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

Author

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  • Kennedy, Mary Clare
  • Boyd, Jade
  • Mayer, Samara
  • Collins, Alexandra
  • Kerr, Thomas
  • McNeil, Ryan

Abstract

Overdose prevention sites (OPS) are a form of supervised consumption facility that have been 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 worker involvement in OPS programming, including how this shapes service dynamics and health outcomes among PWUD. 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 h of observational fieldwork at OPS and 72 in-depth qualitative interviews with PWUD. Data were analyzed thematically, with a focus on peer worker involvement at OPS and related outcomes. OPS implementation and operations depended on peer worker involvement and thus allowed for recognition of capacities developed through roles that peers were already undertaking through local programming for PWUD. Peer involvement at OPS enhanced feelings of comfort and facilitated engagement with OPS among PWUD. These dynamics and appreciation of peer worker expertise enabled communication with staff in ways that fostered harm reduction practices and promoted health benefits. However, many peer workers 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. Our findings illustrate the specific contributions of task shifting OPS service delivery to peer workers, including how this can enhance service engagement and promote the reduction of harms among PWUD. Amidst an ongoing overdose epidemic, expanding formalized peer worker 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 support and workplace benefits to promote the sustainability of this approach.

Suggested Citation

  • Kennedy, Mary Clare & Boyd, Jade & Mayer, Samara & Collins, Alexandra & Kerr, Thomas & McNeil, Ryan, 2019. "Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada," Social Science & Medicine, Elsevier, vol. 225(C), pages 60-68.
    • Handle: RePEc:eee:socmed:v:225:y:2019:i:c:p:60-68
    DOI: 10.1016/j.socscimed.2019.02.014
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    References listed on IDEAS

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    1. repec:aph:ajpbhl:10.2105/ajph.2016.303523_0 is not listed on IDEAS
    2. Johnson, Ginger A. & Vindrola-Padros, Cecilia, 2017. "Rapid qualitative research methods during complex health emergencies: A systematic review of the literature," Social Science & Medicine, Elsevier, vol. 189(C), pages 63-75.
    3. Kennedy, M.C. & Kerr, T., 2017. "Overdose prevention in the United States: A call for supervised injection sites," American Journal of Public Health, American Public Health Association, vol. 107(1), pages 42-43.
    4. Broadhead, Robert S. & Heckathorn, Douglas D. & Altice, Frederick L. & van Hulst, Yaël & Carbone, Michael & Friedland, Gerald H. & O'Connor, Patrick G. & Selwyn, Peter A., 2002. "Increasing drug users' adherence to HIV treatment: results of a peer-driven intervention feasibility study," Social Science & Medicine, Elsevier, vol. 55(2), pages 235-246, July.
    5. McNeil, Ryan & Small, Will, 2014. "‘Safer environment interventions’: A qualitative synthesis of the experiences and perceptions of people who inject drugs," Social Science & Medicine, Elsevier, vol. 106(C), pages 151-158.
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    Cited by:

    1. Betsos, Alex & Valleriani, Jenna & Boyd, Jade & McNeil, Ryan, 2022. "Beyond co-production: The construction of drug checking knowledge in a Canadian supervised injection facility," Social Science & Medicine, Elsevier, vol. 314(C).
    2. Collins, Alexandra B. & Boyd, Jade & Cooper, Hannah L.F. & McNeil, Ryan, 2019. "The intersectional risk environment of people who use drugs," Social Science & Medicine, Elsevier, vol. 234(C), pages 1-1.
    3. Wendy Masterton & Danilo Falzon & Gillian Burton & Hannah Carver & Bruce Wallace & Elizabeth V. Aston & Harry Sumnall & Fiona Measham & Rosalind Gittins & Vicki Craik & Joe Schofield & Simon Little & , 2022. "A Realist Review of How Community-Based Drug Checking Services Could Be Designed and Implemented to Promote Engagement of People Who Use Drugs," IJERPH, MDPI, vol. 19(19), pages 1-25, September.
    4. Fiona Mercer & Joanna Astrid Miler & Bernie Pauly & Hannah Carver & Kristina Hnízdilová & Rebecca Foster & Tessa Parkes, 2021. "Peer Support and Overdose Prevention Responses: A Systematic ‘State-of-the-Art’ Review," IJERPH, MDPI, vol. 18(22), pages 1-24, November.

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