![SCMR Argos Strasbourg novembre 2016-4](https://upload.wikimedia.org/wikipedia/commons/2/21/SCMR_Argos_Strasbourg_novembre_2016-4.jpg)
Supervised injection sites (SIS)
are medically supervised facilities designed to provide a hygienic environment in which people are able to
consume illicit recreational drugs intravenously and prevent deaths due to
drug overdose
A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended. s.
The legality of such a facility is dependent by location and political jurisdiction. Supervised injection sites are part of a
harm reduction
Harm reduction, or harm minimization, refers to a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to de ...
approach towards drug problems. The facilities provide sterile injection equipment, information about drugs and basic health care, treatment referrals, access to medical staff, and, at some facilities, counseling. Most programs prohibit the sale or purchase of recreational drugs at the facility.
Terminology
They are also known as ''overdose prevention centers (OPC)'',
''supervised injection facilities'', ''safe consumption rooms'', ''safe injection sites'',
''safe injection rooms'', ''fix rooms'',
''fixing rooms'',
''safer injection facilities (SIF)'', ''drug consumption facilities (DCF)'',
''drug consumption rooms (DCRs)'', and ''harm reduction centers''.
Facilities
Australia
"Shooting galleries" (the term "shooting" is slang for injecting drugs) have existed for a long time; there were illicit for-profit facilities in
Sydney, Australia
Sydney ( ) is the capital city of the States and territories of Australia, state of New South Wales, and the most populous city in both Australia and List of cities in Oceania by population, Oceania. Located on Australia's east coast, the metro ...
during the 1990s. Authors differentiated the legally sanctioned sites in Australia from those examples in the care they provide. While the operators of the shooting galleries exemplified in Sydney had little regard for the health of their clients, modern supervised injection facilities are a professionally staffed health and welfare service.
The same journal describes the same facility in Australian context as "in general" may be defined as "legally sanctioned and supervised facilities designed to reduce the health and public order problems associated with illegal injection drug use"
The legality of supervised injection is handled on a state-by state basis.
New South Wales
)
, nickname =
, image_map = New South Wales in Australia.svg
, map_caption = Location of New South Wales in AustraliaCoordinates:
, subdivision_type = Country
, subdivision_name = Australia
, established_title = Before federation
, es ...
trialed a supervised injection site in
Sydney
Sydney ( ) is the capital city of the state of New South Wales, and the most populous city in both Australia and Oceania. Located on Australia's east coast, the metropolis surrounds Sydney Harbour and extends about towards the Blue Mountain ...
in 2001, which was made permanent in 2010.
Victoria
Victoria most commonly refers to:
* Victoria (Australia), a state of the Commonwealth of Australia
* Victoria, British Columbia, provincial capital of British Columbia, Canada
* Victoria (mythology), Roman goddess of Victory
* Victoria, Seychelle ...
also opened a supervised injection site in
Melbourne
Melbourne ( ; Boonwurrung/Woiwurrung: ''Narrm'' or ''Naarm'') is the capital and most populous city of the Australian state of Victoria, and the second-most populous city in both Australia and Oceania. Its name generally refers to a met ...
in 2018 on a trial basis; in 2020 the trial was extended for a further three years and a second site approved.
Europe
The first professionally staffed service where drug injection was accepted emerged in the Netherlands during the early 1970s as part of the "alternative youth service" provided by the St. Paul's church in Rotterdam. At its peak it had two centers that combined an informal meeting place with a drop-in center providing basic health care, food and a laundering service. One of the centers was also a pioneer in providing
needle-exchange. Its purpose was to improve the psychosocial function and health of its clients. The centers received some support from law enforcement and local government officials, although they were not officially sanctioned until 1996.
The first modern supervised consumption site was opened in
Bern
german: Berner(in)french: Bernois(e) it, bernese
, neighboring_municipalities = Bremgarten bei Bern, Frauenkappelen, Ittigen, Kirchlindach, Köniz, Mühleberg, Muri bei Bern, Neuenegg, Ostermundigen, Wohlen bei Bern, Zollikofen
, website ...
e, Switzerland in June, 1986. Part of a project combatting HIV, the general concept of the café was a place where simple meals and beverages would be served, and information on safe sex, safe drug use, condoms and clean needles provided. Social workers providing counselling and referrals were also present. An injection room was not originally conceived, however, drug users began to use the facility for this purpose, and this soon became the most attractive aspect of the café. After discussions with the police and legislature, the café was turned into the first legally sanctioned drug consumption facility provided that no one under the age of 18 was admitted.
During the 1990s additional legal facilities emerged in other cities in Switzerland, Germany and the Netherlands.
