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With elevated drug toxicity overdose deaths (3rd worst in Canada), Regina, the capital of Saskatchewan, Canada is confronting a public health syndemic. The rise in overdose incidents, specifically from opioids highlights the critical necessity for harm reduction interventions like Naloxone training. Regina's transportation infrastructure is predominantly non-walkable and car-dependent resulting in additional barriers to accessing essential health services for vulnerable populations. This challenge requires innovative harm reduction approaches, including the deployment of pop-up Naloxone training to bring services directly to service users in various community settings who are unable to access brick-and-mortar services within walking distance.
Methods:
ReportNeedles.ca is a web-based app for the public and first responders to anonymously enter community needle presence. The app provides geographic data that offer valuable insights into the distribution of needles, an indicative marker of areas where individuals requiring substance use services are more likely to be concentrated. Utilizing this data and geographic information software (GIS), disparities between service locations and the locations of service users in Regina and areas with high needle incidence were identified. Between October 2023 and November 2023 four pop-up Naloxone trainings were conducted in these areas. The Naloxone trainings focused on fentanyl overdose risks, recognizing overdose symptoms, responding to overdose, and Naloxone administration. A post-training survey was conducted to collect demographic data and evaluate the effectiveness of the training.
Results:
Training participants (n=29) ranged in age, with an average of 39.6 (SD=13.4), gender (53.3% cisgender women, 30.0% cisgender men, and 6.7% non-binary), and ethnicity (56.7% Indigenous and 36.7% White). In analyzing the geospatial data and examining needle distribution maps it revealed that locations of needles change at different timepoints and that most of the needles are outside of a 15-minute walk buffer to services meaning many service users likely are unable to access services. The majority of participants (75.6%) resided within a 15-minute walk of the pop-up training. When assessing participant Naloxone knowledge 82.8% understood Naloxone's onset time, and 65.6% knew its duration. Almost all (93.1%) participants could identify Naloxone administration methods. In recognizing opioid overdose risks most participants were able to identify factors that increase the risk of opioid overdose with the most knowing that taking a larger than usual dose of fentanyl increases risk (79.3%) and the least know risk factor being an increase in fentanyl purity (55.2%). Most could identify overdose indicators, including blue discoloration (93.1%), slow/shallow breathing (86.2%), loss of consciousness (82.8%), and unresponsiveness (82.8%).
Conclusions and Implications:
This study highlights the feasibility and promise of combining geospatial technology with community-based health interventions for service delivery. By drawing upon geospatial data in this study, the targeted approach to harm reduction enhanced the accessibility to services like Naloxone training. The diverse participant demographics and improved knowledge of overdose prevention strategies indicate this program’s reach and potential community impact. This model leverages geospatial data, offers a pragmatic framework for enhancing service accessibility, and addressing public health challenges with potential applications in other contexts.