Thomas Kerr’s research while affiliated with University of British Columbia and other places

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Publications (824)


A Qualitative Study of Early Experiences and Outcomes of a Fentanyl Powder Safer Supply Program in Vancouver, Canada
  • Article

February 2025

Drug and Alcohol Dependence

Andrew Ivsins

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Christy Sutherland

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Thomas Kerr

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Impacts of the COVID-19 pandemic on supervised consumption service delivery in Vancouver and Surrey, Canada from the perspective of service providers
  • Article
  • Full-text available

January 2025

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16 Reads

Discover Public Health

Following the onset of the COVID-19 pandemic, an ever-increasing number of people have died from the toxic drug supply in Canada. Emerging evidence suggests that reduced access to harm reduction services has been a contributing factor. However, the precise impacts of the pandemic on supervised consumption service (SCS) delivery have not been well characterized. The present study sought to explore the impacts of the pandemic on SCS delivery in Vancouver and Surrey, Canada. Between October 2021 and March 2022, in-depth, semi-structured interviews were conducted with staff from two SCS: SafePoint in Surrey (n = 12) and Insite in Vancouver (n = 9). Thematic analysis focused on key changes to SCS delivery after the emergence of the COVID-19 pandemic, with a focus on associated challenges and emergent staff responses. Participants described key challenges as: capacity restrictions hindering service access and compromising care quality; exclusion of frontline staff perspectives from evolving SCS policy and practice decision-making; intensified power dynamics between staff and service users; and modified overdose response procedures, combined with a rise in complex overdose presentations, undermining service accessibility and quality. Emergent staff responses to these challenges included: collective staff organizing for changes to policy; individual frontline staff non-compliance with emerging policies; and staff experiencing burnout in their roles. This study highlights how COVID-19-related changes to service delivery produced challenges for SCS staff and service users, while identifying strategies employed by staff to address these challenges. Additionally, the findings point to opportunities to improve care for people who use drugs during intersecting public health crises.

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Example of heroin packaging
Permissions Obtained: Eris Nyx, DULF. Drug consumption supplies, naloxone kits, and other resources were available onsite for free. The CC also hosted an overdose prevention site (OPS) where CC members could consume drugs sourced from anywhere (i.e., not just CC-purchased drugs), which kept the same hours as the CC. In addition to the present qualitative investigation, CC members could also participate in quantitative surveys that were collected every three months.
Sample demographics
Qualitative findings from North America’s first drug compassion club

December 2024

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14 Reads

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1 Citation

In Canada, the ongoing fatal overdose crisis remains driven by the unpredictable potency and content of the illicit drug supply. From August 2022 until October 2023, the Drug User Liberation Front [DULF] operated a drug compassion club [CC], which sells drugs of known composition and purity without medical oversight. The present study is a qualitative evaluation of this project. From December 2022 to February 2023, we interviewed 16 CC members about their experiences with DULF’s CC. Using a semi-structured interview guide, participants were interviewed in a private space to ensure confidentiality. Thematic analysis was used to code for a priori and unexpected themes. Participants spoke positively of their experiences with the CC, which ranged from lower overdose risk, health improvements, preference for the drug purchasing process, and mutual respect and trust among CC members, founders, and staff. No participants reported overdosing on CC-sourced drugs, and drugs were described as safe and reliable. For opioid users, the tolerance developed for opioid-potent fentanyl hampered the transition to CC heroin. Suggestions for CC improvements were also identified. Despite political backlash to the project, the CC appears to be a novel and promising approach to reducing overdose morbidity in high needs communities. By promoting participant autonomy, regulating an unstable drug supply, and creating community, this intervention has reduced self-reported overdose risk and improved the health and social wellbeing of members. No overdoses reported from CC-sourced drugs suggests that authorizing, expanding and continually evaluating the CC model is warranted.





Citations (70)


... For example, expanding the range of opioid medications available on the provincial drug formulary to better match client preferences and tolerances is likely to reduce instances of diversion stemming from client dissatisfaction and/or withdrawal (Bardwell et al., 2021;Ferguson et al., 2022). Moreover, providing higher potency medications that are preferred but not received by a large number of SOS clients (Speed et al., 2024) through programs, such as those prescribing fentanyl patches (Norton et al., 2024) would be hepful. Additionally, diversion reportedly occurred to meet basic survival and subsistence needs including procuring food, clothing, shelter, or supporting friends and family, consistent with previous research (Bardwell et al., 2021;Giang et al., 2023;Henderson et al., 2024). ...

Reference:

Motivations for and perspectives of medication diversion among clients of a safer opioid supply program in Toronto, Canada
Preferred pharmaceutical-grade opioids to reduce the use of unregulated opioids: A cross-sectional analysis among people who use unregulated opioids in Vancouver, Canada
  • Citing Article
  • September 2024

International Journal of Drug Policy

... People who use drugs (PWUD) reported preferring smoking over injecting substances for a variety of reasons, including lower financial costs of fentanyl compared to heroin, reduced stigma, improved health benefits (e.g. fewer skin and soft tissue infections), and perceived lower risk of overdose compared to injecting Ivsins et al., 2024;Ciccarone et al., 2024). A recent study in California found a 40 % higher prevalence of non-fatal overdose among people who inject fentanyl compared to people who smoke fentanyl (Megerian et al., 2024). ...

