3. Navigating an emergency response and collective action on the fentanyl frontlines: An ethnographic study of overdose prevention site implementation in Vancouver, Canada’s Downtown Eastside

Friday, 25 November, 2022 - 13:20 to 14:50

Abstract

Even as the overdose crisis has facilitated the expansion of overdose-focused interventions, considerably less attention has been paid to how their implementation is shaped by conditions of austerity and how people who use drugs are collectively responding to the crisis within this context. In Vancouver, Canada’s Downtown Eastside neighbourhood, the epicenter of the country’s overdose crisis, the everyday lives of people who use drugs is framed by the need to navigate survival and ward off ‘dopesickness’ amidst the unrelenting structural violence of economic precarity, gentrification, and drug criminalization—all of which have amplified overdose risks as fentanyl has replaced heroin within the illicit drug supply. Following the declaration of a public health emergency by the Province of British Columbia, low-threshold supervised consumption sites, termed ‘Overdose Prevention Sites’, were rapidly implemented in the neighbourhood beginning in December 2016. Here, we examine how the implementation of overdose prevention sites represented a ‘good enough’ emergency response to the overdose crisis under conditions of decades-long provincial austerity while largely failing to address its social-structural drivers.

This study draws on ethnographic fieldwork undertaken in the Downtown Eastside neighbourhood and within overdose prevention sites, as well as in-depth interviews with 72 people who use drugs, between December 2016 and October 2017.

Although undoubtedly critical in reducing overdose mortality, we discuss how the limitations of overdose prevention sites necessitated new logics of ‘community care’ among structurally vulnerable people who use drugs trying to survive the crisis that reconfigured drug use practices (e.g., assisted injections, naloxone administration, public injecting) while highlighting the urgent need to intervene to address the changing drug supply.

Finally, we consider the implications for the response to overdoses in North America, emphasizing the potential of structural changes (e.g., drug policy reforms, social investment) to work in tandem with grassroots mobilization to more fully respond to this crisis.

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