Experiences Of Substance Use Research Articles

Socially Situated Experiences of Substance Use: A Photo Elicitation Pilot Study

Our study was designed to pilot a photo elicitation methodology and undertake preliminary examination of substance use from the perspectives of two potentially disparate groups. Photo elicitation methodology involved participant generated photos and elicitation interviews to purposefully explore (i) how people who use substances depict and discuss their own substance use, and (ii) how professionals who prescribe/dispense pharmaceuticals depict and portray how substances impact the lives’ of patients/clients. Individuals who use substances told “stories of self.” Health providers blended “stories of others” and “stories of social worlds” that indirectly revealed “stories of self.” All participants confronted dominant social perspectives, offering alternative interpretations and challenging such opinions as incomplete or erroneous. The social nature of substances held contrasting perspectives, with health professionals seeing incentives of “fitting in” with “peers using” and a “coping strategy” to reduce social anxiety. Participants who use substances told stories of positive social connections through shared experiences of substance use and increased effects of sociability. Findings may contribute to nuanced understandings to destigmatise and mitigate Othering.

Promoting research engagement among women with addiction: Impact of recovery peer support in a pilot randomized mixed-methods study

ObjectiveThe impact of involving peers on research engagement is largely unknown. The purpose of this pilot study, a part of a larger research, was to evaluate the impact of recovery peer involvement as a study team member on recruitment/retention of persons with lived experience of SUD during pregnancy and to assess participant perceptions about factors impacting engagement of this population and their children in research, especially brain magnetic resonance imaging (MRI). MethodsThis study randomly assigned participants (1:1) to either Peer or Research Coordinator (RC) arms. Eligible participants were English-speaking adult, non-pregnant females with lived experience of substance use during pregnancy. Certified Peers were recruited word of mouth and completed study-specific training. The impact of trained, certified Peer versus RC on research engagement was assessed by between-arm comparison of retention rates. Quantitative and qualitative survey data on participant perceptions were summarized. ResultsThirty-eight individuals enrolled into the study (19 Peer, 19 RC). Peer versus RC had 7.2 times greater odds of completing Visit 2 (Fisher's exact test; 95%CI: 1.2, 81.8; p = 0.03). The majority (70.4%) of respondents identified being accompanied by a peer and getting a tour of the MRI facility/procedures as ‘extremely’ helpful for improving participant comfort and engagement in future studies. Motivators of future research engagement also included creating a trusting, supportive, non-judgmental research environment, and linkages to treatment and other services. ConclusionFindings support the notion that peers involved as research team members could boost research engagement among persons with substance use during pregnancy.

“Sometimes you have to take the person and show them how”: adapting behavioral activation for peer recovery specialist-delivery to improve methadone treatment retention

BackgroundDespite efficacy of medication for opioid use disorder, low-income, ethno-racial minoritized populations often experience poor opioid use disorder treatment outcomes. Peer recovery specialists, individuals with lived experience of substance use and recovery, are well-positioned to engage hard-to-reach patients in treatment for opioid use disorder. Traditionally, peer recovery specialists have focused on bridging to care rather than delivering interventions. This study builds on research in other low-resource contexts that has explored peer delivery of evidence-based interventions, such as behavioral activation, to expand access to care.MethodsWe sought feedback on the feasibility and acceptability of a peer recovery specialist-delivered behavioral activation intervention supporting retention in methadone treatment by increasing positive reinforcement. We recruited patients and staff at a community-based methadone treatment center and peer recovery specialist working across Baltimore City, Maryland, USA. Semi-structured interviews and focus groups inquired about the feasibility and acceptability of behavioral activation, recommendations for adaptation, and acceptability of working with a peer alongside methadone treatment.ResultsParticipants (N = 32) shared that peer recovery specialist-delivered behavioral activation could be feasible and acceptable with adaptations. They described common challenges associated with unstructured time, for which behavioral activation could be particularly relevant. Participants provided examples of how a peer-delivered intervention could fit well in the context of methadone treatment, emphasizing the importance of flexibility and specific peer qualities.ConclusionsImproving medication for opioid use disorder outcomes is a national priority that must be met with cost-effective, sustainable strategies to support individuals in treatment. Findings will guide adaptation of a peer recovery specialist-delivered behavioral activation intervention to improve methadone treatment retention for underserved, ethno-racial minoritized individuals living with opioid use disorder.