In the first decade of 2000, facilities opened in Spain, Luxembourg, and Norway.
![NaloxoneKit](https://upload.wikimedia.org/wikipedia/commons/d/d3/NaloxoneKit.jpg)
Whereas injection facilities in Europe often evolved from something else, such as different social and medical outreaches or perhaps a homeless shelter, the degree and quality of actual supervision varies. The history of the European centers also mean that there have been no or little systematic collection of data needed to do a proper evaluation of effectiveness of the scheme. At the beginning of 2009 there were 92 facilities operating in 61 cities, including 30 cities in the Netherlands, 16 cities in Germany and 8 cities in Switzerland. Denmark passed a law allowing municipalities to run "fix rooms" in 2012, and by the end of 2013 there were three open. The United Kingdom opened one (officially unsanctioned) facility in Glasgow in September 2020. It was opened by Peter Krykant, a local drugs worker; however, lack of funding and support led to its closure in May 2020. Ireland has legislation to permit the opening of a service (as of May 2017) in the Misuse of Drugs (Supervised Injecting Facilities) Bill 2017, however, has been halted by planning concerns.
To date in July 2022, according to
European Monitoring Centre for Drugs and Drug Addiction
The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is an agency of the European Union located in Lisbon, Portugal, and established in 1993. In June 2022, the Council of the European Union approved a reform of the organization w ...
Belgium has one facility, Denmark five, France two, Germany 25, Greece one, Luxembourg two, Netherlands 25, Norway two, Portugal two, Spain 13, and Switzerland 14.
Canada
There are 39 government authorized SCS in Canada as of July 2019. 19 in
Ontario
Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central Ca ...
, 9 in
British Columbia
British Columbia (commonly abbreviated as BC) is the westernmost province of Canada, situated between the Pacific Ocean and the Rocky Mountains. It has a diverse geography, with rugged landscapes that include rocky coastlines, sandy beaches, ...
, 7 in
Alberta
Alberta ( ) is one of the thirteen provinces and territories of Canada. It is part of Western Canada and is one of the three prairie provinces. Alberta is bordered by British Columbia to the west, Saskatchewan to the east, the Northwest Ter ...
and 4 in
Quebec
Quebec ( ; )According to the Canadian government, ''Québec'' (with the acute accent) is the official name in Canadian French and ''Quebec'' (without the accent) is the province's official name in Canadian English is one of the thirtee ...
An exemption to controlled substances law under
Canadian Criminal Code is granted inside the facilities, but drug possession remains illegal outside the facility and there is no buffer zone around the facility.
Canada's first SCS,
Insite
Insite is the first legal supervised drug injection site in North America, located at 139 East Hastings Street, in the Downtown Eastside (DTES) neighbourhood of Vancouver, British Columbia. The DTES had 4700 chronic drug users in 2000 and ha ...
in
Downtown Eastside
The Downtown Eastside (DTES) is a neighbourhood in Vancouver, British Columbia, Canada. One of the city's oldest neighbourhoods, the DTES is the site of a complex set of social issues including disproportionately high levels of drug use, homeles ...
of
Vancouver
Vancouver ( ) is a major city in western Canada, located in the Lower Mainland region of British Columbia. As the List of cities in British Columbia, most populous city in the province, the 2021 Canadian census recorded 662,248 people in the ...
, commenced operation in 2003.
In August 2020, the largest SCS in North America
ARCHES Lethbridge
ARCHES is a non-profit organization based in Lethbridge, Alberta, that works to reduce the harm associated with HIV/AIDS and Hepatitis C, known for operating the province-funded Lethbridge Supervised Consumption Site from February 2018 until closi ...
located in
Lethbridge
Lethbridge ( ) is a city in the province of Alberta, Canada. With a population of 101,482 in its 2019 Alberta municipal censuses, 2019 municipal census, Lethbridge became the fourth Alberta city to surpass 100,000 people. The nearby Canadian ...
,
Alberta
Alberta ( ) is one of the thirteen provinces and territories of Canada. It is part of Western Canada and is one of the three prairie provinces. Alberta is bordered by British Columbia to the west, Saskatchewan to the east, the Northwest Ter ...
closed shortly after province revoked their grant for misuse of grant funds. It had been open since February 2018
and after it opened, it started causing calls for police service and opioid related EMS calls to the immediate vicinity.
Three weeks after its closure, the city already noticed a 36% decline in opioid related requests for
emergency medical service
Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
.
Expenditure
The average per-capita operating cost of government sanctioned sites are reported to be CAD$600 per unique-client; with the exception of the ARCHES Lethbridge which had a disproportionately high cost of CAD $3,200 per unique client.
