“They’re Not Doing Enough.”: Women’s Experiences with Opioids and Naloxone in Toronto

Abstract BACKGROUND: Amid increasing opioid overdose deaths in Canada, there is currently a need for up-to-date research on Canadian women’s experiences with opioids and their recently down-scheduled antidote, naloxone. Studies on Canadian take-home naloxone programs are promising, but research on perspectives outside these programs is limited. As the first qualitative study since the inception of the 2010’s opioid crisis to focus on Canadian women’s experiences and perspectives, our objective was to address these knowledge gaps and to identify resulting flaws in current policies, responses, and practices.METHODS: We conducted semi-structured, qualitative interviews from January to April 2018 with 10 women with experience of opioid use. They were recruited through the study’s community health partner in Toronto. They provided demographic information, experiences with opioids and naloxone, and their views on the Canadian government’s responses to the opioid crisis. Interviews were transcribed verbatim and inductive thematic analysis was conducted to determine major themes within the data.RESULTS: Participants who had used illicit opioids since the Canadian government’s down-scheduling of naloxone in 2016 were much more knowledgeable about naloxone than participants who had only used opioids prior. The portability, dosage form, and effects of naloxone are important considerations for women who use opioids. Social alienation, violence, and isolation affect the wellbeing of women who use opioids. The Canadian government’s response to the opioid crisis was perceived as neglectful and inadequate. Participants demonstrated differing needs and views on ideal harm reduction approaches, despite facing similar structural issues surrounding stigma, addiction management, and housing.CONCLUSIONS: Participants experienced with naloxone use found it to be useful in preventing fatal overdose, however many of their needs with regards to physical, mental, and social health, housing, harm reduction, and access to opioid treatment remained unmet.