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Opening Canada's first Health Canada-approved supervised consumption sites
Tobie Patterson1, Aamir Bharmal1, Shovita Padhi1
1Population and Public Health, Fraser Health Authority, Suite 400, Central City Tower, 13450 - 102nd Avenue, Surrey, BC, V3T 0H1, Canada.
Insights
The Supervised Consumption Site (SCS) in Surrey, BC, was established to address the opioid overdose crisis, offering services beyond supervised injection to meet diverse drug use needs and prevent overdose deaths.
Area of Science:
- Public Health
- Addiction Medicine
- Harm Reduction
Background:
- British Columbia declared a Public Health Emergency in April 2016 due to the escalating opioid overdose crisis.
- The Fraser Health Authority (FH) region experienced a significant proportion of overdose deaths in BC, with Surrey having the highest number in 2016.
- A needs assessment revealed that many overdose deaths involved drug administration routes other than injection, indicating a need for broader services.
Purpose of the Study:
- To establish a low-barrier supervised drug use site in Surrey to address the opioid overdose crisis.
- To provide services that accommodate various drug consumption methods, including oral and intranasal use, beyond traditional supervised injection.
- To tailor harm reduction services to the specific needs and drug use behaviors of the local population.
Main Methods:
- Conducted an internal assessment of supervised drug use site needs within Fraser Health Authority.
- Applied for and received an exemption from the Controlled Drug and Substances Act from Health Canada.
- Interviewed potential service users to understand drug consumption behaviors and preferred service delivery aspects.
- Opened SafePoint, a Supervised Consumption Site (SCS), offering supervised injection, oral, and intranasal consumption services.
Main Results:
- Injection was the mode of drug administration in 32.8% of overdose deaths in FH (2011-2016); other routes included oral (30.6%), smoking (28.8%), and intranasal (24.2%).
- Service user interviews confirmed diverse drug consumption behaviors and highlighted the importance of flexible hours and co-located services.
- SafePoint opened on June 8, 2017, for supervised injection and received an exemption for oral and intranasal consumption on June 26, 2017.
Conclusions:
- Assessing local drug use practices and evolving needs is crucial for effective harm reduction.
- Tailoring services to the local context can improve engagement with individuals who use substances.
- Supervised Consumption Sites offering diverse consumption methods can potentially prevent more overdoses and overdose deaths.
Setting:
In response to the opioid overdose crisis, a Public Health Emergency was declared in British Columbia (BC) in April 2016. There were 1448 deaths in BC in 2017 (30.1 deaths per 100,000 individuals).
Intervention:
Approximately one third of all overdose deaths in BC in 2016 (333/993) and 2017 (482/1448) occurred within the region served by Fraser Health Authority (FH). We identified a need for a supervised drug use site in Surrey, the city with FH's highest number of overdose deaths in 2016 (n = 122). In order to ensure low-barrier services, FH underwent an internal assessment for a supervised drug use site and determined that a supervised injection site was unlikely to meet the needs of individuals who consumed their drugs using other routes, choosing instead to apply for an exemption to the Controlled Drug and Substances Act in order to open a Supervised Consumption Site (SCS).
Outcomes:
In assessing population needs, injection was identified as the mode of drug administration in only 32.8% of overdose deaths in FH from 2011 to 2016. Other routes of drug (co-) administration included oral (30.6%); smoking (28.8%); intranasal (24.2%); and unknown/other (17.1%). Interviews with potential service users confirmed drug (co-) administration behaviours and identified other aspects of service delivery, such as hours and co-located services that would help align the services better with client needs. With Health Canada's approval, SafePoint in Surrey opened for supervised injection on June 8, 2017 and received an exemption to allow oral and intranasal consumption on June 26, 2017.
Implications:
By assessing drug use practices, the evolving needs of people who use substances, and tailoring services to local context, we can potentially engage with individuals earlier in their substance use trajectory to improve the utility of services and prevent more overdoses and overdose deaths.