UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

A critical ethnographic study of overdose prevention sites as a community-based response to overdose deaths Olding, Michelle


Background: In response to an increasingly toxic illicit drug supply, drug user activists and allied organizations in British Columbia, Canada have rapidly implemented overdose prevention sites (OPS): sanctioned spaces where people can use drugs while monitored by responders trained to manage overdoses. While emerging research documents multiple health and social benefits of OPS, the distinct expertise, socio-spatial practices, and labour underpinning these interventions have not been studied in-depth. This dissertation uses community-based and critical ethnographic approaches to examine the implementation and operation of OPS in Vancouver as a community-based response to escalating overdose deaths. Methods: Ethnographic fieldwork was conducted at four OPS between July 2018 and March 2020. Ethnographic fieldwork entailed observation of OPS activities, in-depth qualitative interviews with staff and service users, and site-specific focus groups with responders with lived experience. Rooted in critical research approaches, I analysed data to explore how OPS operated to mitigate overdose-related harms within the context of broader structural vulnerabilities such as poverty, criminalization, socio-spatial exclusion, and an increasingly unpredictable and toxic illicit drug supply. Findings: Findings underscored how OPS extended forms of experiential and embodied expertise already existing among people who use drugs (PWUD), while also enabling comprehensive, specialized, and collective practices to emerge around overdose management. The overdose response function of sites had to be negotiated with other survival uses of the space by low-income services users who lacked access to safe, affordable housing and were regularly displaced from public space by urban governance techniques. Given their embeddedness within and deep knowledge of the communities they served, OPS workers were able to rapidly implement and adapt operational practices to address the broader social and health vulnerabilities of service users. However, the emotional burden and precarity of OPS labour intersected with other dimensions of structural vulnerability (e.g., poverty, criminalization) to place OPS workers with lived experience at heightened risk of burnout, with adverse impacts on service delivery. Conclusion: This dissertation highlights the importance of overdose prevention services being designed by and leveraging the expertise of structurally vulnerable PWUD, while also indicating the need for policy changes to better support community-based overdose response.

Item Citations and Data


Attribution-NonCommercial-NoDerivatives 4.0 International