Disconnected Perspectives: Patient and Care Provider’s Experiences of Substance Use in Pregnancy

(Int J Gynaecol Obstet. 2021;155:170–178) A negative stigma surrounds substance use in pregnancy and can lead to suboptimal care of parturient women from providers. Indigenous women in Northern British Columbia (BC) have preexisting risk such as generational abuse, racism, and systemic trauma that contribute to increase risk of substance use in pregnancy, putting an already underserved population at greater risk for adverse outcomes. The aim of this study was to discuss substance use in pregnancy from the patient and provider perspective to increase understanding and bridge the gap between patients and providers.

Perinatal alcohol use among young women living with HIV in South Africa: Context, experiences, and implications for interventions

ABSTRACT Perinatal alcohol use is common in South Africa, including among young women living with HIV (WLHIV), but there are few insights into the drivers of alcohol use in this population. Following the completion of a pilot trial of a peer support intervention for WLHIV aged 16–24 years in Cape Town, we purposively selected participants who had reported perinatal alcohol use at ≥1 study visits to complete a qualitative in-depth interview exploring their experiences of substance use. Of 119 women enrolled, 28 reported alcohol use, and 24 were interviewed, with ≥1/3 reporting drinking throughout their pregnancy. Women described living in a community where heavy perinatal alcohol consumption is normalised, including among their peers, leading to social pressure. Despite being aware of the risks of perinatal alcohol use, women described a disconnect between public health messaging and their experiences. Although most acknowledged the negative effects of alcohol in their lives, self-efficacy to reduce consumption was diminished by peer influences and the lack of formal employment and opportunities for recreation. These findings provide insights into the drivers of perinatal alcohol use in this setting, and suggest that without meaningful community-level changes, including employment opportunities and alternatives for socialising, interventions may have limited impact.

Voices of Women With Lived Experience of Substance Use During Pregnancy: A Qualitative Study of Motivators and Barriers to Recruitment and Retention in Research.

Despite concerns about negative neurocognitive effects of in utero substance exposure on child and brain development, research in this area is limited. This study gathered perspectives of persons with lived experience of substance use (eg, alcohol, prescription and illicit opioids, and other illicit substances) during a previous pregnancy to determine facilitators and barriers to research engagement in this vulnerable population. We conducted structured, in-depth, individual interviews and 2 focus groups of adult persons with lived experience of substance use during a previous pregnancy. Questions were developed by clinical, research, bioethics, and legal experts, with input from diverse stakeholders. They inquired about facilitators and barriers to research recruitment and retention, especially in long-term studies, with attention to bio-sample and neuroimaging data collection and legal issues. Interviews and focus groups were audio-recorded, transcribed, and analyzed using inductive coding qualitative analysis methods. Ten participants completed in-depth interviews and 7 participated in focus groups. Three main themes emerged as potential barriers to research engagement: shame of using drugs while pregnant, fear of punitive action, and mistrust of health care and research professionals. Facilitative factors included trustworthiness, compassion, and a nonjudgmental attitude among research personnel. Inclusion of gender-concordant recovery peer support specialists as research team members was the most frequently identified facilitator important for helping participants reduce fears and bolster trust in research personnel. In this qualitative study, persons with lived experience of substance use during a previous pregnancy identified factors critical for engaging this population in research, emphasizing the involvement of peer support specialists as research team members.

‘We are the first responders’: overdose response experiences and perspectives among peers in British Columbia

Aims Peers, i.e. people with lived/living experience of substance use, are at the forefront of harm reduction initiatives in British Columbia, yet they often lack recognition for their contributions. This study aims to understand the role of peers in overdose response settings and their experiences interacting with emergency service providers (ESPs) within the context of the Good Samaritan Drug Overdose Act (GSDOA). Methods Telephone interviews were conducted with 42 people aged 16 years and older, who were likely to witness and respond to overdoses. Participants were asked about their experiences witnessing or responding to overdoses, and interactions with ESPs. Interview transcripts were analyzed thematically. Findings Peers were often the first to respond to overdoses due to their positioning and saw themselves as having unique expertise in responding to overdoses and connecting with other people who use substances. However, peers perceived several barriers that impacted their ability to respond, including stigmatizing attitudes toward ESPs, lack of recognition, and lack of adequate resources. Conclusions While policies, such as the GSDOA are in place to promote calling 9-1-1, peers feel confident and competent in responding to overdoses and often consider calling 9-1-1 a waste of resources. There is a need to better recognize and support peers as first responders in overdose contexts.

