Hamilton Supervised Injection Site Needs Assessment & Feasibility Study

Background: Drug and substance misuse is an important public health issue with significant impacts on the individual and the community. Health and social impacts include death from overdose, inability to work, family disruption and grief, crime, mental illness and addictions, unstable housing, degradation of public spaces, and concerns about neighbourhood safety. Specific to injection drug use, harms include the spread of infectious diseases such as hepatitis C virus (HCV) and human immunodeficiency virus (HIV), and the production of injection litter in the community.
Supervised injection sites (SISs) are locations where people take pre-obtained illicit drugs and inject them in a clean and supervised environment. Staff at SISs are able to respond quickly and effectively to overdoses and can link injection drug users to other health and social support services. As a harm reduction measure, SISs do not require the cessation of injection drug use, but work to minimize the risks associated with injection drug use.
In December 2016, the City of Hamilton Public Health Services (HPHS), the local public health authority for Hamilton, Ontario, was directed by its Board of Health to conduct a needs assessment and feasibility study on SISs in Hamilton in 2017.
Objectives: The objectives of the Hamilton Supervised Injection Site Needs Assessment and Feasibility Study (SIS NAFS) were:
1. To determine the need for one or more supervised injection sites (SISs) in the City of Hamilton;
2. To determine the feasibility of one or more SISs for Hamilton, including the recommended number, geographical location(s), and model type (integrated, stand alone, or mobile);
3. To involve the community and stakeholders in consultation and discussions about issues associated with drug use in Hamilton, and the feasibility of supervised injection sites as a measure to improve health among people who inject drugs.
Methods: The SIS NAFS was a mixed-methods study comprised of quantitative and qualitative components. The quantitative portion aimed to describe the need for SISs in Hamilton by analyzing available health and crime information. Health information included data on drug use and misuse, fatal and non-fatal overdoses in Hamilton, bloodborne infections and drugrelated risk factors, as well as harm reduction service demand.
The qualitative, community-based portion of the study aimed to consult community stakeholders about the need for, and feasibility of, SISs in Hamilton. The qualitative study had three major components: a survey of people who inject drugs (PWID); key informant interviews; and focus groups.