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BEHIND THE STUDY
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/
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
30000Visits
209Overdose Reversals
700Referrals 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,
Melissa McCann,
MSW Middlesex-London Health Unit, melissa.
Shamiram Zendo, PhD Western University,
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,
Marlene Janzen Le Ber, PhD
Brescia Excellence in Research Professor,
Chair School of Leadership & Social Change, Brescia University College
Zayya Zendo, BSc Western University,
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