Rules and Criteria at Supervised Consumption Sites

"We found a range of rules and criteria across the different SCS. Many SCS enacted eligibility criteria that risk excluding the populations most in need of the service. For example, women who use drugs are more likely to experience violence and are at a higher risk of bloodborne virus infections [71], yet some SCS policies (e.g., excluding people who are pregnant or who have children with them), disproportionately impact women attempting to access SCS. Many SCS did not permit people who are younger than 18 years of age to consume drugs on site. This is problematic because youth who consume illegal drugs are at heightened risk of hazardous consumption patterns or other activities (e.g., sex work) that increase risk of exposure to blood-borne viruses [72, 73]. Excluding people who wish to access these services on the basis of age does not take into account their needs [74, 75], and eliminates an opportunity to improve health outcomes amongst an especially vulnerable subpopulation of people who use drugs. Furthermore, SCS typically have limited operating hours, commonly operating only during the day. Recent research indicates that program participants and consumption patterns vary according to the time of day, with an increase in vulnerable populations (e.g., women and those experiencing homelessness) and stimulant use during night hours [76]. Restricting operating hours may also increase harms to vulnerable subpopulations of people who use drugs (e.g., violence, overdose). In contrast, several SCS sought to address these service gaps by specifically targeting populations of women, including those who engage in sex work [32, 33, 44], permitting people under 18 to access the SCS [33], operating 23–24 h per day [36, 77, 78], or extending hours past midnight [32, 33, 79]."