Unauthorized site in Alberta
In September 2020, a group in
Lethbridge
Lethbridge ( ) is a city in the province of Alberta, Canada. With a population of 101,482 in its 2019 Alberta municipal censuses, 2019 municipal census, Lethbridge became the fourth Alberta city to surpass 100,000 people. The nearby Canadian ...
,
Alberta
Alberta ( ) is one of the thirteen provinces and territories of Canada. It is part of Western Canada and is one of the three prairie provinces. Alberta is bordered by British Columbia to the west, Saskatchewan to the east, the Northwest Ter ...
led by an ARCHES employee started hosting an unauthorized SCS in public places in a tent.
The group did not have authorizations to operate an SCS or a permit to pitch a tent in the park. The organizer was issued citations for the tent; and the
Lethbridge Police Service
The Lethbridge Police Service, formerly known as the Lethbridge Regional Police Service, was established 1905, and serves the city of Lethbridge, a community in southern Alberta of approximately 101,482 in its 2019 municipal census.
History
T ...
advised that users utilizing the unauthorized SCS would be arrested for drug possession, because exemptions do not apply to unauthorized sites. This opening of this illegal drug consumption tent was controversial and became a subject of discussion at the City Council meeting.
United States
Clandestine injection sites have existed for years. A
New England Journal of Medicine
''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. It is among the most prestigious peer-reviewed medical journals as well as the oldest continuously published one.
Hist ...
study from July 2020 reports that an illegal supervised consumption site has been operating at an "undisclosed" city in the U.S. since 2014 where over 10,000 doses of illegal drugs have been injected over a five-year period. Supervised consumption sites with some degree of official sanction from a state or local government have been contemplated, but are rare due to the
federal regulation of drugs and the explicit opposition of federal law enforcement to any form of
decriminalization
Decriminalization or decriminalisation is the reclassification in law relating to certain acts or aspects of such to the effect that they are no longer considered a crime, including the removal of criminal penalties in relation to them. This reform ...
.
Denver (2018)
In November, 2018,
Denver
Denver () is a consolidated city and county, the capital, and most populous city of the U.S. state of Colorado. Its population was 715,522 at the 2020 census, a 19.22% increase since 2010. It is the 19th-most populous city in the Unit ...
city council approved a pilot program for a safe injection site with a 12-to-1 vote. The
Drug Enforcement Administration
The Drug Enforcement Administration (DEA; ) is a Federal law enforcement in the United States, United States federal law enforcement agency under the U.S. Department of Justice tasked with combating drug trafficking and distribution within th ...
's Denver field office and the
United States Attorney
United States attorneys are officials of the U.S. Department of Justice who serve as the chief federal law enforcement officers in each of the 94 U.S. federal judicial districts. Each U.S. attorney serves as the United States' chief federal c ...
's office for the
District of Colorado
The United States District Court for the District of Colorado (in case citations, D. Colo. or D. Col.) is a federal court in the United States Court of Appeals for the Tenth Circuit, Tenth Circuit (except for patent claims and claims against ...
issued a statement together on the proposed site stating that "the operation of such sites is illegal under federal law. 21 U.S.C. Sec. 856 prohibits the maintaining of any premises for the purpose of using any controlled substance."
Philadelphia (2020)
A safe injection site in the United States was projected to open in
Philadelphia
Philadelphia, often called Philly, is the largest city in the Commonwealth of Pennsylvania, the sixth-largest city in the U.S., the second-largest city in both the Northeast megalopolis and Mid-Atlantic regions after New York City. Sinc ...
February 2020, under the auspices of the organization Safehouse and with the support of the city government. Immediate neighbors strongly objected to the site, and the owner of the first proposed location withdraw a lease offer under pressure.
United States District Attorney
United States attorneys are officials of the U.S. Department of Justice who serve as the chief federal law enforcement officers in each of the 94 U.S. federal judicial districts. Each U.S. attorney serves as the United States' chief federal c ...
William McSwain sued to stop the Safehouse project, losing in district court in October 2019, but winning an injunction in January 2021 from a 3-judge panel of the
United States Court of Appeals for the Third Circuit
The United States Court of Appeals for the Third Circuit (in case citations, 3d Cir.) is a federal court with appellate jurisdiction over the district courts for the following districts:
* District of Delaware
* District of New Jersey
* Ea ...
.
Safehouse said its proposed operation was "a legitimate medical intervention, not illicit drug dens" and claimed protection under the
Free Exercise Clause
The Free Exercise Clause accompanies the Establishment Clause of the First Amendment to the United States Constitution. The ''Establishment Clause'' and the ''Free Exercise Clause'' together read:
Free exercise is the liberty of persons to re ...
because "religious beliefs compel them to save lives at the heart of one of the most devastating overdose crises in the country".
