“We’re here, and we're non-judgmental, we’re here to save lives”: stressors and fulfillment among overdose response hotline operators in Canada

BACKGROUND: The toxic drug supply and overdose epidemic in North America has led to deaths, reduced quality of life, and emotional burdens, especially for harm reduction workers who experience stress from grief and trauma. This study aims to evaluate the benefits and harms of working in overdose prevention hotlines and to identify strategies to reduce stress and trauma for lived-experience operators in these settings. METHODS: We conducted a sequential mixed-methods study comprising 11 qualitative interviews and a survey with 15 operators and volunteers with Canada's National Overdose Response Service (NORS). The study explored operator challenges, compassion fatigue, and quality of life with previously validated quality of life surveys (ProQOL), while also assessing the perceived effectiveness of the hotline in reducing overdose deaths, mental health impacts, and emergency medical service call-outs. RESULTS: From our qualitative interviews, 3 major themes emerged including (1) The duality of remote overdose response work including: tension between flexibility, accessibility, and supportive team dynamics, with ethical challenges, lack of physical presence, and complex client interactions. (2) Emotional burden and stress in a remote context and: (3) Meaning, purpose, and peer connection as drivers of fulfilment. Overall, most participants ranked their burnout levels as low (13/15 (86.6%)), compassion satisfaction as high (13/15 (86.6%)), and secondary traumatic stress as low (14/15 (93.3%)). CONCLUSION: This study reveals that work with overdose prevention hotlines is both rewarding and sustainable, with operators experiencing low burnout, low secondary traumatic stress, and high compassion satisfaction. The flexibility, strong team support, and inclusive approach of NORS make remote harm reduction a viable model for aiding marginalized individuals effectively in the overdose crisis.