Sector News

  1. Challenges faced by Peer Helpers

    Background

    • The role of peer helpers came out of a need to address the limitations of the traditional “provider-client model.”
    • Mediators or Peer Helpers act as both secondary distribution agents and advocates. They have become a valuable component of the most successful strategies aimed at injection drug using communities as they bring the reality of the lives of marginalized populations into strategic discussions.
    • This study aimed to explore the difficult situations peer helpers may find themselves in when they attempt to implement harm reduction practices and balance potential serious health problems and even death against anticipated backlash from users, medical staff, and the community.

    Approach

    A series of focus group sessions were conducted with peer helpers over a two-year time frame in Cape Breton, Canada.

    Findings/Key Themes

    Officially sanctioned peer helper practices

    • Overall, few moral dilemmas arose with the official distribution part of the peer helper role unless there was a shortage of supply.
    • Peer helpers viewed education of new users as a very important part of their harm reduction role. They felt that the hidden nature of injecting left them responsible for “how to” training.
    • Contrary to public discourse, peer helpers attempt to dissuade individuals from taking that first hit. However, they were exposed to threats from others such as neighbours and child protection workers because of how their role is perceived by the general public.
    • Peer helpers can be credited with the high rates of safe needle disposal. They play a key role in developing and reinforcing return practices.

    Unofficial peer helper practices

    • Given that peer helpers are viewed as authorities on safe injection within their community, one of the first ways they can be drawn into an unofficial role is through requests for assistance.
    • The imminent threat of death from overdose is on the top of the minds of peer helpers, not the threat of blood-borne pathogens.
    • Peer helpers are the ones who typically step in to deal with overdose and will usually make the call to emergency services despite repercussions from health professionals and police as well as the users themselves. As a result, peer helpers find themselves caught in the middle of competing courses of action – do they call the police or not?
    • Due to users’ hesitation to seek medical treatment, peer helpers find themselves treating wounds and abscesses. Some helpers find themselves saving and sharing antibiotics (even though they know it’s problematic) to help those who refuse to seek medical attention.
    • Many peer helpers also take on the role of counselor
    • Peer helpers lived experience enables them to empathize with those struggling with addiction – “they almost never give up on people.” They let people who were homeless come to their homes for food, a shower and a night’s sleep.

    Conclusion

    Peer helpers find themselves in difficult situations with user populations often because people who inject drugs feel undeserving of services and discriminated against when they do seek services. This adversely impacts users, and particularly the peer helpers seeking to assist them. In an effort to keep users alive, peer helpers engage in practices that extend far beyond their roles of disseminating sterile syringes and safe injection materials.

    Dechman, M.K. (2015). Peer helpers’ struggles to care for “others” who inject drugs. International Journal of Drug Policy. Vol. 26. Pp. 492-500.