A qualitative study on perceptions and experiences of overdose among people who smoke drugs in Vancouver, British Columbia
  • Citing Article
  • March 2024

Drug and Alcohol Dependence

... Average pain level on typical day (mean, SD) 7.6 (1.9) than half (53.5%) of their sample turned to the unregulated supply once denied a legitimate prescription for pain (Piret et al., 2024). Another possibility is the transition from prescribed to illicitly produced opioids in those who were tapered rapidly or discontinued. ...

Denial of prescription pain medication among people who use drugs in Vancouver, Canada

Harm Reduction Journal

... Furthermore, government reports and studies have highlighted notable program engagement barriers, including weaker effects of prescribed versus unregulated drugs, and limited prescriber education and resources related to safe supply prescribing [76][77][78]. Further pursuit of non-medical safe supply approaches may help to address these limitations and support access at an appropriate scale [3,79]. ...

The impact of an unsanctioned compassion club on non-fatal overdose
  • Citing Article
  • February 2024

International Journal of Drug Policy

... Between August 2021 to April 2022, the first author (SW) conducted in-depth interviews with 38 SuperMIX and 38 VMAX participants who completed surveys during the pandemic. We used an ethno-epidemiological ('ethnoepi') random sampling recruitment technique with the aim of increasing the generalizability of the results across the cohort samples (Walker et al., 2024). Investigation topics included impacts of the pandemic and associated restrictions on experiences of housing, employment, and income status; social relationships and support; access to health services; drug use; and interactions with law enforcement -the latter of which are the focus of this article. ...

Using Ethno-Epidemiology in a Prospective Observational Study to Increase the Rigour of Nested Qualitative Research

... Increasing opioid-stimulant co-use represents a growing public health concern for several reasons, including overdose risk; several studies have documented higher rates of non-fatal and fatal overdoses among individuals who co-use opioids and stimulants (relative to those who use opioids only; Karamouzian et al., 2024;Korthuis et al., 2022;Palis et al., 2022). Between 2015 and 2022, the proportion of US overdose deaths involving stimulants rose from 23% to 53% (Centers for Disease Control and Prevention, 2024a), and opioids were co-involved in 78.6% and 65.7% of overdose deaths involving cocaine and psychostimulants (e.g., methamphetamine), respectively (in 2021; Spencer et al., 2023). ...

Longitudinal polysubstance use patterns and non-fatal overdose: A repeated measures latent class analysis
  • Citing Article
  • January 2024

International Journal of Drug Policy

... Various medical interventions have been implemented to quell overdose incidents by providing pharmaceutical alternatives to the unregulated drug supply and have been successful insofar as hydromorphone, the primary opioid medication prescribed to offset sole reliance on the unregulated market, was detected in only 3% of overdose fatalities in B.C. in 2023 [8]. Nonetheless, their application through clinician prescribing often requires medical oversight, which might include prescriber determination of medication dose, pickup schedule, daily witnessed consumption requirements, and urinalysis [9][10][11][12]. These factors create barriers to engagement for large numbers of individuals at heightened risk of overdose [13]. ...

A qualitative assessment of tablet injectable opioid agonist therapy (TiOAT) in rural and smaller urban British Columbia, Canada: Motivations and initial impacts
  • Citing Article
  • October 2023

Journal of Substance Use and Addiction Treatment

... 104 This vein of research has importantly established broad scholarly agreement regarding the harms caused by a criminalized and unregulated drug supply, through explicitly discriminatory policies (ie, Refs. 105,106 ) and those embedded in our social fabric (ie, Refs. 103,107 ) However, research that continues to apply a REF analysis risks re-producing concepts and structures that are, in some cases, antiquated and unnecessary, including in the flow of material resources connected to research. ...

Police seizure of drugs without arrest among people who use drugs in Vancouver, Canada, before provincial ‘decriminalization’ of simple possession: a cohort study

Harm Reduction Journal

... Throughout Canada, however, drug toxicity mortality rates have remained high even in the presence of multiple interventions. Radical policy and social reforms are likely to be essential to address the root causes of the overdose crisis, both proximal-a highly unpredictable illicit drug supply-and distal-strained health systems [37][38][39] and socio-economic precarity [40][41][42] chief among these. Changes to the legal status of currently illicit drugs; strengthened mental health systems; policies to address Canada's housing affordability crisis and reduce homelessness; and social programs and policies targeting poverty should all be investigated as part of a socio-structurally oriented response to drug poisonings. ...

Socioeconomic marginalization and risk of overdose in a community-recruited cohort of people who use drugs: A longitudinal analysis
  • Citing Article
  • July 2023

International Journal of Drug Policy

... The combined use of opioids and methamphetamine is a substantial cause for concern, as it can result in serious health consequences, such as an increased risk of overdose, hospitalizations, and death (Al-Tayyib et al., 2017;Spencer et al., 2022;Strickland et al., 2021). The increasing use of methamphetamine has also complicated the opioid use disorders' (OUD) treatment landscape (Chan et al., 2020;Cui et al., 2023;Frost et al., 2021). Studies have found that methamphetamine use among people receiving medications for OUD is associated with higher rates of treatment dropout and poorer treatment outcomes, including lower rates of abstinence and higher rates of relapse (Chan et al., 2020;Cui et al., 2023;Frost et al., 2021). ...

The Impact of Longitudinal Substance Use Patterns on the Risk of Opioid Agonist Therapy Discontinuation: A Repeated Measures Latent Class Analysis

International Journal of Mental Health and Addiction