Abstract
BackgroundOngoing legal and social discrimination, and stigmatization of people with lived experience of drug use (PWLE) continues to contribute to overdose-related deaths in Canada. The involvement of PWLE working in harm reduction services has proven effective in decreasing drug-related harms among PWLE; however, there exist unintended negative impacts. PWLE working in harm reduction services risk overextending themselves beyond employment parameters (e.g., emotional labor) with few systems in place (e.g., employment advocacy) for support. While meaningful participation of PWLE in harm reduction programs is critical to addressing the overdose crisis, their labor in Canada’s overdose response commands further investigation and recognition. This paper examines some of the benefits and negative aspects of working in harm reduction among PWLE.MethodsFifty qualitative surveys were completed by PWLE working in harm reduction services from across Canada at the National 2018 Stimulus conference held in Edmonton, Alberta. The surveys focused on the benefits and negatives of ‘peer’ employment and recommendations for organizational transformation through short answer written sections. Surveys were analyzed thematically using NVivo, informed by critical perspectives on substance use, with attention to key re-occurring themes on employment equity.ResultsWhile participants described multiple benefits of working in harm reduction services, such as the valuing of their expertise by fellow ‘peers,’ growing skill sets, countering stigma, and preventing overdose deaths, issues of workplace equity were significantly identified. Stigma, tokenism, workplace discrimination, including power and pay inequities, as well as lack of worker compensation and benefits were identified as key factors persisting in the everyday experiences of participants.ConclusionContinued exposure to stigma, workplace discrimination, and/or power imbalances, combined with the impact of high stakes employment (e.g., dealing with overdose deaths), can have significant consequences for PWLE working in harm reduction, including burn out. Policy recommendations include large-scale structural changes that address inequities of hierarchical ‘peer’ employment for PWLE, including increased leadership roles for diverse PWLE, pay equity and benefits, unionization, as well as more supportive working environments attentive to the intersecting social-structural factors (poverty, criminalization, racism, gendered violence) impacting the everyday lives of PWLE working in harm reduction.
Highlights
In response to limitations of conventional drug services, since the 1990s peer-based models of care have become a significant and expanding component of harm reduction interventions in Canada [1,2,3], including overdose prevention and addiction treatment programs
Interrogating ‘peer’ work and its impacts is significant given the magnitude of preventable drug overdose deaths driven by a poisoned illicit drug supply in Canada [10] and the US [11], and the increased uptake of people with lived experience of drug use working in overdose prevention sites and harm reduction services [12, 13]
This study stems from a 5-year project initiative commenced in 2018 that operates as a component of the Canadian research consortium, CRISM (Canadian Research Initiative in Substance Misuse) to address gaps in overdose prevention responses with a leadership working group of people with lived expertise of drug use associated with four regional nodes across Canada: British Columbia; Ontario; Quebec/Atlantic regions; and the Prairies
Summary
In response to limitations of conventional drug services, since the 1990s peer-based models of care have become a significant and expanding component of harm reduction interventions in Canada [1,2,3], including overdose prevention and addiction treatment programs. This follows a large body of evidence indicating that the involvement of people who use(d) drugs extends the reach and effectiveness of interventions, including by reaching those who do not access traditional public health programs [4,5,6,7,8,9].
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