School of Social Work, Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada.
Social Dimensions of Health, Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada.
Int J Drug Policy. 2018 Mar;53:83-89. doi: 10.1016/j.drugpo.2017.12.011. Epub 2018 Jan 4.
The current opioid overdose crisis in North America is heightening awareness of the need for and the challenges of implementing harm reduction, notably within complex and diverse settings such as homeless shelters. In this paper, we explore the implementation of harm reduction in homeless shelters during an emerging overdose emergency.
The objective of this qualitative study was to identify and understand micro-environment level factors within emergency shelters responding to homelessness and substance use, and the macro-level influences that produce and sustain structural vulnerabilities. We conducted eight focus groups with a total of 49 participants during an emerging overdose emergency. These included shelter residents (n = 23), shelter staff (n = 13), and harm reduction workers (n = 13).
The findings illustrate the challenges of implementing an overdose response when substance use is prohibited onsite, without an expectation of abstinence, and where harm reduction services are limited to the distribution of supplies. In this context, harm reduction is partially implemented and incomplete. Shelters can be a site of risks and trauma for residents and staff due to experiencing, witnessing, and responding to overdoses.
The current overdose crisis heightens the challenges of implementing harm reduction, particularly within complex and diverse settings such as homeless shelters. When harm reduction is limited to the distribution of supplies such as clean equipment and naloxone, important principles of engagement and the development of trust necessary to the provision of services are overlooked with negative implications for service users.
北美目前的阿片类药物过量危机加剧了人们对实施减少伤害的必要性和挑战的认识，尤其是在复杂多样的环境中，如无家可归者收容所。在本文中，我们探讨了在出现阿片类药物过量紧急情况时，在无家可归者收容所中实施减少伤害的情况。
这项定性研究的目的是确定和了解应对无家可归和药物使用的紧急避难所中的微观环境因素，以及产生和维持结构脆弱性的宏观影响。在出现阿片类药物过量紧急情况期间，我们进行了八次共 49 名参与者的焦点小组讨论。这些参与者包括收容所居民（n=23）、收容所工作人员（n=13）和减少伤害工作者（n=13）。
研究结果说明了在现场禁止使用药物、不期望戒除药物且减少伤害服务仅限于供应品分发的情况下，实施过量反应的挑战。在这种情况下，减少伤害部分实施且不完整。由于经历、目睹和应对过量用药，收容所对居民和工作人员来说可能是一个风险和创伤的场所。
目前的阿片类药物过量危机加剧了实施减少伤害的挑战，尤其是在复杂多样的环境中，如无家可归者收容所。当减少伤害仅限于分发清洁设备和纳洛酮等用品时，就会忽略提供服务所需的接触和建立信任的重要原则，对服务使用者产生负面影响。