Maine (2021)
Similar to Safehouse, Jesse Harvey attempted to claim religious freedom protection by forming the Church of Safe Injection in Maine. After his death from a drug overdose, the organization obtained a relaxation in regulations from the governor of Maine and approval from the Maine CDC to operate as an authorized
needle exchange
A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It ...
in several cities (but not a supervised injection site).
New York City (2021)
The first government-authorized supervised injection sites that began operating in New York City on November 30, 2021 with the approval of
Mayor Bill de Blasio. The
New York City Department of Health and Mental Hygiene
The New York City Department of Health and Mental Hygiene is the department of the government of New York City responsible for public health along with issuing birth certificates, dog licenses, and conducting restaurant inspection and enforcem ...
refers to the initiatives as "overdose prevention centers" (OPC); they are attached to the pre-existing
syringe exchange programme sites. A peer-reviewed study of the first two months of the OPC's operation has been published in
JAMA
''The Journal of the American Medical Association'' (''JAMA'') is a peer-reviewed medical journal published 48 times a year by the American Medical Association. It publishes original research, reviews, and editorials covering all aspects of biom ...
. News media have been allowed access to the OPC sites as well.
Public criticism of the New York City OPC's has so far been limited. One problem brought up by the leadership of the
Metropolitan Transportation Authority
The Metropolitan Transportation Authority (MTA) is a public benefit corporation responsible for public transportation in the New York City metropolitan area of the U.S. state of New York. The MTA is the largest public transit authority in th ...
is how use migrates from the centers to nearby
New York City Subway
The New York City Subway is a rapid transit system owned by the government of New York City and leased to the New York City Transit Authority, an affiliate agency of the state-run Metropolitan Transportation Authority (MTA). Opened on October 2 ...
stations when the OPC's are closed. In response
Mayor Eric Adams called for the centers to be funded to operate continuously.
Though sanctioned by the city, the sites arguably remain illegal under federal law, and rely on non-enforcement by federal officials to keep operating. The
United States Department of Justice
The United States Department of Justice (DOJ), also known as the Justice Department, is a federal executive department of the United States government tasked with the enforcement of federal law and administration of justice in the United State ...
, during the
Presidency of Joe Biden
Joe Biden's tenure as the 46th president of the United States began with his inauguration on January 20, 2021. Biden, a Democrat from Delaware who previously served as vice president under Barack Obama, took office following his victory ...
, has signaled some openness and stated that it is "evaluating supervised consumption sites, including discussions with state and local regulators about appropriate guardrails for such sites, as part of an overall approach to harm reduction and public safety."
Elsewhere
Local governments in San Francisco, Seattle, Boston, Vermont, Delaware, and Portland, Oregon have considered opening safe injection sites as well. Plans to open an injection site in
Somerville, Massachusetts
Somerville ( ) is a city located directly to the northwest of Boston, and north of Cambridge, Massachusetts, Cambridge, in Middlesex County, Massachusetts, United States. As of the 2020 United States Census, the city had a total population of 81, ...
in 2020 were delayed by the
COVID-19 pandemic
The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identif ...
.
Evaluations
In the late 1990s there were a number of studies available on consumption rooms in Germany, Switzerland and the Netherlands. “The reviews concluded that the rooms contributed to improved public and client health and reductions in public nuisance but stressed the limitations of the evidence and called for further and more comprehensive evaluation studies into the impact of such services.” To that end, the two non-European injecting facilities, Australia’s Sydney Medically Supervised Injecting Centre (MSIC) and Canada’s Vancouver Insite Supervised Injection Site have had more rigorous research designs as a part of their mandate to operate.
The
NSW
)
, nickname =
, image_map = New South Wales in Australia.svg
, map_caption = Location of New South Wales in AustraliaCoordinates:
, subdivision_type = Country
, subdivision_name = Australia
, established_title = Before federation
, es ...
state government has provided extensive funding for ongoing evaluations of the Sydney MSIC, with a formal comprehensive evaluation produced in 2003, 18 months after the centre was opened. Other later evaluations studied various aspects of the operationservice provision (2005), community attitudes (2006), referral and client health (2007) and a fourth (2007) service operation and overdose related events. Other evaluations of drug-related crime in the area were completed in 2006, 2008 and 2010, the SAHA International cost-effectiveness evaluation in 2008 and a final independent KPMG evaluation in 2010.
The
Vancouver Insite facility was evaluated during the first three years of its operation by researchers from the BC Center for Excellence in HIV/AIDS with published and some unpublished reports available. In March 2008 a final report was released that evaluated the performance of the Vancouver Insite against its stated objectives.
