Implementation contexts and the impact of policing on access to supervised consumption services in Toronto, Canada: a qualitative comparative analysis

Geoff Bardwell,Jason Altenberg,Thomas Kerr,Carol Strike,Lorraine Barnaby

doi:10.1186/s12954-019-0302-x

Abstract

BackgroundSupervised consumption services (SCS) are being implemented across Canada in response to a variety of drug-related harms. We explored the implementation context of newly established SCS in Toronto and the role of policing in shaping program access by people who inject drugs (PWID).MethodsWe conducted one-to-one qualitative semi-structured interviews with 24 PWID. Participants were purposively recruited. Ethnographic observations were conducted at each of the study sites as well as in their respective neighbourhoods. Relevant policy documents were also reviewed.ResultsPolicing was overwhelmingly discussed by participants from both SCS sites. However, participant responses varied depending on the site in question. Subthemes from participant responses on policing at site #1 described neighbourhood police presence and fears of police harassment and drug arrests before, during, or after accessing SCS. Conversely, subthemes from participant responses on policing at site #2 described immunity and protection from police while using the SCS, as well as a lack of police presence or fears of police harassment and arrests. These differences in implementation contexts were largely shaped by differences in local neighbourhoods and drug scenes. Police policies highlighted federal laws protecting PWID within SCS, but also the exercise of discretion when applying the rule of law outside of these settings.ConclusionsParticipants’ perspectives on, and experiences with, policing as they relate to accessing SCS were shaped by the implementation contexts of each SCS site and how neighbourhoods, drug scenes, and differences in policing practices affected service use. Our findings also demonstrate the disconnect between the goals of policing and those of SCS. Until larger structural barriers are addressed (e.g. criminalization), future SCS programming should consider the impact of policing on the SCS implementation context to improve client experience with, and access to, SCS.

Highlights

Supervised consumption services (SCS) have been implemented in Australia, Europe, and North America in response to a variety of drug-related harms such as overdose and infectious disease transmission [1,2,3,4,5]
Sometimes referred to as drug consumption rooms or safe injection sites, international studies have demonstrated the effectiveness of these public health interventions in reducing harms for people who inject drugs (PWID)
The following themes related to policing of the SCS are discussed : (1) significant police presence, (2) fears of arrest, (3) lack of police presence, and (4) immunity from arrests

Summary

Introduction

Supervised consumption services (SCS) have been implemented in Australia, Europe, and North America in response to a variety of drug-related harms such as overdose and infectious disease transmission [1,2,3,4,5]. Sometimes referred to as drug consumption rooms or safe injection sites, international studies have demonstrated the effectiveness of these public health interventions in reducing harms for people who inject drugs (PWID). SCS have led to a decrease in syringe reuse and sharing among PWID [9, 10]. Supervised consumption services (SCS) are being implemented across Canada in response to a variety of drug-related harms. We explored the implementation context of newly established SCS in Toronto and the role of policing in shaping program access by people who inject drugs (PWID)

Methods

Results

Discussion

Conclusion