Perspectives of key interest groups regarding Supervised Consumption Sites (SCS) and novel Mobile Overdose Response Services (MORS): A qualitative Canadian study.

doi:10.21203/rs.3.rs-3443875/v1

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Research Article

Perspectives of key interest groups regarding Supervised Consumption Sites (SCS) and novel Mobile Overdose Response Services (MORS): A qualitative Canadian study.

https://doi.org/10.21203/rs.3.rs-3443875/v1

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Journal Publication

published 27 Jul, 2024

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Background

Supervised consumption sites (SCS) are proven effective for preventing drug poisoning deaths during the opioid epidemic. Despite their successes, SCS still contend with structural and logistical barriers that limit their accessibility. Mobile Overdose Response Services (MORS) are novel technologies reminiscent of informal “spotting” methods that may address some of the limitations of SCS. Here, we strove to qualitatively examine the factors that may encourage or deter utilization of MORS compared to SCS.

Methods

A total of 52 participants across Canada were recruited using convenience, purposive, and snowball methods. A semi-structured interview was conducted by evaluators from a third-party research organization. Inductive thematic analysis informed by grounded theory was utilized to identify the major themes.

Results

Participants viewed MORS as an opportunity to consume substances without being hindered by fear of apprehension/criminalization, stigma, and invasion of privacy. They also noted that MORS provided more flexibility for clients who could not easily access the physical sites (e.g., due to location, weather concerns, time of day). There was some ambivalence as to whether MORS or physical sites provided more social connection and relationship building. Some viewed physical SCSs to be safer due to perceived shorter overdose response times.

Conclusion

In sum, participants viewed SCS and MORS as filling different needs and gaps. This study adds to a growing body of literature which informs how virtual services can serve as useful adjunct services to SCS.

opioid epidemic

drug poisoning

spotting

mobile overdose response service

supervised consumption sites

Data reported by Health Canada revealed 5,265 hospitalizations due to opioid-related poisoning and 7,328 apparent opioid toxicity deaths across the country in 2022 (1). Solitary substance use is a major risk factor for fatal overdose, with over 80% of overdose deaths occurring in private residences in British Columbia (2). This has been further exacerbated by the public health and social distancing measures implemented during the COVID-19 pandemic (1,3).

Supervised consumption sites (SCS), or safe injection facilities (SIFs), first appeared in Canada during the mid-1990s to prevent transmission of human immunodeficiency virus (HIV) (4). Currently, they offer a wide range of evidence-based harm reduction services, including safe, clean spaces for people to consume pre-obtained drugs in the presence of trained staff (5). Many SCS also direct clients to substance use treatment and other appropriate health or social resources (5). Between 2017 and 2023, there were approximately 47,000 overdoses and drug-related medical emergencies in Canadian SCS; however, no overdose related fatalities have been reported within any of these sites (6). Today, there are 38 sites operating across Canada with an estimated 2600 visits each day, with most located in the central downtown urban areas (6,7). While SCS are effective at preventing accidental fatal overdose and thereby alleviating the strain on emergency medical services, they continue to be faced with socioeconomic, political, and legal barriers that limit their uptake (8–10). Over the years, novel strategies to combat the opioid epidemic have appeared, including mobile SCS to address the needs of people who use substances (PWUS) residing in rural areas (11). Even though mobile SCS piloted in a rural health authority in British Columbia garnered fairly positive responses from PWUS, they faced numerous logistical issues such as crowding and limited hours of operation (11). In addition, long wait times, fear of police surveillance, stigma, concerns with privacy, and suspension also serve as significant barriers to access (Urbanik and Greene, 2021; Rioux, Marshall, and Ghosh, 2023).