Practical Considerations for Engaging Youth With Lived And/or Living Experience of Substance Use as Youth Advisors and Co-Researchers

Background Although youth participatory action research (YPAR) has been gaining popularity in the context of substance use research over the last decade, few studies report on how to apply these methods effectively with youth. To address this gap, this paper describes how we engaged youth as advisors and research assistants in a qualitative research study, as well as our key learnings and practical considerations for engaging youth with lived and/or living experience of substance use. Methods We applied YPAR methods by partnering with youth from across BC who have lived and/or living experience of substance use to form a project youth advisory that co-designed the research protocol and materials. Three members became youth research assistants to facilitate focus groups and qualitative interviews with other youth with lived/living experience and peer support workers who work with youth, and support with data analysis and the dissemination of research findings. Mid- and end-point surveys were distributed to evaluate and improve our youth engagement methods over the course of the study. Results The positive impact of engaging youth with lived/living experience over the course of the study was reflected by study participant responses to the quality and relevance of the focus group/interview questions and positive experiences with the youth facilitators. Youth partners also described developing new skills in research, group facilitation, leadership, communication, and professionalism. Lessons learned and considerations for engaging youth in substance use research included: an equitable hiring process; proper compensation; communication, transparency, and accountability; safe spaces; flexibility; and youth capacity building. Conclusion This study demonstrates varying ways of engaging youth with lived and/or living experience of substance in research and how youth contributions can improve the relevance, quality, and validity of the research. Lessons learned from this study can be applied by other researchers considering engaging youth with lived/living experience or other marginalized populations.

Core competencies of peer workers who use pulse oximeters to supplement their overdose response in British Columbia.

IntroductionPeer workers (those with lived/living experience of substance use) are at the forefront of overdose response initiatives in British Columbia, Canada. The onset of the coronavirus disease pandemic has significantly compounded the impact of the overdose crisis. Peer workers are integral in supporting people who use substances. However, despite the important work they do, peer workers often lack formalized credibility and do not have the same resources available to them as service providers without lived experience. The peer-led project titled the Peer2Peer Project implemented several support programs for peer workers, including providing pulse oximeters to peer workers to supplement their overdose response procedures.Materials and methodsThis study was a component of a larger evaluation of the pulse oximeter program at two organizations in BC. The study aims to highlight the competencies of peer workers who use pulse oximeters. Telephone interviews were conducted with seven peer workers who were given pulse oximeters. The transcripts were thematically coded using Covert et al.’s framework of core competencies of community health workers to compare our sample with other widely recognized professions.FindingsWe found that peer workers who used pulse oximeters described several core competencies in their work and these were aligned with Covert et al.’s core competencies for community health workers, including assessment, community health practice, communication, diversity and inclusion, professional practice, and disease prevention and management.ConclusionBy aligning peer workers’ skills to those of community health workers, we create awareness on the competencies of peer workers in using oximeters to supplement overdose response and advocate for them to receive more recognition and respect within the workplace. Further, our findings act as groundwork for future research in identifying the professional proficiencies of peer workers.

