Empowering people, reducing harms

Written by Jackie Wong for the Peter Wall Institute for Advanced Studies

In the midst of a fatal overdose crisis, harm reduction scales up across B.C.

Illicit drug use in British Columbia has become a heavy-hearted feature of the public conversation. Overdose deaths killed 914 people in the province last year, marking a new record for the province. As all levels of government have struggled to respond, a close-knit network of people across the province has been working quietly to reduce drug-related harms in their communities for years.

The group consists of five people with lived experiences with substance use, better known as peers. They each live in one of B.C.’s five health authority regions. Members, who refer to themselves as PEEPs (shorthand for the Peer Engagement and Evaluation Project at the heart of their work) share knowledge and perspectives that inform harm reduction planning, strategizing, and evaluation across B.C. The PEEP project is supported by a 2014 Wall Solutions Award. Funding from the Wall Solutions Initiative enables University of British Columbia faculty members to engage with community partners to develop innovative research solutions to societal problems.

The PEEPs have travelled to communities in B.C.’s five healthcare regions to conduct peer-driven focus groups on how to improve harm reduction services. That knowledge will inform a new set of best-practice guidelines for engaging peers in harm reduction. The guidelines will be published on TowardsTheHeart.com, a partner website of PEEP, in the next few months.

It’s a “boots-on-the-ground” operation, explains Charlene Burmeister, who lives in Quesnel and is the northern representative for PEEP. Every two weeks since 2014, the group has been meeting by phone, in addition to travelling to gather face-to-face with each other and with community focus groups.

From crisis, opportunity

Since the peers started meeting almost three years ago, much has changed in the political landscape, particularly how governments perceive harm reduction.

“It’s kind of changed the way people talk,” says Dr. Jane Buxton, PEEP principal investigator with the BC Centre for Disease Control and UBC’s School of Population and Public Health.

The new federal government, she says, has been more open to harm reduction as a necessary part of the healthcare spectrum.

“People realize that we need to save people’s lives,” she says. She adds that, conventional, abstinence-based approaches to addressing drug addiction don’t always work.

“Not everybody’s ready for treatment,” Dr. Buxton says. “Treatment isn’t always available. But we need to do something to help people respond when an overdose happens so that they can survive.”

Dr. Buxton has partnered with the BC Harm Reduction Services and Strategies Committee, BC Ministry of Health, BC First Nations Health Authority, provincial health services, and provincial health authorities to make PEEP happen.

Beyond the soon-to-be published best-practice guidelines on improving the quality of harm reduction services, a broader goal for PEEP is to strengthen a provincial network of people with lived substance-use experience and, in so doing, make peer engagement a strong presence in all aspects of harm reduction planning, policy, and evaluation, Dr. Buxton says.

“Peers—they are the experts,” Dr. Buxton says. “They’re the experts in their own reality on the street, with using drugs, with stigma, with all those kinds of pieces. “The work of the peers is the beginning of an important journey. It’s a crucial step towards building bridges between people who might otherwise be isolated in their substance use and in their access to harm reduction services.

Combatting stigma, building support

“In some communities, people are not accessing harm reduction sites due to stigma, discrimination, location of those services, hours of operation, and lack of outreach,” Burmeister says.

Harm reduction access can also be difficult in small and rural areas. Burmeister has been engaging in this work since 2010, and in the last few years, she has been working with service providers and community members—including peers, local street nurses, and staff at the local homeless shelter—to take steps to make harm reduction more inclusive and accessible.

“There has been great work done in my community,” she says.

Burmeister is working with service providers and community members to establish a peer group in Quesnel. Such a group would be important for informing and addressing issues regarding substance use and harm reduction. Establishing non-judgemental relationships, such as those often forged in peer groups, is key to connecting people to vital health services—especially now, at the height of an overdose crisis.

Thanks to the work of peers, community members and service providers in Quesnel, harm reduction efforts have expanded to become more accessible to people who need them. Notably, harm reduction supplies are now available at Quesnel’s minimum-barrier shelter, an inclusive space open 24 hours.

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Professor Buxton and guest speakers with lived experience of the opioid crisis will be speaking at the next Grand Rounds, ‘More than just numbers: hearing from the real experts in the opioid crisis’ on March 3rd in Michael Smith Laboratories Room 102 at 9am. Click here to learn more.

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