QMJC January 2021 - It's an emotional roller coaster… But sometimes it's fucking awesome”: Meaning and motivation of work for peers in overdose response environments in British Columbia

First published: 25/02/2021 | Last updated: February 25th, 2021

SSA Qualitative Methods Journal Club (QMJC) January 2021

Article: Pauly, B.B., Mamdani, Z., Mesley, L., McKenzie, S., Cameron, F., Edwards, D., Howell, A., Knott, M., Scott, T., Seguin, R. and Greer, A.M., 2020. “It’s an emotional roller coaster… But sometimes it’s fucking awesome”: Meaning and motivation of work for peers in overdose response environments in British Columbia. International Journal of Drug Policy, 88,.

The article can be accessed here.

Glasgow Caledonian University (GCU) team: GCU Substance Use Research Group (@SubMisuseGCU): Matt Smith (lead), Carol Emslie, Elena Dimova, Amy McEwan, Antonia Lloyd

Online journal club discussion with 19 colleagues supported by Scottish Alcohol Research Network @SARNalcohol

Paper Summary

This paper explored the roles, positive experiences, and challenges for a group of “experiential workers” commonly known as “peers” (workers with past or present experience of drug use) carrying out harm reduction work in two organisations in British Columbia, Canada. The research team consisted of academic researchers as well as Experiential Research Assistants (ERAs), who had past or present experience of drug use. This paper was chosen for discussion because of the innovative approach to integration of ERAs in project design, management, data collection, data analysis and write up. Five experiential workers were recruited from partner organisations and trained in research methods. Several more ERAs were added to the team, and some took leave or withdrew from the project. Focus groups were conducted by two members of the research team, an ERA who facilitated the focus group and an academic researcher who took field notes and provided logistical support.

Involving ERAs in data analysis is particularly challenging. In this work ERAs were fully integrated via a “participatory coding process”. In addition an “interpretative description” approach was used, which prioritises generating practical and applied knowledge as opposed to building or extending theory. The in-depth description of data analysis in this paper provides a ‘good practice’ manual for this approach for other researchers. At each stage ERAs were asked for their preferences (for example working from templates rather than full transcripts) and worked closely with academic researchers to best contribute their lived experience perspectives. Initially academic researchers developed a coding framework, which was validated and added to by ERAs. This was inputted into NVivo where analysis continued iteratively and reflexively.

Three themes of motivation are outlined in the findings: a sense of purpose from helping others; being an inspiration for others; and a sense of belonging. These findings align with previous research in this area, and provide further evidence that people with lived experience must form a central role in research and service provision. The paper makes strong recommendations that: experiential workers should work in teams to improve resilience; that they should be paid as other researchers are to properly value their work; that organisations need to be flexible in order to properly benefit from experiential workers (e.g. not insist on periods of abstinence before engagement); and finally, that experiential workers must be at the forefront of the response to the drugs death crisis.

QMJC paper discussion

The group was very lucky to have the lead author (Prof. Bernie Pauly) present, and she was able to provide some background and context for the study. She emphasised that this work was the result of many years of relationship development with lived experience organisations in BC, and fielded questions about the practicalities and benefits of such long-term collaborative partnerships.

We discussed why the paper was an excellent example of good practice for integration of peers into research. It argues for improved peer representation and provides clear suggestions on how to conduct peer research in a meaningful way. There was agreement that the lessons learned here could be applied to any research aiming to integrate peers meaningfully, not just addiction related research.  The group discussed, some from personal experience, how people with lived experience can be made to feel like outsiders within academic environments, regardless of the area of study. This depended on many aspects, including: formats of meetings; language used (technical jargon etc.); unrealistic expectations of capacity and many other details. We agreed that carrying out meaningful peer engagement required detailed planning and resources.

This lead on to discussions about balances of power in research between academia, people with lived experience, peer researchers and participants, and practical conversations about how inequity could be addressed, for example having researchers go to “sit at the peers’ table”, rather than vice-versa. In practical terms this might mean physically going to where peers are based and being a lone academic among a group of peers, rather than inviting peers to what could be an intimidating room of academics or other partners. These discussions around power dynamics covered all areas of research. We agreed that shifts in concepts and cultures are needed to address power dynamics, so that we as academics become facilitators, and ERAs/peers become experts.

The group also talked about what the paper meant in terms of stigma around substance users, and service culture. One of the recommendations of the paper – that experiential researchers should not be required to have a specified period of abstinence before working as peers or ERAS – was, according to Prof. Pauly, specifically aimed at Scotland, where some organisations have a 2-year minimum abstinence period. Participants discussed what would be required to change culture in Scotland and the UK, including better knowledge exchange, and training for academics and third sector workers to combat stigma and develop a more nuanced and empathetic approach to lived realities of substance users.

The group then discussed what is necessary for peer inclusion in research to be “meaningful” for the research and for the peers. The main aspect seemed to be follow through, and follow up, i.e. proof that ERAs or peers had been properly listened to and integrated. There was also discussion about how to progress ERA related efforts more broadly, and that showcasing progress between projects is important.

This paper advocates strongly and effectively for more ERA developed and coordinated research, and greater integration of peers in all stages of the research. The group discussed to what extent researchers should be advocates, and it was agreed that it is important to carry out strong advocacy in research, especially in an area like addictions research in Scotland and Canada, where drug related deaths are at their worst levels on records. Public crises like these mean that researchers need to be strong voices in policy and culture change to try and address this, and not advocating risks perpetuating issues like stigma.

The group felt the paper made an important contribution to the debate about where addictions research should go in the future. It provided interesting data and learning, but perhaps more importantly provided a model of how to redress power dynamics, how to heighten voices of people who are marginalised, how to prioritise people with lived experience as experts, how to practically develop research programmes where peer integration moves beyond tokenistic efforts, and how to be an authentic and effective voice for change. Like all good research, the paper addressed specific questions, but also made us think about issues on a much broader scale, and inspired conversation about how we should move forward.