Preventing and Responding to an Overdose

Anything Can be Cut With Fentanyl

Anything can be cut with fentanyl. This means you never know what is in the illicit or street drugs you are taking.

This illicit Fentanyl is often made as a powder and mixed with other drugs (like heroincocaine or crack). It is also being pressed into pills and sold as things like 'oxycodone' (oxycontin, oxys, Percocet, eighties) or other pills including speed and ecstasy/MDMA.

These counterfeit pills can be made to look almost identical to prescription opioids and other medications. There is no easy way to know if Fentanyl is in your drugs.

Anything can be cut with fentanyl

You can't see it, smell it or taste it. Illicit fentanyl has been found in Ottawa.

In the News: ALERT: Potential Risk of Overdose from Counterfeit Prescription Pills

A very small amount of the powder, like the size of 2 grains of salt, can kill someone.

Overdose Prevention: Reduce your Risk

If you are going to use:

Don't Use Alone

  • If you overdose when you are alone there will be no one there to help you.
  • When using with someone else, don't use at the same time. Be sure your friend is willing to call for help, and make a plan for what to do if an overdose happens.  
  • If you do use alone, tell someone before you use. Leave the door unlocked and have someone come check on you.

Don't Mix Drugs

  • Don't mix drugs with other drugs or alcohol.
  • Mixing with other drugs puts you at higher risk of overdose.
  • If you are going to mix, use one drug at a time or use less of each drug.  

Go Slow

  • The quality of street drugs is unpredictable. Fentanyl is being cut (mixed) into both opioid and non opioid drugs:
    • Made as a powder and mixed into cocaine, heroin, and crack.
    • Made as pills and being sold as 'oxycodone' (eighties, oxys) or other pills including ecstasy/MDMA.
  • You may not be able to taste, smell or see it. Even very small amounts can cause an overdose.
  • Start using in small amounts and do "testers" (or test doses) to check the strength of what you are using.

Carry Naloxone

  • Naloxone is a medication that can temporarily reverse an opioid overdose.
  • Naloxone is available free to people who use drugs and their family and friends!
  • Learn more about Naloxone and where to get a kit.

Know your tolerance 

  • Tolerance is the body's ability to 'handle' the effects of the drug being used. Tolerance to a drug develops over time.
  • Drug tolerance will decrease when somebody has taken a break from using - whether intentionally or unintentionally (like while in treatment, hospital or jail).
  • Your tolerance will also change depending on: 
    • Weight,
    • Illness,
    • Stress,
    • Lower immune system (from hepatitis for example),
    • Lack of sleep,
    • Other drugs/medications being used, and
    • General health. 
  • Use less drugs when your tolerance may be lower.
  • Your risk of overdose increases if you are a new user or haven't used in 3+ days!

Be aware

  • Drugs can be tampered with at any point. People buying or selling drugs may not be aware if it has been cut with anything before they sell it to you.

A paramedic speaks about overdose prevention and calling 911.

Signs and Symptoms of an Overdose

An overdose may look different from one person to the next and depending on the drugs involved.  An overdose is a medical emergency and the first step is always to call 911.

Type of drug

Common signs and symptoms of an overdose

Opioids 

(like heroin, morphine, fentanyl, methadone, oxycontin)

Opioid overdose signs and symptoms

Download: Signs and Symptoms of an opioid oversdose [PDF 1.8 MB]

Breathing is very slow, or irregular, or they may not be   breathing at all

Fingernails and/or lips are blue

Body is limp

Deep snoring or gurgling sounds

Loss of consciousness/passed out (can't wake the person   up)

Unresponsive  (not answering when you talk to them or   shake them)

Pinpoint (tiny) pupils

Stimulants

(like cocaine, speed, crystal meth, MDMA/ecstasy)

Seizures

Pressure and tightness in chest

Foaming at the mouth

Racing pulse

Excessive sweating

Vomitting

Headaches/dizziness/ringing in the ears

Hard time breathing

Sudden collapse

Loss of consciousness/passed out (can't wake the person   up)

Hallucinogens

(like acid, LSD, ketamine, magic mushrooms)

Catatonic syndrome (person will be in a trance like state)

Psychosis (their reality is altered may be having   hallucinations or delusions)

Nausea/vomiting

Seizures

How to Respond to an Opioid Overdose

5 Steps to Save a Life

What to do in case of overdose?

