Experiences Of Substance Use Research Articles

In Case You Haven't Heard…

National Institute on Drug Abuse director Nora Volkow, M.D. published a blog last week calling for community involvement in addiction science, and this means “[i]ncluding people with experience of substance use and addiction in the scientific workforce — and making sure they feel safe and recognized as valuable members of the research team…” Their perspectives, she wrote, “are invaluable in making sure that the right research questions are asked.” For the blog, go to https://nida.nih.gov/about‐nida/noras‐blog/2024/11/improving‐community‐engagement‐in‐addiction‐science

Exploring women’s lived experiences of substance use and social work to inform social work education and practice, an Irish perspective

ABSTRACT Mothers dealing with substance use face increased stigma when interacting with the health and social systems, putting them under pressure. Contemporary Irish social work policies emphasize Hidden Harm, which prioritizes the well-being of the child. Though this is necessary to an extent to protect children in social care situations, the needs of parents are often unconsidered. Likewise, their perspectives on social work are underrepresented within the field’s discourse. This study explores the perspectives of Irish women in substance use treatment on their experiences within the social work system. A semi-structured group discussion methodology was utilized. All women who were engaged with services at Agency One and Two, two women-only substance use treatment facilities, were invited to participate. Nine discussion groups were formed across the two services. A total of n = 47 women participated in the study. The participants reported a lack of support and transparency from social work professionals and overwhelmingly negative experiences in the care system. Experiences of intergenerational pathways to entering the care system were strongly present. The experiences of the participants were largely negative and contradicted Ireland’s social work policies. Continued perspectives from this population, along with social work professionals, are necessary.

‘This is PEEP’ participatory qualitative study: learning from a provincial consultation and advisory group of people with lived and living experience of substance use in British Columbia, Canada

ObjectivesTo summarise PEEP’s (Professionals for Ethical Engagement of Peers—a group of consultants with lived and living experience of substance use) outputs and gain insights into PEEP’s impact and suggestions for...

Exploring the Impact of Stigma on Health and Wellbeing: Insights from Mothers with Lived Experience Accessing Recovery Services.

Stigmatisation is the process by which an individual is devalued based on their attributes, characteristics, and/or behaviour, with this often leading to prejudice, social and health-related harms, active discrimination, and microaggressions. The aim of this paper is to show how social harms can occur and how stigma is damaging to the health and wellbeing of a person in recovery. To do so, we focus on the harms that arise from the internalisation of labels that mothers who use drugs encounter in a treatment and recovery setting whilst in active recovery, and how this stigmatisation can manifest negative self-beliefs. Qualitative data was used from two semi-structured focus groups involving females with lived experience of substance use (n = 13). A reflexive thematic analysis approach was used to analyse the interview transcripts, and three themes were identified: (1) the enduring nature of stigma; (2) gender disparity and the need for mothers- and women-only spaces; and (3) stigma as a barrier to services and wellbeing. Findings revealed the enduring nature of stigma amongst mothers who were in active recovery, with women feeling judged more harshly than men and experiencing pressure to live up to a "good mother" ideal whilst in recovery. This paper demonstrates that mothers in recovery are still stigmatised and, as a consequence, approach services with increased sensitivity, with stigma often resulting in disengagement or reluctance to access healthcare settings. We conclude that staff in health, social, and primary care settings need to develop a strong therapeutic alliance with mothers in recovery and promote anti-stigma approaches in their practice, in order to mitigate stigma and reduce harms to health and wellbeing.

