An Analysis of Drug Use-Related Curriculum Documents for Paramedic Students in British Columbia

Paramedics attend an unprecedented number of drug poisoning events daily in British Columbia (BC), Canada, due to the ongoing public health crisis related to an increasingly toxic and unregulated street supply of illicit drugs. Paramedics have the potential to support alternative models of care to reduce harm, but their perspectives toward harm reduction initiatives are polarized. Understanding the drug-related substance use content in paramedic curriculum documents is important for deploying effective harm-mitigating programs. The aim of this study was to determine how illicit drug-related substance curriculum prepares paramedics for practice in British Columbia. We performed a document analysis of curriculum documents in BC's paramedic training institutions, the primary program textbook, and the 2011 National Occupational Competency Profile (NOCP) for Paramedics in Canada. We used O'Leary's eight-step process to guide the planning and procedure of the analysis. We analyzed and coded documents both inductively and deductively and subsequently combined, refined, and used the codes to inform the development of themes via reflexive thematic analysis. The Checklist for Assessment and Reporting of Document Analysis (CARDA) tool was used to report our analysis. Of the 45 documents analyzed, 23 included codes relevant to the research questions. Paramedics are primarily taught to care for people who use drugs in an acute drug poisoning response only, with little consideration of holistic care and no meaningful mention of harm reduction. Some stigmatizing language was found within the content. Many opportunities to introduce holistic models of care for people who use drugs along the entire continuum of care are unaddressed by paramedic curriculum documents in BC. Curriculum developers should include people who have lived and living experience of drug use in the co-design of educational programs involving their care. Further qualitative analyses are required to evaluate the relationship between paramedic education and provider-based stigma.