Shake and shout to check responsivenessCall 9-1-1 if not responsiveGive chest compressions or CPR with no interruptions, except to administer naloxone.Give naloxone at anytimeIs it working? Continue chest compressions or CPR until the person responds or EMS arrives. If they are not awake after 3 minutes, administer second dose of naloxone.

  1. Shake and shout to check responsiveness
  2. Call 9-1-1 if not responsive. Emergency workers are there to save lives, not to judge. You can't be charged for simple possession of illegal drugs, or for pre-trial release, probation orders, conditional sentencing or parole violations related to simple possession when calling for help in an overdose. This exemption applies to you or anyone you are calling 911 for.
  3. Give chest compressions or CPR with no interruptions, except to administer naloxone.
  4. Give naloxone at anytime
  5. Is it working? Continue chest compressions or CPR until the person responds or EMS arrives. If they are not awake after 3 minutes, administer second dose of naloxone.

If you have to leave the person at any time put them in the recovery position.  The recovery position helps keep a person's airway open so they can breathe and can prevent them from choking on vomit or spit.

Recovery Position

 recovery position

  1. Responder extending victims closest arm above the victims head
  2. Responder positions other arm across the victims chest and bends furthest leg at the knee.  Victim is rolled towards responder and placed on side
  3. Victim laying on side with head stabilized on extended arm. Knee is bent and stabilized

It is important to stay with a person after giving them naloxone: 

  • The person may be confused and frightened when they wake up. You will need to tell them what happened.
  • A lot of opioids can last longer in the body than naloxone, so an overdose could return. It is important to make sure that the person knows not to take any more drugs!
  • It is important to tell paramedics everything you know about the situation so they can provide the best care.
  • Naloxone may cause people who have used opioids to go into withdrawal. This may make the person want to use again.  Using more will increase the risk of overdose as the naloxone wears off. 
  • This can be very uncomfortable for the person but is not life threatening.  Withdrawal symptoms may include:
    • Muscle aches,
    • Sweating,
    • Nausea/vomiting,
    • Agitation,
    • Irritability. 

For full training on how to give naloxone, visit the locations listed above.

Learn about tips on how to respond to overdoses of a stimulant (PDF) like cocaine, crystal meth, speed, MDMA, or Ritalin. 

Harm Reduction Services in Ottawa

Harm reduction services, such as OPH's Site Needle and Syringe Program, help reduce harm to people who use drugs and also protect our community. This is done by distributing supplies (such as needles) for safer drug use, teaching about safer drug use, and referring people to other health and social services.

Site Needle and Syringe Program

The City of Ottawa's Site Needle & Syringe Program is an effective mandatory health program, which has been in operation since 1991. The availability of these programs have been deemed a necessary public health measure to prevent the spread of communicable diseases, primarily HIV and Hepatitis-C virus, and to minimize the risks associated with substance use in society.

Program information and background

Mandate of the Ontario Ministry of Health and Long Term Care

Background

In the late 1980's, the rate of HIV and Hepatitis B and C infection grew to epidemic proportions among injection drug users. The Ministry of Health acknowledged the urgent need to implement harm reduction strategies to control the epidemic. The human costs, as well as the financial burden HIV infection was placing on the health-care system, were a major concern.

The Ontario Ministry of Health, under the Health Protection and Promotion Act mandated that:

"The board of health shall ensure that injection drug users can have access to sterile injection equipment by the provision of needle and syringe exchange programs as a strategy to prevent transmission of[ HIV, hepatitis B, hepatitis C and other blood-borne infections and other associated diseases in areas where drug use is recognized as a problem in the community. The strategy shall also include counselling and education and referral to primary health services and addiction/treatment services. The board of health shall produce an annual report of program activities and forward a copy to the Minister of Health

Program goals
To educate clients to reduce and avoid the risk of transmission of HIV, hepatitis and other blood-borne pathogens by:
  • Increasing awareness of the risks involved in needle sharing, other drug using behaviours and unprotected sex. To enhance the skills needed to change high-risk behaviours and/or maintain low and no risk behaviours.
  • Providing accurate information on all modes of HIV transmission (including sexual transmission), testing and prevention.

