Hutchison Abby, Urbanoski Karen, Hore Dennis, Wallace Bruce
Canadian Institute for Substance Use Research, Victoria, Canada.
Canadian Institute for Substance Use Research, School of Public Health and Social Policy, University of Victoria, Victoria, Canada.
Harm Reduct J. 2025 May 19;22(1):83. doi: 10.1186/s12954-025-01234-8.
Impacts of the toxic unregulated drug supply are experienced across all geographic regions in Canada, with high rates of fatal and non-fatal overdoses nation-wide. In British Columbia, rates of overdose fatalities are often higher within smaller urban and rural communities than in larger urban cities. Community drug checking is increasingly explored as a harm reduction intervention; however, these services are typically limited to larger cities. In this study, we explored the contextual factors that service users and implementers consider to be important for context specific drug checking services within smaller communities.
Data collection involved 39 semi-structured interviews with prospective drug checking service users and service implementers from six harm reduction services in four smaller communities on Vancouver Island, BC. Interviews explored perspectives on the contextual factors that may impact the implementation and accessibility of drug checking services within smaller communities. Through inductive thematic analysis, we developed themes that reflected the overarching contextual factors discussed by participants.
Participants described four overarching contextual factors important for accessing and implementing drug checking in smaller communities: community and political climate; close social groups and personal relationships; resource availability; and geographic profile. While many of the contextual factors are similar to those operating in larger urban contexts, they can manifest differently in smaller communities. For example, lack of anonymity and confidentiality are intensified in small and rural communities where "everybody knows everybody". Geographic distance to service and transportation were identified as barriers, with outreach and transportation to services suggested as potential mitigating strategies.
As community drug checking services are established as a response to the toxic unregulated drug market, factors that support equitable access to services beyond inner-city and urban areas are critical. Factors identified as potential barriers offer targets for service adaptation and tailored implementation to enable greater access. With rural communities experiencing high rates of overdose, implementing drug checking services that are contextually relevant and equity-oriented is critical.
加拿大所有地理区域都受到有毒且不受监管的毒品供应的影响，全国范围内致命和非致命过量用药率都很高。在不列颠哥伦比亚省，较小的城市和农村社区的过量用药死亡率往往高于较大的城市。社区药物检测作为一种减少伤害的干预措施越来越受到关注；然而，这些服务通常仅限于大城市。在本研究中，我们探讨了服务使用者和实施者认为对较小社区内因地制宜的药物检测服务很重要的背景因素。
数据收集包括对来自不列颠哥伦比亚省温哥华岛四个较小社区的六个减少伤害服务机构的潜在药物检测服务使用者和服务实施者进行39次半结构化访谈。访谈探讨了可能影响较小社区内药物检测服务实施和可及性的背景因素的观点。通过归纳主题分析，我们得出了反映参与者讨论的总体背景因素的主题。
参与者描述了对在较小社区进行药物检测和实施药物检测很重要的四个总体背景因素：社区和政治氛围；紧密的社会群体和个人关系；资源可用性；以及地理概况。虽然许多背景因素与大城市环境中的因素相似，但它们在较小社区中的表现可能不同。例如，在“人人都相互认识”的小社区和农村社区，缺乏匿名性和保密性的情况会加剧。到服务机构的地理距离和交通被确定为障碍，建议开展外展服务和提供前往服务机构的交通作为潜在的缓解策略。
随着社区药物检测服务作为对有毒且不受监管的毒品市场的应对措施而建立，支持公平获得市中心和城市以外地区服务的因素至关重要。被确定为潜在障碍的因素为服务调整和量身定制实施提供了目标，以实现更大的可及性。由于农村社区的过量用药率很高，实施因地制宜且注重公平的药物检测服务至关重要。
