The Power of Supervised Consumption Sites

Key Points

• Supervised consumption sites (SCS) are an evidence-informed harm reduction strategy that reduces negative health outcomes associated with drug use (National Harm Reduction Coalition, n.d.).

• The benefits of SCS have been consistently demonstrated by over 100 evidence-based, peer-reviewed studies over the past 30 years (Drug Policy Alliance, 2021).

• SCS benefits include preventing overdose, reducing HIV and hepatitis C transmission, reducing injection-related infection, encouraging safe disposal of syringes, decreasing public substance consumption, providing access to medical and social devices with decreased barriers, and reduced costs for the healthcare system (Canadian Mental Health Association, n.d)

• No one has died of an opioid overdose in a SCS in the entire world (Drug Policy Alliance, 2021; Gordon, 2018; Ng et al, 2017).

• SCS foster a sense of community and connection between people who use drugs (Gordon, 2018)

Supervised consumption sites (SCS) may be referred to by various names (ex. Overdose prevention centers, supervised injection sites, etc) but they all operate similarly. They are an evidence-informed harm reduction strategy that reduce negative health outcomes associated with drug use, such as the transmission of blood-borne disease and overdose.

​Benefits of SCS (Drug Policy Alliance, 2021, Gordon, 2018).

• Prevention of overdose deaths

• Providing clean equipment reduces HIV and Hepatitis C transmission

• Reduced healthcare costs due to decreased disease, overdose deaths, and need for emergency medical services

• Providing a safe place for people who use drugs to find connection and care without stigma or fear of criminalization

• Increased access to treatment for substance use disorder, such as methadone maintenance treatment

• Care without barriers results in referrals for medical and social services

• Reduced public drug use and syringe and/or other drug paraphernalia litter

These facilities serve as a place in which people can bring their pre-obtained drugs to use while a criminal code exemption is in place. It acknowledges the fact that these people were going to use anyways, and would rather them use in safer ways, like where they can receive care with fewer barriers. Sterile equipment is provided to users to prevent complications such as blood-borne illnesses, such as HIV and hepatitis C (Canadian Mental Health Association, n.d.). Trained staff are present to prevent and respond to overdoses, equipped with naloxone (Canadian Mental Health Association, n.d.). Keep an eye out for a future post on naloxone in the 'harm reduction' tab under 'content'. Anyhow, these facilities also foster community and connection between users. Although this does not address tainted supply if drug checking is not available, some provinces are already on their way to budgeting for safe supply, like in British Columbia (Egan-Elliot, 2021). No one has died of an opioid overdose in a SCS in the entire world (Drug Policy Alliance, 2021; Gordan, 2018; Ng et al, 2017).

What?	Where?	Why?	Results?
Criminal code exemption, sterile equipment, trained staff, MMT, possible checks for tainted supply	Providences with most overdoses in the country - Ontario, British Columbia, Alberta, Québec	No overdose deaths at any SIC in the world, allows for increased access to treatment, sense of connection	Decreased overdose deaths, decrease incidence of HIV, decreased burden on hospitals, decreased stigma

200 supervised consumption sites are currently operating in 14 countries around the world, which includes Switzerland, Australia, Portugal, the Netherlands, Germany, Spain, Luxembourg, Norway, Denmark, Iceland, Canada, Ukraine, Belgium, and the United States (Drug Policy Alliance, 2021). The United States was recently added to this list. The first government-authorized SCS began operating in New York City in 2021, however, though legal under city and state law, it is still arguably illegal under federal law, and thus relies on a lack of enforcement by federal officials (Mann & Lewis, 2021).

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Although there are already supervised consumption sites in place across the country, the funding continues to lack, with sites being shut down despite the evidence of their need and success in practice. Various other factors may be impeding their success. This includes the need for more trained staff, tainted supply concerns, and barriers to care such as opposition to facilities from police enforcement. Since tainted supply is one of the driving forces of the crisis, if not safe supply funding, supervised consumption sites can allow for those using unknown supply to be supervised and provided prompt support if an accidental overdose does occur (Belzak & Halverson, 2018).