Providing health education, needle exchange, and condom distribution. To encourage self-esteem in substance users and other clients and an awareness of health issues by:

  • Increasing awareness of health status regarding HIV and hepatitis B and C by offering testing.
  • Encouraging and providing hepatitis A/B and influenza vaccination.
  • Providing health education, anonymous HIV testing, confidential testing for hepatitis B and C, Chlamydia, gonorrhea, syphilis, provision of hepatitis A/B vaccine, HIV and hepatitis C counselling and partner follow-up.

To provide a supportive environment for substance users and other clients to access medical and social services by:

  • Gaining a client's trust to a point of access for meeting their service and health care needs.
  • Referring substance users to treatment, counselling services, medical and other social service supports.
  • Providing crisis counselling, referrals to community agencies and drug treatment programs.
Services provided
  • distribution of harm reduction supplies (injecting and inhalation supplies)
  • distribution of condoms and lube
  • health education/ promotion
  • substance use counselling
  • general counselling and support
  • referral to health and social service agencies including drug treatment services
  • Peer Overdose Prevention Program(POPP) please reference below for more information

Clinical services offered:

POPP (Peer Overdose Prevention Program)

Are you at risk of opiate overdose?

Did you know?
  • Anyone can overdose (first time and long time users, youth and older adults).
  • Fentanyl is often made as a powder and mixed with other drugs. It is also being pressed into pills. It is around 50 to 100 times more toxic than morphine. This makes the risk of accidental overdose much higher.
  • There is an increased risk of overdose after a period of non-use (like being released from prison, hospital, or a treatment facility) or from a lack of access to drugs.
What can I do to reduce my overdose risks?
Here are some overdose prevention tips:
  • Avoid using alone. Fix with a friend and leave the door unlocked.
  • Avoid mixing drugs with prescription and over the counter drugs, alcohol, benzodiazepines, other opiates and/or uppers like cocaine or crack.
  • Use one drug at a time if you are mixing and take a break between drugs.
  • Inject, snort, or smoke a very small amount first to test its strength.
  • Illicit fentanyl is much more toxic than other pharmaceutical opioids
  • There is no easy way to know if fentanyl is in your drugs. You can't see it, smell it or taste it
  • Fentanyl is being cut (mixed) into both opioid and non opioid drugs
  • If you are feeling sick or under the weather, use less and be more careful.
  • Use less when your tolerance is low (like when you haven't used in 3 or more days).
  • Let your community agency know if you notice any changes with your drugs.
  • An overdose is a medical emergency! If you or someone else is overdosing, do not hesitate to CALL 9-1-1.
What is naloxone?
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What is POPP?

Peer Overdose Prevention Program

  • Education about the drug Naloxone.
  • Overdose risk and myth information.
  • Overdose prevention training.
  • Steps on how to respond to an overdose.
  • A POPP certification.
How do I get POPP?
Just walk-in the Site office or call the Site van to get a free POPP kit, certification and training.

You can also get a naloxone kit for free from pharmacies.

Supervised consumption services (SCS), Site office, Mobile van hours and other Supervised Injection Services (SIS)

 Location

Day 

 Time

Telephone

Site Needle & Syringe Program 
and
Supervised consumption services
179 Clarence St.

7 days a week  

9 am to 9 pm

613-580-6744 ext. 29047

Site mobile van

7 days a week 

5 to 11:30 pm 

613-232-3232

Collect calls accepted   

Ottawa Inner City Health Shepherds of Good Hope (SIS)
230 Murray St. (Trailer)

7 days a week

24 hours

613-241-6494

Sandy Hill Community Health Centre
221 Nelson St

Monday - Friday

8 am to 8 pm

613-569-3488 ext. 2101

Somerset West CHC Overdose Prevention Services
55 Eccles St

7 days a week

8 am to 8 pm

613-238-8210 ext. 2246

Partner agencies / Pharmacy partners
Over the past few years, accessibility of needle exchange and other harm reduction services in Ottawa have been greatly increased through partnerships with other agencies serving the same clientele.

Both Site Program and partner agency staff are alert for, and take advantage of, opportunities to educate clients on the safe use of syringes/glass stems and other drug using equipment. 

