Public Consultations

Consultation Survey about Enhancing Harm Reduction Services in Ottawa

On June 20, 2016, Ottawa Public Health (OPH) presented a report [Enhancing Harm Reduction Services - Data, Guiding Principle and Next Steps PDF] to the Ottawa Board of Health. The report presents some possible ways to expand harm reduction services in Ottawa.

The possible ways to expand harm reduction services include longer hours, increased number of harm reduction service locations, and two (2) specific tools that are currently not offered in Ottawa:

  1. Harm reduction dispensing units (HRDU)
  2. Supervised injection services (SIS)
Results of Ottawa Public Health's Public Consultation Survey on Enhanced Harm Reduction Services in Ottawa

This report presents results of Ottawa Public Health's (OPH) public consultation survey on enhanced harm reduction services in Ottawa. The objective of the survey was to give residents, community partners, and businesses an opportunity to share their thoughts on enhanced harm reduction services in our city.

Results of Ottawa Public Health's Public Consultation Survey on Enhanced Harm Reduction Services in Ottawa [PDF 407 KB]
 Frequently asked questions about Harm Reduction
 
 What is harm reduction?
 Harm reduction:
  • Focuses on keeping people safe as well as preventing death, disease and injury
  • Aims to reduce harm from drug use through programs such as needle and syringe programs, methadone maintenance treatment, supervised injection services, and outreach and education programs
  • Saves lives and improves quality of life for people who use drugs by supporting them to be part of society and by linking  them with health and social support services
  • Recognizes that drug use may continue despite the risks
  • Benefits the community through less open drug use, proper disposal of used needles, and reduced health and enforcement costs related to drug use1,2
 What harm reduction services are currently available in Ottawa?
In Ottawa, harm reduction services are provided according to Best Practice Recommendations for Canadian Harm Reduction Programs (link is external). Ottawa has many locations across the city that offer harm reduction service. These services are a mix of fixed (agency-based) and mobile van services.  Harm reduction services are provided by Ottawa Public Health's (OPH) Site Needle and Syringe Program (NSP), as well as 20 community partners, including 3 mobile services. These programs:
  • Distribute safer drug using supplies (needles, cookers, sterile water, alcohol swabs)
  • Dispose of used drug using supplies
  • Distribute safer sex materials (condoms and lubricant)
  • Provide prevention education related to human immunodeficiency virus (HIV), hepatitis C, skin and vein problems
  • Provide training in overdose prevention and Naloxone to people at risk of opioid overdose
  • Offer testing for sexually transmitted and blood-borne infections (STBBI) such as HIV and hepatitis C, pregnancy testing, emergency birth control, vaccinations and first aid.

In Ottawa, agencies also distribute safer crack use equipment, coordinated through Somerset West Community Health Centre. 
 What are the current hours of operation of harm reduction services in Ottawa?
Right now, there are 22 places in Ottawa where people can get harm reduction services. These are 'fixed' locations that operate from office settings and agencies across the city, including community health centres and Ottawa Public Health. Most of these 'fixed' services are open Monday to Friday during regular business hours (8:30 am to 4:30 pm, Monday - Friday). A few fixed services offer some weekend hours during the day. Ottawa has three (3) mobile harm reduction vans that run in the evenings (5 to 11:30 pm) most days throughout the year.
 Do harm reduction programs enable or encourage drug use?
Many studies have concluded that needle programs and other harm reduction services do not increase drug use. 

For people who do not want to quit using drugs, are not ready to quit using drugs, or cannot quit using drugs, harm reduction services have been shown to prevent human immunodeficiency virus (HIV), hepatitis C and other drug-related harms, and death for people who use drugs. 

Harm reduction is often the only link that some people have to health and social services. Harm reduction services increase the possibility that drug users will:

  • Re-engage in broader society
  • Engage in less crime
  • Lead productive lives
  • Quit using drugs
 Do harm reduction programs increase public disorder 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. 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.5,6,7
 What is a harm reduction dispensing unit (HRDU)? 
A harm reduction dispensing unit (HRDUs) is a machine that distributes safer drug using supplies such as needles and other safer injection supplies for free only to people who have been provided special tokens by harm reduction or needle and syringe program staff.
 Why do we need harm reduction dispensing units (HRDUs) in Ottawa?
There is a need to expand access to harm reduction services (safer drug using supplies) across the City of Ottawa. Some areas of the city have no harm reduction services. Harm reduction dispensing units (HRDUs) are useful in that they:
  • can provide access to harm reduction supplies in areas of the city that do not have fixed access through an agency, and
  • can provide access during times of the day when services are closed.

HRDUs have been successful in reaching high-risk hidden populations, as the anonymous and confidential nature makes these services attractive to these groups.8

Are harm reduction dispensing units (HRDUs) used anywhere else?

