Navigating Overdose and Structural Vulnerability amidst a Toxic Drug Supply

Navigating Overdose and Structural Vulnerability amidst a Toxic Drug Supply: Insights from a Program of Community-Engaged Research in Vancouver, Canada's Downtown Eastside with Ryan McNeil, PhD Associate Professor of Internal Medicine Director of Harm Reduction Research, Program in Addiction Medicine, Yale University School of Medicine.
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North America’s overdose crisis has been driven by changes to the drug supply, including the transition to fentanyl and the emergence of other adulterants, and most impacted structurally vulnerable people who use drugs. In Vancouver, Canada’s Downtown Eastside neighborhood, an epicenter of North America’s overdose crisis, the everyday lives of people who use drugs are framed by the need to navigate survival and ward off ‘dope sickness’ amidst an evolving and highly toxic drug supply characterized by fentanyl and emerging adulterants and the unrelenting structural violence of economic precarity, gentrification, and criminalization. Drawing on community-engaged qualitative research undertaken in this neighborhood since 2016, this presentation examines how these dynamics converge to shape overdose vulnerability and the implementation and effectiveness of novel harm reduction interventions, including drug-checking, supervised consumption services, and safer supply, and outlines actions needed to better align the overdose response with the lived realities of people who use drugs.
Ryan McNeil, PhD, is an Associate Professor (Internal Medicine) at the Yale School of Medicine and Director of Harm Reduction Research with the Yale Program in Addiction Medicine. Through his National Institutes of Health and CIHR-funded community-engaged qualitative and ethnographic research, he examines how forces operating within the risk environments of people who use drugs shape risk and harm, focusing in particular on the intersections of the changing drug supply and socio-economic marginalization.
0:00 Introductions
1:50 Navigating Overdose and Structural Vulnerability
4:45 Overdose Deaths in the US (1999-2021)
7:14 Vancouver BC Community Led-Innovations
10:11 Methods. Community-Engaged Research
13:14 Ethnographic Fieldwork
21:15 Gendered and Racialized Dynamics
24:06 Structural Vulnerabilities
26:32 Rapid Scale-Up of Overdose Prevention Sites
34:36 Operation of Overdose Prevention Sites Constrained
42:38 Risk Mitigation in the Context of Dual Public Health Emergencies
43:47 Q & A
Recorded Wednesday., March 13th, 2024