  • AIDS Committee of Ottawa 19 Main Street, 613-238-5014
  • Carlington Community Health Centre 900 Merivale Road, 613-722-4000
  • Centre 454 454 King Edward Avenue,613-235-4351
  • Centre 507 507 Bank Street, 613-233-5626
  • Centretown Community Health Centre 420 Cooper Street, 613-233-4697
  • Elizabeth Fry Society of Ottawa 311-211 Bronson Avenue, 613-237-7427
  • Lowertown Community Resource Centre 40 Cobourg Street 613-789-3930 
  • Minwaashin Lodge - STORM Van  424 Catherine Street 613-265-7558
  • Ontario Addictions Treatment Centres
    • 401 Somerset Street W. 613-233-1114
    • 1318 Carling Avenue, 613-627-0856
    • 263 Montreal Road, 613-749-9666
  • Operation Come Home 150 Gloucester Street, 613-230-4663
  • OPH Site Needle and Syringe Program 179 Clarence Street, 613-234-4641 Site Van, 613-232-3232
  • Onyx Community Service  265 Montreal Rd., 613-422-2294
  • Pinecrest-Queensway Health and Community Services 1365 Richmond Road, 2nd floor, 613-820-2001
  • Sandy Hill Community Health Centre 221 Nelson Street, 613-569-3488
  • Shepherds of Good Hope 230 Murray Street, 613-241-6494 256 King Edward Ave, 613-562-7845
  • Somerset West Community Health Centre 55 Eccles Street, 613-238-1220 NESI Mobile Van 613-761-0003
  • South-East Ottawa Community Health Centre 1355 Bank Street, suite 600, 613-737-5115
  • Wabano Centre for Aboriginal Health 299 Montreal Road Vanier, 613-748-5999
  • Youth Services Bureau of Ottawa 147 Besserer Street, 613-241-7788 ext 300

Pharmacy partners:

  • Riverside Drugstore  1919 Riverside Drive   613-523-3066
  • Trust Care Pharmasave  1020 St Laurent Blvd.  613-749-8577
  • Palmyra Guardian   1013 Merivale Rd.  613-729-7117
  • First Care Pharmacy  4 Lorry Greenberg Dr.  613-248-8000
  • Parkway Pharmacy  311 McArthur Ave.   613-749-2324
Harm reduction dispensing units

In 2017, Ottawa Public Health (OPH) launched a pilot project that saw four (4) harm reduction dispensing units installed at various locations across the city. Harm reduction programs and services are an integral part of Ottawa Public Health's front-line work within the City of Ottawa. The harm reduction dispensing units fill a current gap in service for those who need safer drug using supplies when in-person services are not available.

What is a harm reduction dispensing machine?

A harm reduction dispensing unit (HRDUs) is a machine that distributes safer drug using supplies such as sterile needles and other safer injection supplies as well as supplies for safer inhalation. Harm reduction materials help prevent the re-use or sharing of needles and other materials with a goal of reducing the transmission of infectious diseases such as HIV and Hepatitis C. 

Where are the harm dispensing units installed?

The harm reduction dispensing units are installed at four locations in the city:

  • Ottawa Public Health Site Needle & Syringe Program - 179 Clarence Street
  • Sandy Hill Community Health Centre - 221 Nelson Street
  • Somerset West Community Health Centre - 55 Eccles Street
  • Carlington Community Health Services - 900 Merivale Road
What do the harm reduction dispensing units contain?

The harm reduction dispensing units contain single-use equipment to help prevent disease transmission and reduce potential health risks associated with drug use. The units will supply:

  • Sterile needles and other safer injection supplies as well as supplies for safer inhalation, and information on how to access harm reduction services
  • All safer injection supplies are packaged in a small biohazard container for safe disposal and safer inhalation supplies are packaged in an envelope
  • Each safer injection pack contains alcohol swabs, sterile needles, steri-cups, sterile water and a tourniquet
  • Each safer inhalation kit contains glass stems, packs of screens, push sticks, mouthpieces and a token
Will harm reduction units replace front-line services that Ottawa Public Health offers?

