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Background: Peer assistance is an emerging area of study in injection drug use. When Canada’s first supervised consumption site (SCS) opened in 2003 in Vancouver, BC, clients were prohibited from injecting their peers; only recently has this practice been introduced as a harm reduction measure at these sites. In 2018, Health Canada granted federal exemption to allow peer-assisted injection at certain SCS sites, under the Controlled Drugs and Substances Act. Literature pertaining to peer-assisted injection addresses several topics: interpersonal relationships between the injection provider and recipient; the role of pragmatism; trust and expertise; and gender relations.
Methods: In this qualitative study, participants (n=16) were recruited to be interviewed about their experiences in a peer-assisted injection program (PAIP) at one SCS regulated by Health Canada. Interview data were transcribed and thematically analyzed. Quantitative administrative data was used to provide context and to describe the study population, comprised of people in the PAIP (n=248)
Results: PAIP clients made up 17.4% of all SCS clients. PAIP clients were more likely to be female and Indigenous. Injection providers expressed being moved by compassion to help others inject. While their desire to assist was pragmatic, they felt a significant burden of responsibility for the outcomes. Other prominent factors related to the injection provider-recipient relationship were social connection, trust, safety, social capital, and reciprocity. Participants also made suggestions for improving the PAIP which included adding more inhalation rooms so that if someone was unable to inject they could smoke in a safe place instead. Additionally, being required by law to divide drugs outside of the SCS, prior to preparing and using in the site, created unsafe conditions for clients.
Conclusions: Regular use of the SCS, and access to its resources, enabled participants to lower their risk through smoking and to practise lower-risk injections. At the federal level, there is considerable room to advocate for allowing clients to divide drugs safely within the SCS, and to increase capacity for safer alternatives such as inhalation.
Keywords
drug consumption room, supervised consumption, injection drug use, peer assist, harm reduction
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CURRENT STATUS: Published
View the published article at Harm Reduction Journal.
Version 3
Posted 18 Nov, 2020
No community comments so far
Editorial decision: Accept
On 09 Dec, 2020
Reviewer #1 agreed
On 20 Nov, 2020
Review #1 received
Received 20 Nov, 2020
Reviewers invited
Invitations sent on 17 Nov, 2020
Editor assigned
On 15 Nov, 2020
Submission checks complete
On 15 Nov, 2020
Editor invited
On 15 Nov, 2020
No comments provided
Editorial decision: Major revision
On 19 Oct, 2020
Review #1 received
Received 13 Oct, 2020
Review #2 received
Received 11 Oct, 2020
Reviewer #2 agreed
On 29 Sep, 2020
Reviewer #1 agreed
On 27 Sep, 2020
Reviewers invited
Invitations sent on 26 Sep, 2020
Editor assigned
On 09 Sep, 2020
Submission checks complete
On 08 Sep, 2020
Editor invited
On 08 Sep, 2020
No comments provided
Editorial decision: Major revision
On 10 Jun, 2020
Review #3 received
Received 01 Jun, 2020
Review #4 received
Received 01 Jun, 2020
Review #2 received
Received 01 Jun, 2020
Review #1 received
Received 29 May, 2020
Reviewer #4 agreed
On 21 May, 2020
Reviewers invited
Invitations sent on 20 May, 2020
Reviewer #1 agreed
On 20 May, 2020
Reviewer #2 agreed
On 20 May, 2020
Reviewer #3 agreed
On 20 May, 2020
Editor assigned
On 24 Apr, 2020
Submission checks complete
On 23 Apr, 2020
Editor invited
On 23 Apr, 2020
First submitted
On 21 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
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A new preprint design is coming!
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See the published version of this preprint at Harm Reduction Journal.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Harm Reduction Journal.
Version 3
Posted 18 Nov, 2020
No community comments so far
Editorial decision: Accept
On 09 Dec, 2020
Reviewer #1 agreed
On 20 Nov, 2020
Review #1 received
Received 20 Nov, 2020
Reviewers invited
Invitations sent on 17 Nov, 2020
Editor assigned
On 15 Nov, 2020
Submission checks complete
On 15 Nov, 2020
Editor invited
On 15 Nov, 2020
No comments provided
Editorial decision: Major revision
On 19 Oct, 2020
Review #1 received
Received 13 Oct, 2020
Review #2 received
Received 11 Oct, 2020
Reviewer #2 agreed
On 29 Sep, 2020
Reviewer #1 agreed
On 27 Sep, 2020
Reviewers invited
Invitations sent on 26 Sep, 2020
Editor assigned
On 09 Sep, 2020
Submission checks complete
On 08 Sep, 2020
Editor invited
On 08 Sep, 2020
No comments provided
Editorial decision: Major revision
On 10 Jun, 2020
Review #3 received
Received 01 Jun, 2020
Review #4 received
Received 01 Jun, 2020
Review #2 received
Received 01 Jun, 2020
Review #1 received
Received 29 May, 2020
Reviewer #4 agreed
On 21 May, 2020
Reviewers invited
Invitations sent on 20 May, 2020
Reviewer #1 agreed
On 20 May, 2020
Reviewer #2 agreed
On 20 May, 2020
Reviewer #3 agreed
On 20 May, 2020
Editor assigned
On 24 Apr, 2020
Submission checks complete
On 23 Apr, 2020
Editor invited
On 23 Apr, 2020
First submitted
On 21 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Harm Reduction Journal.
Background: Peer assistance is an emerging area of study in injection drug use. When Canada’s first supervised consumption site (SCS) opened in 2003 in Vancouver, BC, clients were prohibited from injecting their peers; only recently has this practice been introduced as a harm reduction measure at these sites. In 2018, Health Canada granted federal exemption to allow peer-assisted injection at certain SCS sites, under the Controlled Drugs and Substances Act. Literature pertaining to peer-assisted injection addresses several topics: interpersonal relationships between the injection provider and recipient; the role of pragmatism; trust and expertise; and gender relations.
Methods: In this qualitative study, participants (n=16) were recruited to be interviewed about their experiences in a peer-assisted injection program (PAIP) at one SCS regulated by Health Canada. Interview data were transcribed and thematically analyzed. Quantitative administrative data was used to provide context and to describe the study population, comprised of people in the PAIP (n=248)
Results: PAIP clients made up 17.4% of all SCS clients. PAIP clients were more likely to be female and Indigenous. Injection providers expressed being moved by compassion to help others inject. While their desire to assist was pragmatic, they felt a significant burden of responsibility for the outcomes. Other prominent factors related to the injection provider-recipient relationship were social connection, trust, safety, social capital, and reciprocity. Participants also made suggestions for improving the PAIP which included adding more inhalation rooms so that if someone was unable to inject they could smoke in a safe place instead. Additionally, being required by law to divide drugs outside of the SCS, prior to preparing and using in the site, created unsafe conditions for clients.
Conclusions: Regular use of the SCS, and access to its resources, enabled participants to lower their risk through smoking and to practise lower-risk injections. At the federal level, there is considerable room to advocate for allowing clients to divide drugs safely within the SCS, and to increase capacity for safer alternatives such as inhalation.
Figure 1
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