Some posit that safe injection sites help reduce improperly discarded needles in public. This was found to be the case in a report by the
Canadian Mental Health Association
The Canadian Mental Health Association (CMHA) is a Canadian non-profit mental health organization that focusing on resources, programs and advocacy. It was founded on April 22, 1918, by Dr. Clarence M. Hincks and Clifford W. Beers. Originally nam ...
in 2018. Prior to the establishment of a supervised injection site in
Vesterbro, Copenhagen
Vesterbro is one of the 15 administrative, statistical, and city tax districts (''bydele'') comprising the municipality of Copenhagen, Denmark. It covers an area of 3.76 km², and has a population of 51,466 and a population density of 13, ...
in Denmark in 2012, up to 10,000 syringes were found on its streets each week. Within a year of the supervised injection site opening this number fell to below 1,000.
There has been some attempt to standardise evaluation reporting across supervised injection sites in a type of
Core outcome set with researchers from the United States funded by
Drug Policy Alliance
The Drug Policy Alliance (DPA) is a New York City–based nonprofit organization that seeks to advance policies that “reduce the harms of both drug use and drug prohibition, and to promote the sovereignty of individuals over their minds and b ...
available; however, the intermediary process of how this consensus set was generated is unpublished.
The Expert Advisory Committee found that Insite had referred clients such that it had contributed to an increased use of detoxification services and increased engagement in treatment. Insite had encouraged users to seek counseling. Funding has been supplied by the Canadian government for detoxification rooms above Insite.
[see ]
SIS sites and social disorder
A longitudinal studyUrban Social Issues Study (USIS)from January 2018 and February 2019undertaken by
University of Lethbridge
, mottoeng = ''Let there be light''
, type = Public
, established =
, academic_affiliations = Universities Canada
, endowment = $73 million (2019)
, chancellor = Charles Weasel ...
's professor Em M. Pijl and commissioned by the
City of Lethbridge,
Alberta
Alberta ( ) is one of the thirteen provinces and territories of Canada. It is part of Western Canada and is one of the three prairie provinces. Alberta is bordered by British Columbia to the west, Saskatchewan to the east, the Northwest Ter ...
, Canada explore "any unintended consequences" of supervised consumption services (SCS) within the "surrounding community".
[ Report commissioned by the City of Lethbridge] The USIS study was undertaken in response to a drug crisis in Lethbridge that impacted "many neighbourhoods in many different ways." Researchers studied the "perceptions and observations of social disorder by business owners and operators" in a neighborhood where SCS was introduced.
The report cautioned, that drug abuse-related antisocial behavior in Lethbridge, in particular, and in cities, in general, has increased, as the "quantity and type of drugs in circulation" increases. As the use of
crystal meth
Methamphetamine (contracted from ) is a potent central nervous system (CNS) stimulant that is mainly used as a recreational drug and less commonly as a second-line treatment for attention deficit hyperactivity disorder and obesity. Methamphe ...
eclipses the use of opiates, users exhibit more "erratic behavior". Crystal meth and other "uppers" also "require more frequent use" than "downers" like opiates.
The report also notes that not all social disorder in communities that have a SCS, can be "unequivocally and entirely attributed" to the SCS, partly because of the "ongoing drug epidemic."
Other variables that explain increased anti-social behaviour includes an increase in the number of people aggregating outdoors as part of seasonal trends with warmer temperatures.
Philadelphia
Philadelphia, often called Philly, is the largest city in the Commonwealth of Pennsylvania, the sixth-largest city in the U.S., the second-largest city in both the Northeast megalopolis and Mid-Atlantic regions after New York City. Sinc ...
's ''
WPVI-TV
WPVI-TV (channel 6), branded on-air as 6 ABC, is a television station in Philadelphia, Pennsylvania, United States, airing programming from the ABC network. Owned and operated by the network's ABC Owned Television Stations division, the station ...
'' Action News team traveled to
Toronto
Toronto ( ; or ) is the capital city of the Canadian province of Ontario. With a recorded population of 2,794,356 in 2021, it is the most populous city in Canada and the fourth most populous city in North America. The city is the ancho ...
, Canada in 2018 to make first hand field observations of several safe consumption sites already in operation. A drug addict interviewed by the reporter said she visits the site to obtain supply, but did not stick around and used the supplies to shoot up drugs elsewhere and acknowledged the site attracts drug users and drug dealers. A neighbor interviewed by the reporter said there was drug use before, but he reports it has increased since the site opened.
WPVI-TV's Chad Pradelli narrated the news team's observation as:
Over the two days we sat outside several of Toronto's safe injection facilities, we witnessed prevalent drug use out front, drug deals, and even violence. We watched as one man harassed several people passing by on the sidewalk, even putting one in a chokehold. One guy decided to fight back and security arrived.
