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The implementation of overdose prevention sites as a novel and nimble response during an illegal drug overdose public health emergency.
Int J Drug Policy. 2019 04; 66:64-72.IJ

Abstract

BACKGROUND

Drug-related overdoses were declared a public health emergency in British Columbia, Canada in April, 2016 facilitating the scale-up of responses including rapid sanctioning and implementation of overdose prevention sites (OPSs). OPSs are a health service providing supervised injection and immediate overdose response. In BC, OPSs were operational within weeks of sanctioning. In the first year of operation over 20 OPSs were established with approximately 550,000 visits and no overdose deaths at any site. In this paper, we examine the implementation of OPSs as a novel and nimble response to prevent overdose deaths as a result of injection drug use.

METHODS

A multiple case study design was used with the Consolidated Framework for Implementation (CFIR) informing the analysis. Three sites in a single city were included with each site constituting a case. In this paper, we focus on qualitative interviews with 15 staff and their perceptions of the implementation of the OPSs as well as provincial and local documents.

RESULTS

The legislative process to implement OPSs was unprecedented as it sanctioned supervised injection services as an extraordinary measure under a declared public health emergency. Innovative and inclusionary practices were possible within state-sanctioned OPSs, as the sites were government-directed yet community-developed, with PWUD centred in service design, implementation and delivery. OPSs lack permanency and may be limited to the duration of the public health emergency.

CONCLUSION

The rapid implementation of OPSs provides an international example of an alternative to lengthy and often onerous sanctioning processes for supervised consumption services (SCSs). Overdose prevention sites provide an example of a novel service design and nimble implementation process that combines the benefits of state-sanctioned injection services with community-driven implementation. Such evidence questions the continued acceptability of governments' restrictive sanctioning processes, which have limited expansion of SCSs internationally and the implementation of services that are not necessarily aligned with the needs of PWUD.

Authors+Show Affiliations

Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada. Electronic address: barclay@uvic.ca.Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada. Electronic address: fpagan@uvic.ca.Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada. Electronic address: bpauly@uvic.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30708237

Citation

Wallace, Bruce, et al. "The Implementation of Overdose Prevention Sites as a Novel and Nimble Response During an Illegal Drug Overdose Public Health Emergency." The International Journal On Drug Policy, vol. 66, 2019, pp. 64-72.
Wallace B, Pagan F, Pauly BB. The implementation of overdose prevention sites as a novel and nimble response during an illegal drug overdose public health emergency. Int J Drug Policy. 2019;66:64-72.
Wallace, B., Pagan, F., & Pauly, B. B. (2019). The implementation of overdose prevention sites as a novel and nimble response during an illegal drug overdose public health emergency. The International Journal On Drug Policy, 66, 64-72. https://doi.org/10.1016/j.drugpo.2019.01.017
Wallace B, Pagan F, Pauly BB. The Implementation of Overdose Prevention Sites as a Novel and Nimble Response During an Illegal Drug Overdose Public Health Emergency. Int J Drug Policy. 2019;66:64-72. PubMed PMID: 30708237.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The implementation of overdose prevention sites as a novel and nimble response during an illegal drug overdose public health emergency. AU - Wallace,Bruce, AU - Pagan,Flora, AU - Pauly,Bernadette Bernie, Y1 - 2019/01/29/ PY - 2018/03/07/received PY - 2018/08/14/revised PY - 2019/01/15/accepted PY - 2019/2/2/pubmed PY - 2020/2/8/medline PY - 2019/2/2/entrez KW - Drug consumption rooms KW - Harm reduction KW - Implementation science KW - Overdose KW - Overdose prevention sites KW - Supervised injection sites SP - 64 EP - 72 JF - The International journal on drug policy JO - Int J Drug Policy VL - 66 N2 - BACKGROUND: Drug-related overdoses were declared a public health emergency in British Columbia, Canada in April, 2016 facilitating the scale-up of responses including rapid sanctioning and implementation of overdose prevention sites (OPSs). OPSs are a health service providing supervised injection and immediate overdose response. In BC, OPSs were operational within weeks of sanctioning. In the first year of operation over 20 OPSs were established with approximately 550,000 visits and no overdose deaths at any site. In this paper, we examine the implementation of OPSs as a novel and nimble response to prevent overdose deaths as a result of injection drug use. METHODS: A multiple case study design was used with the Consolidated Framework for Implementation (CFIR) informing the analysis. Three sites in a single city were included with each site constituting a case. In this paper, we focus on qualitative interviews with 15 staff and their perceptions of the implementation of the OPSs as well as provincial and local documents. RESULTS: The legislative process to implement OPSs was unprecedented as it sanctioned supervised injection services as an extraordinary measure under a declared public health emergency. Innovative and inclusionary practices were possible within state-sanctioned OPSs, as the sites were government-directed yet community-developed, with PWUD centred in service design, implementation and delivery. OPSs lack permanency and may be limited to the duration of the public health emergency. CONCLUSION: The rapid implementation of OPSs provides an international example of an alternative to lengthy and often onerous sanctioning processes for supervised consumption services (SCSs). Overdose prevention sites provide an example of a novel service design and nimble implementation process that combines the benefits of state-sanctioned injection services with community-driven implementation. Such evidence questions the continued acceptability of governments' restrictive sanctioning processes, which have limited expansion of SCSs internationally and the implementation of services that are not necessarily aligned with the needs of PWUD. SN - 1873-4758 UR - https://www.unboundmedicine.com/medline/citation/30708237/The_implementation_of_overdose_prevention_sites_as_a_novel_and_nimble_response_during_an_illegal_drug_overdose_public_health_emergency_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0955-3959(19)30025-8 DB - PRIME DP - Unbound Medicine ER -