Implementation of risk mitigation prescribing during dual public health emergencies: A qualitative study among Indigenous people who use drugs and health planners in Northern British Columbia, Canada.
Brittany Barker: First Nations Health Authority, 100 Park Royal S, Coast Salish Territory, BC V7T 1A2, Canada; Canadian Institute of Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada; School of Public Health and Social Policy, University of Victoria, PO Box 1700 STN CSC Victoria, BC V8W 2Y2, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby BC V5A 1S6, Canada. Electronic address: bccsu-bb@bccsu.ubc.ca.
Alexa Norton: First Nations Health Authority, 100 Park Royal S, Coast Salish Territory, BC V7T 1A2, Canada; Canadian Institute of Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada; Department of Medicine, University of British Columbia, 2775 Laurel St, 10th Floor, Vancouver, BC V5Z 1M9, Canada.
Shawn Wood: First Nations Health Authority, 100 Park Royal S, Coast Salish Territory, BC V7T 1A2, Canada; Canadian Institute of Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada.
Celeste Macevicius: Canadian Institute of Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada.
Katherine Hogan: Canadian Institute of Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada.
Katt Cadieux: First Nations Health Authority, 100 Park Royal S, Coast Salish Territory, BC V7T 1A2, Canada; Canadian Institute of Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada.
Louise Meilleur: First Nations Health Authority, 100 Park Royal S, Coast Salish Territory, BC V7T 1A2, Canada.
Bohdan Nosyk: Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby BC V5A 1S6, Canada.
Karen Urbanoski: School of Public Health and Social Policy, University of Victoria, PO Box 1700 STN CSC Victoria, BC V8W 2Y2, Canada; Department of Medicine, University of British Columbia, 2775 Laurel St, 10th Floor, Vancouver, BC V5Z 1M9, Canada.
Bernie Pauly: Canadian Institute of Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada; School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria BC V8W 2Y2, Canada.
Nel Wieman: First Nations Health Authority, 100 Park Royal S, Coast Salish Territory, BC V7T 1A2, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby BC V5A 1S6, Canada.
BACKGROUND: In response to the dual public health emergencies of COVID-19 and the overdose crisis, the Government of British Columbia (BC) introduced risk mitigation prescribing, or prescribed safer supply. In the context of colonialism and racism, Indigenous people are disproportionately impacted by substance use harms and experience significant barriers to receiving care, particularly those living in rural and remote communities. As part of a larger provincial evaluation, we sought to assess the implementation of risk mitigation prescribing as experienced by Indigenous people who use drugs (IPWUD) in Northern BC. METHODS: We used the Consolidated Framework for Implementation Research and the First Nations Perspective on Health and Wellness as conceptual frameworks to guide the study. In partnership with people with lived/living experience, we conducted 20 qualitative interviews with IPWUD. Data were supplemented by four interviews with health planners and analyzed thematically. RESULTS: Participants reported limited implementation of risk mitigation prescribing in Northern BC, with unique regional challenges and innovative facilitators to access. Analysis of supplementary health planner data was consistent with the experiences of IPWUD and together provided a comprehensive picture of implementation in Northern BC. Four themes emerged: 1) Northern socio-politico-cultural barriers to implementation (outer setting), 2) rural and remote healthcare delivery challenges (inner setting), 3) adaptability of risk mitigation prescribing on Northern wellness (intervention characteristics), and 4) Northern ingenuity, relationality and champions facilitating access (implementation process). CONCLUSIONS: Implementation and access to risk mitigation prescribing in Northern BC was limited, with region-specific applicability challenges and a health service delivery model that was not able to sufficiently meet the unique service needs of IPWUD. Demonstrating Northern ingenuity, peer groups, harm reduction community champions, and telehealth services were identified as stopgap measures that promoted access and reduced inequitable implementation within the region.