Coping Strategies and Workplace Supports for Peers with Substance Use Disorders

Introduction: Substance use disorder (SUD) peers provide support and navigation through a fragmented treatment system for people who use drugs (PWUD) and those in recovery. While barriers to peers’ work are well established, from role ambiguity to stigma surrounding substance use, little research has focused on factors that facilitate peers’ work. Methods: We conducted in-depth semi-structured interviews (N=20) with peers as part of an evaluation of a larger project related to the opioid crisis in Western New York. Participants were recruited from a regional peer network via flyers, emails, and a brief presentation. Interviews were conducted in person or by phone, audio recorded, and transcribed. Transcripts were analyzed using thematic content analysis. Results: Peers emphasized two factors: healthy personal coping strategies and strong workplace supports. Coping strategies included a sense of community, setting appropriate boundaries, and self-care routines. At the workplace, peers valued mental and emotional support, as well as professional relationships and organizational policies that made their work easier and supported self-care. For a few peers, professional relationships included advocating on behalf of PWUD by sharing personal experiences of SUD. Conclusions: Peers valued peer colleagues and peer-led organizations, noting how shared experiences of substance use and recovery enabled a unique support system. For peers who lack such support at work, the authors suggest peer networks as an alternative. We also recommend organizational policies and practices to facilitate peers’ work, such as promoting peer input and feedback, but further research is needed to measure effects on peer retention and job satisfaction.

Engagement of persons with lived experience in research that uses linked administrative health data - the BC Provincial Overdose Cohort.

Illicit drug overdose is a significant public health challenge in British Columbia (BC) that has been worsened by the COVID-19 pandemic. In 2021, 2224 persons died of overdose in BC– more than any year on record. The vast majority of overdose deaths are attributed to consumption of illicit substances and poisoning due to fentanyl. Since the 2016 emergency declaration, efforts have been made to create new data infrastructure that allows for comprehensive ascertainment of non-fatal and fatal overdose. The BC Provincial Overdose Cohort (BC-ODC) is a unique cohort that was created under public health order that includes all identified cases of illicit drug overdose in BC from January 1 2015-December 31, 2020 that is updated annually. With its unique data extracts, shared data governance structure and novel mandate, a critical component of stewarding the BC-ODC is engagement of persons with lived experience of substance use, overdose and/or incarceration. Two initiatives were launched in 2019 and 2022 to work with persons with lived experience to prioritize research that uses the BC-ODC data. Engagement of persons with lived experience of incarceration started in 2022 to inform projects that examined topics related to decriminalization, criminal legal system involvement (charges and convictions) and incarceration. This presentation will describe these initiatives to show the importance of peer involvement in research that uses linked administrative health data particularly when designing, interpreting and disseminating findings to reduce stigma towards persons who use substances.

Priority setting for Canadian Take-Home Naloxone best practice guideline development: an adapted online Delphi method

BackgroundTake-Home Naloxone (THN) is a core intervention aimed at addressing the toxic illicit opioid drug supply crisis. Although THN programs are available in all provinces and territories throughout Canada, there are currently no standardized guidelines for THN programs. The Delphi method is a tool for consensus building often used in policy development that allows for engagement of stakeholders.MethodsWe used an adapted anonymous online Delphi method to elicit priorities for a Canadian guideline on THN as a means of facilitating meaningful stakeholder engagement. A guideline development group generated a series of key questions that were then brought to a 15-member voting panel. The voting panel was comprised of people with lived and living experience of substance use, academics specializing in harm reduction, and clinicians and public health professionals from across Canada. Two rounds of voting were undertaken to score questions on importance for inclusion in the guideline.ResultsNine questions that were identified as most important include what equipment should be in THN kits, whether there are important differences between intramuscular and intranasal naloxone administration, how stigma impacts access to distribution programs, how effective THN programs are at saving lives, what distribution models are most effective and equitable, storage considerations for naloxone in a community setting, the role of CPR and rescue breathing in overdose response, client preference of naloxone distribution program type, and what aftercare should be provided for people who respond to overdoses.ConclusionsThe Delphi method is an equitable consensus building process that generated priorities to guide guideline development.

A qualitative study exploring how young people perceive and experience substance use services in British Columbia, Canada

