“If there’s any clinical evidence against how effective these sites are, it would have surfaced by now”

– Donald MacPherson, drug policy advocate & founding Executive Director of Canadian Drug Policy Coalition

INTRODUCTION

Being an issue with multiple intersecting factors, the opioid crisis is a complex epidemic that is affecting the everyday person each day. There have been many approaches to this issue, such as addiction treatment and abstinence – where drug use is prohibited. Though abstinence is a well-supported approach among politicians and the general public, it fails to reach out to those at risk for opioid-related overdoses. As opioid use can lead to unintentionally fatal overdoses, the purpose of harm reduction is to minimize the negative impacts of drug use. In this article, we will be looking at the harm reduction strategy of Safe Consumption Sites, outlining…

• What Safe Consumption Sites are
• The General & Economic Effects of Safe Consumption Sites
• The Various Barriers to Implementing the Strategy
• Steps to Consider Moving Forward

What Are Safe Consumption Sites?

One harm reduction initiative used to address the impact of the opioid crisis is supervised consumption sites. These sites are legally sanctioned facilities with trained staff that supervise the use of pre-obtained drugs. 

Along with supervised injection, these sites provide people with sterile supplies, education on safer consumption, overdose prevention and intervention, medical and counselling services, and referrals to addiction treatment, income support, housing and much more. 

Due to the controversial discussions, that surround the idea of supervised consumption sites, there has been a delay in implementing the concept (to be discussed later). Yet, these sites provide something all other opioid crisis recovery approaches lack – the ability to initiate the path to addiction recovery. These sites work as great bridges that connect those consuming drugs to the services that would contribute to their journey to recovery.

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The Effects of Safe Consumption Sites

Over 100 evidence-based, peer-reviewed studies have consistently proven the positive effects of supervised consumption sites. (Drug Policy Alliance, 2018).  Due to the collaborative nature of these facilities, there is an increase in medical and social services support. 

The existence of such sites increases the number of people who enter substance use disorder treatment. The sites have also seen individuals reducing the amount and the frequency of drug use. HIV and Hepatitis C risk behaviours such as syringe sharing are also reduced with the implementation of supervised consumption sites (Drug Policy Alliance, 2018). 

Economic Effects

Along with these benefits, supervised consumption sites are seen to contribute to great economic savings…

• A San Francisco economic analysis estimated that for each dollar ($1.00 US) spent on these facilities, $2.33 would be saved in emergency medicine, law enforcement, and other costs to contribute to $3.5 million dollars of savings each year (Iwrin et al., 2016). 
• Johns Hopkins Bloomberg School of Public Health report discovered that the city of Baltimore would save $6 million dollars a year by opening just one site (Irwin et al., 2017). 
• Vancouver-based supervised consumption program with an operating cost of $3 million (CAD), stated that if their program was shut down, the number of HIV infection incidents would increase and hence contribute to $17.6 million in lifetime medical care costs related to HIV (Pinkerton, 2010). 

Barriers

Along with the barriers of conducting research, there are other barriers that prevent the implementation of supervised consumption sites. 

Legal 

Without the legal space to conduct the sites, the existence of supervised consumption sites would violate many drug laws. This barrier can be overcome by permitting special permissions and legal sanctions to approved specific sites, yet long-term benefits can only occur by addressing the ideologies and assumptions that surround the strategy. 

Discarded & Dismissed Findings

Though there is evidence proving the effectiveness of supervised consumption sites, some studies face the issue of being deemed invalid for having unknown quality for having small sample sizes or using observation studies rather than randomized control trials.  

The strategy is also argued to be unadoptable due to the issue of homogenizing results, as they may generalize consumers without considering the local context. 

Supervised consumption sites are said to lack evidence that supports their use. Yet with limited resources, limited funding, and limited legal space, it becomes difficult to conduct high quality, localized studies. The United States contributes to a large portion of the world’s scientific evidence, and as their legal system deems many of the processes involved in supervised consumption sites as illegal, it leaves a large gap in research on supervised consumption sites.

Ideologies & Mentalities

The concept of these sites is highly controversial and stigmatized. Especially in the case of the United States, enabling a safe consumption site would be contradicting the War on Drugs mentality. Permitting a supervised consumption site would mean admitting the failure of the no-tolerance approach for drugs. 

The existence of these sites threatens the practice of idealism. Adopting the concept would mean acknowledging the police cannot eliminate illegal drug use and the issues associated with street-based injecting practices. Accepting supervised consumption sites would mean accepting that some harm is inevitable. This must be done in order to effectively address the opioid crisis.

Lack of Community Support

It is widely assumed that the presence of a safe consumption site would increase crime and drug use in the neighbourhood. Even though there is no evidence that supports this claim, such assumptions can deem a neighbourhood undesirable, highlighting the gap in the public’s knowledge about the efficacy of these sites. 

Ineffective Health Promotion Campaigns

With public health campaigns that are not effective in educating the public on the opioid crisis and the effects of supervised consumption sites, along with narratives being left aside as they challenge the interests of those behind the dominant narrative, public health professionals should take extra efforts to implement safe consumption sites. 

Moving Forward

It is important to implement the approach in an efficient and effective manner. Public health professionals must take the initiative to understand and include stakeholders (other than the priority population, e.g. community members), and find ways to reduce backlash. 

It is essential to create strong campaigns that educate the public and politicians about the issue, the approach, its effect on the community, and the effects towards the issue, all while dispelling common myths and misbeliefs. 

Safe consumption sites provide a safe space that removes the barriers that prevent individuals from initiating substance use disorder treatment. It helps care providers build rapport with the individuals, allowing staff to educate them on the harms of substance use, and encourage treatment. No other approach provides the opportunity to start this conversation. 

It’s time we look at how our assumptions and mentalities are contributing to the opioid epidemic. 

Written by: Ragshica Sotheeswaran, HBSc