Grant: Doctoral Research Award -PA: Research in First Nations, Métis &/or Inuit Health

The overdose epidemic remains one of the most pressing public health issues in Canada. In British Columba (BC), Indigenous people who use drugs (IPWUD) have been disproportionally affected by the overdose crisis. Further, it has become clear that overdose epidemic patterns are different among IPWUD. For example, while non-Indigenous men are overdosing at greater rates than non-Indigenous women, Indigenous women remain disproportionately impacted by the overdose crisis, and are experiencing non-fatal overdoses and overdose deaths at rates similar to Indigenous men. Diverse models of overdose-focused interventions are now being implemented in jurisdictions such as Vancouver's Downtown Eastside neighbourhood. However, research to date has failed to examine the overdose risk environment surrounding IPWUD living off reserve in inner cities. Given the ongoing harms experienced by off-reserve IPWUD, research is urgently needed to improve overdose-focused harm reduction and substance use programs for this population. This study addresses this gap by using ethnographic approaches that center Indigenous knowledges and ways of knowing to examine how social-structural and environmental conditions shape access to and outcomes from overdose-focused harm reduction and substance use treatment programs among IPWUD. Findings from this study will contribute to the overdose response for IPWUD by identifying policy and programmatic changes to improve the public health benefits of overdose response services.