Supervised injection facilities in Canada: past, present, and future

Thomas Kerr,Ryan Mcneil,Sanjana Mitra,Mary Clare Kennedy

doi:10.1186/s12954-017-0154-1

Abstract

Canada has long contended with harms arising from injection drug use. In response to epidemics of HIV infection and overdose in Vancouver in the mid-1990s, a range of actors advocated for the creation of supervised injection facilities (SIFs), and after several unsanctioned SIFs operated briefly and closed, Canada’s first sanctioned SIF opened in 2003. However, while a large body of evidence highlights the successes of this SIF in reducing the health and social harms associated with injection drug use, extraordinary efforts were needed to preserve it, and continued activism by local people who inject drugs (PWID) and healthcare providers was needed to promote further innovation and address gaps in SIF service delivery. A growing acceptance of SIFs and increasing concern about overdose have since prompted a rapid escalation in efforts to establish SIFs in cities across Canada. While much progress has been made in that regard, there is a pressing need to create a more enabling environment for SIFs through amendment of federal legislation. Further innovation in SIF programming should also be encouraged through the creation of SIFs that accommodate assisted injecting, the inhalation of drugs. As well, peer-run, mobile, and hospital-based SIFs also constitute next steps needed to optimize the impact of this form of harm reduction intervention.

Highlights

Canada has long contended with health-related and social harms associated with injection drug use
In conclusion, our review of Canada’s experience with supervised injection facilities (SIFs) demonstrates that considerable progress has been made towards integrating this form of intervention into the continuum of programs offered to people who inject drugs (PWID), continued activism, research advocacy, and litigation has been necessary in order to advance this evidence-based approach in Canada
Increased acceptance of SIFs as a result of Canada’s overdose crisis and political changes has led to the rapid escalation of efforts to expand SIFs across the country

Summary

Background

Canada has long contended with health-related and social harms associated with injection drug use. In Vancouver’s DTES, in response to the rapidly increasing number of deaths, local activists including Ann Livingston and Sarah Blythe erected a tent with tables where people could sit and inject or smoke drugs under supervision and receive emergency overdose response as needed [70] During this time, line ups at the local sanctioned SIF became long and the program was unable to meet demand. After calls on the federal government to declare an emergency failed, the Health Minister of British Columbia instructed various regional health authorities to open what have become known as “overdose prevention sites” (OPSs) [73] At these sites, PWID are provided with sterile equipment for injection in a closed indoor setting, and staff (unusually non-nursing staff) provides emergency response in the event of overdose. The City of Vancouver has sought federal approval for a womenonly SIF, which is expected to open in 2017 [50]

Discussion

Conclusions

Findings

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