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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 the supervision of medical staff. People bring pre-obtained drugs and inject them themselves. Staff do not supply or inject drugs.
SIS may offer a range of services including sterile injection supplies, supervised injections, drug use education, overdose prevention and intervention, counselling and medical support, information and referral to treatment or other services, peer support, food and beverages.
Do supervised injection services exist anywhere else?
Yes. SIS started in Europe and there are now more than 90 sites worldwide.
In Canada, there are currently two SIS – both in Vancouver. Insite, located in Vancouver’s Downtown Eastside, opened in 2003 and was North America’s first SIS. As of February 2017, Health Canada has approved three new SIS which will be located in Montreal. It is also reviewing 10 additional applications for injection sites across Canada (three from Toronto, two from Vancouver, two from Surrey, one from Victoria, one from Ottawa, and one for a mobile site in Montreal).
Locally, Sandy Hill Community Health Centre submitted an exemption application to Health Canada in January 2017 and aims to begin offering SIS in summer 2017.
Why are you considering offering supervised injection services?
We want to offer SIS because every person deserves access to health services, and people who use drugs are typically not well connected to health care services. SIS provide the first point of contact for injection drug users with the health system. They make it possible for marginalized people in our community to connect to other health and social services. Without this link, people who use drugs are less likely to access health services.
Supervised injection is also a safe health service that saves lives by reducing overdoses and the spread of disease. We know the following from Ottawa Public Health data:
- Since 2009, both drug-related emergency room (ER) visits and unintentional opioid overdose deaths have increased in Ottawa.
- There were approximately 1,750 drug-related ER visits (2015) and 36 unintentional overdose deaths (2014) in Ottawa.
- Two-thirds of the unintentional overdose deaths were due to opioids such as fentanyl and oxycodone.
In addition, Ottawa has Ontario's highest rates of HIV and Hepatitis C among people who inject drugs.
Finally, Somerset West Community Health Centre wants to offer supervised injection services because they improve community safety. They do this by reducing public drug use and drug litter. There is no evidence that SIS contribute to increased crime.
For further information on substance use in Ottawa, please refer to the following reports by Ottawa Public Health:
- Problematic Substance Use in Ottawa Technical Report, June 2016
- Enhanced Harm Reduction Services in Ottawa, June 2016
What are the drug use and overdose rates in Ottawa?
According to Ottawa Public Health data, there are between 1,200 and 5,600 people in Ottawa who inject illicit drugs. Fatal and non-fatal overdoses occur in Ottawa and are a concern. There are approximately 48 drug–related deaths in Ottawa each year, 40 related to drug overdose and 8 related to infectious disease deaths. 
What are the HIV and Hepatitis C rates for people who inject drugs in Ottawa?
Ottawa has the highest rate of HIV (13%) and Hepatitis C (73%) amongst people who inject drugs in Ontario. 
Do harm reduction programs actually work?
Yes. Data from Insite, one of Vancouver’s 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.
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.
Why is Somerset West Community Health Centre expanding services to include supervised injection?
Because we are in a crisis and people are dying. Our ward – the Somerset Ward of Ottawa – has the second highest counts and rates of average annual:
- Emergency room visits related to unintentional drug overdose between 2013-2015 
- Number of individuals diagnosed with Hepatitis C or HIV with reported injection drug use between 2011-2014.
Moreover, Somerset West Community Health Centre is well-suited to offer SIS because we:
- Already have expertise in harm reduction. We have one of the largest city-wide harm reduction programs in Ottawa.
- Offer a range of complimentary health and social services. People who access our harm reduction services can also access counselling, mental health support, and medical services on-site.
Why are you calling this an expansion of your services? What are you already doing?
Somerset West Community Health Centre already offers a range of harm reduction services. These include providing clean injection and safer inhalation supplies and condoms 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 outside and in other unsanitary locations. 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.
Why would someone use a supervised injection service?
People use SIS for a variety of reasons. In focus groups and interviews with drug users , people said the main reasons they would use SIS were that they:
- Could use drugs in a safe and clean place where they would have less risk of being robbed, assaulted, being arrested or confronted by the police;
- Would have access to sterile and hygienic drug use equipment and be able to safely dispose of used drug equipment; and
- Would have access to health professionals and support staff.
Overdose intervention was also a commonly reported health-related reason.
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.
What would the service hours be?
We are in the early stages of developing this service. Feedback from SWCHC clients is overwhelmingly in support of the SIS being open 7 days a week, anywhere between 4 to 12 hours a day. Peak hours would be mornings, and most people indicated they would use the service on average 3 times per day.
We plan to begin offering SIS Monday to Friday. The hours of operation would be the same as the Eccles Branch hours of service:
- Monday, 9 a.m. to 5 p.m.
- Tuesday, 9 a.m. to 8 p.m.
- Wednesday, 9 a.m. to 5 p.m.
- Thursday, 1 p.m. to 8 p.m.
- Friday, 9 a.m. to 4:30 p.m.
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?
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. Our safety policy and procedures will be reviewed and will continue to apply to all services at all times.
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.
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?
At this stage, we are preparing an application for approval from Health Canada for this service and seeking funding. We hope to submit our application to Health Canada by June 2017.
Does the City of Ottawa support your application?
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.
  Ottawa Public Health, Problematic Substance Use in Ottawa Technical Report, June 2016
 TOSCA, 2012; Participatory Research in Ottawa: Understanding Drugs (PROUD), 2016