Perspectives of key interest groups regarding supervised Consumption sites (SCS) and novel virtual harm reduction services / overdose response hotlines and applications: a qualitative Canadian study

BackgroundSupervised consumption sites (SCS) and overdose prevention sites (OPS) have been implemented across Canada to mitigate harms associated with illicit substance use. Despite their successes, they still contend with challenges that limit their accessibility and uptake. Overdose response hotlines and apps are novel virtual technologies reminiscent of informal “spotting” methods that may address some of the limitations. Here, we strove to qualitatively examine the factors that may encourage or deter utilization of these virtual services and SCS.MethodsA total of 52 participants across Canada were recruited using convenience and snowball sampling methods. These included people with lived and living experience of substance use, family members of people with lived experience, healthcare providers, community harm reduction workers, and virtual harm reduction operators. Semi-structured telephone interviews were conducted and inductive thematic analysis was performed to identify the themes pertaining to SCS and virtual harm reduction.ResultsParticipants viewed overdose response hotline and apps as an opportunity to consume substances without being hindered by logistical barriers (e.g., wait times), fear of law enforcement, invasion of privacy, and more. They also noted that these virtual services provided more flexibility for clients who opt for routes of consumption that are not supported by SCS, such as smoking. Overall, SCS was perceived to be better than virtual services at facilitating social connection, providing additional resources/referrals, as well as prompt response to overdose.ConclusionIn sum, participants viewed SCS and virtual services as filling different needs and gaps. This study adds to a growing body of literature which informs how virtual harm reduction services can serve as useful adjunct to more standard harm reduction methods.

Harm Reduction in the Field: First Responders' Perceptions of Opioid Overdose Interventions.

Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with first responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and community-trained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, field-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for first responder programs. Our team completed semi-structured, qualitative interviews with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February-May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached. Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for first responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff. These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors.

Implementing Canada’s first national virtual phone based overdose prevention service: lessons learned from creating the National Overdose Response Service (NORS)

The opioid epidemic remains one of the largest public health crises in North America to date. While there have been many diverse strategies developed to reduce the harms associated with substance use, these are primarily concentrated within a few large urban centers. As a result, there have been increased calls for equitable access to harm reduction services for those who cannot or choose not to access in-person harm reduction services. In December 2020, Canada’s National Overdose Response Service (NORS) a telephone based overdose response hotline and virtual supervised consumption service, was established in collaboration with various agencies and people with lived and living experience of substance use (PWLLE) across Canada to expand access to harm reduction services using novel Opioid Response Technology. In this manuscript we explore the lessons learned from the establishment and continued operation of the service exploring topics related to the initial establishment of the service, securing a phone line, routing technology, EMS dispatch solutions, peer and volunteer recruitment, legal and ethical support, policy and procedure development, securing funding, and marketing. Furthermore, we detail how this service has grown and changed in response to the various needs of service users.

A social network analysis approach to assess COVID19-related disruption to substance use treatment and informal social interactions among people who use drugs in Scotland.

To assess the extent of Coronavirus-related disruption to health and social care treatment and social interactions among people with lived or living experience of substance use in Scotland, and explore potential reasons for variations in disruption. Cross sectional mixed methods interview, incorporating a social network 'egonet interview' approach asking about whether participants had interactions with a range of substance use, health, social care or third sector organisations, or informal social interactions. Five Alcohol and Drug Partnership Areas in Scotland. 57 (42% women) participants were involved in the study, on average 42 years old. Five-point Likert scale reporting whether interactions with a range of services and people had gotten much better, better, no different (or no change), worse, or much worse since COVID19 and lockdown. Ratings were nested within participants (Individuals provided multiple ratings) and some ratings were also nested within treatment service (services received multiple ratings). The nested structure was accounted for using cross classified ordinal logistic multilevel models. While the overall average suggested only a slight negative change in interactions (mean rating 2.93), there were substantial variations according to type of interaction, and between individuals. Reported change was more often negative for mental health services (Adjusted OR = 0.93 95% CI 0.17,0.90), and positive for pharmacies (3.03 95% CI 1.36, 5.93). The models found between-participant variation of around 10%, and negligible between-service variation of around 1% in ratings. Ratings didn't vary by individual age or gender but there was variation between areas. Substance use treatment service adaptations due to COVID19 lockdown led to both positive and negative service user experiences. Social network methods provide an effective way to describe complex system-wide interaction patterns, and to measure variations at the individual, service, and area level.

