex and diverse settings such as homeless shelters. In this paper, we explore the implementation of harm reduction in homeless shelters during an emerging overdose emergency. METHODS: The objective of this qualitative study was to identify and understand micro-environment level factors within emergency shelters responding to homelessness and substance use, and the macro-level influences that produce and sustain structural vulnerabilities. We conducted eight focus groups with a total of 49 participants during an emerging overdose emergency. These included shelter residents (n = 23), shelter staff (n = 13), and harm reduction workers (n = 13). RESULTS: The findings illustrate the challenges of implementing an overdose response when substance use is prohibited onsite, without an expectation of abstinence, and where harm reduction services are limited to the distribution of supplies. In this context, harm reduction is partially implemented and incomplete. Shelters can be a site of risks and trauma for residents and staff due to experiencing, witnessing, and responding to overdoses. CONCLUSION: The current overdose crisis heightens the challenges of implementing harm reduction, particularly within complex and diverse settings such as homeless shelters. When harm reduction is limited to the distribution of supplies such as clean equipment and naloxone, important principles of engagement and the development of trust necessary to the provision of services are overlooked with negative implications for service users.
BACKGROUND: The current opioid overdose crisis in North America is heightening awareness of the need for and the challenges of implementing harm reduction, notably within complex and diverse settings such as homeless shelters. In this paper, we explore the implementation of harm reduction in homeless shelters during an emerging overdose emergency. METHODS: The objective of this qualitative study was to identify and understand micro-environment level factors within emergency shelters responding to homelessness and substance use, and the macro-level influences that produce and sustain structural vulnerabilities. We conducted eight focus groups with a total of 49 participants during an emerging overdose emergency. These included shelter residents (n = 23), shelter staff (n = 13), and harm reduction workers (n = 13). RESULTS: The findings illustrate the challenges of implementing an overdose response when substance use is prohibited onsite, without an expectation of abstinence, and where harm reduction services are limited to the distribution of supplies. In this context, harm reduction is partially implemented and incomplete. Shelters can be a site of risks and trauma for residents and staff due to experiencing, witnessing, and responding to overdoses. CONCLUSION: The current overdose crisis heightens the challenges of implementing harm reduction, particularly within complex and diverse settings such as homeless shelters. When harm reduction is limited to the distribution of supplies such as clean equipment and naloxone, important principles of engagement and the development of trust necessary to the provision of services are overlooked with negative implications for service users.
Authors: Alexandria Macmadu; Lisa Frueh; Alexandra B Collins; Roxxanne Newman; Nancy P Barnett; Josiah D Rich; Melissa A Clark; Brandon D L Marshall Journal: Int J Drug Policy Date: 2022-07-08
Authors: Laura Brandt; Aimee N C Campbell; Jermaine D Jones; Suky Martinez; Joanne Neale; Stephen Parkin; Caral Brown; John Strang; Sandra D Comer Journal: Subst Abus Date: 2021-09-14 Impact factor: 3.716
Authors: Kristin E Schneider; Catherine Tomko; Danielle Friedman Nestadt; Bradley E Silberzahn; Rebecca Hamilton White; Susan G Sherman Journal: Int J Drug Policy Date: 2020-07-22
Authors: Zahra Mamdani; Sophie McKenzie; Bernadette Pauly; Fred Cameron; Jennifer Conway-Brown; Denice Edwards; Amy Howell; Tracy Scott; Ryan Seguin; Peter Woodrow; Jane A Buxton Journal: Harm Reduct J Date: 2021-02-11