Research PaperSheltering risks: Implementation of harm reduction in homeless shelters during an overdose emergency
Section snippets
Data collection
Focus groups exploring issues related to substance use and harm reduction in shelters were conducted from December, 2015 to January, 2016. A total of 49 participants participated in eight focus groups that included shelter residents (n = 23), shelter staff (n = 13) or harm reduction workers (n = 13). Each focus group lasted between 40 and 60 min, and was conducted by experienced researchers who have long-standing collaborations with individuals and agencies responding to homelessness and
Results
Overdoses were identified by all groups as the most significant concern associated with substance use in shelters. Below we outline four themes that describe the shelter as a micro-environment in which harms may be mitigated or exacerbated by policy and political processes in the macro-level environment.
Limitations
The qualitative focus groups for this research were limited to two homeless shelters within a single city. This study, of shelter staff and residents during an emerging opioid overdose crisis is uniquely positioned to gather rich and timely data on substance use issues. While generalizability is not the objective of qualitative research, one limitation of this study is that the findings may not reflect experiences within different contexts. Although our sampling sought to include a diversity of
Discussion
Our findings indicate the inadequacies of harm reduction responses that focus primarily on the distribution of supplies within settings prohibiting use. Risks related to incomplete implementation of harm reduction include concealing use within a setting that prohibits use, and tragically, frequent overdoses, notably within the shelter washrooms that become de facto unsupervised consumption sites (Wallace et al., 2016). A distribution model of harm reduction within shelters are micro
Conclusions
The current illicit drug overdose crisis heightens awareness of the challenges in fully implementing harm reduction responses, notably within complex and diverse settings such as homeless shelters. This study found a combination of low-threshold service delivery, and distribution of harm reduction supplies with prohibition of use on-site, which was described as a context of mixed messages and competing priorities. The shelter is identified as a site of risks and trauma, as experiencing,
Conflict of interest
The authors report no conflicts of interest to declare.
Acknowledgements
This work was supported by the Vancouver Foundation. The funding body had no role in the study design or preparation of the manuscript.
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