Spotting is an informal harm reduction method that is utilized by PWUS to consume substances under the virtual supervision of a trusted individual (e.g., a friend, or family member) (Perri et al., 2023). It ensures autonomous and confidential substance use without being subjected to stigma or adherence to rigid organizational policies (Perri et al., 2023). Born out of these grassroots efforts, formalized Mobile Overdose Response Services (MORS) have been designed to prevent fatal overdoses, especially for those who prefer to use substances in a solitary environment and/or do not have immediate access to an SCS (10). Previous literature uses various names for these services, including virtual supervised consumption services (VSCS) and virtual overdose monitoring services (VOMS) (13,14). However, results from a yet unpublished Delphi consensus study on preferences for the nomenclature of these services indicate that MORS is the preferred term amongst interested groups and will be used throughout this article. National Overdose Response Service (NORS) and Never Use Alone are hotline services in Canada and the United States, respectively, that connects clients to an operator who can dispatch emergency medical services to the site of overdose (13,15). BRAVE is another form of MORS available in North America that exists as a mobile application. British Columbia and Alberta have also developed their own timer-based mobile applications called LifeGuard and the Digital Overdose Response Service (DORS), respectively, that initiate an emergency response when the individual becomes unresponsive and is unable to shut off or renew the timer (15). While there is limited evidence on the efficacy of these services, the authors are not aware of studies that have qualitatively explored the factors that may encourage or deter PWUS from choosing formalized virtual services over physical sites or vice versa (Matskiv, Marshall, Krieg, Viste and S. Monty Ghosh, 2022). With the ever-evolving nature of substance use disorder (SUD), it is important to comparatively evaluate the implications of the emerging, as well as the standard harm reduction strategies. This study aims to identify some of the strengths as well as the gaps in the current provision of various MORS to inform the development of these services in the future.

Informants from selected key interest groups were interviewed in order to elucidate the key differences in perceptions of MORS and SCS. These included people with lived or living experience of substance use, health care providers, harm reduction workers, and those working in MORS operations (operators). Participants were recruited using a combination of purposive, convenience, and snowball sampling through existing networks with the researchers and operators of the MORS. The study was open to any individuals residing in Canada who were 18 years of age or older, able to communicate effectively in English, and provide informed verbal consent.

A semi-structured interview guide was formulated through collaboration with MORS operators, individuals with lived experience, and the research team. Participants were assured that all information would remain confidential, anonymous, and stored on a secure server. Mental health support was offered in the event that participants were in distress (no participants accessed this). A total of 52 interviews were conducted between November 2021 and April 2022 by evaluators who were part of a third-party research organization specializing in qualitative interviews to support the main team. TapeACall was used to record the interviews and a third-party transcription service was used to transcribe. The evaluators and interview participants had no previously established relationship and were the only individuals present during the call. The telephone interviews ranged from 20-60 minutes in length, and all participants were provided with a brief overview of MORS prior to the interview to ensure equivalent levels of baseline knowledge. Honorariums of $50.00 were granted to people of lived and living experience, and no participant was excluded during or after the completion of interviews.

Inductive thematic analysis informed by grounded theory was utilized to identify major themes and subthemes that reflect the perceptions of participants regarding MORS and physical SCS (16,17). Dedoose software was utilized by two evaluators (SJ and LA) with master’s level training in qualitative methods to code the transcripts. Of note, the individuals coding were the same as those who conducted the interviews. They collectively examined the first three transcripts to ensure alignment between various themes. Thereafter, the evaluators coded the transcripts on their own using a jointly created codebook with each evaluator coding approximately half of the transcripts. Throughout the process, each evaluator reviewed transcripts coded by their counterpart through Dedoose to ensure coding congruency. Discrepancies within the coding were discussed between the two evaluators to achieve consensus. Once initial coding was complete, the two evaluators reviewed a representative sample of coded quotations for each theme with a consulting project manager (KM, with master’s level training in qualitative methods). Interviews were conducted until thematic saturation across all participants was reached based on the consensus of the two evaluators, a consulting project manager (KM), and the principal investigator (MG).

Data triangulation and theme checking were conducted by sharing a paper format of the key themes with various stakeholders, including people with lived experience, MORS operators, researchers, and interested government officials.

We used the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to report the results. The study complies with the Tri-Council Policy Statement for Ethical Conduct for Research Involving Humans (TCPS 2) and the Helsinki Declaration. The study was approved by the University of Calgary Conjoint Health Research Ethics Board (REB21-1655).

Out of the total 52 individuals interviewed, 25 identified as persons with lived or living experience of substance use, 10 as healthcare providers, 5 as family members of PWUS, and 12 as harm reduction workers/MORS operational personnel. The following themes represent participant perceptions towards the MORS and physical SCS.

THEME 1: MORS can alleviate logistical barriers for PWUS who cannot readily access a SCS.

PWUS voiced how access to SCS was hindered by various logistical and geopolitical barriers such as long wait times, limited hours of operation, centralization in downtown areas, the possibility of arrest/altercations with law enforcement/police, and more. They also believed that MORS offered easier and more convenient access to harm reduction for individuals with mobile devices.