Most opioid-related deaths in recent years have occurred in British Columbia, Alberta, and Ontario, making these the priorities (Government of Canada, 2021). There are currently 21 supervised injection sites recognized in Ontario, mostly located in Toronto, where the need is highest (Government of Canada, 2022). British Columbia and Alberta each have several, with other provinces having just a handful currently open to the public.

The Facts

• Ng et al (2017) found that SCS are associated with decreased overdose mortality, 67% fewer ambulance calls to respond to overdoses, and decreased HIV infections in Vancouver, B.C.

• Pinkerton (2010) found that the operating costs of a SCS in Vancouver were more than sufficiently offset in averted HIV-related medical care costs

  • The SCS operating costs come to approximately $3 million/year

  • However, mathematical models were used to calculate the expected HIV infections if the SCS were closed, which was $17.6 million in life-time-HIV-related medical costs

• 30 years of SCS operations in 14 countries have demonstrated that SCS prevent overdose deaths, decrease HIV and hepatitis C transmission and injection-related infection, and increase public disposal of syringes (National Harm Reduction Coalition, n.d.).

• SCS do not increase drug use or crime in communities they are introduced in (National Harm Reduction Coalition, n.d.).

Misinformation continues to fuel those against the implementation SCS, despite their claims being disproven or not rooted in evidence. One study previously clung to was published in the International Journal of Drug Policy in 2018, which reported that the evidence was not as strong as previously thought (Gordon, 2018). However, this article was soon retracted due to methodological weaknesses.

When you look at the facts, although they are not a sufficient long-term fix when it comes to the opioid crisis, it is undeniably clear that SCS are saving lives right now.

Until next time,

Raquel

References

Belzak, L., & Halverson, J. (2018). The opioid crisis in Canada: A national perspective. Health promotion and chronic disease prevention in Canada: Research, policy and practice, 38(6), 224–233. https://doi.org/10.24095/hpcdp.38.6.02

Canadian Mental Health Association. (n.d.). Harm reduction. Retrieved from https://ontario.cmha.ca/harm-reduction/

Drug Policy Alliance. (2021). Overdose prevention centers. Retrieved from https://drugpolicy.org/issues/supervised-consumption-services

Egan-Elliot, R. (2021). Federal government provides $4M for Victoria safer drug program. Victoria Times Colonist. Retrieved from https://www.timescolonist.com/local-news/federal-government-provides-4m-for-victoria-safer-drug-program-4687191

Gordon, E. (2018). What’s the evidence that supervised drug injection sites save lives? National Public Radio. Retrieved from https://www.npr.org/sections/health-shots/2018/09/07/645609248/whats-the-evidence-that-supervised-drug-injection-sites-save-lives

Government of Canada. (2021). Opioid and stimulant-related harms in Canada. Retrieved from https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/

Government of Canada. (2022). Supervised consumption sites: Status of applications. Retrieved from https://www.canada.ca/en/health-canada/services/substance-use/supervised-consumption-sites/status-application.html#wb-auto-4

Mann, B., & Lewis, C. (2021). New York City allows the nation's 1st supervised consumption sites for illegal drugs. National Public Radio. Retrieved from https://www.npr.org/2021/11/30/1054921116/illegal-drug-injection-sites-nyc

Mosel, S. (2022). Harm reduction guide. American Addiction Centers. Retrieved from https://americanaddictioncenters.org/harm-reduction

National Harm Reduction Coalition. (n.d.). Supervised consumption sites. Retrieved from https://harmreduction.org/issues/supervised-consumption-services/

Ng, J., Sutherland, C., & Kolber, M. R. (2017). Does evidence support supervised injection sites? Canadian Family Physician, 63(11), 866. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/

Pinkerton, S. D. (2010). Is Vancouver Canada’s supervised injection facility cost-saving? Addiction, 105(8), 1429-1436. doi: 10.1111/j.1360-0443.2010.02977.x.