Tales of compassion and grief: A qualitative study of peer worker experiences in Vancouver, Canada, during the toxic drug supply crisis

Public Health Addictions Dissertation Prize Winner

Abstract

Background: The public health emergency linked to illicit drug deaths was declared in 2016 in British Columbia (BC), Canada. Since that date, more than 10 000 people have lost their lives from overdoses in BC, and public health authorities increased the surveillance and interventions to prevent those deaths. In that context, a community response emerged, and people with lived experience (PWLE) of substance use stepped up to become significant actors in the overdose response strategy. From first responders in the overdose prevention sites to advisors and content specialists for public health bodies, they are at the frontline of a crisis causing thousands of deaths in the last six years. This qualitative study explores the impacts of the toxic drug supply crisis on frontline peer workers in Vancouver, Canada, by analysing their experiences, challenges, and coping mechanisms.

Methods: Data was collected via in-depth, semi-structured online interviews, between April and July 2022, with seven Vancouver frontline peers (3 females, 3 males and 1 two-spirited) working or having recently worked at any level of the overdose response since 2016. Using the inductive theme analysis method described by Braun and Clark (2013), four main themes related to the research question ‘How is the opioid crisis impacting harm reduction peer workers in Vancouver’ were identified.

Results: The overdose crisis created numerous job opportunities for PWLE of substance use in Vancouver, facilitating development of their role in the public health response to the toxic drug supply crisis in Vancouver. Peers got involved in overdose response early on and in an emergency context, emergency linked to the high increase of the number of deaths since 2016. Their work conditions, and the nature of the job, created tremendous challenges, and the risk for burnout was prevalent for most of the peers included in the study, six related mainly to grief and bereavement. Stigma linked to substance use impacted their professional and personal life, and systemic and organisational support is needed to recognise their role and improve their wellbeing. Finally, compassion was identified as the leading motivation for doing the work. PWLE working on the frontline expressed their determination to help their community and people impacted by substance use stigma. They are essential advocates for systemic and policy changes and should be included in policy making.

Conclusion: PWLE are vital actors in the public health response to the toxic drug supply crisis that impacts British Columbia. Their expertise and motivation to do the job are invaluable. They need to be supported by evidence-based interventions as they face trauma linked to grief and precarious work conditions, putting them at high risk of burnout. Participative research should be conducted in these environments to develop innovative solutions to support them and allow them to participate in improving work conditions and substance use related policies.