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Supervised Injection Services

Frequently Asked Questions

What are supervised injection services (SIS)?

Supervised injection services (SIS) are health services that provide a safe and hygienic environment where people can inject drugs under supervision. People bring pre-obtained drugs and inject them themselves. Staff do not supply or inject drugs.

At a supervised injection service, people who use drugs also receive other health services, including:

  • Computer and phone access, clothing and other basic needs.
  • One-on-one support to help people find the resources they need. This can include basic needs like food, housing, and dental hygiene. Also navigating the legal system, mental health system, and the medical system.
  • Help to develop healthier approaches to life. This could include healthy eating and reducing how often they smoke.
  • A peer program that sees people not just as accessing services, but people who also have skills and knowledge, and can help deliver services.
  • Our medical walk-in clinic, primary care, HIV testing.

Do supervised injection services exist anywhere else?

Yes. Supervised Injection Services started 20 years ago in Europe and there are now more than 90 worldwide. Across Canada there are supervised injection services in Montreal, Toronto, Vancouver, Kamloops and Surrey. Many cities have applications in process, including Calgary, Edmonton and Lethbridge.

In Ottawa, Sandy Hill Community Health Centre has received approval for a safe injection site and the first site will open on Clarence St in The Market.

For a list of supervised injection service applications received by Health Canada visit this site

Why have you applied to offer supervised injection services?

Ottawa Public Health data shows that Somerset Ward has the second highest rates in Ottawa of drug overdose, hepatitis C and HIV. We must acknowledge and address that people who use drugs live and work in our community.

In a June 2016 report, Ottawa Public Health identified Somerset Ward as having the second highest counts and rates of average annual: 

  • Emergency room visits related to unintentional drug overdose between 2013-2015. (Source: Problematic Substance Use in Ottawa — Technical Report, Ottawa Public Health 2016)
  • Number of individuals diagnosed with Hepatitis C or HIV with reported injection drug use between 2011-2014.

In addition, Ottawa has Ontario's highest rates of HIV and Hepatitis C among people who inject drugs.

For further information on substance use in Ottawa, please refer to the following reports by Ottawa Public Health:

Do harm reduction programs actually work?

Yes. Data from Canadian supervised injection services, has shown:

  • Reduced overdose deaths
  • Reduced unsafe injection practices and behaviours that cause HIV and Hepatitis C transmission
  • Increased use of detox and treatment services
  • Reduced public drug use
  • No increase in crime in the community

Dr. Isra Levy, Ottawa’s Medical Officer of Health, supports harm reduction programs, including supervised injection services. Ottawa Public Health reports from 2016 also detail positive outcomes from treatment and harm reduction services in Ottawa, including:

  • 60 lives saved since 2012 from the naloxone peer overdose prevention program
  • 39% retention in first-time opioid replacement therapy
  • A 75% reduction in drug use by students enrolled in the School-based Substance Abuse Program

Why are you calling this an expansion of your services? What are you already doing? 

Somerset West Community Health Centre has been offering a range of harm reduction services for 20 years. These include providing condoms, and clean injection and safer inhalation supplies through the Needle Exchange and Safer Inhalation (NESI) program. The Centre also offers smoking reduction support.

From October 2015 to September 2016, our Needle Exchange and Safer Inhalation (NESI) program distributed 207,418 needles and 28,606 inhalation supplies. When collecting clean supplies, people who use drugs can also access:

  • One-on-one support to help find the resources they need. This can include basic needs like food, housing, and dental hygiene. Also navigating the legal system, mental health system, and the medical system.
  • Help to develop healthier approaches to their life. This could include healthy eating and reducing how often they smoke.
  • Computer and phone access, clothing and other basic needs.
  • Peer support from people who have lived experience and can help deliver services.
  • Our medical walk-in clinic, primary care, counseling and HIV testing.

Will intravenous drug users use supervised injection services?

We frequently hear from clients that they use drugs in spaces that do not feel safe to them, including public washrooms, alleys, parks or doorways. They avoid being observed, are most often alone, and may dispose of needles in public places. Overdose is more likely and more often fatal under these conditions. The lack of a safe space to inject drugs in the Somerset Ward has resulted in a tragic increase in opioid overdose incidents, deaths and community trauma experienced by residents and our clients.