Harm reduction dispensing units complement and do not replace front-line services. Ottawa Public Health recognizes the value of front-line contact and the opportunity for support, and referral to other services (such as mental health, treatment).  The addition of harm reduction dispensing units ensures that people can access harm reduction supplies during times of the day when services are closed.

Why are the dispensing units being implemented?

Results from several local studies that have examined the needs of people who use drugs in Ottawa have identified that there is a need to increase access to harm reduction services in the city. On June 20 2016, the Board of Health (BOH) approved a report entitled  Enhanced Harm Reduction Services in Ottawa - Data, Guiding Principle and Next Steps and updated the Board of Health June 19, 2017 with its report entitled Harm Reduction and Overdose Prevention - Overview and Update.

Harm reduction dispensing units have been introduced in several European countries including Switzerland, Germany, France, Italy, the Netherlands, Austria, and are also available in Australia and New Zealand. Dispensing units have proven effective in serving hard-to-reach high-risk populations, as the anonymous and confidential nature makes these services accessible to these groups. Currently, Vancouver is the only other city in Canada where you can find harm reduction dispensing units.

How can the harm reduction dispensing units be accessed?
The harm reduction dispensing units can only be accessed by a token that is provided by program staff at one of the partner agencies where the units are located. When people access services for tokens they will also be provided with education about safer drug use, safe equipment disposal and offered information about other health, social and treatment services available. 

Supervised consumption services at Ottawa Public Health

Supervised consumption services

On September 22, 2017, under Section 56.1 of the Controlled Drugs and Substances Act, Health Canada provided an exemption to Ottawa Public Health via the Sandy Hill Community Health Centre authorizing the operation of Supervised Injection Services (SIS) on an interim basis by Ottawa Public Health at 179 Clarence Street. On May 10, 2018, OPH was granted an exemption from the Controlled Drugs & Substance Act (CDSA) to operate a Supervised Consumption Site under the section 56.1 of the CDSA, valid for one year.

The Health Canada exemptions allow OPH to offer health services that provide a hygienic environment for people to either inject, swallow or inhale pre-obtained drugs under supervision. The supervised consumption service (SCS) is staffed with public health employees with experience in harm reduction and trained and authorized to provide supervised consumption services.

While SCS is an important component of any comprehensive approach to working with people who inject, swallow or snort drugs, it will not solve all the issues related to the current opioid crisis.

OPH is working closely with Ottawa Police Services (OPS), the City of Ottawa's Corporate Security Services and Ottawa Community Housing to ensure safety for staff, clients, and the surrounding community and is committed to continuing an ongoing dialogue with the community.

OPH will continue to monitor the situation and work alongside and in support of partners, including local shelters, other local harm reduction service providers, peer-led services and the Ottawa Overdose Prevention and Response Task Force, who all share a common goal of saving lives from potential overdoses.

What are supervised consumption services?

OPH has enhanced its existing harm reduction services by adding a supervised consumption service (SCS) to its existing services for people who inject, swallow or snort drugs (OPH's Site program at 179 Clarence Street). Supervised consumption services are health services that provide a hygienic environment for people to inject pre-obtained drugs under supervision.

Supervised consumption services have four (4) main goals [1] [2]

  1. To reduce spread of infectious diseases (HIV and hepatitis C);
  2. To reduce the number of drug overdose deaths;
  3. To bring people who inject, swallow or snort drugs into contact with other health and social and treatment services; and,
  4. To reduce issues in the community such as drug use in public places, and discarded needles.

In addition to supervised consumption, individuals are provided with sterile injection supplies, clean inhalation supplies, education on safer consumption, overdose prevention and intervention, medical and counselling services, and referrals to drug treatment, housing, income support and other services.

What is the difference between supervised consumption services and overdose prevention services?

The permanency and range of services offered at each site are the main differences between the two.

Overdose Prevention Services (OPS):

Overdose Prevention Services are an extension of existing harm reduction programs that provide easy-to-access, life-saving harm reduction services in a stigma-free environment, to help reduce the growing number of opioid-related overdose deaths. The sites will provide:

        •Supervised injection

        •Harm reduction supplies, including disposal of used supplies

        •Naloxone

Sites may also provide additional services based on local need and capacity, including supervised oral and intranasal drug consumption and fentanyl test strips as a drug checking service.

