Lupick T. By circumventing drug laws, Vancouver`s social housing operators are creating consumption spaces for tenants who fear fentanyl. 2017. The Georgia Straight. Available at: www.straight.com/news/859986/skirting-drug-laws-vancouver-social-housing-operators-create-consumption-rooms-tenants. Accessed May 12, 2017. McNeil R, Kerr T, Lampkin H, Small W. «We need a place where we can smoke crack»: an ethnographic study of an unapp approved safer smoking room in Vancouver, Canada. Int J Drug Policy. 2015;26(7):645–52. At least 100 monitored injection sites are in operation worldwide, mainly in Europe, Canada and Australia. As a rule, drug users arrive with their own drugs and are given clean needles and a clean and safe space to consume.
Staff are available with breathing masks and naloxone, the antidote to overdoses, providing advice on safer injections and information on drug treatment and other health services. Monitored injection sites such as Insite in Vancouver, Canada, provide addicts with clean needles and other supplies to prevent the spread of the disease. Elana Gordon for WHYY Hide caption Much of the existing research into the effects of supervised injection sites comes from two locations: the medically supervised injection site in Sydney, Australia, and Insite, a Vancouver facility that public health officials have been leading and researching for 15 years. Marshall BD, Milloy MJ, Wood E, Montaner JS, Kerr T. Reduced overdose mortality following the opening of the first safer, medically supervised injection site in North America: a retrospective population-based study. Lancet. 2011;377(9775):1429–37. While community consultation is important to ensure that public health and safety interests are balanced, this bill appears to be structured in such a way that the voices of opponents of harm reduction, however misinformed they may be, are favored over others that highlight the strong evidence that supervised injection facilities save lives.
The result is that Bill C-65 can put the views of people who find intravenous drug users tasteless above the need to take effective measures to limit the spread of disease and save lives. This bill appears to ignore evidence from a decade of experience in Vancouver, which jeopardizes the expansion of these services to other Canadian cities where a need has been identified.2 At the city level, it is difficult to know the size of the actual basic population of drug users. This leaves unanswered the number of websites needed to have a wider impact on the community. And where should they go? Who could benefit the most from a website and what is the most effective way to engage it? With a new government expressing support for FIS, and in light of the emerging epidemic of opioid overdoses, a number of communities have begun to develop plans to establish SIFs, and several have launched feasibility studies on FIS. Montreal quickly advanced its plan to open three ISPs and received approval from the federal government in February 2017 . Polls have shown that public support for the SIFs in Montreal is high and that all levels of government support it . Plans to open a mobile FIS were also discussed in Montreal . In addition, the City of Vancouver has sought federal approval from several other ISPs, including a women-only ISP, which is expected to open in 2017 .
Other cities with advanced plans to open FIS were Victoria (one location) , Toronto (three locations) , Ottawa (one location) , Surrey (two locations)  and Edmonton (four locations, including a hospital) . However, RIS support has changed significantly in these settings. In Ottawa, the mayor and police have strongly opposed FIS, making a number of statements that are inconsistent with the available evidence, including the suggestion that FIS increase crime [56, 57]. In Victoria, citizens` groups spoke out against needle exchange and other harm reduction programs and spoke out against SIFs . In Kelowna and Kamloops, public opposition to FIS, particularly from local business associations , appears to have led local health authorities to opt for a mobile rather than a fixed FIS in each of these communities, as it proved too difficult to obtain acceptance of a particular permanent location for fixed FIS . Watson TM, Bayoumi A, Kolla G, Penn R, Fischer B, Luce J, Strike C. Police perceptions of supervised consumption sites (SCS): a qualitative study. Name Use abuse. 2012;47(4):364–74.
Shannon K, Ishida T, Morgan R, Bear A, Oleson M, Kerr T, Tyndall MW. Potential impact of safer and medically supervised smoking facilities for crack users on the community and public health. Harm Reduct J. 2006;3:1. Wood E, Tyndall MW, Montaner JS, Kerr T. Summary of the results of the evaluation of a medically supervised and safer injection facility. CMAJ. 2006;175(11):1399–404. Wood E, Kerr T, Small W, Li K, Marsh DC, Montaner JS, Tyndall MW.
