Indigenous Peoples experiences with overdose and response in Vancouver, Canada's Downtown Eastside

Introduction: Despite the implementation of North America’s most comprehensive set of harm reduction interventions, Indigenous people who use drugs (IPWUD) have been disproportionally affected by this crisis. In Vancouver, Canada, and elsewhere, these drugs related harms are framed by the historical and ongoing trauma related to settler colonialism and is most acutely visible in Vancouver’s Downtown Eastside (DTES) - a low-income neighbourhood that is a site of Canada’s largest street-based illicit drug scene, characterized by high rates of poverty, substance use, violence, and homelessness. This study seeks to examine IPWUD experiences with and perspective on opioid and stimulant use and related interventions, including harm reduction and addiction treatment programs and to situate their experiences within the context of colonialism.

Methods: Embedded in the theoretical and methodological frameworks that seek to meaningfully engage IPWUD, Indigenous peers led the study design, data collection and analysis. The research team for this project included the Western Aboriginal Harm Reduction Society (WAHRS), and academic researchers from the British Columbia Center on Substance Use (BCCSU), as well as an Indigenous Research Coordinator. Qualitative interviews were conducted with IPWUD between May 2019-February 2020.

Results: The Indigenous-led interviews identified four key themes that illustrated the experiences IPWUD in the DTES (a) risk reduction and safer consumption knowledge and practices among IPWUD; (b) IPWUD experiences of distrust and adversarial relationships with law enforcement and other medical services; (c) displacement from ancestral territories and (d) the importance of culturally-relevant, peer-led harm reduction services.

Conclusion: Our work demonstrates that IPWUD experience vulnerability to drug-related harms, framed by the historical and ongoing traumas of colonization. However, IPWUD narratives revealed risk reduction and safe consumption practices and strategies that can improve IPWUD access and experiences, including those informed by the diverse perspectives of IPWUD, and those that include, peer-led, trauma-informed and culturally safe practices.