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Item In from the cold? Reflections on participatory research from 1970-2005(Convergence, 2005) Hall, Budd L.Participatory Research is a term which was first articulated in Tanzania in the early 1970s to describe a variety of community-based approaches to the creation of knowledge. Taken together these approaches combine social investigation, education and action in an interrelated process. The International Council for Adult Education provided a home in 1976 for what became the International Participatory Research Network, the means by which the ideas and practices of participatory research became more widely visible. Participatory research was a concept which, unlike most contemporary research paradigms, originated in the majority world. It originated in the rapidly expanding networks of non-governmental organisations in the 1980s and 90s. It has been the research approach of choice in many of the social movement interventions of the past 20 years. Participatory research and its sister concept participatory action research have in the past 15 years been taken up in many universities around the world both as a teaching subject and as a research method for graduate studies. One might say that, participatory research has come “in from the cold”, that it has come in from the margins to become an accepted member of the academic family.Item Participatory research: Revisiting the roots(Mosaic Books, 2002) Tandon, Rajesh; Hall, Budd; Brown, L. David; Jaitli, Harsh; Kanhere, Vijay; Small, Dele; Gaventa, John; Merrifield, Juliet; Madiath, Anthya; Belamide, Eileen; Bryceson, Deborah; Manicom, Linzi; Kassam, Yusuf; Vio Grossi, Francisco; Hirabai Hiralal, Mohan; Tare, Savita; Batliwala, Srilatha; Patel, Sheela; Khot, SeemantineeIt has been nearly a quarter of a century since the early formulations of participatory research began to be presented hesitatingly and tentatively. Those early proposals were essentially a reaction to the classical methodology of research and inquiry which had alienated the social science research enterprise from the very people about whom research was being carried out. In a simple way, stated then, participatory research challenged the 'monopoly of knowledge' which has been vested in the elites of our society. The production of knowledge, its certification and dissemination have been controlled by intellectual elites in all human societies, since a long period of time. The Brahmanical order justified its hierarchy by making the distinction between intellectual work and physical work. Brahmins were the repositories of knowledge and wisdom, could use the language of God's 'Sanskrit', and interpret the religious scriptures to prescribe the social norms and behaviour for the rest of society. Similar Brahmanical orders have existed in other cultures and other histories. Therefore, the first significant contribution of participatory research has been to challenge the mythical and artificial divide between mental labour and manual labour, intellectual pursuits and physical pursuits. It has questioned the belief that capacity for intellectual work resides in only a few. It argued that popular knowledge, ability to produce and use knowledge, is a universal human phenomenon, and such capacity exists in all human beings, so argued participatory research then.Item I wish this were a poem of practices of participatory research(SAGE Publications, 2000) Hall, Budd L.The practices of participatory research (PPAR), as this collection eloquently demonstrates, have arisen in many parts of the world. This chapter is drawn from my own roots, that part of the PAR family tree which found its early expression in Tanzania between the mid-1960s through the mid-1970s. These particular expressions joined with Latin American traditions and those from Asia and elsewhere and in turn nurtured the early International Participatory Research Network which was associated with the early International Council for Adult Education between 1976 and 1991.Item Trauma and healing in early childhood years within refugee newcomer populations: A decolonial analysis(2021) Moosa-Mitha, MehmoonaDecolonial perspectives of trauma eschew bio-medical models that regard trauma as a brain-related injury resulting from experiencing an out of the ordinary one-time event. Based on the influential work of Franz Fanon, a decolonial lens for understanding trauma is sociogenic in nature. A sociogenic analysis pays attention to the relationship between the individual and their environment. that s the result of prevalent in scholarly literature on trauma as particularly as they pertain to refugee newcomer