Peer worker or client?: conflicting identities among peer workers engaged in harm reduction service delivery

Background: This study sought to identify challenges surrounding peer programming in Ottawa and to provide realistic recommendations for reducing these barriers.Methods: In-person, semi-structured qualitative interviews were conducted with managers of peer programming initiatives and people with lived experience of drug use who had previously been or were currently engaged in peer programming in Ottawa. Interviews were transcribed and coded for emergent themes using thematic analysis informed by grounded theory.Results: Eleven interviews were held with peer workers and six were held with program managers between January and March 2016. A number of emergent themes were identified, but an overarching message emerged about peer workers' difficulties separating their identities as people who use drugs and require harm reduction services from their identities as peer workers working in harm reduction to help others who use drugs. This manifested in difficulty reporting issues of triggering, reluctance to use the agency's harm reduction services, and feeling stuck' in positions that were dependent on a drug user' identity.Conclusion: The themes explored by peer workers in this study, particularly those of conflicting identities and the pressure to perform, contribute substantially to the evidence base on peer workers in harm reduction. We explore these themes through a symbolic interactionist lens, which notes that one's sense of self-worth is often intrinsically linked with one's ability to successfully perform a given identity. Collaboration between agencies in supporting peer workers and reminding them of their ongoing ability to use agency services as a client at the agency where they are employed or elsewhere, along with offering training sessions to help peer workers develop skills outside of harm reduction work may be beneficial in alleviating these challenges.