More specialized harm reduction services needed for women who use drugs

published on September 13, 2018

Overdose prevention strategies must consider the unique experiences of women who use drugs to reduce risk of overdose and exposure to gender-based violence, say researchers from the BC Centre on Substance Use (BCCSU) and University of British Columbia (UBC).

Supervised consumption sites (SCS) and overdose prevention sites (OPS) have been central to the response to opioid overdoses. To date, no one has died of an overdose in any of these sites in British Columbia. However, new research published today in the peer-reviewed journal Addiction shows that some women experience barriers to accessing these life-saving services.

Researchers interviewed 35 women who use drugs in Vancouver’s Downtown Eastside about their experiences with overdose prevention sites. Participants described these sites as safer spaces to consume drugs, but their willingness to use them may be limited based on their gender and race. Providing women-focused services, including assisted injections and injecting partnerships, could increase access and allow women more control over their drug use. Until the opening of a single women-only (transgender-inclusive) site, OPS in BC have operated as ‘gender neutral’ interventions.

“Under the constraints of drug prohibition, overdose prevention sites are a great example of a community-led response to a public health crisis,” says Dr. Jade Boyd, research scientist at BCCSU and lead author of the study. “However, some OPS are perceived as ‘masculine’ spaces, suggesting that women-centred approaches that consider the experiences of women who use drugs are critical to ensuring everyone is able to benefit from these services equally.”

While men continue to comprise the vast majority of opioid overdose fatalities in the province (nearly 80% of all fatalities in 2018), marginalized women who use drugs – particularly Indigenous women and those experiencing poverty – are also vulnerable not only to overdose, but also physical and sexual violence.

Study participants reported that because severe intoxication and overdose occurred quickly and from the consumption of small amounts of opioids, fentanyl-adulterated drugs compromised their ability to limit their exposure to predatory violence in risk environments within the drug scene. Their descriptions of ‘safety’ most often centered around the need to protect themselves from violence, even as the number of overdose-related deaths mounted.

“The women we spoke to described their struggles to manage opioid use within the context of extreme poverty, criminalization, and a toxic drug supply,” says Dr. Ryan McNeil, research scientist at BCCSU and senior author of the study. “For them, overdose prevention sites are a safe haven from violence and exposure to police within the drug scene. Their experiences tell us that overdose responses should prioritize their physical safety as well as reducing overdose risk.”
Based on their interviews, the study authors recommend overdose response incorporate gender-specific and culturally-responsive peer-led services.