Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada.
Int J Drug Policy. 2019 Apr;66:64-72. doi: 10.1016/j.drugpo.2019.01.017. Epub 2019 Jan 29.
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.
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.
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.
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.
2016 年 4 月，加拿大不列颠哥伦比亚省宣布药物相关过量成为公共卫生紧急事件，这促进了应对措施的扩大，包括快速批准和实施过量预防场所 (OPS)。OPS 是提供监督注射和即时过量反应的一项卫生服务。在不列颠哥伦比亚省，OPS 在获得批准后的几周内就开始运作。在运营的第一年，就建立了 20 多个 OPS，有大约 55 万人次的访问量，且任何地点都没有发生过量死亡事件。在本文中，我们研究了 OPS 的实施情况，因为它是一种新颖且灵活的应对措施，可以防止因注射毒品而导致的过量死亡。
采用多案例研究设计，使用整合实施框架 (CFIR) 进行分析。一个城市中的三个地点被纳入研究，每个地点构成一个案例。在本文中，我们主要关注对 15 名工作人员的定性访谈，以及他们对 OPS 实施情况的看法，以及省级和地方文件。
实施 OPS 的立法过程是前所未有的，因为它在宣布的公共卫生紧急事件下批准了监督注射服务作为一项特殊措施。在州批准的 OPS 内，可以采取创新和包容性做法，因为这些场所是由政府指导但由社区开发的，以 PWUD 为中心进行服务设计、实施和交付。OPS 缺乏永久性，可能仅限于公共卫生紧急事件的持续时间。
OPS 的快速实施为监督消费服务 (SCS) 的冗长且往往繁琐的批准程序提供了一个国际范例。过量预防场所提供了一个新颖的服务设计和灵活的实施过程的例子，该过程结合了州批准的注射服务的优势和社区驱动的实施。这种证据质疑了政府限制批准程序的持续可接受性，这些程序限制了 SCS 在国际上的扩张，以及实施不一定符合 PWUD 需求的服务。
