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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. [ABSTRACT FROM AUTHOR]

Alcohol use disorders (AUDs) are not equitably spread across the population, with some groups, such as people who are experiencing homelessness, being more vulnerable to AUDs due to social inequalities, stigma, and complex social and structural processes. Managed alcohol programs (MAPs) are a harm reduction approach first developed in Canada for those experiencing AUDs and homelessness with positive results. This study aimed to describe the factors that should be considered when implementing MAPs in Scotland. Qualitative data were collected in Scotland via semi‐structured interviews with 29 individuals in a range of roles, including strategic informants (n = 12), service staff (n = 8), and potential beneficiaries (n = 9). Vignettes were used to support data collection. Data were analysed using Framework in NVivo. Participants highlighted six considerations to inform the implementation of MAPs in Scotland: the importance of individualized care; provision of alcohol; holistic care and a focus on well-being; types of settings and service models; staffing; and autonomy and rules. Future research should focus on piloting MAPs in a range of service contexts, using different models of care and settings, to develop an enhanced understanding of their effectiveness in addressing harms and promoting well-being for those experiencing AUDs and homelessness. [ABSTRACT FROM AUTHOR]

Background: While there is robust evidence for strategies to reduce harms of illicit drug use, less attention has been paid to alcohol harm reduction for people experiencing severe alcohol use disorder (AUD), homelessness, and street-based illicit drinking. Managed Alcohol Programs (MAPs) provide safer and regulated sources of alcohol and other supports within a harm reduction framework. To reduce the impacts of heavy long-term alcohol use among MAP participants, cannabis substitution has been identified as a potential therapeutic tool. Methods: To determine the feasibility of cannabis substitution, we conducted a pre-implementation mixed-methods study utilizing structured surveys and open-ended interviews. Data were collected from MAP organizational leaders (n = 7), program participants (n = 19), staff and managers (n = 17) across 6 MAPs in Canada. We used the Consolidated Framework for Implementation Research (CFIR) to inform and organize our analysis. Results: Five themes describing feasibility of CSP implementation in MAPs were identified. The first theme describes the characteristics of potential CSP participants. Among MAP participants, 63% (n = 12) were already substituting cannabis for alcohol, most often on a weekly basis (n = 8, 42.1%), for alcohol cravings (n = 15, 78.9%,) and withdrawal (n = 10, 52.6%). Most MAP participants expressed willingness to participate in a CSP (n = 16, 84.2%). The second theme describes the characteristics of a feasible and preferred CSP model according to participants and staff. Participants preferred staff administration of dry, smoked cannabis, followed by edibles and capsules with replacement of some doses of alcohol through a partial substitution model. Themes three and four highlight organizational and contextual factors related to feasibility of implementing CSPs. MAP participants requested peer, social, and counselling supports. Staff requested education resources and enhanced clinical staffing. Critically, program staff and leaders identified that sustainable funding and inexpensive, legal, and reliable sourcing of cannabis are needed to support CSP implementation. Conclusion: Cannabis substitution was considered feasible by all three groups and in some MAPs residents are already using cannabis. Partial substitution of cannabis for doses of alcohol was preferred. All three groups identified a need for additional supports for implementation including peer support, staff education, and counselling. Sourcing and funding cannabis were identified as primary challenges to successful CSP implementation in MAPs. [ABSTRACT FROM AUTHOR]

Managed alcohol programs (MAPs) have been implemented in Canada to reduce harms of severe alcohol use disorder and homelessness. Programs traditionally provide participants with regulated doses of alcohol as part of residential housing or shelter services. This study describes the experience of members of a non-residential, peer-initiated and peer-run MAP in Vancouver, BC, Canada. Semi-structured qualitative interviews were conducted with 14 members of the Community Managed Alcohol Program (CMAP) using questionnaires from the larger Canadian Managed Alcohol Program Study. Participants were recruited through word of mouth; interviews were audio-taped and transcribed. Data were coded inductively and analyzed using the constant comparative method. The CMAP was a community response to ongoing harms and increasing deaths related to the consumption of non-beverage alcohol (NBA). Participants reported that daily doses of self-managed alcohol and other supports provided by the program enabled them to change harmful drinking patterns, reduce NBA consumption, engage in program activities and feel a greater sense of well-being. Implementation of a non-residential, peer-initiated and peer-run MAP had an overall positive impact on participants' lives. Reported benefits included shifting away from NBA use, self-managing levels of alcohol consumption and developing stronger community engagement. Further investigation of this model of MAP is warranted. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Managed alcohol programs (MAP) are a harm reduction approach for those experiencing alcohol use disorders (AUD) and homelessness. These programs were developed in Canada and have had positive results; very few exist in the UK and Ireland. The aim of this study was to scope the feasibility and acceptability of implementing MAPs in Scotland. Design and Methods: Using mixed‐methods, we conducted two linked phases of work. Quantitative data were collected from the case records of 33 people accessing eight third sector services in Scotland and analysed in SPSS using descriptive and inferential statistics. Qualitative data were collected in Scotland via semi‐structured interviews with 29 individuals in a range of roles, including strategic informants (n = 12), service staff (n = 8) and potential beneficiaries (n = 9). Data were analysed using Framework Analysis in NVivo. Results: The case record review revealed high levels of alcohol use, related health and social harms, illicit drug use, withdrawal symptoms, and mental and physical health problems. Most participants highlighted a lack of alcohol harm reduction services and the potential of MAPs to address this gap for this group. Discussion and Conclusions: Our findings highlight the potential for MAPs in Scotland to prevent harms for those experiencing homelessness and AUDs, due to high levels of need. Future research should examine the implementation of MAPs in Scotland in a range of service contexts to understand their effectiveness in addressing harms and promoting wellbeing for those experiencing AUDs and homelessness. [ABSTRACT FROM AUTHOR]