Limited hours of operation, seasonal impacts, and wait time barriers

Participants identified limited hours of operation as a major barrier to the use of SCS. Long wait times were identified as another obstacle to utilizing an SCS due to the risk of experiencing withdrawal symptoms while waiting to use. For example, one PWUS brought up how, “when I lived in Vancouver, sometimes you'd be waiting for 45 minutes to get into an SCS and it's not exactly convenient to wait 45 minutes when … you’ve just gotten something and you're trying to be safe.” Those residing in rural/remote areas or without reliable transportation expressed frustrations regarding the difficulty in accessing an SCS which is often centralized in urban downtown. Seasonal impacts were also considered a barrier. For instance, interviewees indicated that severe weather conditions and cold temperatures during the winter deter people from reaching SCS due to fear of exposure. Given these factors, participants viewed virtual spotting such as MORS as a convenient alternative for keeping individuals safe during times of necessary solitary use.

Support for different routes of substance use

Though participants acknowledged that many SCS permit injection, nasal insufflation, and oral routes of substance use, it was noted that they often did not allow the use of inhalants (e.g., paint thinner) or the smoking of products. MORS may support clients regardless of their routes of consumption including inhalation and smoking, which were emphasized by some participants.

“Inhalation, they can use the drugs they want. You know there's one inhalation site in all of Canada. So for them to really smoke their drugs in their home while not using alone. It gives them peace of mind.” (PWUS)

“[This] is one of the biggest benefits for NORS and DORS is that people can use at home while they’re inhaling their substances, whether its methamphetamines or opioids.” (MORS Operational Personnel/Harm Reduction Worker).

Stigma, discrimination, autonomy, and privacy

The fear of being seen at a SCS was a recurring theme among PWUS, highlighting the prevailing issue of stigma around SUD. Some respondents discussed feelings of shame and embarrassment going to SCS, referring to past instances of discrimination. Participants also felt that MORS might enhance respect and privacy for some people using substances.

“Discrimination and […] stigma, and there’s judgment associated with attending a physical SCS.” (MORS Operational Personnel/Harm Reduction Worker).

“In the privacy of your own house, you don’t have that voice in your head saying that they could see me.” (MORS Operational Personnel/Harm Reduction Worker).

Despite efforts to make SCS more welcoming, some participants noted that SCS can be “pretty intimidating to be around” (Healthcare Provider) if the client is not familiar with the setting. From this finding, MORS may be more appropriate for clients who may prioritize anonymity and privacy.

Barred access, losing their substances, and altercation with law enforcement

It was also brought to attention that certain individuals due to their past history of misconduct and restraining orders are prohibited from visiting SCS. However, if such individuals possess a phone or other technologies, it is still possible for them to receive harm reduction services through MORS. Some PWUS also shared their experience of having their substances stolen from them en route to SCS. PWUS expressed fears surrounding the risk of arrest if they encountered law enforcement en route to a SCS.

“The drug was getting dropped off by my place, if the drug dealer’s coming out, I wouldn’t go across the city to use it. It wasn’t like a social club for me. And also, I'd be taking a risk, because drugs are criminalized, to get all the way down there on the train or whatever, sneak on the train. Just use the SCS and then risk going to jail on the way. The cops would just search you. They would just randomly search you. Especially if you had a record.” (PWUS)

Political barriers and legislation surrounding illicit substances

Many participants shared the sentiment that MORS could be particularly beneficial in places where the political atmosphere is not supportive of SCS. It was felt that political and community-based opposition often hinder the uptake of SCS, and hence, MORS could be a reasonable option to support individuals regardless of where they are located geographically. Overall, MORS were regarded as a particularly beneficial tool, especially in heavily policed jurisdictions and provinces where possession of illicit drugs is still criminalized.

“I don’t know the exact status of our consumption sites now, but I know that there has been some concerns or pushback or challenges to the consumption sites, so I don’t know how long they’re actually going to be around for” (Healthcare Provider). Providing options for people through MORS “can show people that you don’t have to be somewhere in order for us to care about you and your safety.” (PWUS).

THEME 2: SCS may be preferred by clients who value therapeutic relationships and social connections.

