A study to explore the need for and feasibility of implementing supervised consumption services in the City of Greater Sudbury Summary and Highlights

“We respectfully acknowledge the traditional territory of Atikameksheng Anishnawbek and Wahnapitae First Nation, as well as the Robinson- Huron Treaty on which this study was conducted. These lands encompass strong and vibrant communities of the Anishinabek and the many other Indigenous Peoples who reside in these communities. Their enduring presence and resilience is felt throughout our shared history and in present day. We strive for respectful relationships with all Indigenous Peoples. We are committed to honour our shared history and ensure healthier communities for all.”

Highlights

Supervised consumption services (SCS) are monitored spaces where people can consume drugs under supervision in an environment with sterile supplies.

The Community Drug Strategy for the City of Greater Sudbury undertook a study to determine the need for and the feasibility of implementing SCS. The study consisted of a peer-led survey with 190 people who inject drugs (PWID), an online survey responded to by 2251 Greater Sudbury community members, and focus groups with 52 community partners and stakeholders. In addition to these primary sources of information, the researchers also consulted secondary data on population health information, drug use, opioid harms, prescription patterns, opioid toxicity, and opioid overdoses.

The City of Greater Sudbury would benefit from supervised consumption services.

• For 2018, per 1000 population, Sudbury and districts ranked twelfth in the province for opioid-related emergency department visits, seventh in the province for confirmed opioid-related deaths, and tenth for hospitalizations. Within Sudbury and districts, there were 199 opioid-related deaths between 2010 and 2018.
• The negative health outcomes are increasing: The frequency of emergency medical service (EMS) calls for suspected opioid overdose was higher in 2019 (468 calls) compared to 2018 (200 calls). Deaths due to opioid-related overdoses in Sudbury and districts increased in 2019, with approximately the same number of deaths in the first half of 2019 (28 deaths) as were experienced in all of 2017 (34 deaths) or 2018 (32 deaths).
• People who inject drugs do so frequently; 43.0% of PWID survey respondents inject several times per day.
• Drugs mixed with other substances can pose a risk because the user may experience an unexpected or adverse reaction. The majority of PWID surveyed, 85.2%, indicated that they have taken a drug they believed was mixed with another substance.
• Accidental overdose is a common experience among PWID in Greater Sudbury. Among the PWID surveyed, more than half had accidently overdosed in their lifetime. Injecting drugs alone poses increased risk of adverse consequences. The large majority of PWID surveyed (83.2%) said that they have injected alone.
• Injecting in public may demonstrate that there is a need for designated supervised space for injecting. Three-quarters (75.0%) of respondents said they had injected drugs in public.
• One-third of respondents (32.6%) indicated they have used a needle previously used by someone else, placing them at greater risk of contracting blood borne infections such as HIV and Hepatitis C.

From the perspectives of law enforcement and health care providers, drug use creates pressures on social services, police, paramedic, hospitals. The need for EMS workers and police officers at overdose sites means that they are pulled away from other community needs.

Supervised consumption services may be a feasible strategy for the City of Greater Sudbury, but there are some concerns that would need to be addressed.

The majority of PWID (89.0%), indicated that they would be willing to use SCS. Among those PWID who would use SCS, their single most important benefit was access to sterile injection equipment (27.5%), or that overdoses can be prevented (20.9%) or treated (20.3%).

Among community survey respondents, 59.8% believed that these services would be helpful in Greater Sudbury, while 33.6% of respondents did not believe these types of services would be helpful, and 6.1% were neutral or unsure.

Stakeholders identified benefits for people who inject drugs, the community and services.

“The benefits of having a SCS is that it’s located in one area, access to other services, so whether it’s drug information or access to other social workers or nurses, or people, I guess ultimately the idea is that if you got a user in front of you, you can try and help them.”

The following potential benefits were identified by community respondents:

• less public drug use on streets or in parks (62.3%)
• fewer used needles on the streets or in parks (62.3%)
• less risk of injury and death from drug overdose (60.1%)

There are concerns and challenges associated with supervised consumption services

Although 89.0% of PWID indicated that they would make use of SCS, those who responded that they would not use these services, or may not use them frequently, expressed concerns about anonymity and fear of police, or noted that they were self-sufficient and not in need of these services.

Business owners and community members expressed concerns about negative impacts around the area of SCS, with effects on perceived neighbourhood safety and desirability, a potential increase in crime and drug use, and more drug dealers targeting the area. Approximately one-third of survey respondents had concerns that SCS could lead to more drug use, more drug selling or trafficking in the area, and more people who use drugs in the area.

There are possible mitigation strategies to address the concerns

It was felt by some focus group participants that many concerns are due to lack of knowledge about the benefits and effectiveness of SCS and lack of understanding about mental health/illness and the link to addiction, and that increased awareness could mitigate some of the concern. Community residents felt that some common mitigation strategies could be helpful:

• Provide information about the goals of SCS and how they can help the community.
• Have a community group to work on issues about SCS.
• Evaluate the services, share results with the community, and take action.

Supervised consumption services should be integrated with existing services

Focus group participants said it was important to build on existing harm reduction programs in Greater Sudbury. Organizations that offer these programs were identified as having the appropriate approach/model to support the needs of those who would use SCS and the needs of the larger community.

If supervised consumption services are considered, the most appropriate location(s) should be carefully chosen

Community survey respondents had concerns about locating SCS in close proximity to schools or other community locations occupied by children. If SCS are considered, PWID were most likely to suggest the downtown core of Sudbury (65.8%) among possible locations. In general, among those who would consider SCS as an option, focus group participants and community survey respondents suggested one SCS site, located in a centralized location in the downtown core, although a mobile site was also suggested to provide services closer to wherever users live. The majority of health care and social services are located in the downtown core, and a downtown location would be in close proximity these supports.

This item was last modified on June 29, 2020