Sharing Knowledge and Generating New Evidence to Support Implementation of Supervised Consumption Services in Canada (SCS)

PI: Elaine Hyshka (University of Alberta, AB)

Leadership Group: Ayden Scheim (St. Michael’s Hospital, ON); Cam Wild (University of Alberta, AB); Carole Morissette (Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal, QC); Dan Werb (St. Michael’s Hospital, ON); Lois Jackson (Dalhousie University, NS); Ryan McNeil (University of BC, BC)

Supervised consumption services (SCS), also known as overdose prevention sites (OPS), provide a safe and sterile environment where people can consume pre-obtained illegal drugs, be monitored, and receive emergency medical attention in the event of an overdose. These services provide injection equipment and other harm reduction supplies, and frequently offer referrals to other internal or external health and social supports. Numerous studies—including extensive evidence from Vancouver’s Insite—have demonstrated the positive public health impacts of SCS including: reducing the risk of overdose death, HIV incidence, and other negative health outcomes; increasing treatment and health service engagement; and mitigating disorder and debris related to public injection drug use. Canada’s national overdose crisis is precipitating an unprecedented period of SCS and OPS expansion. Up until the end of 2016 only two formal SCS had been implemented nationally. Seventeen months later, the federal Minister of Health has approved 27 SCS, and there are 7 additional SCS applications pending. In addition to federally-approved services, dozens of OPS—typically operating in impermanent locations with pared-down service models—have been opened under the purview of provincial health officials. Notwithstanding this rapid expansion, SCS remain relatively uncommon in Canada; currently only available in four provinces—British Columbia, Alberta, Ontario, and Quebec; and largely situated in major urban centers. Even within provincial jurisdictions that have opened services, some communities continue to experience delays and challenges in establishing SCS. Further, despite growing concerns about overdose in Manitoba, Saskatchewan, and parts of Atlantic Canada and the North, no significant progress towards SCS implementation has been achieved. As a result, access to SCS in Canada is best described as insufficient and highly variable, and health authorities have yet to integrate these services as a routine component of the spectrum of care available to people who use drugs (PWUD).

Inconsistent implementation of SCS despite recent progress in some settings is largely attributable to how difficult it is to establish an SCS in Canada. Securing a federal exemption can take more than a year and is contingent on a detailed and technical application that includes: evidence of community consultation; data on local conditions indicating a need for SCS; information about potential impacts on crime; finalized operational policies and procedures; security plans; a successful site inspection; among other documentation. Proponents’ efforts to build successful cases in support of SCS are further challenged by a lack of readily-available information, resources, and guidance on how to successfully demonstrate need, conduct community consultations, design, apply for, build and operate an SCS in Canada.

The present implementation science program is designed to address some of the current impediments to the scale-up and sustainability of SCS in Canada by synthesizing and disseminating existing knowledge, and generating new research evidence. Under these broad aims, we plan to address the following specific objectives:

  • Develop a national evidence-based guidance document and online resource repository to assist communities in their efforts to plan, design, secure support for, and implement SCS;
  • Promote accurate scientific communication regarding SCS through the creation of evidenced-based lay language resources explaining SCS and their potential public health impacts;
  • Systematically describe extant SCS models in Canada, examine their reach within specific target populations, and produce in-depth case studies of particularly innovative approaches.