Facilitating access to supervised smoking facilities: a qualitative study

The implementation of supervised smoking facilities (SSFs) as a harm reduction intervention has public health benefits for people who inhale drugs, but there are significant knowledge gaps surrounding the perspectives of SSF visitors and staff on their implementation and accessibility. We conducted this study to learn about their perspectives on barriers and facilitators to accessibility at SSFs.

The study used a community-based participatory research study design. PWUD and SSF leadership were involved in all phases of the research project as members of the research team. Between June 2021 and April 2022, we conducted 10 qualitative semi-structured interviews with peer workers and stakeholders at an SSF in Vancouver, Canada to examine perspectives on how to facilitate accessibility for visitors. Interviews were analyzed using an abductive analytic approach, themes were defined and organized collaboratively by the research team.

Peer workers and SSF leadership interviewed in the study described aspects of the SSF that contributed to a low-barrier service model and resulted in greater accessibility for visitors, including: (1) non-punitive approaches to interpersonal challenges, (2) anonymity and privacy, (3) peer involvement, and (4) physical environment. Limitations to access were also described and included: (1) age restrictions, (2) geographical location and (3) infrequent, temporary bars for certain behaviors.

Findings from this study identified many dimensions of the low-barrier SSF service model and site design that may contribute to greater accessibility for SSF visitors. Findings from this study could be used to inform the scale-up and implementation of SSFs as a harm reduction approach to reducing mortality and other negative outcomes related to the current drug toxicity crisis.