OPS that meet the necessary criteria will be approved to operate on a time-limited basis, usually three to six months (with the possibility of extension), by the Province of Ontario. OPS may act as “interim” services as they are set-up rather quickly (only a few weeks) to address an immediate need in the community while waiting to establish Supervised Consumptions Services.  For more information on OPS criteria and application process please visit http://www.health.gov.on.ca/en/news/bulletin/2018/hb_20180111.aspx

Supervised Consumption Services (SCS):

A SCS is tailored to be a permanent site with integrated support servcies. As such, the application process to Health Canada for a SCS is more complex and involves several steps. The process can take months as it includes fulsome consultations with the community, partners and participants along with selecting and renovating a permanent location. Health Canada grants a one-year exemption and once expired a renewal application is reviewed for another year exemption. SCS must have registered nurses on staff working under medical directives in order to provide medical intervention such as administering oxygen. Another requirement for SCS is to have a network of support services at their sites for individuals, such as addiction treatment programs, counselling and support for permanent housing. At 179 Clarence, the SCS offers direct links to these kinds of services and allows injection, oral or intranasal forms of consumption. 

Why do we need supervised consumption services in Ottawa?

Research has concluded that Ottawa would benefit from multiple supervised consumption services (SCS) that are integrated into health services already working with people who use drugs. Conditions in Ottawa support the need for SCS.

Rates of HIV (10%) and hepatitis C (70%) infection among people who inject drugs in Ottawa are higher than for the general population.[3] In addition, twenty-five percent of people who inject drugs usually or always inject in public places and 19% report sometimes injecting in a public place [4].

A total of 48 Ottawa residents died from unintentional drug overdose in 2015, 29 (60%) of which were due to opioids such as fentanyl, oxycodone, and morphine. [5]  Between 2000 and 2015, the rate of death due to unintentional drug overdose from any drug increased 23% in Ottawa. Unintentional overdose deaths due to opioids were 2.7 times higher during 2009-2015 (24 per year) compared to 2003-2008 (9 per year). For more drug use and overdose statistics, see OPH's website.

Recent anecdotal information from community groups and service agencies are reporting increased numbers of overdoses and deaths. Even though many of these overdoses are not seen in emergency departments, there were nearly 700 drug overdose-related Emergency Department visits during the first half of 2017.

Are other supervised injection/consumption services operating in Ottawa?

Currently there are three other supervised injection sites in Ottawa:

  • Ottawa Inner City Health - Trailer
  • Sandy Hill CHC
  • Somerset West CHC

All of the above are operating under exemptions from the federal Controlled Drugs and Substances Act (CDSA). 

Why is supervised consumption service needed at Ottawa Public Health at this time? Why do we need supervised consumption service if we already have harm reduction services such as needle and syringe programs?

OPH works with over 20 community agencies to provide harm reduction services in Ottawa and is actively working with municipal and community agencies to address the opioid crisis in our community, which includes increasing overdose peer support in the community and ensuring naloxone is readily available to prevent overdoses.

Supervised consumption services will improve harm reduction services that are currently offered in Ottawa. SCS provide a safe, clean, indoor, supervised environment for people to inject, swallow or snort illicit drugs with an opportunity for safer drug use teaching, overdose prevention support, and referral to counselling, withdrawal management, and addiction and other health care services. Without a safe place to use illicit drugs, people may use in isolation thereby increasing the risk of overdose death and/or may inject, swallow or snort in public spaces. Using illicit drugs in public is not only an issue for people who are homeless, but people living in shared accommodation or shelters may be afraid of losing their accommodation if they use on the premises, so they turn to public spaces. [6]Research has found that people who inject drugs will only travel short distances (i.e. a few city blocks) to use health services, including supervised injection services.[7] [8] The SCS will allow OPH to address the ever-growing public health issue and the continued need for opioid overdose prevention services.

How does the supervised consumption service at OPH work?

A number of people who use the services are already existing clients of OPH's Site program.

