British Columbia Centre On Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
J Urban Health. 2022 Oct;99(5):855-864. doi: 10.1007/s11524-022-00679-7. Epub 2022 Aug 31.
The majority of overdose deaths in British Columbia (BC) occur among people using illicit substances alone in private residences. Some supportive housing in BC includes on-site access to a variety of health and substance use-related services. More recently, a number of supportive housing locations have started offering prescribed safer supply medications to people at high overdose risk, though these remain limited and under-evaluated. In this study, we describe the drug use practices - including access to and use of on-site supervised consumption, OAT, and prescribed safer supply medications - of study participants living in permanent supportive housing with integrated primary care, substance use treatment services, and supervised consumption spaces. Qualitative interviews were conducted with 30 residents of a permanent supportive housing site in Vancouver, Canada. Data were analyzed using a sequential process to identify both a priori (e.g., low-barrier substance use treatment, pandemic effects on service access) and emerging themes (e.g., using alone). Most (N = 27) study participants reported using alone in their rooms, despite having access to an on-site supervised consumption area. Reasons for using alone include the following: preference for being alone, discretion/stigma, and restrictive housing policies. Less than half (N = 12) of the study participants accessed on-site prescribed safer supply medications. Participants receiving on-site prescribed safer supply described positive benefits including reduced use of illicit opioids, and less reliance on illicit income generation activities. On-site prescribed safer supply programs within supportive housing environments are an important tool in addressing overdose risk.
不列颠哥伦比亚省（BC）的大多数过量用药死亡事件都发生在独自在私人住所使用非法物质的人群中。BC 的一些支持性住房包括现场获得各种健康和药物使用相关服务的机会。最近，一些支持性住房场所开始向处于高风险过量用药的人群提供规定的更安全供应药物，但这些服务仍然有限且评估不足。在这项研究中，我们描述了生活在设有综合初级保健、药物使用治疗服务和监督消费空间的永久性支持性住房中的研究参与者的药物使用行为，包括获取和使用现场监督消费、OAT 和规定的更安全供应药物的情况。对加拿大温哥华一个永久性支持性住房场所的 30 名居民进行了定性访谈。使用顺序过程对数据进行了分析，以确定事先确定的主题（例如，低障碍药物使用治疗、大流行对服务获取的影响）和新兴主题（例如，独自使用）。尽管有机会使用现场监督消费区，但大多数（N=27）研究参与者报告在自己的房间内独自使用药物。独自使用的原因包括：喜欢独处、谨慎/耻辱感和限制住房政策。不到一半（N=12）的研究参与者使用现场规定的更安全供应药物。接受现场规定的更安全供应药物的参与者描述了积极的好处，包括减少非法阿片类药物的使用，以及减少对非法收入来源活动的依赖。支持性住房环境中的现场规定的更安全供应计划是应对过量用药风险的重要工具。
