Navigating concurrent public health emergencies: Indigenous perspectives from the Cedar Project in British Columbia.

Connection and resilience are critical to the health and wellbeing of Indigenous Peoples who use drugs (IPWUD): connection to family, cultural supports, safer coping mechanisms and circles of care. Urban IPWUD are more likely to face multiple harms from emergency public health restrictions alongside ongoing toxic drug and housing crises in British Columbia. This paper aims to amplify the experiences of urban IPWUD as they navigated the COVID-19 pandemic and the corresponding public health response in Vancouver and Prince George, BC. Nineteen semi-structured interviews were completed with Indigenous Peoples enrolled in the Cedar Project COVID-19 Study in Vancouver (n = 9) and Prince George (n = 10). Interpretive description was adapted to identify themes across participants' stories. Emerging themes were brought back to participants for member checking using iterative techniques. Interviews were conducted in person between March-May 2022. The median age of participants was 36, with 37% men and 63% women. Four themes were identified: 1) Enduring impacts of colonialism worsened pandemic-related stress for Indigenous Peoples, led to 2) Cycles of isolation, uncertainty and crisis destabilized Indigenous Peoples, and 3) Fear and Trauma-Driven Distrust amplified experiences of grief and loss amidst conflicting public health protocols. However, 4) Resilience and connection were important buffers against pandemic-related harm. Urban IPWUD face ongoing public health emergencies that threaten daily security, safety, and health. This study demonstrated the complex ways Indigenous People navigated COVID-19 and concurrent emergencies, and the challenges they faced. These findings shed light on the ongoing discrimination against urban IPWUD, and reiterate that they are the experts in their own needs and determining how to best survive and thrive through health emergencies.