Clients arrive at the program with pre-obtained drugs. Each person is assessed to ensure they are eligible for the program. Clients are then given sterile injecting equipment or clean inhalation supplies  with instruction on safer drug use. A nurse supervises their consumption in a room dedicated for this purpose, and intervenes in the case of any medical emergencies. Once the clients have consumed their drugs, they are directed to a waiting area, and encouraged to stay for 15 minutes to be observed for any negative drug reactions. Clients also receive information and referrals about other health and social supports. This small-scale service has 2 consumption booths and is located in the Site program's existing location at 179 Clarence Street. The Site program and the supervised consumption service are open 7 days a week 9:00 am to 9:00 pm. The SCS is staffed by public health nurses trained in supervised consumption and overdose response, and by outreach/social workers and Peer Educators experienced and trained in harm reduction.

What are the benefits of supervised consumption services?

International and Canadian research shows that supervised consumption services have benefits both for individuals using the services and for the community, including:

  • Reducing the number of drug overdoses and deaths;
  • Reducing risk factors leading to infectious diseases such as HIV and hepatitis;
  • Increasing the use of detox and drug treatment services;
  • Connecting people with other health and social services;
  • Reducing the amount of publicly discarded needles;
  • Cost-effectiveness; and,
  • Not contributing to crime or increased drug use in the local community.
Are supervised consumption services legal?
Yes. In Canada, supervised consumption services operate through an exemption under Section 56.1 of the Controlled Drugs and Substances Act (CDSA). The exemption allows health services to operate without the risk that its clients or staff will be charged for the crime of having illegal drugs. Exemptions are granted by the federal Minister of Health in situations that are seen as "necessary for medical or scientific purpose or is otherwise in the public interest". [9]
Won't these services just encourage more drug use?
People do not start using drugs because of the availability of supervised consumption services. There is no evidence that harm reduction services promote drug use. Supervised consumption services are used mainly by people with a long history of drug use. Research has also found that supervised consumption services do not cause people to relapse (e.g., start using drugs after a period of abstinence) or prevent people from stopping drug use altogether.
Will the supervised consumption service increase crime in the neighbourhood or threaten public health and safety?

Research has shown that harm reduction programs do not increase public disorder or threaten public safety. In fact, they tend to have the opposite effect. Supervised consumption services are located in neighbourhoods where there is a demonstrated need, usually where drug use is already having an impact on the community. Harm reduction programs have a positive impact on public health and safety by:

  • Preventing blood-borne infections such as human immunodeficiency virus (HIV) and hepatitis C among people using drugs
  • Ensuring that more needles and syringes are disposed of safely through programs, rather than discarded in the community
  • Supporting agreements between police and harm reduction services that ensure drug trafficking laws are enforced. This creates an environment where open drug dealing is discouraged, and people who use drugs are encouraged to access needed services.
How will OPH ensure public and community safety for individuals in the neighbourhood who are not SCS clients?
OPH is working closely with Ottawa Police Services (OPS), Corporate Security and Ottawa Community Housing to ensure safety for staff, clients, and surrounding community.
Will there be an opportunity for community input?

OPH conducted a public consultation in 2016 (see report for results of the consultation). Among the consultation's findings:

  • 66% of respondents thought that having supervised injection services available would be beneficial.
  • 60% of respondents thought that offering harm reduction services in more areas of the city would be beneficial.

Feedback, comments, questions from the public are always welcome using your choice of communications channel. Contact information here.

Supervised Consumption Site Data

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Evaluation of OPH's Interim Supervised Injection Service

To respond to an emergency situation in Ottawa, and to enhance harm reduction and help prevent overdoses in the community, Ottawa Public Heath (OPH) started offering supervised injection services (SIS) on an interim basis at its Clarence Street location. Between September 2017 and December 2017, OPH evaluated the implementation and operations of its interim SIS. The evaluation monitored how the services were used (i.e. client data, services provided) and the experiences of four distinct groups: clients, employees, neighbours (residents and businesses) and community partners. We gathered information through: a review of clinical forms; client comment cards; focus groups with partners and employees; surveys with clients and with neighbours (collected by going door-to-door); and, secondary data sources, such as police data and calls/contacts to 311 and OPH’s contact centre.