Syringe dispensing machines were first introduced in Denmark and Norway in the late 1980s. After this, they were introduced in many countries in Europe including Switzerland, Germany, France, Italy, the Netherlands, and Austria; they are also in Australia and New Zealand.9 Currently, the only dispensing machines in Canada are in Vancouver. These two (2) units dispense safer crack-use supplies and are located at two Drug User Resource Centres. 10
 What is a supervised injection service?
A supervised injection service is a health service that provides a safer and clean space where people can inject drugs with a nurse supervising. The nurse may help in case of an emergency such as a drug overdose. The nurse can also provide clinical services, health teaching, and referral to other services.

Supervised injection services usually have four (4) main goals11,12

  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 drugs into contact with other heath and social and treatment services; and,
  4. To reduce issues in the community such as drug use in public places, and discarded needles.

Services may include:

  • Distribution of supplies for safer injection
  • Supervision of a nurse while injecting
  • Safer drug use education
  • Overdose prevention and intervention
  • Medical and counselling services
  • Referrals to drug treatment
  • Assistance with housing and other support services13
 Are supervised injection services legal?

In Canada, supervised injection services operate through an exemption under Section 56 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".14
 Where else are supervised injection services operating?

The first supervised injection service opened 30 years ago in Switzerland. Today, there are more than 90 supervised injection services in the world, mostly in European countries and Australia.15 There are two supervised injection services in Canada, both in Vancouver:

  • Vancouver's In-site is located in the Downtown Eastside and is operated by the Vancouver Coastal Health Authority
  • Dr. Peter Centre operates a small supervised injection service that is part of their services for people living with human immunodeficiency virus (HIV).
 Is there any research to support supervised injection services?
International research on supervised injection services has shown that these services are positive for people using the service as well as for the broader community. Supervised injection services have been shown to:
  • Reduce overdose deaths and save lives;
  • Reduce sharing of needles that causes HIV and Hepatitis C;
  • Increase use of detox and addiction treatment services;
  • Be cost-effective;
  • Reduce public drug use;
  • Reduce the numbers of publicly discarded needles and injection supplies;
  • No increase crime in the surrounding area.
 What does the evidence say about supervised injection services and drug-related crime?
Research on Vancouver's Insite found less public injecting, fewer publically discarded needles, and no increase in crime in nearby neighbourhoods. 17,18,19 Research in Sydney, Australia found no increase in robbery, theft, drug-related loitering or drug-related criminal offences in nearby neighbourhoods after opening Sydney's Medically Supervised Injecting Centre.20 
 Are there 'no-go zones' around supervised injection services?
A "no-go zone" is an area that certain people are not allowed to enter. There is concern that a supervised injection service would have a 'no-go zone' - an area a few blocks around the supervised injection service - that police would not be allowed to enter. There is no such thing as a 'no-go zone'. The Ottawa Police will enforce the criminal code everywhere in Ottawa and can lay charges and seize drugs.21 According to the Controlled Drugs and Substances Act, the only place that would be exempt from drug possession laws is inside the building where supervised injection services are being offered.  Police cannot enforce drug possession laws in these locations.22 
 What are the different models for providing supervised injection services?

There are three (3) models for providing supervised injection services:23,24 

  1. Fixed service that is integrated within existing health and harm reduction services In this model, supervised injection services are offered with other services for people who use drugs. These other services may include harm reduction services, drug treatment, health care, housing, and other social services. With this model, clients can access many needed services at one place.
  2. Fixed service that is stand-alone, not within existing health and harm reduction services In this model, the service is a supervised injection only. It is not with other services as with the model above. It provides a supervised, safe space for people to inject drugs. Staff can refer people to other agencies for services such as harm reduction services, drug treatment, health care, housing, and other social services.
  3. Mobile service is a van that can travel around the city to meet clients where they are This service is offered using a specially fitted van that has one (1) to three (3) safer injection booths where between 1 and 3 people can inject at once.  As with fixed sites, a mobile van offers harm reduction services such as needle and syringe programs (NSP), testing for HIV and hepatitis C, and referral to other services. The mobile service can travel to where people need services. 
Why do we need supervised injection services if we already have harm reduction services such as needle and syringe programs?
Supervised injection services would improve harm reduction services that are currently offered in Ottawa. Supervised injection services provide a safe and clean space for people to inject, especially for people who are homeless. While current harm reduction program staff do teach about safer drug use and overdose prevention, right now staff are not able to supervise injections and they are not able to help if someone overdoses after they have left. Without a safe place to inject, people may inject in public spaces. Injecting 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 inject on the premises, so they turn to public spaces.25
 Won't supervised injection services attract more people who use drugs to our community?
Most people using supervised injection services will be clients who already access harm reduction services. 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.26,27
 Why should we invest in harm reduction services rather than more treatment services? 

