Between solitude and safety: A qualitative scoping review of overdose risk and the built environment

Given the ongoing overdose crisis, it is imperative to investigate how physical environments facilitate or protect against overdose in order to inform place-based interventions that seek to reduce risk. This scoping review synthesizes qualitative literature on the built environment and overdose to provide indepth perspectives and experiences of decision-making and drug use navigation. Studies published between January 1980 and October 2024 that describe built environment factors related to fatal and non-fatal overdose were included. The review followed the JBI Manual for Evidence Synthesis scoping review methodology, including the standardized checklist for reporting on scoping reviews(PRISMAScR). Forty articles were included. Results were divided into four overarching categories: indoor and outdoor locations that shape drug use behaviour and overdose; intersections of built environments and other social/structural factors impacting risk navigation, including privacy, sociability, and comfortability; and targeted interventions for the built environment that are intended to reduce overdose, including technologies and service availability. Key findings from this scoping review focus on how the built environment influences the consumption practices and experiences of people who use drugs when navigating harm reduction practices and the integrity of their drug-taking experience. Tensions exist between privacy and comfortability, and experiences of sociability and safety. Balancing surveillance versus monitoring is essential to consider when implementing built environment interventions that support individual autonomy. This research is important for understanding the built environment factors that facilitate or reduce the risk of overdose and is integral for informing policy and place-based interventions.