SWCHC has provided training to people who use drugs so they can support each other and take care of each other. This has led to their active involvement in the design, development and implementation of the supervised injection service. The people helping to create the service understand their peers’ realities. The result is that the service will meet the unique needs of people who use drugs.

The 2016 Participatory Research in Ottawa: Understanding Drugs study showed that 75% of people who inject drugs would use a supervised injection service if it were available in Ottawa.

Additionally, Somerset West Community Health Centre (SWCHC) conducted surveys during July and August 2016 with Needle Exchange and Safer Inhalation (NESI) program clients. 78 per cent indicated they would use a supervised injection service here at SWCHC's Eccles Branch.

We anticipate that most of the people who would user SIS at SWCHC are already accessing other services such as health care and counseling.

Where would your supervised injection services be located?

SIS would be offered at SWCHC’s Eccles Branch (55 Eccles Street). Our existing harm reduction program – the Needle Exchange and Safer Inhalation (NESI) program – is also located at the Eccles Branch. Counselling and medical services are also on-site at this location.

How will the supervised injection service work? Describe the steps. 

The Somerset West Community Health Centre safe injection site will be easy to access. There will be no questions asked and clients will not need to show any identification to use the service.

The Somerset West Community Health Centre supervised injection service will be a different model than Vancouver’s InSite. We are planning to add a small-scale supervised injection service with five injection cubicles within our existing program space with no change to the exterior of the building.

  • One harm reduction outreach worker to greet clients in the needle exchange and safer inhalation (NESI) gear room as they arrive to use the supervised injection service, review the code of conduct for the SIS, and provide them with sterile injection supplies.
  • Clients will then walk across the hall to the injection room where a nurse will perform a pre- and post-injection assessment of the individual’s current health status, needs and risk of overdose, offer safer injecting counselling and information, supervise the injection and intervene in the case of medical emergency.
  • The room will have four cubicles for injecting under supervision.
  • The nurse will be present in injection room during the entire time that it is open.
  • Clients will wait in the injection room for 5-10 minutes after the injection.
  • They will then be asked to move into the needle exchange and safer inhalation (NESI) drop in space where community workers will assist them by watching for signs of any negative drug reactions, provide information and referrals about other health and social services.
  • We estimate that clients would need to be in the injection room for 20 minutes and, with 4 injection booths in the room, we could host an average of 60 injections in a 5-hour day.

We anticipate that most of the people who would use a supervised injection service at SWCHC are already accessing our needle exchange and safer inhalation program.

Photo: Example of small scale supervised injection service at the Dr. Peter Centre, Vancouver.

What would the service hours be?

The Somerset West Community Health Centre supervised injection service is being created with input from people who use drugs so that it meets their needs.

Feedback from clients at SWCHC is overwhelmingly in support of the SIS being open 12 hours per day, 7 days a week

How will medical emergencies be handled?

We will have processes in place to ensure the safety of the people using SIS and the clients and staff of the Eccles Branch. These processes are still in development. At this time, we expect the process to be as follows.

  • All medical and other SIS staff, including peers, will be trained in the administration of Naloxone. Naloxone is a prescription medicine that blocks the effects of opioids and reverses an overdose.
  • In the event of an overdose, the nurse will lead the medical response, supported by the outreach worker.
  • The nurse will determine if paging for medical assistance is required and if 9-1-1 needs to be called.

Community Health Centre resources are already stretched. Can you afford to add a new service?

Supervised injection services (SIS) build on our harm reduction program for existing clients. We will require additional funding from the Province of Ontario to offer this service.

SIS save the health care and emergency response systems money and are proven to reduce:

  • Public drug use
  • The number of overdose deaths
  • Rates of new HIV infections among injecting drug users
  • Emergency room visits

Will this sort of service just encourage more people to use drugs?

No. There is no evidence that harm reduction services increase drug use.

Will other clients in the building be safe?

Client safety is very important to us. Our clients will continue to be safe. Studies show that supervised injection sites do not increase crime.