Defining a public health approach to substance use: Perspectives from professionals and practitioners across Canada

BackgroundWhile increasingly referenced in the literature and policy discussions, a “public health approach” (PHA) to substance use has been inconsistently defined or remained undefined. As part of a larger project on building the capacity to implement a PHA to substance use, we aimed to understand how professionals and practitioners across Canada who work with or whose work directly impacts the lives of people who use substances conceptualize a PHA. MethodsWe conducted a cross-sectional national online survey of public health professionals, public safety professionals, health and social service providers, and other relevant professionals and practitioners. The survey contained closed- and open-ended questions designed to gauge familiarity and comfort with application of a PHA to substance use, and perspectives on an organizational definition of such an approach. Survey recruitment was active between May and July 2021. Data analysis included descriptive statistics and thematic analysis. ResultsA total of 1041 surveys were completed. Most respondents (76 %) reported having heard of a PHA to substance use, as it was defined. Over half (54 %) indicated a high level of comfort with applying such an approach within their work. In relation to defining a PHA to substance use, the following thematic suggestions emerged from respondent's open-ended answers: explicitly recognize people with lived/living experience of substance use; incorporate trauma-informed understanding and acknowledge the varied underlying reasons for substance use; decolonize approaches to substance use and empower communities; and consider a more critical appraisal of a PHA and the terminology in its definition. ConclusionEmpirically unpacking multi-stakeholder understandings of a PHA to substance use can help to inform a more cohesive definition and build the consensus needed for more effective, coordinated, and community-led responses to substance use. Future work, especially qualitative research, will provide richer and more practical understandings of a PHA to substance use.

Medical training to effectively support patients who use substances across practice settings: a scoping review of recommended competencies.

The responsibility for addressing the healthcare needs of PWUS is the responsibility of all physicians. Within the healthcare system, research consistently reveals inequitable experiences in healthcare with people who use substances (PWUS) reporting stigmatization, marginalization, and a lack of compassion. The aim of this scoping review was to find and describe competencies being taught, developed, and fostered within medical education and then to provide recommendations to improve care for this population of patients. Nineteen articles were included. Recommended knowledge competencies tend to promote understanding neurophysiological changes caused by substances, alongside knowing how to evaluate of 'risky' behaviours. Commonly recommended skills relate to the screening and management of substance use disorders. Recommended attitude competencies include identifying personal bias and establishing a patient-centered culture among practice teams. The disease model of addiction informed all papers, with no acknowledgement of potential beneficial or non-problematic experiences of substance use. To enhance knowledge-type competencies, medical education programs are advised to include addiction specialists as educators and prevent stigmatization through the hidden curriculum. To reduce experiences of stigmatization and marginalization among patients who use illicit substances and to improve quality of care, knowledge, skills, and attitudes competencies can be more effectively taught in medical education programs.Résumé.

Feeling safer: effectiveness, feasibility, and acceptability of continuous pulse oximetry for people who smoke opioids at overdose prevention services in British Columbia, Canada

BackgroundSmoking is the most common mode of unregulated opioid consumption overall and implicated in fatal overdoses in British Columbia (BC). In part, perception of decreased risk (e.g., fewer who smoke carry naloxone kits) and limited smoking-specific harm reduction services contribute to overdose deaths. Overdose prevention services (OPS) offer supervised settings for drug use. Continuous pulse oximetry, common in acute care, allows real-time, remote oxygen monitoring. We evaluated the effectiveness of a novel continuous pulse oximetry protocol aimed at allowing physical distancing (as required by COVID-19, secluded spaces, and to avoid staff exposure to vaporized opioids), its feasibility, and acceptability at OPS for people who smoke opioids.MethodsThis was a mixed methods survey study. We developed a continuous pulse oximetry protocol in collaboration with clinical experts and people with lived/living experience of substance use. We implemented our protocol from March to August 2021 at four OPS in BC permitting smoking. We included adults (≥ 18 years) presenting to OPS to smoke opioids. Peer researchers collected demographic, health, and substance use information, and conducted structured observations. OPS clients participating in our study, OPS staff, and peer researchers completed post-monitoring surveys. We analyzed responses using a thematic inductive approach and validated themes with peer researchers.ResultsWe included 599 smoking events. OPS clients participating in our study had a mean age of 38.5 years; 73% were male. Most (98%) reported using “down”, heroin, or fentanyl; 48% concurrently used other substances (32% of whom reported stimulants); 76% reported smoking alone in the last 3 days; and 36% reported an overdose while smoking. Respondents reported that the protocol facilitated physical distancing, was easy to use, high satisfaction, improved confidence, improved sense of safety, and that they would use it again.ConclusionsContinuous pulse oximetry allowed safe physical distancing, was feasible, and acceptable in monitoring people who smoke opioids at OPS.

