On March 1, the Canadian harm reduction movement enjoyed a quiet win. Health Canada, the country’s national health agency, permitted all safe consumption sites (SCS, also known as overdose prevention sites) in the country to consider supporting peer injection assistance. The previously forbidden practice is known to facilitate vulnerable drug users’ access to such harm reduction centers.
Now, people who use drugs are authorized to prepare and perform injections on their fellow community members in facilities where “appropriate policies and procedures are in place,” a Health Canada spokesperson told Filter. At publication time, 20 Canadian sites had already adopted the practice.
The end to the nearly 20-year prohibition on the practice is almost certain to make the sites more accessible. It is used by anwhere between one-quarter to one-half of Canadian drug users outside of SCSs—particularly by marginalized people, including women and people with disabilities.
“Women appreciate low-barrier SCS or overdose prevention services (OPS), and Indigenous and more marginalized women have expressed feeling more comfortable in a non-medical environment run by people with lived expertise of drug use,” wrote Canadian HIV/AIDS Legal Network (AIDS Law) in a May 11 summary report.
“These at-risk subpopulations are less likely to use a supervised consumption site if peer assistance is not permitted,” explained the Health Canada spokesperson. “Allowing peer assistance can help bring this population into sites where people are monitored for possible overdose, and where they can access a range of services, including counseling, medical services, and access to treatment.”
SCS offer women a safe space to be assisted with injection, whereas outside the spaces, being injected by others may be bound up with intimate partner violence and exploitation, as Filter has reported.
SCS clients themselves seem to find peer assistance a meaningful expression of community care. “You get him high, and get him over his [dope] sickness, and I’m happy; he’s happy,” said Ashley, a client at ARCHES, an Alberta SCS, in an April 29 study still pending peer review.
Similarly, Kyle, another ARCHES client, added, “I don’t like to see them stab themselves so many times, and when they’re really dope sick, I know how that feels too, so then I’ll give them a hand.” Tyson, who also attends ARCHES, wanted to ensure his economically vulnerable peers made the most of a costly substance. “The drugs cost a lot of money; and if they lose [it], they waste it; [and] they’re going to have to try and go get more,” he told the researchers.
Peer assistance has been banned ever since Vancouver’s Insite, the country’s first sanctioned SCS, opened in 2003. Assisters bore legal liability if something went wrong and nurses didn’t have “clear professional guidance,” wrote harm reduction nurse Marilou Gagnon in 2017. The gap in services in Vancouver was filled by an unauthorized grassroots site, “wherein peers oversaw and assisted with injections,” Erin Mason, the data and evaluation co-manager at an Alberta SCS and co-author of the April 29 study, told Filter.
At publication time, Insite had yet to be granted permission for peer injection assistance.
SCS operators across the country have been “tirelessly working with Health Canada to better establish the premise of need for peer assist in SCSs,” said Mason. In response, pilot programs were authorized by Health Canada in June 2018 at 16 sites. The pilots found that “allowing peer assistance helped reduce the risks of harm and overdose faced by women, people with disabilities and vulnerable populations. Specifically, it prevented overdoses, educated people on harm reduction, and connected people to health and social services,” reported the agency spokesperson. With their study results in hand, the federal government green-lit the policy.
Empowering peers to support one another is a win, but there’s more work to be done on the scope of SCS services offered. “One drawback of peer-to-peer injection is placing the onus on people who use drugs to seek someone out to assist them with the injection, rather than having staff provide this health care service at a SCS,” AIDS Law’s Director of Research and Advocacy Sandra Ka Hon Chu told Filter. “Some people who access SCS may not know someone willing to provide them with this assistance, or they may be required to pay (or compensate in some other way) someone for this service. It would be important to provide an option for people who use drugs to receive assistance with injection from SCS staff.”
“Health Canada’s approach to supervised consumption sites has evolved over time to respond to the ongoing opioid crisis and adapt to the needs of the communities in which they are established,” said the agency spokesperson. Hopefully, that will continue.
May 19, 2020 Correction: Sandra Ka Hon Chu, not Emma Riach, gave comment for AIDS Law.
Photograph of a Sydney, Australia SCS by Nigel Brundson