Business team putting hands together on top of each other stock photo Credit: iStock

An intersectional investigation of women’s experiences of overlapping overdose and COVID-19 public health crises

The challenge

Women have been more negatively impacted by the COVID-19 pandemic than men, exacerbating existing health inequities. Overdose epidemics have largely been framed as men’s public health crises. Little is known about how women (transgender, Two-Spirit and non-binary inclusive) might differentially navigate overdose risk environments or access life-saving health services. A range of overdose prevention interventions have been implemented in Canada, including peer-led and low-barrier supervised consumption sites, naloxone distribution, drug checking, and the expansion of access to opioid agonist medications. Despite policy changes during COVID-19, some subpopulations of women who use drugs are not fully benefiting from current interventions.

The project

The project aims to:

  1. Examine how intersecting social, structural, and environmental forces (interpersonal, and structural violence and COVID-19) shape women’s overdose risk environments and contribute to inequities in health outcomes;
  2. Assess the implementation of interventions to address overlapping overdose and COVID-19 health crises, including policy recommendations (take home prescriptions; stay-at-home directives), and their impacts on women’s health including overdose-related outcomes and
  3. Explore the experiences of women in mitigating overdose-related risk during the COVID-19 pandemic including uptake of overdose and COVID-19-focused interventions and identification of facilitators and barriers to uptake during dual public health emergencies.
The method

Building upon our extensive experience in examining risk, harm and health care access among women who use drugs, the study integrates in-depth interviews with ethnographic methods including observation. In addition, digital storytelling, an arts-based method, will be employed with a sample of participants, enabling them act as co-researchers while highlighting their reflections and perspectives. Leveraging two ongoing NIDA-funded cohort studies, our ethno-epidemiological approach will generate evidence to guide the real-time optimization of existing interventions, as well as the ethical and effective implementation of new responses.

The impact

The study aims to develop a comprehensive understanding the multiple factors that shape overdose morbidity and mortality among marginalized women who use drugs. Results will generate new insights critical to reducing overdose related morbidity and mortality among women who use drugs and inform ethical and effective policy and practice-recommendations to address the gender-related impacts of intersecting public health emergencies.

Project collaborators

British Columbia Centre on Substance Use, Canada; Brown University, USA; University of British Columbia, Canada; University of Victoria, Canada; Yale University, USA

Project funding

Canadian Institutes of Health Research Project Grant