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Supervised Consumption Harm Reduction Goes Digital

April 26/2021

U of T Researchers Test Novel Method to Reduce Opioid Deaths During the Pandemic

by Françoise Makanda, Communications Officer at DLSPH

A group of researchers at DLSPH and The Canadian Association of People Who Use Drugs are studying a remote supervised-consumption model known as “spotting” to understand its benefits among people who use drugs.

With spotting—a term the DLSPH team coined for the model—the spottee consumes their drugs in a safe location like their home and a friend, family member or an acquaintance —known as a spotter—monitors through a digital method.

“Before someone consumes a drug, they call their spotter on the phone who will be there on the call with them as they use,” says project lead and Prof. Carol Strike. “The spotter stays on the line with the spottee for another five to 15 minutes to ensure they are safe or call for help if needed.”

Research Assistant Natalie Kaminski and Prof. Carol Strike

Research Assistant Natalie Kaminski and Prof. Carol Strike

So far, Strike has found that spotters and spottees appreciate the model as a way to be safe during the pandemic.

“If the spottee overdoses, the spotter will call a neighbour, friend or an ambulance to come and help,” says Natalie Kaminski, a research assistant on the project. The plan for overdose response is created by both parties before the spottee consumes a substance.

While people who use drugs have spotted each other in person for a long time, the study is exploring how it is being used during the pandemic, says Kaminski.

Team members with lived experience of drug use recruited 30 participants from Nova Scotia or Ontario from their personal network to take part in the study. Participants reported an increase in their safety and appreciated the privacy and stigma-free environment spotting offered. Spotters have reported an improved connection with their community and a sense of accomplishment when working with spottees.

“Also, given COVID, they can consume at home instead of coming to the safe injection site,” says Strike.

Novel tactics are needed as statistics point to an uptick in fatal opioid overdoses in Canada, further worsened by the pandemic.

The model has its drawbacks. Spotters fear help may not arrive in time to revive spottees.

“There are also concerns about police intervention if 911 is called especially among people who use drugs who are racialized,” says Strike, alluding to recent headlines relating to over-policing and criminalizing of racialized people.

The team has produced recommendations to improve spotting programs, notably the development of guidelines for spotters and spottees, awareness programs for spotting services in the community and trauma support for spotters.

The team has already begun presenting results to conferences and will submit their findings to an open-access journal. Strike and her team are poised to receive additional funding to create educational materials like animated videos and tip sheets. The team hopes to do more research about app-based supervised consumption and the recently-launched National Overdose Prevention Service – a service funded to provide spotting 24/7.

“The primary goal of this project is to improve options for overdose prevention,” says Kaminski. “We’re hoping to make spotting safe for more people. In particular, those who don’t have access to supervised consumption sites.”

The study was made possible through funding from DLSPH. The DLSPH research team includes Melissa Perri, Natalie Kaminski, Matthew Bonn, Gillian Kolla, Adrian Guta, Corey Ranger, Ahmed Bayoumi, Laurel Challacombe, Marilou Gagnon, Natasha Touesnard, Patrick McDougall, and project lead Prof. Carol Strike.