Synthetic Opioid key responses
- Mapping evidence-based key responses to synthetic opioids and their implementation strategies
- Field-tested Toolkit with seven implementation guides
Circumstances of First Injection Among Illicit Drug Users Accessing a Medically Supervised Safer Injection Facility
There have been concerns that safer injecting facilities may promote initiation into injection drug use. We examined length of injecting career and circumstances surrounding initiation into injection drug use among 1065 users of North America’s first safer injecting facility and found that the median years of injection drug use were 15.9 years, and that only 1 individual reported performing a first injection at the safer injecting facility. These findings indicate that the safer injecting facility’s benefits have not been offset by a rise in initiation into injection drug use.
METHODS: First, we examined length of injecting career. To avoid the potential bias resulting from participants’ potential unwillingness to report that their first injection was within the safer injecting facility, we calculated duration of injection drug use by subtracting each participant’s age at first injection from the participant’s current age rather than asking this question directly. Later in the interview, we assessed the circumstances surrounding initiation into injection drug use among SEOSI participants. Variables of interest included injection by someone else during first injection, injection with a used syringe during first injection, and location of first injection (including within the safer injecting facility). As a subanalysis, we compared the overall rate of initiation into injection drug use among SEOSI participants since the safer injecting facility had opened with the expected rate of initiation among local street youths during a similar follow-up period.
Consumption and Treatment Services (CTS) Planning Study for the City of Cambridge
The City’s Official Plan and Zoning By-laws do not currently include policies or regulations for consumption and treatment services and/or other similar services. The interim control by-law, under the Planning Act, puts a hold on any sites being established until land-use rules can be developed. The hold applies to the three core areas of Hespeler, Preston and Galt (with buffer areas of 500 metres).
The planning study provides Official Plan policy and zoning recommendations for consumption and treatment services and/or other similar services. The planning study reviews Federal and Provincial criteria for the siting of consumption and treatment services, along with other land use compatibility considerations.
Consumption and Treatment Services: Application guide
The federal government (Health Canada) remains responsible for granting exemptions to Section 56.1 of the Controlled Drugs and Substances Act (CDSA) to operate Supervised Consumption Services (SCS). Ontario is augmenting Health Canada’s SCS program to include requirements for treatment and support services (herein referred to as Consumption and Treatment Services [CTS]). In order to receive provincial funding for CTS, applicants must demonstrate their proposed service meets federal requirements, as well as additional requirements under Ontario’s CTS program. The Consumption and Treatment Services: Application Guide provides guidance on the provincial CTS program requirements and the application process.
Consumption Spaces Consultation and Needs Assessment. Winnipeg
This study took place on the ancestral lands of the Anishinaabeg, Cree, Oji-Cree, Dene, and Dakota peoples, and the homeland of the Métis nation, Treaty 1 territory. We approach this project in partnership and collaboration and with a commitment to reconciliation.
This study captured perspectives on safety and harms of drug use as they relate to spaces in which drugs are consumed, with implications for SCS in inner-city Winnipeg.
The characteristics of desirable and safe spaces for drug consumption described by participants reflected the principles of harm reduction: pragmatic, non-judgemental, respect for autonomy, privacy, resources, meaningful involvement, and inclusion. Some of the desirable spatial characteristics described are key features of SCS (material supplies, access to resources, human support or helpers), while other desirable characteristics such as convenience, privacy, and autonomy, are more challenging for SCS to deliver. Still, many participants indicated that they would likely access SCS, provided services are developed according to the priorities and values of those who would use them.
Providers were supportive of SCS, but realistic about the challenges for development and implementation in the local context. Still, providers were supportive of efforts to establish SCS if this is a service that people who use drugs would value and access.
Crime & Disorder near the Sheldon M. Chumir Health Centre’s Supervised Consumption Services (SCS) Facility
The Calgary Police Service supports the medically endorsed, evidence-based spectrum of treatment and services designed to serve the needs of those with addiction-related issues, and the communities of which they are a part. The Service recognizes that supervised consumption sites are one piece of a broader set of programs, policies, and practices that fall under the umbrella of harm reduction.
On January 29, 2019, the Calgary Police Service released the report “Crime & Disorder near the Sheldon M. Chumir Health Centre’s Supervised Consumption Services (SCS) Facility: 2018 Statistical Overview” which showed an increase in crime and disorder within the area over the three-year average. Since that report, the CPS has made concerted efforts to address crime and disorder issues while continuing to be actively engaged with community and agency partners.
The purpose of this report is to provide a statistical overview of reported crime and disorder for the 1st quarter (Q1) of 2019 in the 250m study area around the SCS. The statistics reported here are not directly comparable to the previous yearly report, as such, please see the Appendix for a quarterly and yearly comparisons. The analysis in this report includes a comparison of the study area to the Centre City and the rest of the city, and a timeline from January 2018 to March 2019. The findings show that increased police presence in 2019 corresponds to decreased crime and disorder issues.
