This piece uses the term people who use drugs (PWUD) multiple times. This article recognizes not all PWUD are impacted the same due to many inequalities. When this piece discusses implementing a supervised consumption site “for people who use drugs,” it refers to those looking for a safer environment to consume their drugs and/or seek out help if they want or need it. PWUD will encompass all modes of drug use from smoking to injecting.
CONTENT WARNING: Substance Use, Addiction
A supervised consumption site (SCS) is a place for people to use illicit drugs under the supervision of trained staff who can intervene and prevent an overdose. These sites reduce harms associated with people’s substance use.
Have you ever visited a SCS?
If you answered no, reconsider.
If you consume alcohol, think back to a time before COVID-19, when you went out to your favourite bar or lounge and used your favourite substance, alcohol.
Maybe you had one drink too many, and your server intervened. Maybe your server brought you a cold glass of water and called you a taxi.
This act is harm reduction according to Guy Felicella, a harm reduction advocate from Vancouver.
Why is one form of harm reduction socially acceptable and the other is not?
Vancouver has been home to North America’s first and longest-running SCS, Insite, since 2003.
A report found the fatal overdose rate within a 500m radius of Insite went down 35 per cent, and the fatal overdose rate for the entirety of Vancouver went down 9.3 per cent after one year of operation.
Vancouver Coastal Health says as of 2019, Insite has had more than 3.6 million visits to inject illicit drugs. Nurses have intervened almost 6,500 times, and the site has had zero fatal overdoses.
Felicella overdosed six times at Insite and staff brought him back each time.
He’s adamant without the safety net of harm reduction he wouldn’t be alive.
Setting the scene
In a 2019 news conference, Manitoba Premier Brian Pallister said Winnipeg didn’t need a formal SCS to combat the meth and opioid epidemic in the city. He said there wasn’t enough data to support the need for a site and not enough evidence proving their effectiveness. Pallister seems to disagree with the Government of Canada’s conclusion “supervised consumption sites benefit communities and save lives.”
“The data is in the report he chose to not read,” said Shohan Illsley, executive director of Manitoba Harm Reduction Network.
Manitoba Harm Reduction Network is a Manitoba-based organization that provides harm-reduction resources and supplies to support healthy communities across the province through workshops, community projects, and events.
Sunshine House and various stakeholders prepared the report in question and presented it to Pallister on April 9, 2019. The report explores implementing a SCS in Winnipeg and how it might impact people in the city.
Pallister threw the report on the floor after receiving it, according to news sources at the time.
“There’s no such thing as safe consumption sites according to experts,” he said.
This statement is almost entirely incorrect.
While no space is completely safe, supervised consumption sites protect PWUD by reducing overdoses and providing social services.
Since Pallister disregarded the report in 2019, the Winnipeg Fire Paramedic Service (WFPS) has responded to more than 5,000 calls, 3,492 for meth and 1,583 for opioids, according to city data.
As of March 2021, Canada had 42 licensed supervised consumption sites operating from British Columbia to Quebec providing services to PWUD. Twelve more sites were pending approval from Health Canada at that time.
Statistics Canada data shows ninety per cent of Canadians can access a supervised consumption site within their province, and yet, Manitobans can’t.
“There is so much overwhelming evidence supporting the importance and value of supervised consumption sites,” said Levi Foy, executive director of Sunshine House.
Foy has been with Sunshine House for seven years and has worked in harm reduction for even longer.
Sunshine House is an inclusive community drop-in providing people a safe space to relax, socialize, and get food if they need it, says Foy.
“It’s absurd we’re in 2021 and we don’t have a supervised consumption site in Winnipeg,” said Foy. “I could drive to Kenora and safely get high, but I can’t in Manitoba.”
Formal supervised consumption sites connect clients to doctors, treatment and other social services. The sites also provide PWUD a safer environment to use their drugs under the supervision of trained professionals.
Formal and informal supervised consumption sites are different.
The government licenses, regulates, and operates formal SCS whereas informal supervised consumption sites aren’t officially regulated.
Illsley said there are many informal sites in the province where PWUD take care of other PWUD. News media often refers to these sites as trap houses or crack houses and make them sound dangerous, but they aren’t she said.
“[Informal SCS] are the safest places for people to use their drugs,” Illsley said. “The biggest reason is there are other people around.”
Informal sites provide a community for PWUD she says. They’re a communal space for people to use their drugs, distribute harm reduction supplies like new needles, provide a place to warm up, and even temporarily live.
For the rest of this article, the term supervised consumption site or SCS will be referring to formal supervised consumption sites unless otherwise stated.
