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Behind The Study Old

The Middlesex-London Health Unit (MLHU) and the

Centre for Research on Health Equity and Social Inclusion (CRHESI)

from Western University Health Sciences engaged in a research

partnership to understand how a temporary overdose prevention

site in southwestern Ontario has influenced the lives of people who

use drugs (PWUD).

Funding for this study was provided by MLHU. Additional in-kind

contributions from both MLHU and CHRESI.

Research Question

Our research question:

How has the temporary overdose prevention site

changed the lives of those who have accessed the site?

We were interested in finding out about the following

types of changes in site users lives, including:

* Behaviours,

* Relationships,

* Interactions with others,

* Feelings, and

* Perceptions of self and other.

Methodology

* Our research design included a Photo Narrative Method which involved

recruiting people who use drugs (PWUD) at the overdose prevention site

to participate in semi-structured interviews and were provided with a

camera to take photos that represented the influence of the site on their

lives.

* Semi-structured interviews took place between May-September 2019.

* The transcribed interviews were analyzed using a critical narrative analysis approach.

* The analysis was conducted by the research team members in a multi-phased

process involving individual and group analysis with the overall goal being

to generate a core narrative supported by key themes.

Recruitment

Site staff assisted with:

* Pre-screening

* Introducing potential participants to researchers, and

* Achieving maximum-variation sample.

Research staff were responsible for:

* Explaining the study purpose and process,

* Obtaining consent, and

* Conducting the interviews.

Data Collection Process

First Interview

* Semi-structured interviews were conducted to gather information of their

experiences on how the site had influenced their day-to-day lives.

* Participants were then provided with a disposable camera to take photos

that represent the influence of the site.

Camera Return and Photo Development

* Participants were asked to return the cameras to the site, where the

researchers then retrieved the cameras and arranged photo development.

Second Interview

* In the follow-up interviews, the photographs were used to facilitate story-telling.

* Participants were asked to share the meaning of the photos they chose.

Changes to Data Collection Protocol

* Due to a low rate of camera return (8/27 participants), a new protocol was

implemented utilizing a Peer Support Worker employed by the Regional

HIV/AIDS Connection (RHAC) to accompany participants in a digital photo

taking process.

* Second Interviews were conducted with participants immediately following

photo taking process with the research team.

Participatory Approach

Changes to Data Collection Protocol

We used participatory approaches throughout the study including:

Study Design

We engaged site users and site staff in discussions on the study design.

Formation of an Advisory Team

We formed an Advisory Team which included four community stakeholders

(i.e. site staff, staff providing services in the Aftercare Room) and three site users.

Member-checking

Member checking was an important part of the café event that gathered

feedback on the preliminary findings with participants, site staff and community

stakeholders.

Café Event to Share Preliminary Findings (Fall 2019)

* The research team presented the proposed core narrative with four chapters

and themes to the Community Advisory Team, research participants, and site staff

in an afternoon café event at RHAC.

* Feedback was overwhelmingly positive regarding both the structure and the

content of the proposed findings.

* This café event helped us to refine the terminology of the chapters and themes.

BACKGROUND AND LOCAL CONTEXT

Drug Overdose Crisis in Middlesex-London:

Our community of Middlesex-London, like many Canadian communities,

has been significantly impacted by opioid-related deaths.

62 deaths due to opioid overdoses in 2018

60 deaths due to opioid overdoses in 2019

25 deaths in the first quarter of 2020

The rates of emergency department visits, and opioid-related hospitalizations

had also increased during the 2018-2019 timeframe representing a large burden

on the health care system.

For the latest data on Opioid related morbidity and mortality in Middlesex-London

region, visit Public Health Ontario’s Interactive Opioid Tool:

https://www.publichealthontario.ca/en/data-and-analysis/substance-use/

interactive-opioid-tool

In response to this intensifying crisis, multiple community and government

agencies have joined in local efforts to save lives, and address harms

associated with opioid use.

One such effort was the establishment of a temporary overdose prevention

site (TOPS).

In February 2018, Ontario’s first legally sanctioned temporary overdose

prevention site opened its doors in London.

It was a collaboration between its founding partners, the Middlesex-London

Health Unit and Regional HIV/AIDS Connection.

In April 2019, TOPS began to transition to the new provincially-funded

Consumption and Treatment Services (CTS) program, named CarePoint

Consumption and Treatment Services.

About CarePoint

The site provides a safe place for people to consume substances under

the supervision and care of health professionals (Registered Nurse or

Emergency Medical Services) and harm reduction workers.

The staff are situated in the drug consumption room to support clients and

provide education about substance use practices, as well as potential health

concerns from injection drug use [e.g. soft tissue injuries, cellulitis, abscesses,

Invasive Group A Streptococcal Infections (iGAS), Hepatitis C Virus (HCV),

Human Immunodeficiency Virus (HIV)].

The site is supported by several community partner agencies

that provide wrap-around services on a rotational basis at the

site. Among these are the

Southwestern Ontario Aboriginal Health Access Centre (SOAHAC),

London Cares Homeless Response Services (LCHRS),

Addiction Services Thames Valley (ADSTV),

London Intercommunity Health Centre (LIHC),

Canadian Mental Health Association (CMHA), and the

Middlesex-London Health Unit (MLHU)

When first established, the site operated six hours per day.

However, with enhanced provincial funding to the interim site

in the summer of 2019, the hours expanded.

Currently, the site is open seven days per week, including Statutory

holidays, from 9:30 am to 9:00 pm.

Our Numbers

After 2 yearsof operation, the site had provided

30000 Visits

209 Overdose Reversals

700 Referrals to health and social services

Contact Us

Our Project Team included the following individuals

which also aligns with the authors of our reports:

Michelle Sangster Bouck, MA Program Evaluator

Middlesex-London Health Unit,

michelle.sangsterbouck@mlhu.on.ca

Abe Oudshoorn, RN, PhD

Western University,

aoudshoo@gmail.com

Melissa McCann,

MSW Middlesex-London Health Unit, melissa.

mccann@mlhu.on.ca

Shamiram Zendo, PhD Western University,

szendo@uwo.ca

Helene Berman, RN, PhD

Distinguished University Professor Emerita, Western University

Academic Director, Centre for Research on Health Equity and Social Inclusion

Jordan Banninga, MSc

Middlesex-London Health Unit,

jordan.banninga@mlhu.on.ca

Marlene Janzen Le Ber, PhD

Brescia Excellence in Research Professor,

Chair School of Leadership & Social Change, Brescia University College

Zayya Zendo, BSc Western University,

zzendo@uwo.ca

We would like to acknowledge the following for their contributions:

All our participants for sharing your stories All the staff at CarePoint

With special thanks to:

Sonja Burke, Director

Kailey Anderson,

Peer Support Worker

Advisory Committee

Blair Destini

Jennie

Mike

Sam

Sommer

Trevor

For more information:

What to learn more or have questions about the study?

Email the Project Team: photo.study@mlhu.on.ca