Peer Response to Opioid Overdoses in the Community: An Interpretative Phenomenological Analysis

Abstract

Canada and many other countries are currently in the midst of a drug poisoning crisis, primarily driven by an increasingly toxic unregulated drug supply and the ongoing criminalization of people who use drugs (PWUD). Since 2016, over 44,000 PWUD have died from drug toxicity, representing 22 deaths each day in the first 9 months of 2023. Research to date has demonstrated that most drug overdoses occur in private residences (at home), and PWUD themselves are often burdened with the task of responding to these overdose events. To date, minimal research has been completed to understand the psychological trauma and burden of care associated with responding to drug overdoses in the community, outside of formal supports and services. In response to this, we sought to explore the experience of overdose response in the community through a qualitative study with PWUD using an interpretative phenomenological analysis (IPA) approach. Our goals were to explore the psychological trauma and stress associated with responding to overdoses; understand the overdose response experiences of PWUD and peers in the community or at home and their gaps in support; explore the necessary changes that are required for PWUD to be supported in their overdose response; and inform the development of policies, laws, and resources to support and encourage peers given their crucial involvement in the drug poisoning crisis. To situate and guide this research within this understanding of trauma, Bonnie Burstow's radical trauma theory and her layers of trauma framework were employed. A total of 20 questionnaires and semi-structured interviews were completed with research participants in downtown Ottawa, Canada. From this data collection, major findings included 1) the invisible labour that PWUD regularly participate in, 2) the importance of citizenship amongst PWUD, 3) the trauma regularly experienced by research participants, 4) deficits and gaps in current services and supports for PWUD, and 5) the importance of evolution moving forward within the drug poisoning crisis. These findings help to expose the complex and intertwining forces (and resultant tension) which impact peer overdose response in the community and how this has reinforced the need for PWUD to insulate themselves from a constant barrage of violence and rejection. Further, future directions and recommendations from the research participants themselves contribute to understanding how to navigate the drug poisoning crisis moving forward.