Supervised consumption sites benefit PWUD, their communities, and the economy. The sites reduce overdose rates, hospital visits, public drug use, publicly discarded needles, spread of bloodborne illness, and stigma relating to substance use, according to the Government of Canada. The facilities also provide PWUD better access to treatment and social services to assist with the negative consequences associated with their drug use.
If the government provided PWUD a place to use their drugs in a supervised, stigma-free environment, there will be less public drug use. People will dispose of needles properly, leaving fewer to litter the ground.
PWUD will have better access to social support services they might not otherwise have. Illsley said many of Winnipeg’s social services are inaccessible for people who aren’t fully detoxed.
“A lot of the services in the city intended to help people will turn away the people who need help if they are under the influence,” said Illsley.
Supervised consumption sites provide low-barrier access to services essential for helping people address or eliminate the consequences associated with their drug use.
Doctors and treatment can be difficult to access for people who aren’t completely detoxed or sober. Many SCS connect clients to doctors as they are.
Besides the social benefits of supervised consumption, many studies have concluded SCS to be cost-effective.
Cost-effectiveness refers to a site saving more money in the long run than it uses to operate.
The cost-effectiveness in this study from the Harm Reduction Journal refers to the amount of money saved from implementing a site versus not implementing one.
The study states the reduced costs related to fewer EMS and police responses to drug-related incidents and reduced health care costs outweigh the cost of operating a site.
The study above references more than 40 other peer-reviewed studies explaining “the many benefits of SCS and lack of negative impacts.”
COVID-19 enflames the situation
Across the country overdose death rates were trending down between 2018 and 2019. Statistics Canada reported a 13 per cent decrease. Recently, data from the federal government and the City of Winnipeg shows the pandemic has led to a massive increase in overdoses and deaths.
The Public Health Agency of Canada (PHAC) says more PWUD are overdosing alone in 2020 because of self-isolation health regulations. Illsley says the safest way for people to use their drugs is around other people who use drugs.
Illsley grew up in northern Manitoba and spent her early years in an impoverished area in The Pas, given the racialized label of “the ghetto” (now Kelsey Estates).
She recounts seeing a variety of substance use throughout her life.
“People who use drugs take care of people who use drugs” said Illsley. “That’s just how it’s always been.”
Recent statistics from the City of Winnipeg show an increase in opioid-related incidents in 2020. From 2016 until 2019, EMS administered Naloxone, an opioid antagonist medication, to an average of 714 patients a year.
Naloxone, also known as Narcan, combats the effects of a drug overdose and restores breathing, according to the National Harm Reduction Coalition.
EMS administered the medication more times in the first six months of 2020 than 2019.
Pandemic-related public health measures like self-isolation and physical distancing have taken tolls on many people in the city, not just PWUD.
Reducing overdoses means reducing deaths
Since 2015, nearly 5,000 patients received Naloxone to combat an overdose in Winnipeg, preventing many deaths.
On average, the number of patients who’ve received Naloxone steadily increased through 2019.
Twelve months and a pandemic later, the number of patients has doubled in Winnipeg.
Vancouver’s Insite is the best case study for Canadian SCS because of the abundance of data the site provides. Experts don’t need to use a couple years of data to make mathematical projections of the potential benefits.
The beneficial data from Insite goes back to 2003 and resulted in Insite winning a very public court case in 2011. The conservative government wanted to shut the site down, but nine supreme court judges voted unanimously to keep Insite open after a five-year-long court battle.
When a person goes to Insite to use their drugs, they can visit the “chill-out room” after. In this safe space, people can have coffee or juice, or hang out and talk to staff, so they aren’t walking around outside immediately after.
Statistics Canada conducted interviews with 36 coroners, medical examiners, and toxicologists across the country from 2017 to 2018 in a “qualitative effort to better understand the circumstances surrounding these preventable deaths.”
The study concluded many people who died from drug overdose shared many things in common. Among those things in common were a history of mental health concerns, unavailable help at the time of overdose, and a lack of support and coordinated services.
A SCS provides a solution to all the commonalities in the study under one roof.
Increased access to health and social supports and reducing stigma
A Winnipeg SCS would reduce stigma surrounding substance use and make it easier for people to get help, should they want it, to combat the negative consequences of their drug use.
The phrase “reduce the stigma” is a term used by many harm reduction advocates but can be a difficult concept to understand.
The Government of Canada says stigma is negative attitudes and beliefs about a group of people due to their life circumstances. Stigma includes discrimination, prejudice, judging, labelling, isolating, and stereotyping.