Sydney, Australia
The Sydney MSIC client survey conducted in 2005, found that public injecting (defined as injecting in a street, park, public toilet or car), which is a high risk practice with both health and public amenity impacts, was reported as the main alternative to injecting at the MSIC by 78% of clients. 49% of clients indicated resorting to public injection if the MSIC was not available on the day of registration with the MSIC. From this, the evaluators calculated a total 191,673 public injections averted by the centre.
[NCHECR, 2007 pp. 7, 39]
Vancouver, Canada
Observations before and after the opening of the
Vancouver
Vancouver ( ) is a major city in western Canada, located in the Lower Mainland region of British Columbia. As the List of cities in British Columbia, most populous city in the province, the 2021 Canadian census recorded 662,248 people in the ...
, British Columbia, Canada Insite facility indicated a reduction in public injecting. "Self-reports" of INSITE users and "informal observations" at INSITE, Sydney and some European SISs suggest that SISs "can reduce rates of public self-injection."
Alberta, Canada
In response to the opioid epidemic in the province of Alberta, the
Alberta Health Services
Alberta Health Services (AHS) which is headquartered in Edmonton, Alberta is the single health authority for the Canadian province of Alberta and the "largest integrated provincial health care system" in Canada. AHS delivers medical care on beha ...
's (AHS),
Alberta Health
Ministry of Health (Alberta) is a ministry of the Executive Council of Alberta. Its major responsibilities include setting "policy and direction to achieve a sustainable and accountable health system to promote and protect the health of Albe ...
, Indigenous Relations, Justice and Solicitor General including the Office of the Chief Medical Examiner, and the
College of Physicians and Surgeons of Alberta
The College of Physicians & Surgeons of Alberta (CPSA) is a regulatory college in the Canadian province of Alberta. Its stated purpose is to "register physicians and issue medical practice permits, develop and administer standards of practice a ...
met to discuss potential solutions. In the November 2016 Alberta Health report that resulted from that meeting, the introduction of supervised consumption services, along with numerous other responses to the crisis, was listed as a viable solution.
The 2016 Alberta Health report stated that, SIS, "reduce overdose deaths, improve access to medical and social supports, and are not found to increase drug use and criminal activity."
According to January 2020 ''
Edmonton Journal
The ''Edmonton Journal'' is a daily newspaper in Edmonton, Alberta. It is part of the Postmedia Network.
History
The ''Journal'' was founded in 1903 by three local businessmen — John Macpherson, Arthur Moore and J.W. Cunningham — as ...
'' editorial, by 2020 Alberta had seven SIS with a "100-per-cent success rate at reversing the more than 4,300 overdoses" that occurred from November 2017when the first SIS opened in the provinceuntil August 2019.
= Calgary
=
Safeworks Supervised Consumption Services (SCS)
Safeworks was located at the
Sheldon M. Chumir Health Centre, which operated for several months, as a temporary facility, became fully operational starting April 30, 2018 with services available 24 hours, 7 days a week.
From the day it initially launched in October 30, 2017 to March 31, 2019, 71,096 people had used its services
The staff "responded to a total of 954 overdoses."
In one month alone, "848 unique individuals" made 5,613 visits to the SCS.
Its program is monitored by the Province of Alberta in partnership with the Institute of Health Economics.
In the City of Lethbridge's commissioned 2020 102-page report, the author noted that "Calgary’s Sheldon Chumir SCS has received considerable negative press about the "rampant" social disorder around the SCS, a neighbourhood that is mixed residential and commercial."
According to a May 2019 ''Calgary Herald'' article, the 250 meter radius around the safe consumption site Safeworks in
Calgary
Calgary ( ) is the largest city in the western Canadian province of Alberta and the largest metro area of the three Prairie Provinces. As of 2021, the city proper had a population of 1,306,784 and a metropolitan population of 1,481,806, makin ...
located within the
Sheldon M. Chumir Centre
The Sheldon M. Chumir Centre is a health centre located in Calgary, Alberta. The facility is administered by the Calgary Zone of Alberta Health Services. The centre provides 24/7 Urgent Care services but is not a full-service hospital and does no ...
has seen a major spike in crime since its opening and described in a report by the police as having become "ground zero for drug, violent and property crimes in the downtown." Within this zone, statistics by the police in 2018 showed a call volume increase to the police by 276% for drug related matters 29% overall increase relative to the three-year average statistics.
