British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, V6Z 1Y6, BC, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada.
British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, V6Z 1Y6, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Soc Sci Med. 2021 Feb;270:113631. doi: 10.1016/j.socscimed.2020.113631. Epub 2021 Jan 5.
Overdose response programs in North America increasingly employ task shifting-shifting overdose response tasks to less specialized workers-to increase effectiveness and promote involvement of people with lived/living experience of drug use (PWLE). In Canada, task shifting has occurred through community-driven implementation of overdose response programs staffed primarily by PWLE. The implications of this task shifting on workers' well-being and service delivery has received little scholarly consideration, despite reports of widespread burnout among frontline responders. This study examines experiences and drivers of burnout among PWLE working at low-barrier supervised consumption sites ("Overdose Prevention Sites" or OPSs) in Vancouver, Canada. Between December 2016 and March 2020, we conducted ethnographic fieldwork at four OPSs, including in-depth interviews with 23 overdose response workers, three site-based focus groups with 20 additional workers, and 150 h of naturalistic observation. Data were analyzed to explore how working conditions, labour arrangements, economic insecurity and social disadvantage shaped burnout. We found that overdose response workers commonly reported burnout, which they attributed to the precarious and demanding nature of their work. While casual positions offered low-barrier employment, PWLE often lacked the wages and benefits enjoyed by other frontline workers, with limited supports and opportunities for advancement. Due to their social position within drug-using networks, PWLE's work encompassed hidden care work that participants felt was constant and undervalued. The scarcity of permanent full-time positions, alongside barriers to transitioning into formal employment, prevented many PWLE from earning livable wages or taking time off to 'recharge.' This study highlights how the devaluing and casualization of overdose response labour, compounded by other dimensions of structural vulnerability, are central to burnout among overdose response workers with lived experience. Interventions to address burnout within this setting must extend beyond individual-level interventions (e.g. counselling, self-care) to also strengthen working conditions and economic security of PWLE.
北美地区的过量用药应对项目越来越多地采用任务转移——将过量用药应对任务转移给非专业程度较低的工作人员——以提高效率并促进有用药经历的人（PWLE）的参与。在加拿大，通过社区驱动的方式实施过量用药应对项目，这些项目主要由 PWLE 人员配备，从而实现了任务转移。尽管有报道称一线应对人员普遍出现倦怠，但这种任务转移对工作人员福祉和服务提供的影响却很少得到学术界的关注。本研究考察了在加拿大温哥华的低门槛监督消费场所（“过量预防场所”或 OPS）工作的 PWLE 人员的倦怠经历和驱动因素。在 2016 年 12 月至 2020 年 3 月期间，我们在四个 OPS 进行了民族志实地工作，包括对 23 名过量用药应对工作人员进行深入访谈、对另外 20 名工作人员进行三次基于地点的焦点小组以及 150 小时的自然观察。我们对数据进行了分析，以探讨工作条件、劳动安排、经济不安全和社会劣势如何塑造倦怠。我们发现，过量用药应对工作人员普遍报告出现倦怠，他们将倦怠归因于工作不稳定和要求苛刻。虽然临时职位提供了低门槛的就业机会，但 PWLE 通常缺乏其他一线工作人员享有的工资和福利，晋升机会有限，支持也有限。由于他们在吸毒者网络中的社会地位，PWLE 的工作包括他们认为是持续且被低估的隐藏护理工作。由于缺乏永久性全职职位，以及过渡到正式就业的障碍，许多 PWLE 无法赚取可维持生计的工资或休假来“充电”。本研究强调了如何将过量用药应对劳动力的贬值和临时化，以及其他结构脆弱性方面，是有用药经历的过量用药应对工作人员出现倦怠的核心因素。在这种情况下，解决倦怠问题的干预措施必须超越个人层面的干预措施（例如咨询、自我保健），还要加强 PWLE 的工作条件和经济安全。