populations identify three concepts as integral to an understanding of trauma: Culture, inter- generational trauma and the (colonial) nation-state.Item “Give me the reigns of taking care of myself with a home”: Healing environments in an Indigenous-led alcohol harm reduction program(Harm Reduction Journal, 2024) Brown, Meaghan; Hunt-Jinnouchi, Fran; Robinson, Jennifer; Clark, Nancy; Mushquash, Christopher; Milaney, Katrina; Pauly, BernieDistinct from western Managed Alcohol Programs (MAPs), Indigenous-led alcohol harm reduction programs can be defined by both ‘culture as healing’ and decolonized harm reduction philosophies. We sought to explore experiences of Indigenous ‘family members’ (participants) in an Indigenous-led alcohol harm reduction program and culturally supportive housing to identify appropriate supports according to family member perspectives, and to inform delivery of the program.Item Challenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysis(International Journal of Drug Policy, 2023) Karamouzian, Mohammad; Rafat, Bijan; Kolla, Gillian; Urbanoski, Karen; Atkinson, Kate; Bardwell, Geoff; Bonn, Matthew; Touesnard, Natasha; Henderson, Nancy; Bowles, Jeanette; Boyd, Jade; Brunelle, Caroline; Eeuwes, Jolene; Fikowski, Jill; Gomes, Tara; Guta, Adrian; Hyshka, Elaine; Ivsins, Andrew; Kennedy, Mary Clare; Laurence, Gab; Martignetti, Lucas; Nafeh, Frishta; Salters, Kate; Tu, David; Strike, Carol; Pauly, Bernie; Werb, DanBackground Canada is experiencing an unprecedented drug toxicity crisis driven by a highly toxic unregulated drug supply contaminated with fentanyl, benzodiazepine, and other drugs. Safer supply pilot programs provide prescribed doses of pharmaceutical alternatives to individuals accessing the unregulated drug supply and have been implemented to prevent overdose and reduce related harms. Given the recent emergence of these pilot programs and the paucity of data on implementation challenges, we sought to document challenges in their initial implementation phase. Methods We obtained organizational progress reports from Health Canada, submitted between 2020 and 2022 by 11 pilot programs located in British Columbia, Ontario, and New Brunswick. We analyzed the data using deductive and inductive approaches via thematic analysis. Analyses were informed by the consolidated framework for implementation research. Results We obtained 45 progress reports from 11 pilot programs. Six centres were based in British Columbia, four in Ontario, and one in New Brunswick. Four overarching themes were identified regarding the challenges faced during the establishment and implementation of pilot programs: i) Organizational features (e.g., physical space constraints, staff shortages); ii) Outer contexts (e.g., limited operational funds and resources, structural inequities to access, public perceptions); iii) Intervention characteristics (e.g., clients’ unmet medication needs); and iv) Implementation process (e.g., pandemic-related challenges, overly medicalized and high-barrier safer supply models). Conclusions Safer supply pilot programs in Canada face multiple inner and outer implementation challenges. Given the potential role of safer supply programs in addressing the drug toxicity crisis in Canada and the possibility of future scale-up, services should be well-supported during their implementation phases. Refining service provision within safer supply programs based on the feedback and experiences of clients and program administrators is warranted, along with efforts to ensure that appropriate medications are available to meet the clients’ needs.Item "Forced to become a community": Encampment residents’ perspectives on systemic failures, precarity, and constrained choice(International Journal on Homelessness, 2022) Olson, Nicholas; Pauly, BernieHomelessness is a serious public health concern with devastating consequences for health and wellbeing of homeless people. Visible signs of homelessness often appear in the form of encampments or tent cities. Such sites often raise controversies about public health and safety without attention to the structural, systemic and individual factors that contribute to their existence, including deficits in basic determinants of health and a failure to protect human rights to housing. The purpose of this paper is to explore the conditions that contribute to homeless encampments and ongoing issues of precarity, and right to housing from the perspective of residents of one encampment. The data set was comprised of 47 affidavits taken from 33 people from one tent city in Victoria, British Columbia (BC) in anticipation of legal action to remove residents and their belongings