I was easier for him to control when I was drunk: women’s experiences of substance use and domestic abuse victimisation

Many women who are victims of domestic abuse also experience problematic substance use; yet there is a gap in knowledge concerning the interplay of both issues from the perspective of women. While some may use substances to cope with the impact of abuse, their use of substances can also be used against them by the perpetrator as a means of control. This narrative study seeks to reduce the gap in knowledge regarding women’s substance use and victimisation experiences by presenting findings from interviews with women who have experienced the co-occurring issues. Reflecting on the definition of coercive control, and exploring women’s narratives, this article demonstrates how perpetrators may use a woman’s substance use as justification to increase dependency, isolate them from sources of support, reduce their independence and regulate their everyday behaviour. This is an important finding, evidencing how substances are a tactic of coercive control. Conversely, the narratives also illustrate how women may use their substance use to be in control in an uncontrollable situation. Initial recommendations highlight the need to explore the nuance of experience among women with co-occurring substance use and domestic abuse, so that support is provided that is reflective of their lived experience.

Programs and practices that support pregnant people who use drugs’ access to sexual and reproductive health care in Canada: a scoping review

BackgroundPregnant people who use unregulated drugs (PPWUD) are at high risk of health complications yet experience a range of barriers to sexual and reproductive health care. Given that improving maternal health and access to reproductive health care are key targets underpinning the Sustainable Development Goals (SDG), there is an urgent need to improve access to appropriate supports and services for this population. Little is known about what programs and practices exist to support PPWUD’s access to sexual and reproductive health care. This scoping review aimed to identify the available literature on these programs and practices in Canada.MethodsA scoping review was conducted using JBI methodology and reported using PRISMA guidelines. Scholarly databases and grey literature sources were searched to identify literature published between 2016–2023 in English or French that discussed, defined, conceptualised, or evaluated programs and practices that support PPWUD’s access to sexual and reproductive health care in Canada. Identified literature was screened using Covidence. Data were extracted from included texts, then analysed descriptively. Frequencies and key concepts were reported.ResultsA total of 71 articles were included, most of which were grey literature. Of the total, 46 unique programs were identified, as well as several useful practices. Most programs were in urban centres in Western Canada, and most programs offered holistic ‘wrap-around services.’ Several programs delivered these services on-site or as ‘drop-in’ programs with the support of staff with lived/living experience of substance use. Most frequent program outcomes included keeping parents and children together, improving connection to other services, and reducing substance use harms. Noted helpful practices included non-judgmental care and the use of harm-reduction strategies.ConclusionsSeveral programs and practices that support PPWUD exist in Canada, though few focus exclusively on sexual and reproductive health. There remain opportunities to improve access to programs, including expanding geographic availability and range of services. The review has clinical application by providing an overview of available programs that may support clinicians in identifying services for PPWUD. Future research should consider client perspectives and experiences of these programs.Review registration numberOpen Science Framework https://osf.io/5y64j.

Partnering with People with Lived/Living Experience of Mental Health and substance Use in Participatory Evaluation of an integrated virtual navigation support service for people experiencing substance use challenges.

