Empowering people, reducing harms

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Dr. Jane Buxton is the principal investigator of the Peer Engagement and Evaluation Project supported by a 2014 Wall Solutions Award.

In the midst of a fatal overdose crisis, harm reduction scales up across B.C.

By Jackie Wong

Illicit drug use in British Columbia has become a heavy-hearted feature of the public conversation. Overdose deaths killed 914 people in the province last year, marking a new record for the province. As all levels of government have struggled to respond, a close-knit network of people across the province has been working quietly to reduce drug-related harms in their communities for years.

The group consists of five people with lived experiences with substance use, better known as peers. They each live in one of B.C.’s five health authority regions. Members, who refer to themselves as PEEPs (shorthand for the Peer Engagement and Evaluation Project at the heart of their work) share knowledge and perspectives that inform harm reduction planning, strategizing, and evaluation across B.C. The PEEP project is supported by a 2014 Wall Solutions Award. Funding from the Wall Solutions Initiative enables University of British Columbia faculty members to engage with community partners to develop innovative research solutions to societal problems.

The PEEPs have travelled to communities in B.C.’s five healthcare regions to conduct peer-driven focus groups on how to improve harm reduction services. That knowledge will inform a new set of best-practice guidelines for engaging peers in harm reduction. The guidelines will be published on TowardsTheHeart.com, a partner website of PEEP, in the next few months.

It’s a “boots-on-the-ground” operation, explains Charlene Burmeister, who lives in Quesnel and is the northern representative for PEEP. Every two weeks since 2014, the group has been meeting by phone, in addition to travelling to gather face-to-face with each other and with community focus groups.

From crisis, opportunity

Since the peers started meeting almost three years ago, much has changed in the political landscape, particularly how governments perceive harm reduction.

“It’s kind of changed the way people talk,” says Dr. Jane Buxton, PEEP principal investigator with the BC Centre for Disease Control and UBC’s School of Population and Public Health.

The new federal government, she says, has been more open to harm reduction as a necessary part of the healthcare spectrum.

“People realize that we need to save people’s lives,” she says. She adds that, conventional, abstinence-based approaches to addressing drug addiction don’t always work.

“Not everybody’s ready for treatment,” Dr. Buxton says. “Treatment isn’t always available. But we need to do something to help people respond when an overdose happens so that they can survive.”

Dr. Buxton has partnered with the BC Harm Reduction Services and Strategies Committee, BC Ministry of Health, BC First Nations Health Authority, provincial health services, and provincial health authorities to make PEEP happen.

Beyond the soon-to-be published best-practice guidelines on improving the quality of harm reduction services, a broader goal for PEEP is to strengthen a provincial network of people with lived substance-use experience and, in so doing, make peer engagement a strong presence in all aspects of harm reduction planning, policy, and evaluation, Dr. Buxton says.

“Peers—they are the experts,” Dr. Buxton says. “They’re the experts in their own reality on the street, with using drugs, with stigma, with all those kinds of pieces. “The work of the peers is the beginning of an important journey. It’s a crucial step towards building bridges between people who might otherwise be isolated in their substance use and in their access to harm reduction services.

Combatting stigma, building support

What’s harm reduction?

Naloxone kit

Standard Naloxone kit distributed in B.C. Photo: James Heilman

Harm reduction refers to a spectrum of support services to reduce the harms associated with substance use, including death, disease, and injury from risky behaviour. A harm-reduction approach to substance use aims to keep people safe by “meeting people where they are.” Key to the harm reduction is that it does not work from a perspective that substance users are deficient or morally weak. Different from more traditional abstinence-based approaches to substance use, harm reduction embraces peer support programs like PEEP; overdose prevention like the overdose prevention units that the provincial government opened across the province in December; substitution therapies like the heroin-assisted treatments tested in Vancouver’s SALOME and NAOMI clinical trials; supervised consumption facilities like Vancouver’s Insite supervised injection facility; and outreach and education.

“In some communities, people are not accessing harm reduction sites due to stigma, discrimination, location of those services, hours of operation, and lack of outreach,” Burmeister says.

Harm reduction access can also be difficult in small and rural areas. Burmeister has been engaging in this work since 2010, and in the last few years, she has been working with service providers and community members—including peers, local street nurses, and staff at the local homeless shelter—to take steps to make harm reduction more inclusive and accessible.

“There has been great work done in my community,” she says.

Burmeister is working with service providers and community members to establish a peer group in Quesnel. Such a group would be important for informing and addressing issues regarding substance use and harm reduction. Establishing non-judgemental relationships, such as those often forged in peer groups, is key to connecting people to vital health services—especially now, at the height of an overdose crisis.

Thanks to the work of peers, community members and service providers in Quesnel, harm reduction efforts have expanded to become more accessible to people who need them. Notably, harm reduction supplies are now available at Quesnel’s minimum-barrier shelter, an inclusive space open 24 hours.

“I love this work”

For Charlene Burmeister in Quesnel, working with PEEP has marked a pivotal step forward in her own life.

“I was green when I walked through the door,” she remembers, of her first new days with PEEP. Today, she’s a sought-after leader in connecting peers with service providers, working with the First Nations Health Authority’s Compassion, Inclusion, and Engagement Group, as well as peer-driven group called Life Experts for Inclusive, Collaborative Action. She has co-facilitated naloxone training for peers and service providers, and facilitated peer groups in rural communities across the province.

“Most peers in the areas where I go, other than the Lower Mainland, have never engaged in peer-based work or have the understanding or concepts of peer organizations,” she says.

“It’s amazing how peers have been stigmatized and isolated to the point where they have no confidence in themselves. I love to be able to say to someone, ‘Hey, I have something that I’d like you to be involved with.’ And they’re like, ‘What? Let’s go!’”

“I love this work. I think it’s probably one of the most productive and empowering and wonderful parts of my life other than raising my children.”