Dennis Watson, Associate professor of Social and Behavioral Sciences at IUPUI, and Paul Shaw, COO at Light House Mission, talk the housing-first approach to aiding those facing homelessness. (By Sam Caravana/For IndyStar)
The opioid epidemic has affected countries across North America, with opioid overdose deaths being the number one cause of accidental deaths on the continent. The province of British Columbia in Canada has been hit particularly hard by the epidemic, and as a result, has been working to increase the number of the overdose prevention and response interventions in housing programs designed to treat those living with substance use disorder (SUD). According to a recent article by Bardwell and colleagues published in the Harm Reduction Journal, supervised consumption sites (SCS), among other interventions, have been identified as an evidence-based approach to reducing the number of overdose deaths that occur among those living in supportive housing programs .
Examples of interventions implemented in housing programs across British Columbia thus far include “housing-based overdose prevention sites, peer-led naloxone training and distribution, peer witness injection programs and shared-using rooms.” Despite the implementation of these interventions, research exploring both the effectiveness of and need for harm reduction housing interventions is limited. This is largely due to the lack of evaluation of these innovative programs. In addition, the data that is available is largely based on programs where coverage of the populations served is limited and data is context-specific.
SCS allow individuals a space to use pre-obtained drugs under the supervision of a trained health care provider, thus, ensuring safe injection practices and reversing overdose, should it occur. SCS have been shown to lower rates of overdose deaths and improve health outcomes for those with SUD. As such, there is yet to be a single overdose at any of the SCS in operation in Europe, Australia, or Canada . Overdose prevention sites (OPS) are similar to SCS in regards to the supervision of injection to prevent poor health outcomes, but OPS have been identified as “simpler in design and operation, are more peer driven, and offer no or fewer clinic services.” Both SCS and OPS have been implemented in supportive housing programs serving substance users in Canada; however, lack of governmental support in implementing and funding such programs create a barrier to increasing the number of these programs in housing locations.
As described by the authors of the article, including SCS and other prevention and response interventions as a part of housing programs “provides multiple opportunities to address overdose risk and drug-related harms.” Implementing more overdose prevention and response programs into housing programs will also provide more “flexible” interventions that can better overcome the numerous barriers and risks faced by people who use drugs. While there is a need for increased implementation of these interventions in housing programs, there is also a need for effective evaluation of these programs in order to successfully gain support from governmental agencies that may offer funding opportunities. The implementation of overdose prevention and response interventions in housing programs holds promising health outcomes for people who use drugs. With proper implementation and evaluation, the creation of such programs will be more commonplace, leading to a reduction in overdose related deaths.
Check out the following resources to learn more about a housing first model and ways to prevent and respond to an overdose:
 Bardwell, G., Collins, A., McNeil, R., & Boyd, J. (2017) Housing and overdose: an opportunity for the scale-up of overdose prevention interventions? Harm Reduction Journal, 14(77). doi: https://doi.org/10.1186/s12954-017-0203-9
 Potier, C., Laprevote, V., Dubois-Arber, F., Cottencin, O., & Rolland, B. (2014). Supervised injection services: What has been demonstrated? A systematic literature review. Drug and Alcohol Dependence, 145, 48-68. doi: https://doi.org/10.1016/j.drugalcdep.2014.10.012