A "one size fits all approach" can not address the harms of drug use in our community. We need harm reduction services to provide health services to those people who are actively using drugs, and treatment services for those who want to reduce or stop using drugs.28 It is not a matter of one or the other. We need to invest in both harm reduction and treatment services to meet client needs across the spectrum of drug use. 
What are the anticipated costs of expanding harm reduction services as proposed? Who would pay for this expansion?

It is too early to know how much it will cost to expand harm reduction services in Ottawa. All involved organizations will need to explore what the costs will be for them and apply for funding as needed. 

If you have any questions, please contact the Site Needle and Syringe Program at site@ottawa.ca.

 References:
  1. Cheung, Y. W. (2000). Substance Abuse and Developments in Harm Reduction. Canadian Medical Association Journal. June 13, 2000. 162(12): 1697.
  2. British Columbia Ministry of Health (2005). Harm Reduction: A British Columbia Community Guide. Available online: http://www.health.gov.bc.ca/library/publications/year/2005/hrcommunityguide.pdf
  3. Satcher, D. (2000). Evidence-Based Findings on the Efficacy of Syringe Exchange Programs: An Analysis of the Scientific Research Completed Since April 1998. Washington, D.C.: U.S. Department of Health and Human Services.
  4. Hagan, H. et al. (2000). Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. Journal of Substance Abuse Treatment. 19(3), 247-252.
  5. Huo, D. et al (2005). Drug use and HIV risk practices of secondary and primary needle exchange users. AIDS Education and Prevention. 17(2), 170-184.; Watters, J. K. et al. (1994).
  6. Watters, J.K. et al (1994). Syringe and Needle Exchange as HIV/AIDS Prevention for Injection Drug Users. Journal of the American Medical Association. 271:115-120.
  7. Paone, D. et al (1995) Syringe Exchange: HIV Prevention, Key Findings, & Future Directions. International Journal of the Addictions. 30, 1647-1683.
  8. Islam, M et al. (2008). The effectiveness and safety of syringe vending machines as a component of needle syrnge programs in community settings. International Journal of Drug Policy, Dec; 19(6):436-411.
  9. Islam, M Et al. (2007). Assessing the Role of Syringe Dispensing Machines and Mobile Van Outlets in Reaching Hard-to-reach and High-risk Groups of Injecting Drug Users (IDUs). Harm Reduction Journal; 14 (4).
  10. Newspaper Article: The Province, February 11, 2014. Available online: http://www.theprovince.com/Vancouver+home+Canada+first+crack+pipe+vending+machines/9490689/story.html
  11. Strike, C et al. (2012). Toronto and Ottawa Supervised Consumption Assessment Study. Available online :  http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf
  12. 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.
  13. Dolan, JK et al. (2000). Drug consumption facilities in Europe and the establishment of supervised injecting cetnres in Australia. Drug and Alcohol Review. 19(3):337-46.
  14. Controlled Drugs and Substances Act. (S.C. 1996, c.19).
  15. Global Platform for Drug Consumption Rooms. Available online: www.salledeconsommation.fr
  16. See Research Summary in Toronto Drug Strategy Implementation Panel (2013). Supervised Injection Toolkit. Toronto, ON. Available: http://www.toronto.ca/legdocs/mmis/2013/hl/bgrd/backgroundfile-59914.pdf
  17. Wood E., et al. (2004). Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal, 171(7): 731-734.
  18. Wood E., et al.  (2006). Impact of a medically supervised safer injecting facility on drug dealing and other drugrelated crime. Substance Abuse Treatment, Prevention, and Policy, 1(1): 13
  19. Boyd N et al. (2008). Final report - Public order and supervised injection facilities: Vancouver's SIS. Vancouver BC.
  20. Freeman K., et al (2005). The impact of the Sydney Medically Supervised Injecting Centre on crime. Drug Alcohol Review; 24(2):173-84.
  21. Personal Communication: Superintendent Cameron, Ottawa Police October 21, 2013.
  22. Controlled Drugs and Substances Act. (S.C. 1996, c.19).
  23. Drug Consumption Rooms in Europe Models, Best Practice & Challenges (2014). Available online: http://www.eurohrn.eu/images/stories/pdf/publications/dcr_europe.pdf
  24. TOSCA Report (2012). Available online: http://www.catie.ca/Sites/default/files/TOSCA%20report%202012.pdf
  25. Toronto Public Health. (2013). Supervised Injection Services Toolkit. Available online: http://www.toronto.ca/legdocs/mmis/2013/hl/bgrd/backgroundfile-59914.pdf
  26. Toronto Public Health. (2013). Ibid.
  27. Strike, C et al. (2012). Toronto and Ottawa Supervised Consumption Assessment Study. Available online: http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf
  28. Toronto Public Health. (2013). Supervised Injection Services Toolkit. Available online: http://www.toronto.ca/legdocs/mmis/2013/hl/bgrd/backgroundfile-59914.pdf

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