in 2016. We used Braun and Clarke’s (2006) approach to thematic analysis to identify, analyze and report patterns within the data. Residents spoke to systemic failures within the homeless sector itself as a factor in decisions to live in an encampment. Participants highlighted the challenges of ‘being chained to a backpack’ with nowhere to go and the impact of bylaws and policing on their health and well being. They acknowledged that while living in an encampment is a last resort it is often a better option than the streets or shelters with the benefits of a community, albeit a forced one with ongoing precarity. Public health responses to encampments should focus on centring human rights to adequate housing including self-determination and access to determinants of health. Such responses are aligned with public health commitments to health equity and social justice and require public health infrastructure.Item Navigating transitions into, through, and beyond peer worker roles: Insider insights from the Supporting Harm Reduction through Peer Support (SHARPS) study(Harm Reduction Journal, 2024) Dumbrell, Josh; Carver, Hannah; Foster, Rebecca; Pauly, Bernie; Steele, Wez; Roy, Michael; Parkes, TessaPeer workers are individuals who draw on their personal experiences in a professional capacity to support clients. Existing research on the role of peer workers in mental health, homelessness, and substance use services has primarily focused on their impact on client outcomes. This paper describes the development of peer workers as they transition into, through, and beyond this role. Utilising data from the Supporting Harm Reduction through Peer Support (SHARPS) study, where Peer Navigators supported people experiencing homelessness and substance use challenges, this paper explores the sense-making involved in an intensive peer support worker role, adaptation to organisational culture, and engagement with opportunities for professional advancement.Item Implementation of pharmaceutical alternatives to a toxic drug supply in British Columbia: A mixed methods study(Journal of Substance Use and Addiction Treatment, 2024) Pauly, Bernie; Kurz, Megan; Dale, Laura M.; Macevicius, Celeste; Kalicum, Jeremy; Pérez, Daniel Gudiño; McCall, Jane; Urbanoski, Karen; Barker, Brittany; Slaunwhite, Amanda; Lindsay, Morgan; Nosyk, BohdanBackground North America has been in an unrelenting overdose crisis for almost a decade. British Columbia (BC), Canada declared a public health emergency due to overdoses in 2016. Risk Mitigation Guidance (RMG) for prescribing pharmaceutical opioids, stimulants and benzodiazepine alternatives to the toxic drug supply (“safer supply”) was implemented in March 2020 in an attempt to reduce harms of COVID-19 and overdose deaths in BC during dual declared public health emergencies. Our objective was to describe early implementation of RMG among prescribers in BC. Methods We conducted a convergent mixed methods study drawing population-level linked administrative health data and qualitative interviews with 17 prescribers. The Consolidated Framework for Implementation Research (CFIR) informs our work. The study utilized seven linked databases, capturing the characteristics of prescribers for people with substance use disorder to describe the characteristics of those prescribing under the RMG using univariate summary statistics and logistic regression analysis. For the qualitative analysis, we drew on interpretative descriptive methodology to identify barriers and facilitators to implementation. Results Analysis of administrative databases demonstrated limited uptake of the intervention outside large urban centres and a highly specific profile of urban prescribers, with larger and more complex caseloads associated with RMG prescribing. Nurse practitioners were three times more likely to prescribe than general practitioners. Qualitatively, the study identified five themes related to the five CFIR domains: 1) RMG is helpful but controversial; 2) Motivations and challenges to prescribing; 3) New options and opportunities for care but not enough to ‘win the arms race’; 4) Lack of implementation support and resources; 5) Limited infrastructure. Conclusions BC's implementation of RMG was limited in scope, prescriber uptake and geographic scale up. Systemic, organizational and individual barriers and facilitators point to the importance of engaging professional regulatory colleges, implementation planning and organizational infrastructure to ensure effective implementation and adaptation to context.Item Implementation of risk mitigation prescribing during dual public health emergencies: A qualitative study among Indigenous