Harm Reduction “Satellite Sites” Are a Powerful, Underutilized Model

    People who use drugs have been taking care of each other ever since people have used drugs. And practicing care takes many forms.

    Sometimes it looks like a safe space to useregardless of whether it’s a sanctioned site, an unsanctioned site or a nice warm apartment with harm reduction supplies. Sometimes it looks like spotting someone else while they’re using; taking care of their kids, pets, and other family members while they’re using; or making sure friends have sterile drug-use equipment. It can look like doing community sweeps for used syringes. And perhaps most important, it looks like always carrying naloxone: People who use drugs are the real first responders to the overdose crisis.

    There are options that can bring together natural networks and formal programming.

    Harm reduction programs in Canada typically offer a variety of services from fixed locations. These are essential, and need to be expanded so that people everywhere have access to life-saving supports. But the community-based organizations that run these programs are usually under-funded, and only able to serve people in specific areas. Additionally, due to criminalization, stigma prevents many people from accessing the limited supports available.

    However, there are options that can bring together natural networks and formal programming.

    In 1998, Raffi Balian, the late drug-user advocate, started COUNTERfit in the east end of Toronto, Canada, with a vision to provide 24-hour harm reduction services for the local community. It was operated by South Riverdale Community Health Centre (SRCHC). At that time, people who use drugs weren’t allowed in the SRCHC building; they had to receive service off-site. So Balian had to get creative.

    Within a year, he started a mobile delivery system for a wide range of harm reduction supplies. He then enlisted volunteers from the SRCHC service-user base to do secondary distribution from their homes.

    Basically, Balian identified people who were getting supplies and info for themselves and their friends, and eventually was able to secure funding to pay people for their work. The places from which these people were working eventually became known as “satellite sites.” 

    Satellite sites can be anywhere people who use drugs regularly gousually someone’s apartment or other accommodation.

    In 2017, Parkdale Queen West Community Health Centre (PQWCHC), in west downtown Toronto, in turn opened its own formal satellite program, modelled after COUNTERfit. 

    Harm reduction satellite sites can be anywhere where people who use drugs regularly gousually someone’s apartment in a social or supportive housing complex, their house, or another type of accommodation. The person who lives there essentially acts as a “middleman” for people to pick up safer-use equipment supplied by a more conventional harm reduction program. But they are much more than that.

    Satellite sites act as one-stop, informal service providers, where they can not only get safer-use supplies and naloxone, but also information, training and in some cases, an unsanctioned safer space to use. Since the resident operators are employed by community health centres, they are able to link their clients directly to other services, including drug checking, primary care, HIV and hepatitis C treatment, counselling and more.

    In October 2020, SRCHC and PQWCHC released a guidebook about satellite sites, called, “Harm reduction satellite sites: A guide for operating harm reduction hubs from the homes of people who use drugs.” The guidebook notes that “Many Satellite sites offer much more than [supplies], including naloxone and overdose response training, safe needle disposal, and referrals to health care services.”

    The guidebook is also full of tips and things to consider in setting up and supporting satellite sites, all based on the many years of experience of people who have been doing this work, from social considerations to practical forms which can be used when applying for grants.

    “Satellite work has been one of the best things to happen to me in my life.”

    Iye Sanneh is a satellite site outreach worker for PQWCHC, providing services directly from the building where she lives. She is also a national board member for the Canadian Association of People Who Use Drugs.

    Iye Sanneh picking up supplies. Photograph by Sara Jane Mortimer.


    “Satellite work has been one of the best things to happen to me in my life,” she told Filter, “given the ability to be invited into other people’s homes as well as hosting others is the foundation of harm reduction: meeting people where they are at.”

    This model particularly shines in the way it supports the building of supportive relationships among marginalized people who use drugs—people who often do not have a lot of personal, social or practical support of any kind.

    Thanks to the rapport Sanneh has built as a satellite site outreach worker, she has been able to respond personally to over 40 overdoses. “I’ve saved lives!” she said. “I also gave referrals for food banks, wellness care and mental health services.”

    Sanneh is just one worker. If she alone has reversed over 40 overdoses, the number of lives saved by satellite sites and the people who run them must be exponentially higher—even if the informality of their provision doesn’t necessarily lend itself to paperwork and data collection.   

    Each of these lives saved belongs to someone’s sibling, parent, child or friend—but above all, regardless of their relationships, to a person

    Satellite sites also represent fewer disease transmissions, soft-tissue infections and other harms. They represent fewer calls to emergency services that are currently under great strain, and fewer used syringes in hallways, schoolyards and parks. So you have to wonder, why not across North America? 

    Compared to the billions being spent on waging the war on people who use drugs, hiring people who are already leaders in their communities to run satellite sites—empowering impacted people and reducing all kinds of harms—has to be considered cost-effective. 

    One problem in the States would be the so-called “crack house” statutewhich for so long was used, if ultimately unsuccessfully, to oppose the legality of establishing even a formal safe consumption site in Philadelphia. But willful political ignorance is a greater obstacle still. If politicians were really open to innovative approaches, maybe there wouldn’t be approximately eight overdose deaths an hour in the US alone. 

    Satellite sites could immediately become an increasingly important part of the picture if we funded them and scaled them up.

    People who use drugs are used to being at the heart of health crises, and that goes not just for the overdose crisis and the COVID-19 pandemic. We’ve also suffered the devastating impact of emergencies like the HIV/AIDS crisis, the hepatitis C epidemic, mass incarceration, police violence and the crisis of affordable housing in cities across North America. What people who use drugs are really experiencing is a syndemic of multiple social and health issues interacting to negatively impact the health outcomes of each. 

    The whole system is broken and we need to fix it. Such complex, intersecting issues have no single, simple solution. Legally regulating all drugs for all purposes, decriminalizing the people who use them, and working, in many ways, to create an equitable society are among the answers, but there are others, too.

    But while we’re working on these long-term systemic changes, there is still plenty that can be doneand is being done dailyby formal or informal harm reduction workers. And satellite sites could immediately become an increasingly important part of the picture if we funded them and scaled them up.

    Without choosing to, we who use drugs live on the frontlines of many things policymakers want to and continue to ignore. And as Iye Sanneh said, “Satellite work is the frontline of frontline work.”


    Top photograph of a building in Toronto that hosts a satellite site by Liam Michaud/Harm Reduction Satellite Sites guidebook

    Toronto’s satellite sites model was the subject of a recent webinar, which can be viewed here.

    • Rhiannon has been working in harm reduction in Toronto for almost 20 years in drop-ins, shelters and community health centers, doing case management, trustee support, needle exchange and outreach. She is a founding member of the Toronto Harm Reduction Alliance, and the co-chair of the Women’s Harm Reduction International Network. She is currently coordinating the COUNTERfit Harm Reduction Program at South Riverdale Community Health Centre in Toronto, Canada.


      Patrick has been working in the field of HIV and harm reduction since 2008. Originally from Halifax, Patrick moved to Vancouver in 2010 and works at the Dr. Peter Centre, which provides care and support services to people living with HIV. Patrick facilitates a Canadian supervised consumption/overdose prevention site service providers video call. He also serves as the co-chair for the Pacific AIDS Network’s board of directors.

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