BackgroundSubstance use among youth (ages 12–24) is troublesome given the increasing risk of harms associated. Even more so, substance use services are largely underutilized among youth, most only accessing support when in crisis. Few studies have explored young people’s help-seeking behaviours to address substance use concerns. To address this gap, this study explored how youth perceive and experience substance use services in British Columbia (BC), Canada.MethodsParticipatory action research methods were used by partnering with BC youth (under the age of 30) from across the province who have lived and/or living experience of substance use to co-design the research protocol and materials. An initial focus group and interviews were held with 30 youth (ages 12–24) with lived and/or living experience of substance use, including alcohol, cannabis, and illicit substances. The discussions were audio-recorded, transcribed verbatim, and analyzed thematically using a data-driven approach.ResultsThree main themes were identified and separated by phase of service interaction, starting with: Prevention/Early intervention, where youth described feeling unworthy of support; Service accessibility, where youth encountered many barriers finding relevant substance use services and information; and Service delivery, where youth highlighted the importance of meeting them where they are at, including supporting those who have milder treatment needs and/or do not meet the diagnosis criteria of a substance use disorder.ConclusionsOur results suggest a clear need to prioritize substance use prevention and early interventions specifically targeting youth and young adults. Youth and peers with lived and/or living experience should be involved in co-designing and co-delivering such programs to ensure their relevance and credibility among youth. The current disease model of care leaves many of the needs of this population unmet, calling for a more integrated youth-centred approach to address the multifarious concerns linked to young people’s substance use and service outcomes and experiences.

Awareness and knowledge of the Good Samaritan Drug Overdose Act among people at risk of witnessing an overdose in British Columbia, Canada: a multi-methods cross sectional study

IntroductionBystanders to drug overdoses often avoid or delay calling 9–1-1 and cite fear of police involvement as a main reason. In 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted by the Canadian government to provide people present at an overdose with legal protection from charges for simple drug possession, and conditions stemming from simple possession. Few studies have taken a multi-methods approach to evaluating the GSDOA. We used quantitative surveys and qualitative interviews to explore awareness, understanding, and perceptions of the GSDOA in people at risk of witnessing an overdose.MethodsQuantitative cross-sectional surveys and qualitative telephone interviews were conducted with adults and youth at risk of witnessing an overdose across British Columbia. Cross-sectional survey participants were recruited at 19 Take Home Naloxone sites and online through Foundry. Multivariable logistic regression models were constructed hierarchically to determine factors associated with GSDOA awareness. Telephone interview participants were recruited by research assistants with lived/living experience of substance use. Deductive and inductive thematic analyses were conducted to identify major themes.ResultsOverall, 52.7% (n = 296) of the quantitative study sample (N = 453) reported being aware of the GSDOA. In multivariable analysis, cellphone possession (adjusted odds ratio [AOR] = 2.19; 95% confidence interval [CI] 1.36, 3.54) and having recently witnessed an opioid overdose (AOR = 2.34; 95% CI 1.45, 3.80) were positively associated with GSDOA awareness. Young adults (25 – 34 years) were more likely to be aware of the Act (AOR = 2.10; 95% CI 1.11, 3.98) compared to youth (16–24 years). Qualitative interviews (N = 42) revealed that many overestimated the protections offered by the GSDOA. To increase awareness and knowledge of the Act among youth, participants recommended adding the GSDOA to school curricula and using social media. Word of mouth was suggested to reach adults.ConclusionBoth awareness and knowledge of the GSDOA remain low in BC, with many overestimating the protections the Act offers. Dissemination efforts should be led by people with lived/living experience and should target those with limited awareness and understanding of the Act as misunderstandings can erode trust in law enforcement and harm reduction policy.

40.4 A Descriptive Report on Internet Access Points from Smartphones of Youth Experiencing Homelessness

Youth experiencing homelessness (YEH) have a variety of challenges. Access to the internet is an important tool for youth to keep connected to others and to access service. This study aims to examine the use of smartphones among YEH. The study uses a sample of 35 youth between the ages of 18 and 24 years recruited through a network of shelters in Chicago. The preliminary data from this study have been published. Substance use was assessed using a subset of the 2011 National Youth Risk Behavior Survey (YRBS). Depression (Patient Health Questionnaire-9 [PHQ-9]) and PTSD (PTSD Checklist for DSM-5 [PCL-5]) were measured at enrollment and at 1 month. Trauma exposure was assessed using the Childhood Trauma Questionnaire (CTQ) and the Trauma History Questionnaire (THQ). As part of this study, participants received a mobile phone with an activated data and service plan. This report uses data that were extracted passively from smartphones of the participants using Purple Robot. This was done with consent from participants. From a dataset containing several thousand data points, we extracted a random subsample of 2000 data points detailing smartphone geospatial data. Trained coders (SHD and DK) reviewed the Service Set Identifier (SSID) labels for each extracted data point and coded these into larger categories (ie, hotel, coffee shop, restaurant, library) according to a rubric developed by the team. Results for this study are pending. The participants had an average age of 19.06 years (SD = 0.85). Most of the participants were women (23/35, 65%), with 31% (11/35) men and 1 transgender participant (1/35, 3%). Participants were predominantly African American (23/35, 66%), 9% White (3/35), 17% mixed race (6/35), 3% other (1/35), and 6% either refused or did not know (2/35). In addition, 20% of the sample reported being Hispanic (7/35). The demographics of these YEH are reflective of national trends, which show disproportionate ethnic minorities and LQBTQ or questioning YEH. We plan to report on the location categories that YEH access the internet and examine correlates with psychological experiences of substance use, depression, and trauma. Smartphones will allow us to assess what future potential programs are needed to make mental health and substance use resources more readily available and accessible to YEH by studying the patterns and needs of this population.