SCS was seen to nurture a greater sense of social connection and meaningful relationships between PWUS and members of the community compared to MORS, as they provide an opportunity for “organic conversations” (PWUS). According to one interviewee, “camaraderie and just connection with somebody in-person which […] a lot of drug users don’t have that” (PWUS). This social aspect was preferred by some respondents who “love having people around that I’m talking to […] it’s nice being around people who are desensitized to seeing substances in front of them, but not unaware of the risks associated, while also just maintaining a relationship with you […] really it feels like that of a friend” (PWUS). Respondents discussed how this is different from talking to someone over the phone. For example, “being with somebody in person, and like interacting is way more meaningful and different”, whereas “virtual apps [can] take away that human aspect” (Healthcare Provider).

Relationships with the staff at SCS were seen as assisting clients meet their healthcare needs in a supportive, trauma-informed environment, and to “heal with whatever pain they’re dealing with and why they’re using [substances] in the first place” (PWUS). The constant engagement between clients and service providers was thought to establish more trust in the public healthcare system, which could be conducive to the overall, sustained mental well-being and health of PWUS (e.g., “the people that know them by name, see them” [PWUS]).

While SCS can alleviate the sense of alienation and loneliness through a face-to-face connection (community harm reduction service provider), some respondents disagreed that SCS provided more opportunities for relationship building.

“[Clients] said they feel more closely bonded to the people – the operators on the line. In the physical supervised consumption sites, they’re often just being observed and there’s less interaction with staff there. So, they’re finding that there is more interaction with the operators on the NORS lines.” (MORS Operational Personnel)

In summary, most participants preferred SCS for facilitating relationships and a sense of community although a minority of interviewees favored MORS in this regard.

THEME 3: MORS should aim to connect clients to additional harm reduction and social services.

It was noted that SCS offer a “clean and safe environment where [they] can use [their substances]” (PWUS). One key benefit indicated by participants was that SCS provided access to clinical services that were not always available through MORS. For instance, SCS can be used to pick up medication (e.g., HIV medication) and receive assessments and first aid (e.g., wound care) by health care professionals in person.

Participants further noted that SCS can directly provide clients with harm reduction supplies (e.g., sterile needles and other paraphernalia). While some were aware of educational services provided by MORS, they were not familiar with MORS distributing harm reduction supplies. Additionally, while SCS could demonstrate clients on how to use supplies safely, participants noted that MORS could at best explain how to do so over the phone. Participants also thought that SCS may also be able to provide clients with a safe supply of opioids to help mitigate the contaminated drug supply. Furthermore, SCS were believed to be able to offer additional services, including social services and a warm place for clients to shelter - both of which it was felt MORS could not match. One interviewee mentioned, “[SCS can provide] meal access or access to a social worker to help them with their social security […] help them get ID, help them get housing stuff” (Healthcare Provider).

THEME 4: A SCS with in-person staff may be more equipped to provide a prompt overdose response.

Many participants regarded SCSs as more adept and reliable at dealing with acute overdoses, which was deemed a key advantage over MORS. Despite this, MORS can still be beneficial, as one respondent stated, “I would say a disadvantage is, response time is much slower.. compared to … brick-and-mortar SCS, but obviously, you're comparing it to none, then any response time obviously is better with a virtual one than none at all” (PWUS). Therefore, participants viewed response times at SCS to be better than MORS, but MORS to be preferable to no overdose monitoring at all.

This study represents one of the first qualitative examinations comparing the strengths and gaps in SCS and MORS through the lens of various key interest groups in Canada. It expands on previous studies that have examined the phenomenon of spotting and the barriers to accessing harm reduction services for PWUS (14,18). Figure 1 illustrates the perceived benefits of MORS compared to SCS from the perspective of key interest groups.

Participants recommended MORS as an adjunctive resource to help mitigate the key barriers to accessing SCS (19). Our study corroborates previous work that wait times and limited spaces serve as a major deterrent to using SCS, driving PWUS to consume substances alone in their own home or private residence (20). For instance, The Trailer, a SCS in Ottawa has been seeing more than double the number of clients it was designed to accommodate (20). Especially during the peak hours, people have been reported to wait outside until booths became available, suggesting that SCS locations are insufficient in number to meet the needs in the area (20). Previous work has also documented client frustration regarding limited operating hours of SCS, which often do not cater towards PWUS and their drug use routines (21). The current study detailed how MORS may be able to fill some of these gaps; however, MORS implementation and expansion should be done in a manner which considers the risk of inadequate staff, bandwidth, or server capacity that could occur should many clients try to use the service at a given time. In particular, the authors believe that MORS which use a live operator may be at most risk of struggling with capacity issues similar to those of SCS, since each client must be paired with an individual operator. While MORS may save money by avoiding the need for a physical location, the use of personnel resources may be less efficient if they require a one-to-one operator to client ratio.

