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Onsite Harm Reduction Services

The significant increase in overdose deaths over the last 5 years across Canada has spurred the implementation of multiple overdose intervention services, and an expansion of safe consumption sites and services (SCS) and overdose prevention sites (OPS). To date, no one has ever died at either type of facility. During COVID-19, group members indicated that these sites have helped reduce the spread of COVID by implementing public health orders including measures to social distance and providing hand hygiene products - situations that aren’t often possible on the street. 

 

Safe Consumption Sites and Services: How do they work?

A person brings their drugs to a site to consume and depending on the site, drugs are injected, snorted, inhaled or consumed as a pill. Trained staff are available to help if there is an accidental overdose. Other services offered include drug checking (see policy #4 for more info); testing for infectious diseases; education on harm reduction practices; and access to treatment medications. SCS facilities are exempted by Health Canada under section 56 of the Controlled Drugs and Substances Act, so that people can use their own illicit drugs in front of staff without being prosecuted for drug possession.

Benefits:

  • reduces risk of accidental overdose because people are not rushing or using alone;

  • connects people to social services (e.g. housing, food banks), healthcare and treatment; and

  • reduces spread of infectious diseases, such as HIV.

Current issues:

  • needs of the community are often not met due to restricted hours of operation for sites and the types of services provided which is typically a result of lack of funding;

  • limited access to SCS outside of major cities, impacting the safety of people who use drugs (PWUD) in rural areas. It is very time consuming to establish a SCS, often taking up to several years to get an approval due to the legal and bureaucratic barriers

 

What are Overdose Prevention Sites?

OPS operate similarly to SCS; people can use their own illicit drugs and access clean equipment, and staff are trained to respond to emergency overdoses. OPS were started as a non-sanctioned, “community-based response to overdose deaths” that are typically run by people with lived and living expertise (PWLE) and tend to be less medicalized compared to SCS (sometimes operating out of tents in public parks).

 

Benefits:

  • Life saving and reduced risk of overdose

  • Significantly fewer barriers to establishing an OPS compared to a SCS – typically operating through temporary province-wide exemptions from the federal government.

  • Connection of PWUD to PWLE who offer expertise and direct experience.

  • A less medicalized setting to better facilitate access for more marginalized populations.

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 Current issues:

  • Since these sites are more informal than SCS and are typically operated by PWLE, there is often a lack of support by municipalities and Health Authorities.

  • As they were initially developed as an emergency response to overdose crises, their permanency is unclear.  

 

Both SCS and OPS have received significant political pushback. Many see OPS and SCS as “enabling addiction,” and argue that the public shouldn’t be spending tax dollars supporting drug use. Again, this is a significantly outdated point of view that doesn’t take into account the positive impacts of these sites.

 

Another harm reduction service that can be either combined with OPS/SCS or operate as a standalone service is drug checking. ‘Drug checking’ refers to a series of different techniques where people can come and get their drugs tested to determine either the contents or purity. As one of our members noted:

“I’m not saying we won’t get an overdose but the chances are much lower. It’s a lower chance of an overdose... because you know, like people don’t know what they’re buying. You know, they’re paying money and they don’t know what they’re getting. When you look at all the difference in the drug supply, it is too poisonous and it’s too toxic. So for that, as a result of that, people are very angry.”

Drug checking, OPS/SCS are some of the many services that exist in Canada that are able to reduce the risks associated with drug consumption in poisoned drug supply. They are, however, not substitutes for safe supply, which would replace the volatile drug market with pharmaceutical grade alternatives.

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