MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada; Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, V8N 5M8, Canada; Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, A1B 3V6, Canada.
MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada.
Int J Drug Policy. 2024 May;127:104419. doi: 10.1016/j.drugpo.2024.104419. Epub 2024 Apr 9.
The emotional impacts of witnessing and responding to overdose and overdose-related deaths have been largely overlooked during the drug toxicity overdose crisis in North America. Scarce research has analyzed these impacts on the health and well-being of harm reduction workers, and the broader determinants of harm reduction work. Our study investigates the experiences and impacts of witnessing and responding to frequent and escalating rates of overdose on harm reduction workers in Toronto, Canada.
Using semi-structured interviews, 11 harm reduction workers recruited from harm reduction programs with supervised consumption services in Toronto, Canada, explored experiences with and reactions to overdose in both their professional and personal lives. They also provided insights on supports necessary to help people cope with overdose-related loss. We used thematic analysis to develop an initial coding framework, subsequent iterations of codes and emergent themes.
Results revealed that harm reductions workers experienced physical, emotional, and social effects from overdose-related loss and grief. While some effects were due to the toll of overdose response and grief from overdose-related losses, they were exacerbated by the lack of political response to the scale of the drug toxicity overdose crisis and the broader socio-economic-political environment of chronic underfunding for harm reduction services. Harm reduction workers described the lack of appropriate workplace supports for trauma from repeated overdose response and overdose-related loss, alongside non-standard work arrangements that resulted in a lack of adequate compensation or access to benefits.
Our study highlights opportunities for organizational practices that better support harm reduction workers, including formal emotional supports and community-based supportive care services. Improvement to the socio-economic-political determinants of work such as adequate compensation and access to full benefit packages are also needed in the harm reduction sector for all workers.
在北美毒品中毒过量危机期间，目睹和应对过量用药和与过量用药相关的死亡对情绪的影响在很大程度上被忽视了。很少有研究分析过这些影响对减少伤害工作者的健康和福祉的影响，以及更广泛的减少伤害工作的决定因素。我们的研究调查了在加拿大多伦多，目睹和应对频繁和不断升级的过量用药对减少伤害工作者的经历和影响。
使用半结构式访谈，从加拿大多伦多设有监督消费服务的减少伤害方案中招募了 11 名减少伤害工作者，他们探讨了在专业和个人生活中与过量用药有关的经历和反应。他们还就帮助人们应对与过量用药有关的损失所需的支持提供了见解。我们使用主题分析来开发初始编码框架、后续的代码迭代和新兴主题。
结果表明，减少伤害工作者因与过量用药有关的损失和悲伤而经历身体、情感和社会影响。虽然一些影响是由于过量用药反应和与过量用药有关的损失而产生的悲痛造成的，但由于缺乏对毒品中毒过量危机规模的政治反应，以及减少伤害服务长期资金不足的更广泛的社会经济政治环境，这些影响更加严重。减少伤害工作者描述了由于反复过量用药反应和与过量用药有关的损失而缺乏适当的工作场所支持，以及非标准的工作安排导致缺乏足够的补偿或获得福利的机会。
我们的研究强调了改善组织实践的机会，以更好地支持减少伤害工作者，包括正式的情感支持和基于社区的支持性护理服务。在减少伤害部门，还需要改善工作的社会经济政治决定因素，如充分补偿和获得全面福利套餐，以使所有工人受益。