Somerset West Community Health Centre is creating a safer neighbourhood by making it possible for drug use to take place in a safe environment where drug paraphernalia can be disposed of responsibly.

Will people in the neighbourhood be safe?

Yes. The Somerset West ward will continue to be safe. Supervised injection sites can make communities safer by keeping drug use off the street and creating a cleaner environment. In fact, most studies about SIS find that thefts, vehicle break ins, discarded needles and drug use in public spaces decrease after SIS are established.

In 2011, the Supreme Court of Canada recognized that SIS decrease the risk of disease and death with no discernible negative impact on the public safety around the service.

Although many people express concerns about the public safety impact of this health care service, several studies have demonstrated that the establishment of SIS is not associated with an increase in drug-related crimes (Benninghoff et al., 2003; Boyd et al., 2008; Freeman et al., 2005; MSIC Evaluation Committee, 2003; Wood et al., 2006). In fact, some studies even reported a decrease in rates of vehicle break-ins, vehicle thefts, robbery and property crimes in the surrounding neighbourhoods (Fitzgerald et al., 2010; Wood et al., 2006).

Law enforcement officials in some jurisdictions, including Vancouver, are supportive of SIS and help divert public injecting and drug-related activities to the local SIS (DeBeck et al., 2008). One Vancouver study reported that 17% of respondents had been referred to Insite by police, and that 2% had first heard about the service from the police (DeBeck et al., 2008).

Will staff be at increased risk?

No. The safety of our staff is of utmost importance to us and staff will continue to be safe. Supervised injection sites do not increase crime.

How are area residents and businesses reacting to the proposed new supervised injection service?

Somerset West Community Health Centre has been operating in our current location since 1972 and have long enjoyed a positive relationship with area residents and businesses. This relationship is strong because we provide much-needed individual support and also care about the safety of our community.

Are supervised injection services legal?

Yes. In Canada, legal operation of a supervised injection service requires an exemption under Section 56 of the Controlled Drugs and Substances Act (CDSA). Exemptions are granted by the federal Minister of Health. In 2015, the federal government passed the Respect for Communities Act, which outlines the process and criteria for applicants seeking a Section 56 exemption.

What process must organizations follow to open a supervised injection service?

In order to operate SIS in Canada, agencies must apply to Health Canada for an exemption from the Controlled Drugs and Substances Act- Section 56. This section lists 26 conditions that must be met.

All applications must be sent to the Mayor, the Chief of Police, the Medical Officer of Health in the specific municipality, the Ontario Minister of Health and Long-Term Care, the Ontario Minister of Community Safety and Correctional Services, the College of Nurses, and the College of Physicians and Surgeons of Ontario with a request for a letter of comment on the application for exemption.

An application may be granted even without the support of those individuals and departments.

Where is Somerset West Community Health Centre in this process? How long will it take?

The process to open a supervised injection service includes receiving an exemption under section 56 of the Controlled Drugs and Substances Act and receiving funding.

Exemption: Health Canada has informed us that we have met most of the requirements to receive an exemption under section 56 of the Controlled Drugs and Substances Act to enable us to begin operation of our supervised injection service. They informed us that in order to move our application to the decision phase, we require a letter from the Provincial Minister of Health and confirmation of our provincial funding request.

Funding: The Ministry of Health and Long-Term Care is currently reviewing our supervised injection service funding application and they said they will be getting in touch with us soon to discuss next steps in their internal review process. Once this is completed, Ministry officials will make a recommendation to the Minister of Health regarding how to proceed with his support of our SIS application.

Does the City of Ottawa support your application?

Yes. Studies have repeatedly shown that harm reduction programs like our proposed SIS save lives and money, and don’t increase crime. Dr. Isra Levy, Ottawa’s Medical Officer of Health, supports harm reduction programs. Jeff Leiper and Catherine McKenney, the city councilors for the area we serve, are also very supportive.

Two polls have also shown that the majority of Ottawa residents support the idea of having SIS in our city.

Is Somerset West Community Health Centre encouraging drug use?

No. We recognize that some people in our community use drugs. We want to make it safer for people who do use and for people who don’t use.