ABOUT AMSISE

Access to Medically Supervised Injection Services Edmonton (AMSISE) is made up of 25 community, medical, academic, and public sector representatives. The group has been working together since 2012 to assess the need, look at best practices in other cities, and develop a ‘made in Edmonton’ model.

AMSISE Brochure

AMSISE Community Engagement Report

Letters of Exemption from Health Canada

Wrap Around Supports:

SUPERVISED CONSUMPTION SERVICES IN EDMONTON

The AMSISE plan is to integrate medically supervised consumption services into three existing organizations that already serve people with substance use issues who are usually homeless: Boyle McCauley Health Centre, Boyle Street Community Services and George Spady Society; and a hospital for in-patients only. The model is not a storefront, stand-alone facility. Rather, it adds one more health service to reduce harm and connect individuals with social supports, primary health care, counselling and addiction treatment programs.

In each agency space will be set aside for:

  • a waiting and intake space.
  • a supervised consumption room: a calm and hygienic environment with stations, each equipped with a table and chair and a mirror for observation by a nurse.
  • a monitoring room: after consuming, people have a separate space where they are encouraged to stay in case they have a negative reaction, including an overdose. They can talk with the nurse, addiction counselor or harm reduction support worker about the resources they have in place and how to connect with other health and social supports.

Individuals are offered:

  • sterile injection supplies
  • education on safer consumption, overdose prevention and intervention
  • care for wounds and infections
  • help finding shelter, food and clothing
  • links to detox, transitional recovery, and addiction and mental health treatment.
  • links to diagnoses and care for chronic infectious and non-infectious conditions.

Staff teams will include:

  • a nurse
  • an addiction counsellor
  • a harm reduction support worker

For more information on AHS Supervised Consumption Services visit the AHS website

THE NEED FOR SUPERVISED CONSUMPTION SERVICES

Medically supervised consumption services reduce risks and costs.

Injecting in public is associated with a major increase in all the known risks of injection drug use:

  • Overdose
  • Transmission of hepatitis C and HIV
  • Most commonly, bacterial infections of the skin, bloodstream, heart valves, and joints.

Clean, safe places for consumption dramatically reduce these risks and provide opportunities to engage people with problematic substance use.

Evidence through research tells us supervised consumption services lead to:

  • Increased uptake into primary care and treatment
  • Fewer deaths through overdose
  • Decreased neighbourhood crime: studies show that occurrences of incidents such as thefts and vehicle break-ins tend to decrease after supervised consumption services are established.
  • Increased community safety: 5 years after Sydney, Australia began providing services, local business owners reported a significant decrease in public injecting or publicly discarded injecting equipment.

Insite, a stand-alone medically supervised injecting facility in Vancouver was the first to offer services in North America 14 years ago. You can read a summary of their research results here.

MEDICALLY SUPERVISED CONSUMPTION SERVICES: THE FACTS

  1. Does offering supervised consumption services encourage people to experiment with, and use, drugs?

The people for whom supervised consumption services are designed are already dealing with problematic substance use. They are usually homeless and often resort to consumption in public places because they don’t have the option of a safe environment.

  1. Will introducing supervised consumption create a ‘honey pot’ effect, attracting people from all over the city?

The supervised consumption services are designed for people who consume drugs in public: those who can consume in their own homes are less likely to use them. In an Edmonton study, individuals said they would travel up to one kilometre to use the services. Research in Vancouver revealed that people will walk up to ten blocks to inject safely.

  1. Will people who sell drugs come and target those who are there to use medically supervised consumption services?

Because medically supervised consumption will be integrated within existing facilities used by people with and without addictions, the service individuals are seeking when they enter is not obvious. Enforcement related to drug dealing remains a component of a comprehensive strategy to address substance issues.

  1. Will medically supervised consumption services eliminate existing concerns related to ‘social disorder’ in the inner city?

Medically supervised consumption services are not a silver bullet. They are one part of a comprehensive approach to promote the health and social well-being of all citizens in Edmonton’s inner city.

  1. Instead of spending money on supervised consumption services, shouldn’t we put all our resources into prevention and treatment?

To be effective we need prevention, harm reduction and treatment. No single approach is going to solve the whole problem. Supervised consumption services are one important factor in saving lives and keeping communities safe.

6. Why are the supervised consumption services being introduced in the inner core of Edmonton? Why not put them in other areas of the city?

AMSISE recognizes that there are opioid overdoses taking place in other parts of Edmonton, often among recreational users. We are starting where the need is concentrated, reducing harm for people who are largely homeless and injecting in unsafe public spaces such as back allies and washrooms. The strategy of people coming into a sterile, welcoming environment has been proven to be effective for people using substances under these circumstances but would not necessarily work for people in the mainstream who want their substance use to remain hidden. We are looking at what would be effective strategies in other parts of Edmonton.

      7. Will the three community locations be running 24/7 to offer supervised consumption services?

No. The three locations will offer small-scale supervised consumption services inside agencies where people already have relationships and can access wrap-around supports. These agencies are not extending their hours. Rather, their hours for supervised consumption services combine to provide 24/7 coverage. Not one of the agencies has the space or staffing to offer supervised consumption services around the clock.

 

For more information, please contact Shelley Williams, Chair, AMSISE at shelley.w@hivedmonton.com

Edmonton Drug Use and Health Survey, 2014

In the previous six months…

  • 80% reported injecting in public
  • 17% reported borrowing used syringes; 19% reported lending used syringes
  • 23% reported one or more non-fatal overdoses
  • 29% reported unsafe syringe disposal
  • 26% reported usually injecting alone
  • 47% reported difficulty accessing sterile syringes … 75% cited operating hours as the main access barrier
  • 85% reported having unmet care needs for mental health or substance use problems
  • 91% of those who inject drugs willing to attend supervised injection services.

You can find the full study here

Edmonton Drug Use and Health Survey, Dr. Elaine Hyshka, January 2016

A mother’s definition of harm reduction

Petra Schulz, who lost her 25 year-old son to a fentanyl overdose, provided a mother’s definition of harm reduction: “To me, harm reduction is giving the person the chance to make a better decision on another day.”

Moms Stop the Harm

Maintaining the status quo has a major impact on our healthcare system

HIV: 100 new cases in Edmonton in 2015

  • lifetime treatment costs: $380,000 per person

Hepatitis C: 600 new cases in Edmonton in 2015

  • lifetime treatment cost: $65,000 per person

Opiate and heroin poisonings at the Royal Alexandra Hospital

  • 1800 emergency visits @ $200/visit
  • 200 admissions @ $1605/day

Serious skin, soft tissue, joint, bloodstream and heart valve infections:

  • $50,000 per person, plus physician costs.