Introduction/Background: This presentation shares how the Mid-West Toronto-Ontario Health Team (MWT-OHT) in Toronto, Canada involved patients and partners in the design, implementation, and evaluation of the “In Your Corner Program” to support people with substance use challenges. The experience of embedding the voices of people with living/lived experience in co-designing and evaluating the program will be shared.
 Who is it for? The “In Your Corner” program represents the actualization of key recommendations from people with lived/living experience with substance use challenges in MWT-OHT that identified a need for service navigation supports that helps to close transition gaps. The ‘In Your Corner’ program necessitated the MWT-OHT to take a collaborative, team, and consensus-based approach to coordinating services across the region, re-designing care pathways that better meet the needs of a dynamic and diverse population within the constraints of existing resources and structures.
 Who did you involve & engage with? The MWT-OHT brings together partners across health and social sectors in the mid-west downtown region of Toronto Canada to work together for better, more integrated care. In 2019, MWT-OHT completed co-design work with people with living/lived experiences of substance use and mental health focused on improving the care experience and outcomes for people with challenges related to substance use. The In Your Corner program was implemented in 2021 through a 5-month implementation funding and extended for an additional 4 months through in-kind support from implementation partners. During this time, a participatory evaluation approach was employed with partners as well as clients and providers of the program to inform next steps, scale, and sustainability.
 What results did you get? What impact did you have? Initial implementation findings of the program demonstrated that the model of care capitalizes on existing programs and was able to create a more robust scaffolding for integrated care for the clients served by the program. The opportunity to embed Peer support workers into the model was highlighted along with the need for follow-up supports over a longer period. The program was a first step toward working together with people with living and lived experiences from design to evaluation from a partnered approach that is hoped to be embedded in how the MWT-OHT approaches all initiatives.
 What is the learning for the international audience? The learnings from this program demonstrates the processes and supports needed to meaningfully embed the voices of patients and providers from design phase through implementation, evaluation, and scale at various points in the journey from a systems perspective. Considerations for scale are important, as well as minimizing and preventing tokenism and supporting true partnering.
 What are the next steps? Next steps identified from the co-design evaluation sessions with clients and providers of the In Your Corner Program have informed how to leverage, change, and scale the program to reach more people in the region with substance use challenges. More importantly, this process has become a blueprint for the MWT-OHT in how to embed the voices of patients, families, and caregivers in the designing and evaluating initiatives.

Mobile treatment for opioid use disorder: Implementation of community-based, same-day medication access interventions

BackgroundMedications for Opioid Use Disorder (MOUD) are lifesaving, but <20 % of individuals in the US who could benefit receive them. As part of the NIH-supported HEALing Communities Study (HCS), coalitions in several communities in Massachusetts and Ohio implemented mobile MOUD programs to overcome barriers to MOUD receipt. We defined mobile MOUD programs as units that provide same-day access to MOUD at remote sites. We aimed to (1) document the design and organizational structure of mobile programs providing same-day or next-day MOUD, and (2) explore the barriers and facilitators to implementation as well as the successes and challenges of ongoing operation. MethodsProgram staff from five programs in two states (n = 11) participated in semi-structured interviews. Two authors conducted thematic analysis of the transcripts based on the domains of the social-ecological model and the semi-structured interview guide. ResultsMobile MOUD units sought to improve immediate access to MOUD (“Our answer is pretty much always, ‘Yes, we'll get you started right here, right now,’”), advance equity (“making sure that we have staff who speak other languages, who are on the unit and have some resources that are in different languages,”), and decrease opioid overdose deaths.Salient program characteristics included diverse staff, including staff with lived experience of substance use (“She just had that personal knowledge of where we should be going”). Mobile units offered harm reduction services, broad medical services (in particular, wound care), and connection to transportation programs and incorporated consistency in service provision and telemedicine access.Implementation facilitators included trusting relationships with partner organizations (particularly pharmacies and correctional facilities), nuanced understanding of local politics, advertising, protocol flexibility, and on-unit prescriber hours.Barriers included unclear licensing requirements, staffing shortages and competing priorities for staff, funding challenges due to inconsistency in grant funding and low reimbursement (“It's not really possible that billing in and of itself is going to be able to sustain it”), and community stigma toward addiction services generally. ConclusionsDespite organizational, community, and policy barriers, participants described mobile MOUD units as an innovative way to expand access to life-saving medications, promote equity in MOUD treatment, and overcome stigma.

