(excerpts from Impact: A socio-economic review of supervised consumption sites in Alberta, March 2020)
Canada’s Drug Strategy is based on four pillars: prevention, enforcement, treatment and harm reduction. Supervised [Drug] Consumption Sites (SCS) speak to the issue of harm reduction. However, the way this multipronged approach is currently implemented in Alberta, harm reduction has taken precedence over the other three pillars. (as too in Australia)
In many cases, “adverse events” (even if non-life threating or minor) are reported as overdoses, and the term “reversal” is used even when the response was a simple administration of oxygen. This leaves the public with an inference that without these sites thousands of people would fatally overdose or no longer be alive. Comparatively rare cases resulted in the use of naloxone. As a result, the committee became concerned with issues of transparency and accountability with the regards to the way overdose reversals are tracked and reported. The committee finds this misleading and the ambiguity and faulty reporting cannot responsibly make such a determination.
The Committee became concerned with the lack of focus on referrals to detoxification and treatment resources. Where it was suggested that referrals were made, no evidence was found to support action taken to follow up on such referrals.
Non-opioid substance use, specifically methamphetamine use at some SCS sites, increased substantially and numerous residents complained about aggressive and erratic behaviour of substance users leaving the sites.
Needle debris was a substantial issue with many residents complaining about used and unused needles, broken crack pipes and other drug-related paraphernalia being discarded in the vicinity of the sites and in public areas near the sites.
Except for Edmonton, stakeholder feedback predominantly suggested that the SCS have had a negative social and economic impact on the community. In Edmonton, however, there were reports that stakeholders felt intimidated and were prevented from expressing their true sentiments and opinions about these sites out of fear of retribution from site supporters. The Review Committee also learned about questionable practices (for example, introducing non-injection users to injection practices by SCS staff); the use of 40 naloxone reversal kits by a single client; the alleged misrepresentation of site statistics; and an apparent under-utilization of the full scope of care while inappropriately favouring harm reduction. The Review Committee also noted that there were several potential liability issues for sites and staff arising from the information that had been provided.
The Committee found that several of the SCS sites were not promoting paths to treatment and recovery.
The Committee found that the biggest issue that impacted communities was needle debris. The current SCS policy is needle distribution as opposed to needle exchange. The Province of Alberta should immediately enact policy for needle exchange.
The Committee found that enforcement of the law proximal to the SCS sites in Alberta was inconsistent and often absent due to local politics, interpretation of the law, fear of criticism and apathy. Alberta Justice and Solicitor General, in consultation with front-line police officers, needs to create a meaningful and consistent policing policy that empowers law enforcement in and around the sites to maximize public safety.
The SCS sites were mandated to respond to the opioid crisis; however, they are responding to methamphetamine use up to 50 per cent of the time in some locations. There is a significant requirement for a different strategy to respond to methamphetamine use.
A significant impact on all communities hosting a SCS site was open defecation and urination in public spaces that include doorways, garages, streets, walkways, resident yards and parks. Municipalities should immediately provide for permanent public washroom facilities in and around the SCS sites.
Supervised Consumption Services should be directed by addiction medicine expertise as an entry point to recovery-oriented systems of care, including a managed opioid program. Managed opioid programs and opioid agonist therapies have been shown throughout the literature to reduce criminal behaviour and drug trafficking.