Overdose Prevention and Housing: a Qualitative Study Examining Drug Use, Overdose Risk, and Access to Safer Supply in Permanent Supportive Housing in Vancouver, Canada

The majority of overdose deaths in Brit-ish Columbia (BC) occur among people using illicit substances alone in private residences. Some support-ive housing in BC includes on-site access to a variety of health and substance use-related services. More recently, a number of supportive housing locations have started offering prescribed safer supply medi-cations to people at high overdose risk, though these remain limited and under-evaluated. In this study, we describe the drug use practices - including access to and use of on-site supervised consumption, OAT, and prescribed safer supply medications - of study participants living in permanent supportive housing with integrated primary care, substance use treatment services, and supervised consumption spaces. Qualitative interviews were conducted with 30 residents of a permanent supportive housing site in Vancouver, Canada. Data were analyzed using a sequential process to identify both a priori (e.g., low-barrier substance use treatment, pandemic effects on service access) and emerging themes (e.g., using alone). Most (N=27) study participants reported using alone in their rooms, despite having access to an on-site supervised consumption area. Reasons for using alone include the following: preference for being alone, discretion/stigma, and restrictive housing policies. Less than half (N=12) of the study participants accessed on-site prescribed safer supply medications. Participants receiving on-site prescribed safer supply described positive benefits including reduced use of illicit opioids, and less reliance on illicit income generation activities. On-site prescribed safer supply programs within supportive housing environments are an important tool in addressing overdose risk.