In May 2019, the ''Calgary Herald'', said that
Health Canada
Health Canada (HC; french: Santé Canada, SC)Health Canada is the applied title under the Federal Identity Program; the legal title is Department of Health (). is the Structure of the Canadian federal government#Departments, with subsidiary unit ...
announced in February 2019 of approval for Siteworks to operate for another year, conditional to addressing neighborhood safety issues, drug debris and public disorder. There has been a plan for mobile safe consumption site intending to operate in the
Forest Lawn, Calgary, Alberta, however in response to the statistics at the permanent site at the Sheldon M. Chumir Centre, community leaders have withdrawn their support.
By September 2019, the number of overdose treatment at Safeworks spiked. The staff were overwhelmed and 13.5% of their staff took psychological leave. They have had dealt with 134 overdose reversals in 2019 which was 300% more than the same time period from the previous year. The center's director reported they're dealing with an average of one overdose reversal every other day.
= Lethbridge
=
ARCHES (Closed August 2020)
In response to the mounting death toll of drug overdose in Lethbridge, the city opened its first SCS in February, 2018.
The controversial SCS, known as
ARCHES
An arch is a vertical curved structure that spans an elevated space and may or may not support the weight above it, or in case of a horizontal arch like an arch dam, the hydrostatic pressure against it.
Arches may be synonymous with vault ...
was once the busiest SCS in North America.
The province defunded ARCHES after an audit ordered by government discovered misuse and mismanagement of public monies. Around 70% of ARCHES funding comes from the province,
and it chose to shut it down on August 31, 2020 after the funding was revoked.
The audit found “funding misappropriation, non-compliance with grant agreement
ndinappropriate governance and organizational operations.”
The government is looking into the matter to determine if criminal charges are warranted.
The City of Lethbridge commissioned a report that included an Urban Social Issues Study (USIS) which examined unintended consequences of the SIS site in Lethbridge.
The research found that in smaller cities, such as Lethbridge, that in communities with a SCS, social disorder may be more noticeable. The report's author,
University of Lethbridge
, mottoeng = ''Let there be light''
, type = Public
, established =
, academic_affiliations = Universities Canada
, endowment = $73 million (2019)
, chancellor = Charles Weasel ...
's Em M. Pijl, said that news media tended to the "personal experiences of business owners and residents who work and/or live near an SCS", which contrasts with "scholarly literature that demonstrates a lack of negative neighbourhood impacts related to SCSs."
Impact on community levels of overdose
Over a nine-year period the Sydney MSIC managed 3,426 overdose-related events with not one fatality while Vancouver’s Insite had managed 336 overdose events in 2007 with not a single fatality.
The 2010 MSIC evaluators found that over 9 years of operation it had made no discernible impact on heroin overdoses at the community level with no improvement in overdose presentations at hospital emergency wards.
Research by injecting room evaluators in 2007 presented statistical evidence that there had been later reductions in ambulance callouts during injecting room hours,
but failed to make any mention of the introduction of sniffer dog policing, introduced to the drug hot-spots around the injecting room a year after it opened.
Site experience of overdose
While overdoses are managed on-site at Vancouver, Sydney and the facility near Madrid, German consumption rooms are forced to call an ambulance due to naloxone being administered only by doctors. A study of German consumption rooms indicated that an ambulance was called in 71% of emergencies and naloxone administered in 59% of cases. The facilities in Sydney and Frankfurt indicate 2.2-8.4% of emergencies resulting in hospitalization.
Vancouver’s Insite yielded 13 overdoses per 10,000 injections shortly after commencement, but in 2009 had more than doubled to 27 per 10,000. The Sydney MSIC recorded 96 overdoses per 10,000 injections for those using heroin. Commenting on the high overdose rates in the Sydney MSIC, the evaluators suggested that,
: “In this study of the Sydney injecting room there were 9.2 (sic) heroin overdoses per 1000 heroin injections in the centre. This rate of overdose is higher than amongst heroin injectors generally. The injecting room clients seem to have been a high-risk group with a higher rate of heroin injections than others not using the injection room facilities. They were more often injecting on the streets and they appear to have taken greater risks and used more heroin whilst in the injecting room.
People living with HIV/AIDS
The results of a research project undertaken at the Dr. Peter Centre (DPC), a 24-bed residential HIV/AIDS care facility located in Vancouver, were published in the Journal of the International AIDS Society in March 2014, stating that the provision of supervised injection services at the facility improved health outcomes for DPC residents. The DPC considers the incorporation of such services as central to a "comprehensive harm reduction strategy" and the research team concluded, through interviews with 13 residents, that "the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services", in addition to creating a setting in which drug use could be discussed honestly.
Highly active antiretroviral therapy (HAART) medication adherence and survival are cited as two improved health outcomes.
