Abstract
Setting
A temporary emergency shelter was established inside the Commonwealth Stadium in Edmonton, Alberta, to reduce COVID-19 transmission and mitigate health risks among people experiencing homelessness.
Intervention
A non-profit organization, Boyle Street Community Services, opened an overdose prevention site (OPS) between February and March 2022 inside the temporary emergency shelter. People accessed the shelter-based OPS to consume unregulated drugs (via injection, intranasally, or orally), receive medical aid, access sterile drug use equipment, and be connected to additional health and social supports, without leaving the shelter. We conducted short interviewer-administered surveys with OPS participants to examine participant views and identify suggested improvements.
Outcomes
The shelter-based OPS was accessed a total of 1346 times by 174 unique people. Fentanyl was the most common self-reported drug consumed (59%) and most consumption (99% of episodes) was by injection. OPS staff responded to 66 overdoses and reported no deaths. Survey respondents reported that the shelter-based OPS was convenient, with no need to forfeit their shelter spot or find transportation to another OPS. Respondents indicated that the OPS felt safe and accessible and reported that it reduced drug use in other shelter areas. Participants identified the OPS’ exclusion of inhalation as a limitation.
Implications
People who use unregulated drugs and are experiencing homelessness are at a higher risk of negative health outcomes, which COVID-19 exacerbated. Integrating temporary shelter/housing and harm reduction services may be an innovative way to lower barriers, increase accessibility, and improve well-being for this structurally vulnerable population. Future operators should consider incorporating inhalation services to further reduce service gaps.
Résumé
Lieu
Un refuge d’urgence temporaire avait été établi dans le stade du Commonwealth à Edmonton (Alberta) pour réduire la transmission de la COVID-19 et atténuer les risques pour la santé chez les personnes en situation d’itinérance.
Intervention
Un organisme sans but lucratif, Boyle Street Community Services, a ouvert un centre de prévention des surdoses (CPS) entre février et mars 2022 à l’intérieur de ce refuge d’urgence temporaire. Les gens avaient accès au CPS du refuge pour consommer des médicaments non réglementés (par injection ou par voie intranasale ou buccale), recevoir de l’aide médicale, se procurer du matériel de consommation stérile et être mis en rapport avec d’autres intervenants et intervenantes de la santé et des services sociaux sans sortir du refuge. Nous avons mené de brefs sondages administrés par l’enquêteur ou l’enquêtrice auprès des participantes et des participants du CPS pour étudier leurs points de vue et formuler des suggestions d’améliorations.
Résultats
Le CPS du refuge a été utilisé 1 346 fois par 174 personnes. Le fentanyl a été le médicament le plus souvent consommé selon les utilisateurs et utilisatrices (59 %), et la plupart du temps (dans 99 % des cas), il était consommé par injection. Le personnel du CPS est intervenu lors de 66 surdoses et n’a rapporté aucun décès. Les répondantes et répondants aux sondages ont indiqué que le CPS du refuge était pratique, car il n’était pas nécessaire d’abandonner leur place dans le refuge, ni de trouver un moyen de se rendre dans un autre CPS. Ces personnes ont trouvé le CPS sûr et accessible et ont dit qu’il avait réduit la consommation de drogue dans d’autres zones de refuge. Les participantes et participants ont indiqué que l’exclusion de la consommation par inhalation dans le CPS était toutefois une contrainte.
Conséquences
Les personnes en situation d’itinérance qui consomment des médicaments non réglementés courent un plus grand risque d’avoir des résultats cliniques négatifs, ce que la COVID-19 a exacerbé. L’intégration de refuges/logements temporaires et de services de réduction des méfaits peut être un moyen novateur de réduire les obstacles, d’accroître l’accessibilité et d’améliorer le bien-être de cette population structurellement vulnérable. Les futurs gestionnaires devraient songer à intégrer des services d’inhalation pour réduire encore davantage les lacunes dans les services.
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Acknowledgements
We would like to thank Kylie Bergenhenegouwen as well as all other staff who operated the overdose prevention site inside the Edmonton Commonwealth Stadium shelter for their help facilitating data collection.
Availability of data and material
Survey data gathered during the evaluation activities discussed in this report can be made available upon reasonable request to the corresponding author.
Code availability
Not applicable
Funding
This study was funded by Boyle Street Community Services, from funding originally granted by Alberta Health (RES0058073).
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Authors and Affiliations
Contributions
LG, KS, MT, and EH conceptualized the paper. MT acquired the funding and led the OPS operation and its evaluation. LG, KS, EH, and MT aided in project administration, managing and/or coordinating the project planning, and execution. EH was the principal investigator of the evaluation, overseeing its planning and execution. LG conducted the evaluation activities discussed in the manuscript, including data collection and analysis. LG drafted the manuscript with help from KS. MT and EH contributed to the manuscript’s revision.
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Ethics declarations
Ethics approval
All procedures performed in this study involving human participants were in accordance with the ethical standards of the University of Alberta Health Research Ethics Board (Pro00117412) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Consent to participate
Informed, written consent was obtained from all individual participants included in the study.
Consent for publication
A Boyle Street Community Services employee granted consent for the authors to publish two of their photographs of the overdose prevention site within the temporary shelter. No participant or identifiable information can be found within either photograph.
Conflict of interest
Taylor, a co-author of our study, is the Director of Health Services at Boyle Street Community Services and managed the intervention reported on in our manuscript. In addition, Elaine Hyshka’s faculty received funding from Boyle Street Community Services to evaluate the intervention. We have no other conflicts of interest to disclose.
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Galarneau, L.R., Speed, K., Taylor, M. et al. Operating an overdose prevention site within a temporary emergency shelter during the COVID-19 pandemic. Can J Public Health 114, 787–795 (2023). https://doi.org/10.17269/s41997-023-00803-3
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DOI: https://doi.org/10.17269/s41997-023-00803-3
Keywords
- Homelessness
- Harm reduction
- Supervised injecting facility
- Drug overdose
- Substance-related disorders
- Emergency shelter