PONE-D-19-16948

Impact of Overdose Prevention Sites During an Overdose Emergency in Victoria, Canada

PLOS ONE

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PLOS ONE

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Reviewers' comments:

This paper is a qualitative analysis exploring the perceived impacts of three newly implemented overdose prevention sites (OPSs) in Victoria, BC during the overdose emergency. The authors conducted semi-structured interviews with 27 participants (including experiential staff and clients) of the new OPSs and applied the CFIR framework to interpret the interviews.

Major revisions requested:

1. The structural layout of the paper assumes the audience is very familiar with OPSs, SCSs, and SIFs – and introduces concepts before leaving their explanations until much later in the body of the work. For example, although OPSs and SCSs are first introduced as concepts on page 3, it is not until page 4 (page 5 really) where their similarities and differences are described for the sake of the reader. Similarly, on line 95 (page 5) the authors mention that OPSs prevent fatalities. This is not explained until MUCH later when a client mentions that the quieter/slower pace of the OPS allows him/her to test the drug before consuming more of it (something that would not normally happen in a hurried environment thereby likely increasing the risk of overdose). And on page 13 (line 250-1) mention that the OPSs reduced the need for naloxone etc.

2. There is no explanation for why Victoria was selected as the study site.

3. It would have been beneficial to the reader (especially given the brevity of the interviews) if the interview guide was included as an appendix/supplemental material.

4. Although the authors mention who conducted the interviews, it is unclear who transcribed the codes (e.g. was this contracted to an external services from audio-recordings?), who conducted the coding (number of coders, initials of coders), how coding discrepancies were resolved, if there was any procedure to validate coding, and duration of the interview period (how soon after the implementation of the OPSs the interviews were conducted).

Minor changes recommended:

1. Please revise for run on sentences (e.g. lines 55 – 8), re-introducing acronyms (e.g. line 66), missing refs (e.g. line 71), and typographical errors (e.g. line 99)

2. The formatting of the participants should be revised. Although there are only 27 participants, and for example 15 staff, on line 320 OPS staff 16 is mentioned, and on line 412 staff and service user 17 is listed). Similarly, while there are 12 service users/clients, on line 459 service user 4 is listed, and on line 481 service user 24 is listed. If this is a consequence of some staff being clients of the services as well, this needs to be clarified in the writing and in the nomenclature.

3. Relatedly, language in table 1 needs to be more consistent, and the authors might want to consider endnotes or footnotes to provide additional details on some of the titles they include. Additionally, the number of interviewers that fit each category would help clarify the nomenclature used throughout (e.g. line 360)

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The Impact of Overdose Prevention Sites During a Public Health Emergency in Victoria, Canada

PONE-D-19-16948R1

Dear Dr. Pauly,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Dimitra Panagiotoglou

Academic Editor

PLOS ONE

Reviewers' comments:

The first round of revisions made for a much clearer and succinct paper. Please conduct a final read through to clean up minor errors in spelling and writing before publication.

For example:

Punctuation: lines 81, 212 and 519

Spelling: lines 457, 528

Word tense: line 171

Extra/incorrect words: lines 137, 351

Awkward sentence break: lines 116-120

Others suggestions:

Consider adding "and" after comma between "service, staff" (line 151)

The numbering of respondents was helpful in demonstrating diversity of responses. Please re-insert but explain the numbering format in a footnote to avoid confusion.

A second reviewer made the following Minor revision requests:

I have just a few remaining issues to consider:

Missing “Introduction” heading

Introduction:

    Line 43: would suggest just using the rate per 100,000 for this sentence, the absolute number of ODs is hard to interpret without context or comparison and then same comment for the next sentence.

The last sentence in the first paragraph about Victoria seems out of place, it will be important to mention why it’s the chosen site but I think that it’s enough to mention BC in the first paragraph and then Victoria later on

Supervised consumption services: this term seems a bit awkward, is there another way to phrase, like SCS are is a package of services including…..for example drug consumption rooms are not services, a room is a physical space

Line 59: would suggest specifying what blood born diseases

Line 62: would be helpful to understand what requirements the federal government has imposed

Line 80: would define “experiential”

Line 106: save for the discussion

Materials and Methods:

    I found the organization of this section a bit confusing. I would suggest that any “results” would be in the results sections- this would include the table of the different programs

May be helpful to have some subheadings: such as design, setting, participants, inclusion and exclusion criteria, theoretical framework, analysis

Discussion

    The first paragraph should be a summary of the results, not summarizing the benefits of safe consumption services