BC Centre on Substance Use releases new provincial guidelines for operating supervised consumption services

published on August 11, 2017

The BC Centre on Substance Use (BCCSU) has released the first-ever provincial guidelines for operating supervised consumption services to provide guidance to health authorities establishing new services.

“As new supervised consumption services open in B.C. and across the country, the BCCSU guidelines released today will help sites to provide the best possible care to vulnerable people,” said Judy Darcy, Minister of Mental Health and Addictions. “The guidelines are another example of the work BCCSU is doing to transform and strengthen our approach to the overdose crisis and help save lives.”

Supervised consumption services (also known as SCSs) provide hygienic environments where people who use drugs can safely consume substances under supervision, without fear of arrest. Evidence has demonstrated that SCSs are a life-saving harm reduction intervention. Evaluations to date have revealed that SCSs are effective in reducing public disorder, unsafe injecting, infectious disease risk behaviours, and overdose morbidity and mortality. SCSs have also been found to be cost-effective and to reduce the burden on emergency services, while increasing uptake into withdrawal management services and addiction treatment among clients of SCSs.

“Supervised consumption services are one of the only tools we have to deal with overdoses when they occur, and there’s never been a death due to overdose in one of these facilities anywhere in the world. These are life-saving health services that are urgently needed amid a public health emergency,” said Dr. Thomas Kerr, Associate Director of the BCCSU and principal investigator of Insite, Canada’s first stand-alone supervised injection site. “With years of evidence now available, we can confidently advise on best practices for operating these services to optimize the care provided to those using them and minimize the risks for patients, staff, and the surrounding community.”

Essential recommendations for SCSs include, at minimum:

  • Conduct a needs and feasibility assessment that includes at minimum an assessment of local drug-related harms, existing services, willingness to use a SCS among local people who use drugs, and support from key stakeholder groups.
  • Determine the ideal type of SCS for the setting. For instance, fixed stand-alone SCSs are recommended in settings with large populations of people who use drugs that are concentrated in a specific area, but other models, such as mobile services, should be considered.
  • Establish a staffing structure that considers the many health challenges experienced by people who use drugs in accessing SCSs, as well as the need for emergency overdose response. Where possible, people who use drugs should be involved in staffing SCSs and should be involved in the planning ensure that SCS services meet the needs of local people who use drugs.
  • Create and implement policies and procedures including overdose response protocols, referral pathways, code of conduct and rights and responsibilities for clients and staff, and eligibility criteria and intake.

The guidelines were developed following a review of the available scientific evidence, policies, and procedures in place in B.C., and assembled experts in the area, including operators of the first two SCS facilities in Vancouver – Insite and the Dr. Peter Centre, which has been operating an integrated SCS since 2002.

“The Dr. Peter Centre is pleased to be sharing its approach to community consultation and engagement. We’ve had 15 years of success integrating supervised injection service into our health care services – and into the neighbourhood,” said Maxine Davis, Executive Director of the Dr. Peter Centre, which recently released the ‘Guidance on Community Consultation and Engagement Related to Implementation of Supervised Consumption Service.’ “It is so heartening to have received letters from the West End Business Improvement Association, West End Residents Association, and others conveying they consider supervised consumption service an asset to the neighbourhood.”

An exemption from section 56 of the Controlled Drugs and Substances Act is required in order to open a supervised consumption service. In May, legislation was amended that streamlined the process for opening a SCS, reducing the criteria required to be met from 26 to 5. As a result, the number of SCSs are rapidly expanding across Canada making operational guidance and standards of care critically important. Health Canada has now approved 15 SCSs across the country.

In B.C., there are eight federally approved supervised consumption sites – one each in Kamloops, Kelowna, and Victoria; two in Surrey; and three in Vancouver – with five currently open and operating. In addition to those having received federal approval, there are 20 Overdose Prevention Sites in the province, which were opened under ministerial order in response to the opioid overdose public health emergency.

The Supervised Consumption Service Operational Guidance can be found here.

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About the BC Centre on Substance Use
The BC Centre on Substance Use (BCCSU) is a provincially networked organization with a mandate to develop, help implement, and evaluate evidence-based approaches to substance use. Located at St. Paul’s Hospital in Vancouver with researchers based at the University of British Columbia and Simon Fraser University, the BCCSU aims to build upon the success of its partner organization, the BC Centre for Excellence in HIV/AIDS, by improving the integration of best practices and care across the continuum of responses to substance use through the collaborative development of policies, guidelines, and standards. With the support of the province of BC, BCCSU aims to transform substance use policies, programs, and services by translating research into education and care guidance, thereby serving and improving the health of all British Columbians.

For additional information or to schedule an interview, please contact:
Kevin Hollett, BCCSU
[email protected]