Cited by 93Opioid Use Disorder TreatmentHIV, Drug Use, Sexual RiskHomelessness and Social Issues

Addressing intersecting housing and overdose crises in Vancouver, Canada: opportunities and challenges from a tenant-led overdose response intervention in single room occupancy hotels

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Bardwell, Geoff, Fleming, Taylor, Collins, Alexandra B., Boyd, Jade, McNeil, Ryan·2019·Journal of Urban Health

Abstract

We examined the acceptability, feasibility, and implementation of the Tenant Overdose Response Organizers program (TORO)-a tenant-led naloxone training and distribution intervention. This pilot project was implemented in privately owned single room occupancy (SRO) hotels that were disproportionately affected by overdose in Vancouver's Downtown Eastside (DTES) neighborhood. Semi-structured qualitative interviews were conducted with 20 tenants who had participated in a TORO training session and administered naloxone to someone in their SRO hotel or had overdosed in their SRO hotel and received naloxone from another tenant. Focus groups were conducted with 15 peer workers who led the TORO program in their SRO building. Interviews and focus groups were transcribed and analyzed thematically. Ethnographic observation at SRO hotels involved in the intervention was also co-led with peer research assistants. Ten SROs were included in the study. The level of acceptability of the TORO program was high, with participants describing the urgency for an intervention amid the frequency of overdoses in their buildings. Overdose response training enhanced participants' knowledge and skills, and provided them a sense of recognition. Additionally, the TORO program was feasible in some buildings more than others. While it provided important training and engaged isolated tenants, there were structural barriers to program feasibility. The implementation of the TORO program was met with some successes in terms of its reach and community development, but participants also discussed a lack of emotional support due to overdose frequency, leading to burnout and vulnerability. Our findings suggest that the TORO program was affected by social, structural, and physical environmental constraints that impacted program feasibility and implementation. Despite these constraints, peer-led in-reach overdose response interventions are effective tools in addressing overdose risk in SROs. Future housing interventions should consider the intersecting pathways of overdose risk, including how these interventions may exacerbate other harms for people who use drugs. Further research should explore the impacts of environmental factors on overdose response interventions in other housing contexts.

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Authors
Bardwell, G., Fleming, T., Collins, A. B., Boyd, J., & McNeil, R.
Affiliations
  • University of British Columbia (CA)
  • St. Paul's Hospital (CA)
  • Simon Fraser University (CA)
Corresponding author
McNeil, Ryan
Venue
Journal of Urban Health
Published
2018-08-02
Volume
96
Issue
1
Pages
12-20
ISSN
  • 0028-7091 (ISSN-L)
  • 1099-3460
  • 1468-2869
OpenAlex
W2885059679
Cited by
93
References
37
Citations by year
2026: 5 · 2025: 9 · 2024: 12 · 2023: 14 · 2022: 8 · 2021: 18 · 2020: 14 · 2019: 11 · 2018: 2
FWCI
10.73
Type
journal article
Language
en
Open access
Locations
  • Journal of Urban Health (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institutes of Health (R01DA044181)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
Keywords
opioid overdose, single-room occupancy hotels, naloxone training, peer-led intervention, drug users, Downtown Eastside, Vancouver, peer support workers, burnout, structural barriers, harm reduction
MeSH terms
Adult, Aged, Aged, 80 and over, Canada, Female, Housing, Humans, Male, Middle Aged, Naloxone, Narcotic Antagonists, Peer Group, Pilot Projects, Focus Groups, Drug Overdose

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