Addressing the Needs of People Who Inhale Opiates and/or Stimulants

Background: It has been just over a decade since communities in Canada recognized the impact of the opioid crisis. In 2019, funding expanded supervised consumption sites in Ontario. Attention has focused on injection drug use, with harm reduction programs providing free equipment to prevent blood-borne illnesses. In the changing landscape of substance use, more individuals are now smoking opioids and stimulants, and programs have been slow to adapt. By 2023, three out of four substance-related deaths in Ottawa, Ontario's second-largest city, showed evidence of inhalation. Compounding the complexity of the increasingly toxic and unregulated drug supply, Ottawa has been experiencing a housing crisis. One in six opioid-related deaths in Ontario involved people experiencing homelessness. Sandy Hill Community Health Center and Belong Ottawa Drop-in Centre partnered to study the needs of people experiencing homelessness who inhale stimulants and/or opioids. Methods: A qualitative study using an ethnographic approach was conducted in the summer of 2024 in Ottawa and asked what are the health needs for individuals who are unhoused and using opiates and/or stimulants in urban Ottawa, and what are their barriers to care? Individuals who inhale substances, as well as community agency staff, were interviewed. Interview data were analyzed using thematic analysis, and survey data were analyzed using descriptive statistics. Findings were presented back to the community with the help of the community advisory group. Results: Thirty interviews were conducted with service users who identified as homeless and inhaled opiates and/or stimulants, and 10 interviews were with service providers. Interviews ranged in length from 20-60 minutes and were transcribed. The majority of service users were not homeless before using drugs and approximately one third reported they did not trust health care providers. Themes were organized using an ecological model and included Early Trauma and Lost Connections, Systemic Rigidity, Erasure from Public Space, and Misplaced Blame and the Absence of Home. Conclusions: The study findings are relevant for communities working with people who inhale stimulants and/or opiates, health care providers, and for moving towards greater systems-level organizational change.