Perspectives of business members on physical and virtual harm reduction services in Canada: A Qualitative Study

Background: The opioid epidemic has claimed many lives. Harm reduction strategies have been implemented to reduce overdose mortality and improve health outcomes. Supervised consumption sites (SCS) and their virtual counterparts are interventions to reduce overdose harms by enabling prompt response should an individual become unresponsive while using substances. In this study, we sought to explore the business community's perspectives with commercial space near SCS across Canada on these harm reduction strategies and virtual services. Methods: Twenty-three business owners and staff within 1 kilometre of an SCS were recruited across Canada. Inductive thematic analysis using grounded theory was employed to identify themes. Results: The top three concerns for businesses close within 100m of an SCS were needles on the ground around their business (66.7%), drug-related garbage near their business (58.3%) and people using substances beside their building (58.3%). Those 100m further away from an SCS were concerned with substance use in the bathrooms and theft (44.4%), as well as human waste on site (22.2%). Six themes were identified: (1) participants believed that diverting individuals from SCS could improve the quality of care given by the SCS; (2) access to bathrooms has been a common source of conflict between people who use substances (PWUS) and business owners and staff; (3) substance use and associated disruptions have been on the rise since the COVID-19 pandemic with increasing substance use-related litter (e.g., needles) around the businesses; (4) many businesses feel compassion fatigue when interacting with PWUS; (5) harm reduction services were positively viewed by most participants, with some expressing concern that they could be enabling drug use; (6) virtual harm reduction services were seen necessary and an additional tool in the toolkit with disadvantages being lack of access to a phone and no immediate help available in case of an overdose. Conclusion: This study provides important business insights on harm reduction strategies to understand their viewpoint on SCS and virtual services. Furthermore, the study identifies areas for potential improvement in both overdose prevention interventions and identifies improvements. Virtual services have the potential to expand within communities and improve health outcomes.