"Because we're the experts": centering the expertise of people who use drugs to identify and propose solutions for overdose prevention.

backgroundPeople who use drugs possess valuable expertise, knowledge, needs, and preferences as part of their lived experience, which should be incorporated into overdose-focused public health programs and policies.

methodsWe formed a community advisory board composed of 16 clients from four syringe services programs (SSPs) in Wisconsin for an overdose prevention research study to inform project priorities. Over 6 meetings spanning 10 months, the board engaged in a root cause analysis facilitated by SSP staff and University researchers using a semi-structured assessment technique from the Community Anti-Drug Coalitions of America. The board then identified solutions to each root cause and rated solutions on two dimensions: impact and effort required to implement. Similar solutions were combined by averaging effort and impact scores respectively. After the activity concluded, we gathered members' perceptions of the activity using a brief, open-ended questionnaire.

resultsMembers identified nine root causes of overdose that spanned individual (e.g., solitary drug use), structural (e.g., inaccessible or suboptimal substance use treatment programs), and policy (e.g., criminalization of drug use) drivers of overdose occurrence and fatality risk. Substance use stigma was a cross-cutting, fundamental driver of all root causes. The board proposed 28 solutions responsive to these root causes, including changing policies, implementing whole-person focused harm reduction and treatment programs, and incorporating people with lived/living experience of drug use into the design and implementation of public health programs. Members felt the activity was meaningful and effectively facilitated, but highlighted that several solutions were unable to be acted upon in the context of the research study.

conclusionThis work reinforces a need for multi-dimensional, comprehensive interventions, programs, and policies to address the overdose crisis. Collectively, new and continued overdose prevention programming should broaden access to and use of harm reduction tools (e.g., naloxone, drug checking) and substance use and mental health treatments as well as reform policies that negatively impact the health of people who use drugs. Our findings underscore the need to incorporate the expertise of directly impacted populations into future research and program planning focused on overdose prevention by partnering with people who use drugs.