Evidence on Safe Consumption Sites

"SCS are a core part of a public health response to an unprecedented poisoning epidemic that has resulted in 36,442 opioid toxicity deaths between January 2016 and December 2022, driven largely by the production and trafficking of novel illegally manufactured opioids (Public Health Agency of Canada, 2021). SCS provide monitored spaces where people can consume drugs without risk of criminal sanction, receive emergency health care if needed, and access sterile harm reduction supplies and health and social supports (Health Canada, 2020). The number of federally sanctioned SCS in Canada increased from two in 2016 to a peak of 42 in 2020 (Health Canada, 2020). Additionally, more than 40 overdose prevention sites—a low-threshold form of SCS meeting an immediate community need and requiring less pre-implementation consultation—have opened in Canada since 2016. Collectively, these services have prevented and managed thousands of drug poisoning events and saved thousands of lives (Irvine et al., 2019).

"SCS are designed to reduce health and social risks, including risks associated with using drugs alone amid a toxic drug supply crisis. They also provide social support for structurally vulnerable populations who experience barriers to accessing health care (Kennedy et al., 2017). A substantial body of peer-reviewed research demonstrates the positive impacts of SCS. A systematic review by Kennedy et al. (with findings later corroborated by Levengood et al.) synthesized 47 studies from Vancouver, Australia, Germany, Denmark, Spain, and the Netherlands (Kennedy et al., 2017; Levengood et al., 2021). Studies adopted a mix of prospective cohort, time series or pre/post ecological, cross-sectional, mathematical simulation, or series cross-sectional designs and the majority were assessed to have good methodological quality. The review found that SCS mitigate drug poisoning–related harm and unsafe drug use practices, facilitate uptake of substance use treatment and other health services, are associated with improvements in public order (e.g., reductions in publicly discarded syringes), do not increase drug-related crime, and are cost-effective. A subsequent modelling study estimated that British Columbia’s overdose prevention sites averted 230 deaths in a 20-month period (Irvine et al., 2019). A study from Calgary, Alberta, found significant health system cost-savings arising from decreases in opioid-related ambulance responses and emergency department visits following the implementation of an SCS (Khair et al., 2022)."