Like many Canadian cities and towns, London, Ont., has been impacted significantly by drug addiction. But there is hope a permanent supervised consumption site (SCS) expected to open in mid-March 2022 will help fill a much-needed gap and serve as a catalyst for further community de-stigmatization and harm reduction initiatives.
The Middlesex-London Health Unit reports that the number of opioid-related deaths in London has fluctuated roughly around the Ontario average since 2005. However, the city has experienced a higher burden than the provincial average for many other public health outcomes of drug addiction such as infectious disease spread and opioid-related emergency room visits.
Current estimates indicate that 2 per cent of London’s population are injection drug users, with a significant proportion of this usage occurring within public spaces via unsafe and non-sterile injections. These consumption practices are not surprising given that people who inject drugs (PWID) are known to experience higher rates of homelessness and mental health concerns, along with having limited access to health and social services.
The consequences of unsafe drug usage are evident from the municipality’s high rates of overdose-related hospitalizations and blood-borne infectious diseases. To help decrease the negative health and social impacts of drug use in London, a permanent SCS received final approval for development in November 2020. The site will replace and expand upon the available harm reduction resources at Carepoint, London’s current temporary SCS, with the new site housing six spaces for drug consumption along with a needle exchange program and rooms for treatment and counseling programs.
The benefits of a supervised consumption site
Current literature, along with policy reports on existing SCSs, clearly demonstrate the benefits of harm reduction programs. Initiatives like London’s future SCS have led to reductions in accidental overdoses and preventable injuries arising from usage in unsafe spaces, and significantly inhibited the spread of infectious diseases.
This is especially promising for London, which has Hepatitis C, endocarditis and invasive streptococcal infection rates that are well above the provincial average. These infections are directly related to unsafe injection practices and show that harm-reduction initiatives can play a critical role in prevention and improved health outcomes. In London, a relatively higher proportion of patients with infective endocarditis (55 per cent) are injection drug users. This infection of the heart valves is associated with substantial morbidity and mortality especially in PWID, with studies highlighting up to a third of this vulnerable population ultimately dying as a result of the infection.
Aside from improving a number of health outcomes, SCSs can significantly reduce short- and long-term health-care costs by reducing ambulance calls, emergency room visits and hospitalizations while also increasing the number of patients entering medication-assisted treatment for substance use disorder. Infective endocarditis alone costs London hospitals around $7 million annually – a significant cost to incur for a preventable condition.
SCSs also provide an invaluable opportunity to educate both clients and the broader community on substance use and safe injection practices. PWID often are from a lower socioeconomic background and face multiple barriers to accessing health-care services. Harm reduction sites can serve as a vital resource to help reach a population that often slips through the cracks of the health-care system. Clients can be connected to social services such as mental health counselling, affordable housing and employment assistance as well as be provided with information about available health services.
As well, harm reduction programs are uniquely embedded in certain communities and play a role in destigmatizing substance use, encouraging community members to learn more and debunking stereotypes. For instance, communities with a SCS have shown reductions in public drug use and the number of improperly discarded syringes.
London is home to many health professional programs such as the Schulich School of Medicine & Dentistry, some of whose students have expressed interest in getting involved with a potential SCS. These learning opportunities would allow students to learn first-hand how to provide culturally safe and trauma-informed care to diverse populations, understand the implications of the social determinants of health, advocate for their patients, and identify gaps within current healthcare practices.
Barriers to implementing an SCS
Though the advantages of SCS are evident, there are still significant barriers that first must be overcome. Most importantly, to be legally permissible, the site must first receive an exemption from Section 56 of the Controlled Drugs and Substances Act. This application process requires information regarding the impact of a site on crime rates, consultation from the community, the administrative structure and resources available to support maintenance of a site, and lastly, the local conditions indicating need for a site. Though the London opioid-related statistics clearly justify local need, much of the resistance to the approval and development of the new site has come from community opposition.
In the community consultation report, Londoners expressed concerns relating to perceptions of increased crime and decline in neighborhood reputation, including potentially increasing the number of drug users in the area, rising rates of drug trafficking and decreasing neighborhood cleanliness; all related to potential decreases in personal safety and negative impacts on local businesses and property values. However, studies on the social impacts of safe injection sites in Vancouver and Sydney, Australia, have shown these fears to be unfounded as both sites have seen no increase in violent crime, loitering, theft, drug-related crime or property crime in the surrounding area.
Other community concerns include inadequate funding for effective implementation and operation of the facility. These fears should be soothed by the fact that the provincial government has agreed to fund the $1.7 million annual operational budget and $1.2 million renovation costs of the site. Additionally, if the SCS does become strained for personnel or staffing costs, medical and allied health students could potentially act as a volunteer resource to help run the site and increase long-term sustainability.
Although the SCS approval was contentious, what cannot be contested is the opioid crisis. There is a desperate need in the community for low-barrier access to harm reduction services and treatment. An SCS could not come at a better time – a November 2020 Ontario report revealed a 40 per cent increase in opioid related deaths since the start of the COVID-19 pandemic.
The authors are involved with ASPIRE, a student-led clinic in the London-Middlesex area.