How People with Lived Experiences of Substance Use Understand and Experience User Involvement in Substance Use Care: A Synthesis of Qualitative Studies.

There is a need for more knowledge on how people with substance use problems (SUPs) understand and experience user involvement when receiving care. In this systematic review, we identify and reanalyse the existing qualitative research that explores how people with lived experiences of substance use understand user involvement, and their experiences of key practices for achieving user involvement. We systematically searched seven electronic databases. We applied Noblit and Hare’s meta-ethnography, revised by Malterud, to identify, translate, and summarise the studies. The electronic search resulted in 2065 articles. We conducted a full-text evaluation of 63 articles, of which 12 articles met the inclusion criteria. The primary studies’ synthesis reveals three different understandings of user involvement: user involvement as joint meaning production, points of view represented, and user representation in welfare services. Key practices for achieving user involvement involved seeing and respecting the service user as a unique person, the quality of the interactional process, and the scope of action for people with SUPs, as well as professionals, including issues of stigma, power, and fatalism. The metasynthesis recognises the ambiguity of the concept of user involvement concept and the importance of including the service user’s perspective when defining user involvement. The analysis of key practices emphasises the importance of relational processes and contextual aspects when developing user involvement concepts.

Disconnected perspectives: Patient and care provider's experiences of substance use in pregnancy.

ObjectiveGenerations of colonialism, abuse, racism, and systemic trauma have contributed to Indigenous women in Canada bearing the greatest burden of substance use in pregnancy. Stigma associated with substance use in pregnancy translates into multiple barriers to women engaging in care. Care providers have key interactions that can act as a bridge or a barrier to care.MethodsPatient journey maps were created for women living with substance use (n = 3) and semi‐structured interviews (n = 20) were performed to understand perceptions of maternity‐care providers around women with substance use in pregnancy at a regional hospital in northern British Columbia.ResultsPatient journey maps showed overall emotions of hurt, loss, judgment, and anger at their interface with health care during pregnancy. Providers described gaps in knowledge of substance use in pregnancy and harm reduction. Although care providers overall perceived themselves to be providing compassionate care without bias, the patient journey maps suggested profound judgment on behalf of providers.ConclusionOngoing cultural humility and trauma‐informed care training along the continuum of care is critical to impacting discrepancies between perceived lack of bias and harm in patient interactions. Acknowledgment of systemic racism's impact on provision of maternity care is critical for health system change.

Less than human: dehumanisation of people who use heroin

PurposeStigma reduction is an important public health challenge because of the large morbidity and mortality associated with some forms of substance use. Extreme stigma can lead to dehumanisation of target groups, who are ascribed with lesser humanity. The authors examined whether there was blatant and subtle dehumanisation of people who use heroin, and if these were associated with levels of support for non-discriminatory drug policy.Design/methodology/approachA cross-sectional online study using a UK convenience sample (n = 307 [75.2% female, mean age 28.6 ± 12.2 years]) was conducted. Participants completed assessments of blatant (Ascent of Humans [AoH] scale) and subtle (an emotion attribution task) dehumanisation and a bespoke measure assessing support for non-discriminatory drug policies. Other measures controlled for stigma towards people who use drugs (PWUD) and moral disgust.FindingsThere was greater blatant dehumanisation of people who used heroin compared to the general population and other potentially stigmatised reference groups, including people who use cannabis. The authors also found evidence of subtle dehumanisation, and people who used heroin were rated as being less likely to feel uniquely human emotions, less likely to feel positive emotions and more likely to feel negative emotions. Blatant dehumanisation was associated with significantly lower probability of support for non-discriminatory drug policy.Social implicationsDehumanisation may present significant challenges for stigma reduction initiatives and in fostering public support for drug policy and treatment. Denial of the humanity of this group could be used to justify discriminatory policies or relative deprioritisation of support services in funding decisions. Activities that seek to “rehumanise” PWUD, including social inclusion, and encouraging compassionate media representations that portray the lived experiences of substance use may be useful areas of future work.Originality/valueThis is the first study to investigate blatant and subtle dehumanisation of people who use heroin, and how this relates to public support for drug policy.