Crime
The Sydney MSIC was judged by its evaluators to have caused no increase in crime
[2003 MSIC Evaluation Committee 2003 p. xvi] and not to have caused a ‘honey-pot effect’ of drawing users and drug dealers to the Kings Cross area.
Observations before and after the opening of Insite indicated no increases in drug dealing or petty crime in the area. There was no evidence that the facility influenced drug use in the community, but concerns that Insite ‘sends the wrong message’ to non-users could not be addressed from existing data.
[see Executive Summary of ] The European experience has been mixed.
[see Sections A7 to A9 of Appendix B ]
Financial impropriety by SCS service providers
Audit of Lethbridge ARCHES SCS by Deloitte accounting firm ordered by the Alberta provincial government found the SCS had $1.6 million in unaccounted funds between 2017 and 2018; additionally they've found led $342,943 of grant funds had been expended on senior executive compensation despite the grant agreement allowing only $80,000. Beyond this, an additional $13,000 was spent on parties, staff retreats, entertainment and gift cards,
and numerous other inappropriate expenditures.
Community perception
The Expert Advisory Committee for Vancouver’s Insite found that health professionals, local police, the local community and the general public have positive or neutral views of the service, with opposition decreasing over time.
Predicted cost effectiveness
The cost of running Insite per annum is $3 million Canadian. Mathematical modeling showed cost to benefit ratios of one dollar spent ranging from 1.5 to 4.02 in benefit. However, the Expert Advisory Committee expressed reservation about the certainty of Insite’s cost effectiveness until proper longitudinal studies had been undertaken. Mathematical models for HIV transmissions foregone had not been locally validated and mathematical modeling from lives saved by the facility had not been validated.
See also
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Biomedical waste
Biomedical waste or hospital waste is any kind of waste containing infectious (or potentially infectious) materials. It may also include waste associated with the generation of biomedical waste that visually appears to be of medical or laboratory ...
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Drug disposal
Drug disposal is the discarding of drugs. Individuals commonly dispose of unused drugs that remain after the end of medical treatment. Health care organizations dispose of drugs on a larger scale for a range of reasons, including having leftover ...
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Drug liberalization
Drug liberalization is a drug policy process of decriminalizing or legalizing the use or sale of prohibited drugs. Variations of drug liberalization include: drug legalization, drug re-legalization and drug decriminalization. Proponents of drug ...
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Drug policy of the Soviet Union
The drug policy of the Soviet Union changed little throughout the existence of the state, other than slowly becoming more repressive, although some differences in penalties existed in the different Union Republics.
However, the prevalence of drug a ...
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Drug policy reform
Drug liberalization is a drug policy process of decriminalizing or legalizing the use or sale of prohibited drugs. Variations of drug liberalization include: drug legalization, drug re-legalization and drug decriminalization. Proponents of drug ...
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Illicit drug use in Australia
Illicit drug use in Australia is the recreational use of prohibited drugs in Australia. Illicit drugs include illegal drugs (such as cannabis, opiates, and certain types of stimulants), pharmaceutical drugs (such as pain-killers and tranquillis ...
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Infection prevention and control
Infection prevention and control is the discipline concerned with preventing healthcare-associated infections; a practical rather than academic sub-discipline of epidemiology. In Northern Europe, infection prevention and control is expanded from ...
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Needle and syringe programmes
A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It ...
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Needle remover
A needle remover is a device used to physically remove a Hypodermic needle, needle from a syringe. In developing countries, there is still a need for improvements in needle safety in hospital settings as most of the needle removal processes are do ...
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Needle sharing
Needle sharing is the practice of intravenous drug-users by which a needle or syringe is shared by multiple individuals to administer intravenous drugs such as heroin, steroids, and hormones. This is a primary vector for blood-borne diseases which ...
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Needlestick injury
A needlestick injury is the penetration of the skin by a hypodermic needle or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick i ...
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Prevention of HIV/AIDS
HIV prevention refers to practices that aim to prevent the spread of the human immunodeficiency virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may ...
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Preventive healthcare
Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...
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Responsible drug use
Responsible drug use maximizes the benefits and reduces the risk of negative impact psychoactive drugs cause on the lives of the user. For illegal psychoactive drugs that are not diverted prescription controlled substances, some critics believe tha ...
References
External links
Community member in Philadelphia objects to SCS– Video on NBC 10 Philadelphia journalist's confirmed Twitter account.
{{DEFAULTSORT:Safe Injection Site
Drug culture
Drug overdose
Drug policy
Drug safety
Epidemiology
Harm reduction
Infectious diseases
Medical emergencies
Medical ethics
Medical hygiene
Medical prevention
Medical waste
Medicine in society
Prevention of HIV/AIDS
Substance dependence
Types of health care facilities