When someone experiences stigma, either in society or the health care system, they may feel ashamed of themselves. Once feelings of stigma fester inside someone, their mental health could deteriorate because they begin to feel lonely, devalued, and hopeless.
Sunshine House’s Foy said reducing stigma isn’t some simple five-step process. People need a deep mindset shift. Reducing stigma means changing the way you think about PWUD, racialized people, and impoverished people.
“The reason there is stigma is because people see the people I work with as not human,” said Foy. “All I can do is open the doors at Sunshine House, give people food, and let them do what they need to do.”
He also said people need to approach drug use with humility and not make assumptions about PWUD.
The government says when someone experiences social or structural stigma, they are less likely to reach out for help again.
A 2020 study published by the Harm Reduction Journal says people commonly report stigma and shame resulting from drug use as reasons people hide their drug use and choose to use their substances alone or in non-public places.
If Winnipeg implements a SCS, it will normalize drug use both for PWUD and people who don’t. Implementation would be a way for the government to formally recognize PWUD as just that, people, not “junkies” or “addicts”.
Cost-effectiveness and reducing the spread of bloodborne illness
In 2019, the provincial government released data saying 9 per 100,000 people in Manitoba have HIV. Manitoba is second highest in cases per capita in the country behind Saskatchewan, where 17 per 100,000 people have the virus.
In its annual report on HIV/AIDS in Manitoba, the government also noted people who inject drugs were among the highest risk for contracting the disease.
Harm reduction supplies including new needles provided in supervised consumption sites have the potential to reduce Manitoba’s spread of HIV/AIDS among the highest risk people.
A decrease in HIV/AIDS transmission among the highest risk people in Manitoba could save the province millions in health care costs.
A 2011 study from the Canadian AIDS Society estimates the total “lifetime economic loss” for someone with HIV to be $1.3 million in direct and indirect costs.
The study states direct costs relate to resources used to treat the illness like hospital bills and medications. Indirect costs are costs associated with factors like losing a job, family members withdrawing from the workforce to provide care, and the income los by the sick individual or caregiver.
A different study from the International Journal of Drug Policy estimates Vancouver’s Insite Clinic prevents four to eight cases of needle-transmitted HIV/AIDS per year.
If a SCS comparable to Insite opened in Winnipeg and could prevent four cases of needle-transmitted HIV/AIDS per year, the city could save an estimated $1 million in health care costs and another $4.2 million in future indirect economic loss, according to the cost-estimate above from The Canadian AIDS Society.
2016 census data shows Winnipeg has about 100,000 more people than Vancouver, which might affect the number of HIV infections prevented in a Winnipeg site. One study estimates Insite’s financial benefits outweigh its costs five to one. It isn’t unreasonable to imagine a Winnipeg SCS having similar results.
“The social and economic benefits outweigh the costs,” said Foy. “It’s just more economically viable in the long run than maintaining the status quo.”
Supervised consumption sites save money, not to mention they save lives.
How do we affect change?
“Prohibition, shaming, and stigma do nothing to reduce substance use,” said Foy.
There’s only one way to get a supervised consumption site implemented in Winnipeg.
People need to tell their representatives in government they want supervised consumption services in Winnipeg and vote to put people into power who support harm reduction principles.
Foy said it’s past time for Winnipeg to take a new and more effective approach to how it’s treating substance use.
After years of discussion surrounding a SCS in Winnipeg, city councillors voted in favour of a feasibility study to determine the benefits of a SCS on February 26, 2021.
City staff will return to council 120 days after the decision to report their findings.
Though health care is provincially regulated, the green light on this study is a fantastic move for the city.
Shohan Illsley said a SCS is a step in the right direction, but so much more needs to happen.
“We don’t have a society that says, ‘Let’s talk about substance use and the benefits and potential consequences associated with it,’” said Illsley.
Currently, we have a society only willing to step in and help when someone is already dependant on their substance, she said.
“Telling people, ‘Just don’t use this drug or that substance’ isn’t helpful,” said Illsley.
Illsley said there needs to be a mindset shift to a point where people are ready, willing, and able to talk about their substance use without fear of social stigma.
Illsley said talking about the undesirable effects of substance use would reduce harms.
Implementing a supervised consumption site is not the be-all-end-all solution to eliminating harms associated with substance use. Still, it would be a significant step towards destigmatizing drug use and creating a society willing to talk about substance use and how to mitigate its undesirable effects.
Above everything else, implementing a supervised consumption site in Winnipeg would save lives.