Experiences of people with opioid use disorder during the COVID-19 pandemic: A qualitative study.

To capture pandemic experiences of people with opioid use disorder (OUD) to better inform the programs that serve them. We designed, conducted, and analyzed semi-structured qualitative interviews using grounded theory. We conducted interviews until theme saturation was reached and we iteratively developed a codebook of emerging themes. Individuals with lived experience of substance use provided feedback at all steps of the study. We conducted phone or in-person interviews in compliance with physical distancing and public health regulations in outdoor Vancouver parks or well-ventilated indoor spaces between June to September 2020. Using purposive sampling, we recruited participants (n = 19) who were individuals with OUD enrolled in an intensive community outreach program, had visited one of two emergency departments, were over 18, lived within catchment, and were not already receiving opioid agonist therapy. We audio-recorded interviews, which were later transcribed verbatim and checked for accuracy while removing all identifiers. Interviews explored participants' knowledge of COVID-19 and related safety measures, changes to drug use and healthcare services, and community impacts of COVID-19. One third of participants were women, approximately two thirds had stable housing, and ages ranged between 23 and 59 years old. Participants were knowledgeable on COVID-19 public health measures. Some participants noted that fear decreased social connection and reluctance to help reverse overdoses; others expressed pride in community cohesion during crisis. Several participants mentioned decreased access to housing, harm reduction, and medical care services. Several participants reported using drugs alone more frequently, consuming different or fewer drugs because of supply shortages, or using more drugs to replace lost activities. COVID-19 had profound effects on the social lives, access to services, and risk-taking behaviour of people with opioid use disorder. Pandemic public health measures must include risk mitigation strategies to maintain access to critical opioid-related services.

Substance use and overdose risk: documenting the perspectives of formerly incarcerated persons in the Fraser East region of BC

BackgroundThe relationship between incarceration and risk of overdose has been well-documented in the literature, but few studies document the perspectives of persons at risk of overdose who were incarcerated. This sub-inquiry aimed to understand the experiences of persons with a history of substance use and incarceration in the Fraser East region of BC and how involvement with the criminal justice system affected their drug use and perceived risk of overdose.MethodsThe Fraser East Overdose Response project utilized a community-based participatory action approach that included peer researchers with lived experience in all parts of the research process. This qualitative pilot study aimed to better understand individuals at risk of an unwitnessed overdose in order to prevent deaths and identify effective local responses. A snowball sampling technique was used to recruit persons aged 19 and over who used illicit drugs over the past 3 years in the Fraser East since 2016. In total, 22 participants were interviewed. Of these, 13 participants identified a history of incarceration. Interviews were analyzed using a framework analysis approach.ResultsThe perspectives that participants shared revealed that impacts from incarceration are influenced by policies but also highly individualized. Our inquiry found three broader themes, within which were situated differing and sometimes conflicting interpretations and experiences of systemic environments: (1) incarceration was associated with harms and was perceived to increase risk of overdose following release, (2) incarceration was perceived to have limited impact on substance use and overdose risk, and (3) incarceration was associated with a perceived reduction of substance use and overdose risk.ConclusionsUnderstanding the complexities of the perceptions of those with lived experience of substance use and incarceration is of importance to better inform interventions in this population. The existing knowledge base urgently requires further inquiry into the intersections between qualitative perspectives, environments and policies, and quantitative outcomes of overdose vís-a-vís correctional institution.