people who use drugs and health planners in Northern British Columbia, Canada(International Journal of Drug Policy, 2024) Barker, Brittany; Norton, Alexa; Wood, Shawn; Macevicius, Celeste; Hogan, Katherine; Cadieux, Katt; Meilleur, Louise; Nosyk, Bohdan; Urbanoski, Karen; Pauly, Bernie; Wieman, NelBackground In response to the dual public health emergencies of COVID-19 and the overdose crisis, the Government of British Columbia (BC) introduced risk mitigation prescribing, or prescribed safer supply. In the context of colonialism and racism, Indigenous people are disproportionately impacted by substance use harms and experience significant barriers to receiving care, particularly those living in rural and remote communities. As part of a larger provincial evaluation, we sought to assess the implementation of risk mitigation prescribing as experienced by Indigenous people who use drugs (IPWUD) in Northern BC. Methods We used the Consolidated Framework for Implementation Research and the First Nations Perspective on Health and Wellness as conceptual frameworks to guide the study. In partnership with people with lived/living experience, we conducted 20 qualitative interviews with IPWUD. Data were supplemented by four interviews with health planners and analyzed thematically. Results Participants reported limited implementation of risk mitigation prescribing in Northern BC, with unique regional challenges and innovative facilitators to access. Analysis of supplementary health planner data was consistent with the experiences of IPWUD and together provided a comprehensive picture of implementation in Northern BC. Four themes emerged: 1) Northern socio-politico-cultural barriers to implementation (outer setting), 2) rural and remote healthcare delivery challenges (inner setting), 3) adaptability of risk mitigation prescribing on Northern wellness (intervention characteristics), and 4) Northern ingenuity, relationality and champions facilitating access (implementation process). Conclusions Implementation and access to risk mitigation prescribing in Northern BC was limited, with region-specific applicability challenges and a health service delivery model that was not able to sufficiently meet the unique service needs of IPWUD. Demonstrating Northern ingenuity, peer groups, harm reduction community champions, and telehealth services were identified as stopgap measures that promoted access and reduced inequitable implementation within the region.Item From design to action: Participatory approach to capacity building needs for local overdose response plans(BMC Public Health, 2023) Mallakin, Maryam; Dery, Christina; Woldemariam, Yordanos; Hamilton, Michael; Corace, Kim; Pauly, Bernie; Khorasheh, Triti; AbuAyyash, Caroline Bennett; Leece, Pamela; Sellen, KatherineIn response to the rise in opioid-related deaths, communities across Ontario have developed opioid or overdose response plans to address issues at the local level. Public Health Ontario (PHO) leads the Community Opioid / Overdose Capacity Building (COM-CAP) project, which aims to reduce overdose-related harms at the community level by working with communities to identify, develop, and evaluate capacity building supports for local needs around overdose planning. The ‘From Design to Action’ co-design workshop used a participatory design approach to engage communities in identifying the requirements for capacity building support.Item Applying Normalisation Process Theory to a peer-delivered complex health intervention for people experiencing homelessness and problem substance use(Communications Medicine, 2025) Foster, Rebecca; Carver, Hannah; Matheson, Catriona; Pauly, Bernie; Wallace, Jason; MacLennan, Graeme; Budd, John; Parkes, TessaThe Supporting Harm Reduction through Peer Support (SHARPS) study involved designing and implementing a peer-delivered, harm reduction intervention for people experiencing homelessness and problem substance use. Normalisation Process Theory (NPT) provided a framework for the study.Item Implementing drug checking as an illicit drug market intervention within the supply chain in a Canadian setting(Drugs: Education, Prevention and Policy, 2023) Wallace, Bruce; van Roode, Thea; Burek, Piotr; Pauly, Bernie; Hore, DennisThis research explored drug checking as a market intervention with a potential role in supporting a safer supply within the overdose crisis. We sought the perspectives of potential service users, including those who sell substances. Twenty-six semi-structured interviews were conducted in Victoria, British Columbia (BC), Canada with research guided by the Consolidated Framework for Implementation Research (CFIR). We identified five overarching themes for implementation: ‘Understanding the role of conflicting policies and market pressures,’ ‘Increasing relative advantage of drug checking through quality results and written reports,’ ‘Establishing safe, discrete locations without the risk of arrest or public knowledge,’ ‘Partnering peers with drug knowledge and skilled technicians,’ and ‘Engaging peers and word of mouth to ensure trust and reputation.’ We heard that criminalization and being responsive to market pressures are the most critical factors in implementing drug checking as a market intervention. To operate within this context, drug checking services need to ensure the provision of high-quality services and products, provided by peers and scientists, with established trust and safety. Promotion of drug checking to facilitate quality products and novel strategies were identified, but pose challenges. Continued development of drug checking technologies and methods is required to be relevant and responsive.Item Opioid coprescription through risk mitigation guidance and opioid agonist treatment receipt(JAMA Network Open, 2024) Min, Jeong Eun; Guerra-Alejos, Brenda Carolina; Yan, Ruyu; Palis, Heather; Barker, Brittany; Urbanoski, Karen; Pauly, Bernie; Slaunwhite, Amanda; Bach, Paxton; Ranger, Corey; Heaslip, Ashley; Nosyk, BohdanAt the onset of the COVID-19 pandemic, the government of British Columbia, Canada, released clinical guidance to support physicians and nurse practitioners in prescribing pharmaceutical alternatives to the toxic drug supply. These alternatives included opioids and other medications under the risk mitigation guidance (RMG), a limited form of prescribed safer supply, designed to reduce the risk of SARS-CoV-2 infection and harms associated with illicit drug use. Many clinicians chose to coprescribe opioid medications under RMG alongside opioid agonist treatment (OAT).To examine whether prescription of hydromorphone tablets or sustained-release oral morphine (opioid RMG) and OAT coprescription compared with OAT alone is associated with subsequent OAT receipt.This population-based, retrospective cohort study was conducted from March 27, 2020, to August 31, 2021, included individuals from 10 linked health administrative databases from British Columbia, Canada. Individuals who were receiving OAT at opioid RMG initiation and individuals who were receiving OAT and eligible but unexposed to opioid RMG were propensity score matched at opioid RMG initiation on sociodemographic and clinical variables. Data were analyzed between January 2023 and February 2024.Opioid RMG receipt (≥4 days, 1-3 days, or 0 days of opioid RMG dispensed) in a given week.The main outcome was OAT receipt, defined as at least 1 dispensed dose of OAT in the subsequent week. A marginal structural modeling approach was used to control for potential time-varying confounding.A total of 4636 individuals (2955 [64%] male; median age, 38 [31-47] years after matching) were receiving OAT at the time of first opioid RMG dispensation (2281 receiving ongoing OAT and 2352 initiating RMG and OAT concurrently). Opioid RMG receipt of 1 to 3 days in a given week increased the probability of OAT receipt by 27% in the subsequent week (adjusted risk ratio, 1.27; 95% CI, 1.25-1.30), whereas receipt of opioid RMG for 4 days or more resulted in a 46% increase in the probability of OAT receipt in the subsequent week (adjusted risk ratio, 1.46; 95% CI, 1.43-1.49) compared with those not receiving opioid RMG. The biological gradient was robust to different exposure classifications, and the association was stronger among those initiating opioid RMG and OAT concurrently.This cohort study, which acknowledged the intermittent use of both medications, demonstrated that individuals who were coprescribed opioid RMG had higher adjusted probability of continued OAT receipt or reengagement compared with those not receiving opioid RMG.Item Perspectives of patients who inject drugs on a needle and syringe program at a large acute care hospital(PLoS ONE, 2024) Brooks, Hannah L.; Speed, Kelsey A.; Dong, Kathryn; Salvalaggio, Ginetta; Pauly, Bernie; Taylor, Marliss; Hyshka, ElaineBackground People who inject drugs in North America often continue to inject while hospitalized, and are at increased risk of premature hospital discharge, unplanned readmission, and death. In-hospital access to sterile injection supplies may reduce some harms associated with ongoing injection drug use. However, access to needle and syringe programs in acute care settings is limited. We explored the implementation of a needle and syringe program integrated into a large urban tertiary hospital in Western Canada. The