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Just Published (PREPRINT): Mapping Paramedic Inclusion in Canada's Illicit Drug Strategy Landscape: A Critical Realist-Informed Policy Analysis and Typology

Writer: Paramedics for Drug Policy Reform
Paramedics for Drug Policy Reform
2 days ago
2 min read

Mapping Paramedic Inclusion in Canada's Illicit Drug Strategy Landscape

Paramedics are often the first and sometimes only point of care for people who use drugs (PWUD). Their practice has expanded to include take-home naloxone, referral pathways, and paramedic-initiated treatment. Yet it remains unclear how paramedics are positioned within the policies that shape drug-related care.

That's the focus of a new preprint, Mapping Paramedic Inclusion in Canada's Illicit Drug Strategy Landscape: A Critical Realist-Informed Policy Analysis and Typology, now under review with BMC Health Services Research.

The study analyzed 45 federal and British Columbia drug policy documents published since 2016 and developed a typology to classify how paramedics appear in each: explicitly named, indirectly implied through broad terms like "healthcare providers," or absent altogether. It also distinguished between absences that would be expected and those that represent a missed opportunity.

Why this matters

Policy determines whether innovative models of care stay small and fragmented or become integrated parts of the health system. Explicit naming is one of the main ways a profession gains legitimacy, authority, and a seat at the table. When paramedics are only implied or left out, their role becomes ambiguous and they are more likely to be excluded from program design and upstream strategy.

The buprenorphine example makes this concrete. BC paramedics received federal authority to administer buprenorphine in 2023, but implementation has not followed without corresponding provincial change. Permission without strategic alignment leaves policy inert.

Key takeaways from the study:

  • Federally, paramedics were named mainly in Section 56(1) exemptions for handling controlled substances, but only indirectly referenced in broader strategies like the Canadian Drugs and Substances Strategy

  • BC policies were more inclusive, with 9 of 12 documents naming paramedics directly

  • The BC Ministry of Mental Health and Addictions Service Plan omitted paramedics entirely, despite addressing overdose emergency response and service integration

  • Where paramedics were included, they were framed almost exclusively as emergency responders, with little recognition of their preventive or integrated role

  • Paramedics' regulation outside BC's Health Professions Act reinforces their marginal position in health planning

  • Policymakers should explicitly name paramedics across emergency, preventive, and community-based care frameworks

What's next

This study is Phase 1 of a broader PhD research program examining how Canadian drug policy shapes paramedic practice. Phase 2 will use realist synthesis to examine the contexts and mechanisms behind these patterns, and how they shape paramedic models of care for PWUD. The work will also be discussed on an upcoming episode of Connecting the Dots: Paramedics, Policy, and Possibility.

 
 
 

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