Addressing Intersecting Housing and Overdose Crises in Vancouver, Canada: Opportunities and Challenges from a Tenant-Led Overdose Response Intervention in Single Room Occupancy Hotels

  • Geoff Bardwell
  • Taylor Fleming
  • Alexandra B. Collins
  • Jade Boyd
  • Ryan McNeil


We examined the acceptability, feasibility, and implementation of the Tenant Overdose Response Organizers program (TORO)—a tenant-led naloxone training and distribution intervention. This pilot project was implemented in privately owned single room occupancy (SRO) hotels that were disproportionately affected by overdose in Vancouver’s Downtown Eastside (DTES) neighborhood. Semi-structured qualitative interviews were conducted with 20 tenants who had participated in a TORO training session and administered naloxone to someone in their SRO hotel or had overdosed in their SRO hotel and received naloxone from another tenant. Focus groups were conducted with 15 peer workers who led the TORO program in their SRO building. Interviews and focus groups were transcribed and analyzed thematically. Ethnographic observation at SRO hotels involved in the intervention was also co-led with peer research assistants. Ten SROs were included in the study. The level of acceptability of the TORO program was high, with participants describing the urgency for an intervention amid the frequency of overdoses in their buildings. Overdose response training enhanced participants’ knowledge and skills, and provided them a sense of recognition. Additionally, the TORO program was feasible in some buildings more than others. While it provided important training and engaged isolated tenants, there were structural barriers to program feasibility. The implementation of the TORO program was met with some successes in terms of its reach and community development, but participants also discussed a lack of emotional support due to overdose frequency, leading to burnout and vulnerability. Our findings suggest that the TORO program was affected by social, structural, and physical environmental constraints that impacted program feasibility and implementation. Despite these constraints, peer-led in-reach overdose response interventions are effective tools in addressing overdose risk in SROs. Future housing interventions should consider the intersecting pathways of overdose risk, including how these interventions may exacerbate other harms for people who use drugs. Further research should explore the impacts of environmental factors on overdose response interventions in other housing contexts.


Housing Single room occupancy hotels Risk environments Overdose response Safer environment interventions Peer naloxone programs 



We would like to thank study participants for their contributions to this research. We also thank current and past staff and peer research assistants at the British Columbia Centre on Substance Use for their research and administrative assistance. Thank you to the DTES SRO Collaborative and Vancouver Coastal Health for allowing us to conduct this research.

This study was supported by funding from the City of Vancouver and the US National Institutes of Health (R01DA044181). Geoff Bardwell is supported by a Mitacs Elevate Postdoctoral Fellowship from Mitacs Canada. Alexandra Collins is supported by a Mitacs Award through the Mitacs Accelerate Program. Ryan McNeil is supported by awards from the Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research.


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Copyright information

© The New York Academy of Medicine 2018

Authors and Affiliations

  • Geoff Bardwell
    • 1
    • 2
  • Taylor Fleming
    • 1
  • Alexandra B. Collins
    • 1
    • 3
  • Jade Boyd
    • 1
    • 2
  • Ryan McNeil
    • 1
    • 2
  1. 1.British Columbia Centre on Substance UseSt. Paul’s HospitalVancouverCanada
  2. 2.Department of Medicine, St. Paul’s HospitalUniversity of British ColumbiaVancouverCanada
  3. 3.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada

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