Peer-led safer supply and opioid agonist treatment medication distribution: a case study from rural British Columbia

BackgroundBritish 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 systems and can play a role in connecting patients to care and reducing overdose risk.Case presentationWe outline a peer-led program focused on opioid agonist treatment and prescribed safe supply medication delivery that began in March 2020 at a clinic in rural BC. 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 acute and chronic health conditions. 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 unregulated drug poisoning crisis.ConclusionsThis 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.

A scoping review of Aotearoa New Zealand women's experiences of substance use, alcohol and drug services

INTRODUCTION: The experiences with healthcare services of women who use substances (WWUS)—especially when pregnant or parenting—are largely missing from research in Aotearoa. This scoping review was conducted to inform doctoral research on a new, integrated parenting and substance-use residential-treatment facility in Auckland: Te Whare Taonga. APPROACH: Two objectives of the review were to: 1) collate insights from experiences of women who use substances; and 2) synthesise strengths and weaknesses within current healthcare and alcohol or other drug (AOD) services to understand what works to support WWUS, particularly those who are pregnant or parenting. Peer-reviewed studies, grey literature, and theses published between 1992–2022 exploring the perspectives and views of WWUS and their experiences of substance use, healthcare services, and AOD-treatment providers in Aotearoa New Zealand, were scoped in multiple databases. FINDINGS: The review evidenced a need for gender-specific or gender-sensitive services that are non-stigmatising, accessible to pregnant or parenting women, and culturally appropriate. Holistic care tailored to individual need was considered important. Barriers to treatment included stigma, wait times, negative experiences of healthcare workers, and a lack of appropriate services to meet women’s needs. CONCLUSIONS: There is a lack of AOD services available to WWUS, and, subsequently, research is limited. However, the findings provide an understanding of how healthcare and treatment providers, social workers, whānau (extended family, family group, can include friends with no kinship ties), community, and funders can provide informed and empathetic support to WWUS, including those who are pregnant and parenting.

“A peer support worker can really be there supporting the youth throughout the whole process”: a qualitative study exploring the role of peer support in providing substance use services to youth

BackgroundYouth (ages 12–24) rarely access services and supports to address substance use concerns. Peer support can facilitate service engagement and has been associated with positive substance use recovery outcomes in adults, yet few studies have examined this role among youth specifically. As such, this qualitative study explored the role of peer support in providing substance use services to youth in British Columbia and how best to support them in their role.MethodsParticipatory action research methods were used by partnering with youth who had lived/living experience of substance use, including peer support workers, to co-design the research protocol and materials. An initial focus group and subsequent interviews were held with 18 peer support workers who provide services to youth (ages 12–24) based on their own lived experience with mental health and/or substance use. The discussions were audio-recorded, transcribed verbatim, and analysed thematically using an inductive approach.ResultsPeer support workers' core experiences providing substance use services to youth centred around supporting youth throughout the whole process. This was accomplished by meeting youth where they are at, providing individualized care, and bridging the gap between other services and supports. However, participants experienced multiple organizational barriers hindering their ability to support youth and stressed the importance of having an employer who understands the work you are doing. This involved having someone advocating for the peer support role to promote collaboration, empowering peers to set boundaries and define their own role, and providing adequate training and mentorship. Finally, peer support workers described how their lived experience bridges connection and de-stigmatization at the individual, organizational, and community level, which was unique to their role.ConclusionsPeer support plays a unique role in youths’ substance use journeys, given their own lived experience and flexibility within their role. However, their position is often misunderstood by employers and other service providers, leaving peers with inadequate support, training, and mentorship to do their job. The findings from this study call for improved integration of peer support into service environments, as well as standardized training that is in-depth and continuous.