Critical studies of harm reduction: Overdose response in uncertain political times
North America continues to witness escalating rates of opioid overdose deaths. Scale-up of existing and innovative life-saving services – such as overdose prevention sites (OPS) as well as sanctioned and unsanctioned supervised consumption sites – is urgently needed. Is there a place for critical theory-informed studies of harm reduction during times of drug policy failures and overdose crisis? There are different approaches to consider from the critical literature, such as those that, for example, interrogate the basic principles of harm reduction or those that critique the lack of pleasure in the discourses surrounding drug use. Influenced by such work, we examine the development of OPS in Canada, with a focus on recent experiences from the province of Ontario, as an important example of the impacts associated with moving from grassroots harm reduction to institutionalised policy and practice. Services appear to be most innovative, dynamic, and inclusive when people with lived experience, allies, and service providers are directly responding to fast-changing drug use patterns and crises on the ground, before services become formally bureaucratised. We suggest a continuing need to both critically theorise harm reduction and to build strong community relationships in harm reduction work, in efforts to overcome political moves that impede collaboration with and inclusiveness of people who use drugs.
Debating Safe Injecting Sites in Vancouver's Inner City: Advocacy, Conservatism and Neoliberalism
North America's first and only legal, supervised injection site is located in Vancouver and has been one of Canada's most controversial biomedical interventions. Emerging from a progressive harm reduction model, and adopted in many cities around the globe from Sydney to Paris, safe injection facilities are considered by many to be the hallmark of innovative programming for the urban poor. In Vancouver, an intense public debate resulted, focusing attention on addictions, the rights of drug users, and the politics of knowledge. Drawing on the work of Nikolas Rose and Michel Foucault, this ethnographic article suggests that the politics of activism and care that have emerged from the Insite controversy among scientists, researchers, and advocates are characterized by a neoliberal logic, which limits the full potential of this health care intervention. This article considers the specific ways in which scientists and advocates inadvertently adopted neoliberal techniques of governing and conservative politics.
Designing the Debate: Assessing the Role of Design Practices in Safe Injection Sites
A safe injection site is an urban public health intervention that saves lives. While they remain illegal in the United States, safe injection sites (SIS) reduce incidences of death and disease related to injection drug use in the cities where they exist. As in many healthcare facilities, the design of SIS must be considered to ensure their success. This thesis determines to what extent design frameworks for health and healthcare are being applied to urban public health interventions, such as SIS, and how design is used to improve user experiences of SIS. Previously conducted studies suggest that established design frameworks meant to improve physical and psychological patient outcomes are exclusively applied to private, residential healthcare facilities as opposed to public, short term healthcare facilities like SIS. However, an analysis of SIS in Amsterdam, the Netherlands and Vancouver, Canada reveals that these spaces are highly designed to improve user safety, hygiene, and stress levels. Similarly, harm reduction organizations in the U.S. have intentionally used design to the same end in both their own spaces and in proposals for hypothetical SIS. Drawing from the design strategies uncovered in these findings, designs for a SIS in the U.S. have been proposed in consideration of the controversial debate that has caused them to be rejected by politicians. This study counters prevailing wisdom in literature that designing for healthcare occurs exclusively in private, residential facilities. In fact, design is critical to the success of urban public health interventions, including SIS.
Do supervised injecting facilities attract higher-risk injection drug users?
BACKGROUND: In Western Europe and elsewhere, medically supervised safer injection facilities (SIFs) are increasingly being implemented for the prevention of health- and community-related harms among injection drug users (IDUs), although few evaluations have been conducted, and there have been questions regarding SIFs' ability to attract high-risk IDUs. We examined whether North America's first SIF was attracting IDUs who were at greatest risk of overdose and blood-borne disease infection.
METHODS: We examined data from a community-recruited cohort study of IDUs. The prevalence of SIF use was determined based on questionnaire data obtained after the SIF's opening, and we determined predictors of initiating future SIF use based on behavioral information obtained from questionnaire data obtained before the SIF's opening. Pearson's chi-square test was used to compare characteristics of IDUs who did and did not subsequently initiate SIF use.
RESULTS: Overall, 400 active injection drug users returned for follow-up between December 1, 2003 and May 1, 2004, among whom 178 (45%) reported ever using the SIF. When we examined behavioral data collected before the SIF's opening, those who initiated SIF use were more likely to be aged <30 years (odds ratio [OR]=1.6, 95% confidence interval [CI]=1.0-2.7], p=0.04); public injection drug users (OR=2.6, 95% CI=1.7-3.9, p<0.001); homeless or residing in unstable housing (OR=1.7, 95% CI=1.2-2.7, p=0.008); daily heroin users (OR=2.1, 95% CI=1.3-3.2, p=0.001); daily cocaine users (OR=1.6, 95% CI=1.1-2.5, p=0.025); and those who had recently had a nonfatal overdose (OR=2.7, 95% CI=1.2-6.1, p=0.016).
CONCLUSIONS: This study indicated that the SIF attracted IDUs who have been shown to be at elevated risk of blood-borne disease infection and overdose, and IDUs who were contributing to the public drug use problem and unsafe syringe disposal problems stemming from public injection drug use.
Does evidence support supervised injection sites?
Clinical question: Do supervised injection sites (SISs) reduce mortality,
hospitalizations, ambulance calls, or disease.
Bottom line: Best evidence from cohort and modeling studies suggests that SISs are associated with lower overdose mortality (88 fewer overdose deaths per 100 000 person-years [PYs]), 67% fewer ambulance calls for treating overdoses, and a decrease in HIV infections. Effects on hospitalizations are unknown.