needle and syringe program was administered by an addiction medicine consult team that offers patients access to specialized clinical care and connection to community services. Methods We utilized a focused ethnographic design and semi-structured interviews to elicit experiences and potential improvements from 25 hospitalized people who inject drugs who were offered supplies from the needle and syringe program. Results Participants were motivated to accept supplies to prevent injection-related harms and access to supplies was facilitated by trust in consult team staff. However, fears of negative repercussions from non-consult team staff, including premature discharge or undesired changes to medication regimes, caused some participants to hesitate or refuse to accept supplies. Participants described modifications to hospital policies regarding inpatient drug use or access to an inpatient supervised consumption service as potential ways to mitigate patients’ fears. Conclusions Acute care needle and syringe programs may aid hospital providers in reducing harms and improving hospital outcomes for people who inject drugs. However, modifications to hospital policies and settings may be necessary.Item "We are the first responders": Overdose response experiences and perspectives among peers in British Columbia(Drugs: Education, Prevention and Policy, 2024) Mamdani, Zahra; Loyal, Jackson P.; Xavier, Jessica; Pauly, Bernie; Ackermann, Emma; Barbic, Skye; Buxton, Jane A.; Greer, AlissaPeers, i.e. people with lived/living experience of substance use, are at the forefront of harm reduction initiatives in British Columbia, yet they often lack recognition for their contributions. This study aims to understand the role of peers in overdose response settings and their experiences interacting with emergency service providers (ESPs) within the context of the Good Samaritan Drug Overdose Act (GSDOA). Telephone interviews were conducted with 42 people aged 16 years and older, who were likely to witness and respond to overdoses. Participants were asked about their experiences witnessing or responding to overdoses, and interactions with ESPs. Interview transcripts were analyzed thematically. Peers were often the first to respond to overdoses due to their positioning and saw themselves as having unique expertise in responding to overdoses and connecting with other people who use substances. However, peers perceived several barriers that impacted their ability to respond, including stigmatizing attitudes toward ESPs, lack of recognition, and lack of adequate resources. While policies, such as the GSDOA are in place to promote calling 9-1-1, peers feel confident and competent in responding to overdoses and often consider calling 9-1-1 a waste of resources. There is a need to better recognize and support peers as first responders in overdose contexts.Item The cost of caring: Compassion fatigue among peer overdose response workers in British Columbia(Substance Use & Misuse, 2023) Mamdani, Zahra; McKenzie, Sophie; Ackermann, Emma; Voyer, Rayne; Cameron, Fred; Scott, Tracy; Pauly, Bernie; Buxton, Jane A.Background: The drug toxicity crisis has had dramatic impacts on people who use drugs. Peer overdose response workers (peer responders), i.e., individuals with lived/living experience of drug use who work in overdose response settings, are particularly susceptible to negative physical and mental health impacts of the crisis. Despite that, the mental health impacts on peer responders have yet to be studied and measured. Methods: The Professional Quality of Life survey (Version 5) was completed by 47 peer responders at two organizations in British Columbia between September 2020 and March 2021 to assess compassion satisfaction and compassion fatigue. The Likert scale responses were converted into numerical values and scores were calculated for each sub-scale. The mean score was calculated for each sub-scale and categorized as low, medium, or high, based on the instructions for Version 5 of the instrument. Results: Our study uncovered a high mean score for compassion satisfaction, low mean score for burnout, and medium mean score for secondary traumatic stress among peer responders. These results may be due to the participants’ strong feelings of pride and recognition from their work, as well as the low number of participants that felt they had too much to do at work. Conclusion: Although peer responders derive pleasure and fulfillment from their jobs, i.e., compassion satisfaction, they also sometimes face burnout and stress due to continuous exposure to the trauma of the people they support. These results shed light on the areas that need to