Theme: Social Science and Policy Research Year: 2021
Background: Spotting is an informal practice among people who use drugs (PWUD) wherein an individual who is using drugs of unknown strength (the spottee) can be remotely monitored (the spotter) for sign of overdose. The COVID-19 pandemic is associated with reduced access to harm reduction programing and increased overdose deaths. PWUD are connecting over telephone and other emerging telecommunications methods to reduce their risks. We explore implementation, benefits, and challenges of spotting from the perspective of PWUD and highlight opportunities for improved HIV/HCV prevention. Methods: We recruited 21 PWUD who provided or used informal spotting services from Ontario or Nova Scotia, who completed an in-depth semi-structured telephone interviews (20-60min) with questions about service design, benefits, challenges, and recommendations. Ethics approval was obtained. Audiorecordings were transcribed verbatim and uploaded to NVivo 12. Thematic analysis was conducted. Results: PWUD report having provided or received informal spotting (e.g., from family, friends, partners, and others within their networks) at their homes, cars, outdoors and other locations. Perceived benefits of spotting included: increased safety, privacy, stigma free, reduced exposure to COVID 19, accessible for those who smoke and/or inject, feeling a sense of accomplishment, and improved social connection and increased access to harm reduction and HIV/HCV prevention knowledge. However, spotters worried that if an overdose occurred, community or medical response might not arrive on time to revive the caller, and/or the police might also arrive and try to make an arrest if drugs were present. Participants preferred a trusted person (e.g., intimate partner) was called before 911 in the event an overdose occurred. Conclusions: Spotting is a novel, low-barrier, and community initiated and acceptable harm reduction response. Spotting provides new opportunities to address HIV, Hepatitis C, overdose, and COVID-19 but supports are needed for spotters/spottees to ensure the intervention is delivered safely. Disclosure of interests’ statement: MB reports personal fees from AbbVie and grants and personal fees from Gilead Sciences, outside of the submitted work.
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