Implementation facilitators and barriers to the expansion of a peer-led overdose prevention program

In Canada, there has been a substantial increase of opioid overdoses in recent years. PROFAN, a peer-led overdose prevention initiative, was successfully implemented in Montreal, Quebec, for people who use drugs (PWUD), or those likely to witness overdoses. The worsening of the situation during the COVID-19 pandemic sparked the need to expand the program across the province. Individual interviews were conducted with 17 key informants from 12 health regions to identify implementation facilitators and barriers. A thematic analysis was conducted based on emerging themes. Four main facilitators were reported: 1) presence of an active peer network involved with harm reduction in the region, 2) collaboration among community and public health sectors, 3) stakeholders' awareness of opioid situation, and 4) perceived appropriateness of training. Six main barriers also emerged: 1) geographical isolation, 2) existing offer of similar services, 3) difficulty reaching isolated PWUD, 4) stigmatization of PWUD, 5) unwillingness of stakeholders to address situation, and 6) lack of funding stability. The expansion achieved by the PROFAN program highlights the ability of a peer-driven community organization to lead an overdose prevention program when provided with funding and support from government health agencies and partnerships with other organizations such as addiction worker associations.