Changes in public policy following the opening of a medically supervised and safer injection site for illegal injection drug users. CMAJ. 2004;171(7):731–4. Johnson, J. 2 monitored drug use sites proposed for Surrey Fraser Health is applying for two sites in Whalley. 2017. Available at: www.cbc.ca/news/canada/british-columbia/surrey-supervised-injection-sites-1.3884230. Accessed May 12, 2017.
Rider DP, Pagilaro J. Province is supporting and funding supervised injection sites in Toronto. thestar.com. 9 January 2017. Available at: www.thestar.com/news/city_hall/2017/01/09/province-backs-and-will-fundsupervised-injection-sites-in-toronto.html. Accessed May 12, 2017. Wood E, Tyndall MW, Lai C, Montaner JS, Kerr T. Effects of a medically supervised safer injecting facility on drug trafficking and other drug-related crime.
Name Abuse Policy. 2006;1:13. European Monitoring Centre for Drugs and Drug Addiction. Drug Perspective. Drug consumption rooms: an overview of the offer and evidence. 2016. Available at: www.emcdda.europa.eu/topics/pods/drug-consumption-rooms. Retrieved 12 May 2017.
In September 2003, the first legally sanctioned SCIF in Canada was opened. This happened after a Vancouver-based non-governmental organization, the Portland Hotel Society (PHS), quietly erected a RIS in a nailed and apparently vacant building, and then one day publicly announced that the SIF had been built . Finally, the regional health authority agreed to work with PHS to open the RIS, although it is unclear how long it might have taken if PHS had not taken the rather extraordinary step of building the physical site in secret. Critics say the monitored injection sites encourage drug use and bring crime to surrounding communities. Supporters argue that they can save lives and help people with addictions reconnect with society and receive health services. Outside with the dark alley, fear and shame, they say, with a safe space, clean injection supplies, care and compassion. It is an approach that is part of harm reduction, a public health philosophy that focuses on reducing the harms of drug use. Britten L. The chilliwack emergency room doctor says the city needs a monitored injection site. 2017.
CBC News. Available at: www.cbc.ca/news/canada/british-columbia/chilliwack-supervised-injection-1.3931694. Accessed May 12, 2017. Damon W, Neufeld S. Safe underground injection site must be closed: The Vancouver Health Authority is closing an unapproved drug user site in downtown Eastside. In: Megaphon. Vancouver; 2014. The debate over the Weld C.
Kelowna safe injection site is raging. 2016. Kelowna Capital News. Still, he says the research — both «grey» and robust — highlights the benefits, especially in preventing deaths among society`s most vulnerable. No deaths at an injection site have been reported. A review of 75 studies in 2014 concluded that such places promote safer injection conditions, reduce overdoses, and improve access to health services. The injection sites monitored were associated with lower outdoor drug use and did not appear to have a negative impact on crime or drug use. Johnson L. Fentanyl Crisis: Drug Overdoses Claim An Unprecedented 914 Lives in B.C. in 2016 2017.
Available at: www.cbc.ca/news/canada/british-columbia/overdose-death-statistics-2016-1.3941224. Retrieved 12 May 2017. CBC News. Health Minister Jane Philpott was «incredibly moved» by Insite`s monitored visit to the injection site. January. 2016;16. Available at: www.cbc.ca/news/canada/british-columbia/jane-philpott-insite-1.3414078. Accessed May 12, 2017, Bill C-65, known as the Respect for Communities Act, introduces new requirements for supervised injection sites to obtain an exemption from the Controlled Drugs and Substances Act. Without this legal exception, people who use an injection site risk being prosecuted for drug possession.
It appears that the federal government would see Canada`s drug policy continue to follow a strategy that has proven to be both costly and ineffective in addressing problematic drug use. Alex, C. Thunder Bay should have two safe injection sites, recommends a feasibility study. 2017. CBC News. Available from: www.cbc.ca/news/canada/thunder-bay/thunder-bay-safe-injection-two-sites-1.3971356. Accessed May 12, 2017. Heidenreich P. Edmonton Police Services provides conditional support for supervised injection sites. 2016. Global News.
Available at: globalnews.ca/news/3132475/edmonton-police-service-offers-conditional-support-of-safe-injection-sites/. Retrieved 12 May 2017. In addition, current gaps in the coverage of supervised injection facilities indicate that this evidence-based intervention needs to be scaled up to new environments and new approaches need to be considered.