Women's overdose risk environments and the response to the overdose crisis in Vancouver, Canada

North America's overdose crisis has significantly impacted British Columbia (BC), leading to the declaration of a public health emergency in 2016. With fentanyl-adulterated opioids driving rapid increases in opioid-related drug overdose, new practices to prevent overdose deaths are being implemented in BC, however, they are typically designed and implemented using a "gender neutral" approach that can fail to account for the influences of a wider set of socio-structural forces (e.g., gender inequality, gender norms, colonialism) that may be crucial to effectively intervene to reduce women's risk of overdose. Although a few women-specific and Indigenous-specific interventions have been launched, including North America's first woman-only overdose prevention site, they have yet to be evaluated. Research has demonstrated that gendered power relations shape women's exposure to drug-related risks and harms. However, the relationship between gender and overdose remains poorly understood. Effective overdose-related interventions for highly-impacted subgroups of women (e.g., Indigenous women; transgender women) also must be informed by better understandings of the social experiences of women who use drugs. This 4-year study aims to generate evidence to strengthen interventions and strategies to decrease overdose-related harms, including death, among women who use drugs through an examination of the socio-structural forces shaping overdose risk, women's access to and experiences with overdose-related interventions, and the perspectives of drug-using women on potential strategies to improving overdose-related interventions and outcomes. Our innovative research aims to tackle key enduring knowledge gaps surrounding overdose-related risks and harms to women who use drugs, and to translate research evidence into practical improvements, informing the ethical delivery of effective policies, programs, and practices in BC, across North America and globally.