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
Date
2024
Authors
Barker, Brittany
Norton, Alexa
Wood, Shawn
Macevicius, Celeste
Hogan, Katherine
Cadieux, Katt
Meilleur, Louise
Nosyk, Bohdan
Urbanoski, Karen
Pauly, Bernie
Journal Title
Journal ISSN
Volume Title
Publisher
International Journal of Drug Policy
Abstract
Background 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.
Description
Keywords
community-based participatory research, Indigenous peoples, overdose, prescribed safer supply, public health emergency, risk mitigation measures
Citation
Barker, B., Norton, A., Wood, S., Macevicius, C., Hogan, K., Cadieux, K., Meilleur, L., Nosyk, B., Urbanoski, K., Pauly, B., & Wieman, N. (2024). 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, 136, 104679. https://doi.org/10.1016/j.drugpo.2024.104679