While MORS require activation of emergency services to respond in the event of a suspected overdose, SCS staff can respond more immediately due to being physically present at all times. The time required to respond to overdose can very much impact the overall outcome of opioid-induced respiratory depression, with a proportional increased risk of hypoxic brain injury or even death with delays in overdose response (22). To date, there is no evidence of fatal overdoses having occurred in the context of MORS use; however, information about the effectiveness of MORS in the event of overdose remains sparse (15). Regardless, in the opinion of the authors it seems likely that using MORS would be safer than using alone and research is ongoing to assess its safety. MORS providers and operators should ensure that clients are adequately informed about the limitations of these services in terms of overdose response. It is the opinion of the authors that MORS should be viewed as both a supportive and adjunct harm reduction measure, intended to complement the provision of SCS while emphasizing the reduction of barriers to SCS access to improve SCS uptake as of paramount importance.

In regard to different routes of administration, a recent study by Parent et al. (2021) revealed that 69% of individuals using substances prefer inhalation or smoking. This creates a challenge as only 5% of SCS in Canada offer inhalation support according to the most recently available statistics due to occupational hazards associated with passive inhalation (23,24). With the increasing prevalence of crystal methamphetamine inhalation in major cities like Vancouver, this gap must be addressed by carefully considering its feasibility and acceptability (25). That being said, MORS can still support individuals regardless of their preferred routes of administration at no risk to service personnel.

Concerns regarding confidentiality and privacy have been consistently cited as major barriers to seeking an SCS due to perceived fears around policing and criminalization (14). It is important to recognize that SUD is still a heavily stigmatized health status in North America, and many report not wanting to be seen by someone they know due to shame and embarrassment (21,26). However, MORS may also be contending with similar concerns surrounding privacy as PWUS are reluctant to call emergency medical services in fear of arrest and losing housing or child custody despite the Good Samaritan Drug Overdose Act (Latimore and Bergstein, 2017; Moallef and Hayashi, 2021). Indeed, previous work has demonstrated client concerns around privacy and use of their information in relation to the use by MORS (from unpublished work by Seo et. al. 2023). Regardless, findings from our study still suggest that between virtual and physical services, MORS are perceived to offer a more private and confidential option.

Finding a sense of community and building therapeutic relationships with the staff was considered a unique and valuable aspect of SCS by study participants. PWUS often cite negative experiences of stigma and discrimination within the healthcare system that discourages them from seeking further support for physical and mental health related disorders (29,30). SCS have been previously shown to be a means to break down these barriers and reshape the perceptions of PWUS towards health and social services (31). While not impossible, MORS face more challenges in this regard especially for the automated services like DORS and LifeGuard (as opposed to the hotline versions such as NORS, Brave, and Never Use Alone, where substance-using individuals would actively engage with an operator). Despite differences between specific MORS in their ability to generate community, our study showed that even phone hotlines were viewed by many respondents as poorer for generating community compared to SCS. MORS may wish to focus on community building initiatives in the future to increase uptake and utility of their offerings.

It was highlighted by participants that SCS provided necessary services that were missing in the virtual options. For instance, some sites are embedded in already existing health centers that not only provide immediate harm reduction support but also primary medical care and substance use treatment (e.g., on-site opioid agonist treatment) (31). In addition, services such as wound care, clinical support, and social services are provisioned in a more robust fashion in physical sites, though some MORS (e.g., NORS) offer limited scope connection or referral services (from unpublished work by Rider et al. 2023). Despite this, innovative models for sterile supply distribution could be considered by MORS; past work has suggested that mail-out kits of naloxone, needles, filters, and other supplies, as well as disposal containers and locations of safe disposal sites are ways in which harm reduction services can be provisioned without a physical location for services (French, Favaro, and Aronowitz, 2021).

