title: Key challenges in providing services to people who use drugs: The perspectives of people working in emergency departments and shelters in Atlantic Canada.
abstract: OBJECTIVE
  Many people who use drugs (PWUD) have multiple health and social needs, and research suggests that this population is increasingly accessing emergency departments (EDs) and shelters for health care and housing. This qualitative study explored the practices of those working in EDs and shelters when providing services to PWUD, with a particular focus on key challenges in service provision.
  
  
  METHODS
  EDs and shelters were conceptualized as 'micro environments' with various components (i.e. social, physical and resource). One-on-one interviews were conducted with 57 individuals working in EDs and shelters in Atlantic Canada.
  
  
  RESULTS
  The social, physical and resource environments within some EDs and shelters are key forces in shaping the challenges facing those providing services. For example, the social environments within these settings are focused on acute health care in the case of EDs, and housing in the case of shelters. These mandates do not encompass the complex needs of many PWUD. Resource issues within the wider community (e.g. limited drug treatment spaces) further contribute to the challenges.
  
  
  CONCLUSIONS
  Structural issues, internal and external to EDs and shelters need to be addressed to reduce the challenges facing many who work in these settings when providing services to PWUD.
authors: School of Health and Human Performance, Dalhousie University , Halifax, NS , Canada ; Atlantic Health Promotion Research Centre, Dalhousie University , Halifax, NS , Canada.
authors: Lois A
authors: LA
authors: Jackson
authors: Atlantic Health Promotion Research Centre, Dalhousie University , Halifax, NS , Canada.
authors: Susan
authors: S
authors: McWilliam
authors: Department of Sociology and Social Anthropology, Dalhousie University , Halifax, NS , Canada.
authors: Fiona
authors: F
authors: Martin
authors: AIDS Saint John , Saint John, NB , Canada.
authors: Julie
authors: J
authors: Dingwell
authors: Faculty of Nursing, University of New Brunswick , Fredericton, NB , Canada.
authors: Margaret
authors: M
authors: Dykeman
authors: School of Health and Human Performance, Dalhousie University , Halifax, NS , Canada ; Atlantic Health Promotion Research Centre, Dalhousie University , Halifax, NS , Canada.
authors: Jacqueline
authors: J
authors: Gahagan
authors: School of Social Work, Dalhousie University , Halifax, NS , Canada.
authors: Jeff
authors: J
authors: Karabanow