OPH’s Interim SIS, by the numbers (September 26, 2017 – January 22, 2018)

  • 174 unique clients served
  • +1,800 on-site health services provided
  • 85% of clients received health services on-site
  • 25% of clients were referred to other services
  • +70 referrals (health care 83%, mental health 28%, housing 21%, opioid substitution therapy 14%)

Here is what our stakeholders told us:

Clients
Overall, clients were satisfied with the various services received. Clients told us they:

  • Felt safer when they use drugs at the SIS (93%)
  • Injected in public less often (87%)
  • Thought more about reducing or stopping using drugs (60%)
  • Injected alone (by themselves) less often (77%)
  • Felt that their drug use was more stable/less chaotic (77%)
  • Reported a strong likelihood of recommending the service to other people who inject drugs (97%)
  • Believed that staff provided good support (97%)
  • Felt that staff had talked/helped them access other services (70%)

Selected quotes from clients:

  • "I have overdosed at least 5 times in my life; since you opened I haven’t overdosed."
  • "I feel I am supported and accepted even though I am a drug addict. I feel that I matter."
  • "I have never felt like I can talk with health professionals so openly about my drug use. I am able to talk about others issues in my life. E.g. the other day they helped me by connecting me with mental health. All around they’ve been very helpful." 

Employees
Employees are passionate about helping SIS clients and they enjoy their therapeutic relationships with clients. Team collaboration is strong. Overall, they are satisfied with their additional roles and responsibilities at the SIS. 

Some recommendations from employees:

  • Implement a workplace employee peer-support program
  • Develop a formal training plan
  • Develop a sustainable and more comprehensive model that includes best practices

Neighbours (residents, businesses)
Neighbours have diverse opinions regarding their support for SIS and about the impact that OPH’s interim SIS has had on them,

  • 51% support SIS
  • 37% not supportive
  • 12% were undecided

Regarding the impact of OPH opening an interim SIS in the neighborhood,

  • 44% indicated the impact has been “negative” or “very negative”
  • 39% reported the impact has been “positive” or “very positive”
  • 7% were “neutral”

Concerns expressed by residents include: threats to personal safety, damage to public and personal property, dissatisfaction with officials when responding to their issues and concerns, and an increase in disruptive/nuisance behaviors in the neighborhood.

Partners
The majority believed that OPH’s interim SIS has had no impact on their organization. Those who indicated that there was a negative impact perceive an increase presence of public drug use. While partners talked about public injecting, there were mixed perspectives on whether public injecting has increased or decreased as a result of the new SIS. Partners who were involved in advising OPH on its interim SIS were satisfied with their involvement. There are several factors external to OPH that may have influenced implementation and the experience of those involved with and impacted by the SIS. This included the opening and ending of operations of Overdose Prevention Ottawa’s ‘pop-up’ tent in Raphael Brunet Park and the opening of Shepherds of Good Hope’s SIS trailer; changes in drug use patterns among people who use drugs; and increasing number of overdoses in the community. There is agreement amongst community partners that there are many factors not related to OPH’s SIS that may have impacted the community. As such, it is difficult to attribute causality between OPH’s interim SIS and any impact on the community and partner agencies’ operations. 

For more information:
View the Harm Reduction and Overdose Prevention Follow-up Report received and approved by the Ottawa Board of Health on February 5, 2018.

References

1. Strike, C et al. (2012). Toronto and Ottawa Supervised Consumption Assessment Study. Available online:  http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf

2. Fischer, B et al. (2002). Safer injection facilities (SIFs) for injection drug users (IDUs) in Canada, Canadian Journal of Public Health, 93(3), 336-338

3. I-Track, HIV & HCV Prevention Research Team, University of Ottawa, 2015.

4. Findings of the Ottawa Harm Reduction Needs Assessment Report, Ottawa Public Health, 2014

5. Office of the Chief Coroner for Ontario, extracted June 7, 2016. 

6. Toronto Public Health. (2013). Supervised Injection Services Toolkit. Available online: http://www.toronto.ca/legdocs/mmis/2013/hl/bgrd/backgroundfile-59914.pdf

7. Toronto Public Health. (2013). Supervised Injection Services Toolkit. Available online: http://www.toronto.ca/legdocs/mmis/2013/hl/bgrd/backgroundfile-59914.pdf

8. Strike, C et al. (2012). Toronto and Ottawa Supervised Consumption Assessment Study. Available online: http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf 

9. Controlled Drugs and Substances Act. (S.C. 1996, c.19).  

 

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