be targeted when creating supports for peer responders.Item Access and barriers to safer supply prescribing during a toxic drug emergency: a mixed methods study of implementation in British Columbia, Canada(Substance Abuse Treatment, Prevention, and Policy, 2024) Urbanoski, Karen A.; van Roode, Thea; Selfridge, Marion; Hogan, Katherine C.; Fraser, James; Lock, Kurt; McGreevy, Phoenix Beck; Burmeister, Charlene; Barker, Brittany; Slaunwhite, Amanda; Nosyk, Bohdan; Pauly, BernieIn March 2020, British Columbia, Canada, introduced prescribed safer supply involving the distribution of pharmaceutical grade alternatives to the unregulated toxic drug supply. Prior research has demonstrated positive impacts on overdose mortality, but with limited reach to people who use substances. Objectives of this study were to (1) identify barriers to accessing safer supply prescribing among people who use substances; and (2) determine whether and how barriers differed between people with and without prescriptions, and between urban and rural settings.Item “If it wasn’t for them, I don’t think I would be here”: Experiences of the first year of a safer supply program during the dual public health emergencies of COVID-19 and the drug toxicity crisis(Harm Reduction Journal, 2024) Kolla, Gillian; Pauly, Bernie; Cameron, Fred; Hobbs, Heather; Ranger, Corey; McCall, Jane; Majalahti, Jerry; Toombs, Kim; LeMaistre, Jack; Selfridge, Marion; Urbanoski, KarenIn response to the devastating drug toxicity crisis in Canada driven by an unregulated opioid supply predominantly composed of fentanyl and analogues, safer supply programs have been introduced. These programs provide people using street-acquired opioids with prescribed, pharmaceutical opioids. We use six core components of safer supply programs identified by people who use drugs to explore participant perspectives on the first year of operations of a safer supply program in Victoria, BC, during the dual public health emergencies of COVID-19 and the drug toxicity crisis to examine whether the program met drug-user defined elements of an effective safer supply model.Item Doing community-based research during dual public health emergencies (COVID and overdose)(Harm Reduction Journal, 2023) Beck McGreevy, Phoenix; Wood, Shawn; Thomson, Erica; Burmeister, Charlene; Spence, Heather; Pelletier, Josh; Giesinger, Willow; McDougall, Jenny; McLeod, Rebecca; Hutchison, Abby; Lock, Kurt; Norton, Alexa; Barker, Brittany; Urbanoski, Karen; Slaunwhite, Amanda; Nosyk, Bohdan; Pauly, BernieMeaningful engagement and partnerships with people who use drugs are essential to conducting research that is relevant and impactful in supporting desired outcomes of drug consumption as well as reducing drug-related harms of overdose and COVID-19. Community-based participatory research is a key strategy for engaging communities in research that directly affects their lives. While there are growing descriptions of community-based participatory research with people who use drugs and identification of key principles for conducting research, there is a gap in relation to models and frameworks to guide research partnerships with people who use drugs. The purpose of this paper is to provide a framework for research partnerships between people who use drugs and academic researchers, collaboratively developed and implemented as part of an evaluation of a provincial prescribed safer supply initiative introduced during dual public health emergencies (overdose and COVID-19) in British Columbia, Canada. The framework shifts from having researchers choose among multiple models (advisory, partnership and employment) to incorporating multiple roles within an overall community-based participatory research approach. Advocacy by and for drug users was identified as a key role and reason for engaging in research. Overall, both academic researchers and Peer Research Associates benefited within this collaborative partnerships approach. Each offered their expertise, creating opportunities for omni-directional learning and enhancing the research. The shift from fixed models to flexible roles allows for a range of involvement that accommodates varying time, energy and resources. Facilitators of involvement include development of trust and partnering with networks of people who use drugs, equitable pay, a graduate-level research assistant dedicated to ongoing orientation and communication, technical supports as well as fluidity in roles and opportunities. Key challenges included working in geographically dispersed locations, maintaining contact and connection over the course of the project and ensuring ongoing sustainable but flexible employment.