Facilitated telemedicine for hepatitis C virus: Addressing challenges for improving health and life for people with opioid use disorder.

People who use drugs (PWUD) frequently delay or avoid obtaining medical care in traditional healthcare settings. Through a randomized controlled trial, we investigated facilitated telemedicine for hepatitis C virus (HCV) integrated into opioid treatment programmes. We sought to understand the experiences and meanings of facilitated telemedicine and an HCV cure among PWUD. We utilized purposive sampling to interview 25 participants, 6-40 months after achieving an HCV cure. We interpreted and explicated common meanings of participants' experiences of an HCV cure obtained through facilitated telemedicine. Participants embraced facilitated telemedicine integrated into opioid treatment programmes as patient-centred care delivered in 'safe spaces' (Theme 1). Participants elucidated their experiences of substance use and HCV while committing to treatment for both entities. Facilitated telemedicine integrated into opioid treatment programmes enabled participants to avoid stigma encountered in conventional healthcare settings (Theme 2). Participants conveyed facing negative perceptions of HCV and substance use disorder. Improved self-awareness, acquired through HCV and substance use treatment, enabled participants to develop strategies to address shame and stigma (Theme 3). An HCV cure, considered by PWUD as a victory over a lethal infectious disease, promotes self-confidence, enabling participants to improve their health and lives (Theme 4). Integrating facilitated telemedicine into opioid treatment programmes addresses several healthcare barriers for PWUD. Similarly, obtaining an HCV cure increases their self-confidence, permissive to positive lifestyle changes and mitigating the negative consequences of substance use. In this study of patient involvement, we interviewed patient-participants to understand the meaning of an HCV cure through facilitated telemedicine. Participants from a facilitated telemedicine pilot study provided essential input on the design and outcomes of a randomized controlled trial. Pilot study participants endorsed facilitated telemedicine in a testimonial video. They attended site initiation meetings to guide trial implementation. A Patient Advisory Committee (PAC) ensured that patient participants were active members of the research team.The PAC represented patients' voices through feedback on study procedures. ASustainability Committee supported public involvement in the research process, including educational opportunities, feedback on implementation, and future sustainability considerations.

An evaluation of the Compassion, Inclusion, and Engagement initiative: learning from PWLE and communities across British Columbia

BackgroundThe Compassion, Inclusion and Engagement initiative (CIE) was a social contact intervention that operated in British Columbia between 2015 and 2021. The primary objective of CIE was to increase the participation of people with lived experience of substance use (PWLE) in the planning, design, implementation, and evaluation of harm reduction supports and services.Case presentationCIE used the developmental evaluation methodology outcome mapping to define and measure progress towards its goals. Developmental evaluation emphasizes learning in contrast to other forms of evaluation which are often more focused on determining the value or success of a project or programme based on predetermined criteria. Outcome mapping is a relational practice which acknowledges that change is achieved by an initiative’s partners and the role of the initiative is to provide access to resources, ideas and opportunities that can facilitate and support change.ConclusionsThrough the implementation and evaluation of CIE, it became clear that directly supporting PWLE facilitated more meaningful and lasting change than solely working to improve the health and social services that supported them. The impacts of the CIE initiative extend far beyond the outcomes of any of the dialogues it facilitated and are largely the result of an increase in social capital. CIE engagements created the opportunity for change by inviting people most affected by the toxic drug supply together with those committed to supporting them, but their ability to bring about systemic change was limited. Both PWLE and service providers noted the lack of support to attend CIE engagements, lack of support for actions that came from those engagements, and lack of PWLE inclusion in decision-making by health authorities as limiting factors for systemic change. The lack of response at a systemic level often resulted in PWLE carrying the burden of responding to toxic drug poisonings, often without resources, support, or compensation.