Given the limitations of SCS, the authors believe that MORS may be a much-needed service to equitably serve a large proportion of PWUS who do not have access to immediate spotting or other overdose prevention services. Harm reduction agencies, health care providers, and community partners should consider suggesting the use of MORS to PWUS who use alone or otherwise lack access to SCS. Health Canada recently announced $40 million dollars to assist PWUS by expanding education and training, opioid agonist treatment, peer support, and other various addiction-related resources (33). While this is welcoming news, further efforts are needed to ensure equitable access to harm reduction services and addiction support for marginalized groups, including Indigenous communities and individuals residing in rural areas. As highlighted previously, the scalability of MORS compared to SCS especially in light of political or community opposition makes a strong case for MORS as a reasonable adjunctive option in the opinion of authors. While there is limited evidence regarding the effectiveness and safety of these services, preliminary evidence indicates MORS could still be used to support solitary use of substances, prevent overdose, provide community, and connect PWUS with resources.

Strengths and Limitations

One strength of this study is having a relatively large sample size of individuals recruited from across Canada and representing the perspectives of various key collaborators. The convenience and snowball sampling strategies used may have limited the diversity of the participants, especially those with less knowledge of MORS. Much of our findings were also focused on hotline versions of MORS as opposed to automated versions of them due to only a minority of PWUS participants having experience with automated app MORS. In addition, all participants were required to have access to a mobile device or telephone and communicate effectively in English, which may have biased our sample to anglophone populations and excluded some groups, notably recent immigrants and refugees. While our study explored the potential differences between the SCS and MORS, uptake preferences and safety were not measured quantitatively. Additional research should investigate the efficacy of service referrals from hotline-based MORS. Lastly, the interview guide mainly focused on the hotline and timer-based MORS and did not take into account other virtual harm reduction technologies such as wearable sensors and buttons.

SCS

Supervised Consumption Sites

MORS

Mobile Overdose Response Services

PWUS

People who use substances

The findings of this preliminary study have important implications for understanding how MORS and SCS can complement each other and understand where and in what context one service may be more applicable, acceptable, and useful than the other. These findings will further inform MORS implementation and improvement going forward.

Ethics approval and Consent to Participate

The study was conducted as part of a quality improvement project and received ethical approval from the University of Calgary Conjoint Health Research Ethics Board (REB21-1655).

Consent for Publication

Not applicable

Availability of Data and Materials

The data that support the findings of this study are available on request from the corresponding author, M.G. The data are not publicly available due to the sensitivity of substance use and interview transcripts containing information that could compromise the privacy of research participants.

Competing Interests

Dr. S Monty Ghosh co-founded NORS and belongs to the Canadian Society of Addiction Medicine and has no personal financial conflicts of interest to disclose. Pamela Taplay is a paid NORS staff member. The results of this work may be used to apply for funding for NORS or to make operational changes to NORS. The rest of the authors are unaffiliated with any other VOMS or NORS in particular and have no competing interests to declare.

Funding

Health Canada’s Substance Use and Addictions Program (SUAP) Grant [Agreement Number 2122-HQ-000021] and the Canadian Institutes of Health Research (CIHR) Grant [Funding Reference Number (FRN) 181006] supported this work. The study design, data collection and analysis, interpretation of results, or the decision to submit for publication was done independently of SUAP and CIHR. Health Canada's views are not necessarily represented by the views expressed in this article.

Authors’ Contributions

B.S. and M.G. both contributed equally to the interpretation and writing of the main manuscript text. All authors provided data interpretation, revision, and feedback. S.J. was involved in the data collection and interpretation of results. M.G. conceptualized the study and acquired funding. All authors have read and approved the final manuscript.

Acknowledgments

The authors would like to acknowledge the contributions of Health Canada’s Substance Use and Addictions Program (SUAP) and the Canadian Institutes of Health Research (CIHR) for helping fund this project. We would also like to thank the National Overdose Response Service (NORS), and Grenfell Ministries for helping recruit participants. We also appreciate the work of Three Hive Consulting in conducting interviews and aiding with analysis.

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Competing interest reported. M.G. is a co-founder of NORS; M.G. does not have any financial interest in this work. Pamela Taplay is a paid NORS staff member. The results of this work may be used to make operational changes at NORS. The remaining authors are not affiliated with NORS and certify that they have no competing interests.

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Perspectives of key interest groups regarding Supervised Consumption Sites (SCS) and novel Mobile Overdose Response Services (MORS): A qualitative Canadian study.

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Abstract

Background

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INTRODUCTION

METHODS

RESULTS

Stigma, discrimination, autonomy, and privacy

THEME 2: SCS may be preferred by clients who value therapeutic relationships and social connections.

THEME 3: MORS should aim to connect clients to additional harm reduction and social services.

DISCUSSION

Abbreviations

CONCLUSIONS

Declarations

References

Additional Declarations

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