September 2018 Board Meeting - Supervised Injection Services (SIS) Community Consultation Project Information Report

Meeting Document Type
Information Report
Supervised Injection Services (SIS) Community Consultation Project

Prepared By:

Jenny Diep, Health Promotion Specialist

Date:

August 30, 2018

Subject:

Supervised Injection Services (SIS) Community Consultation Project

Background

Locally in Windsor-Essex County (WEC), we are facing increased morbidity and mortality related to the use of opioids and other drugs.  There were 382 opioid-related emergency department visits in WEC in 2015, which is 3.6-times greater than in 20031.  The rate of opioid-related emergency department visits in Windsor was 2.8-times greater than the rate in Essex County.  There were 24 opioid-related deaths in WEC in 2015; 19 deaths were in the city of Windsor1. Furthermore, the number of hepatitis C cases, a blood-borne infection, increased from 143 reported cases in 2016 to 181 reported cases in 20172.  In 2017, out of the 164 confirmed cases that reported at least one risk factor other than unknown, injection drug use was reported by 62% of cases (101 cases)3.  There have been 211 documented needle-related calls from January 1, 2014 to February 5, 2018 to local municipal service (3-1-1), predominantly in downtown Windsor4.  Number of needle-related calls have significantly increased, from 43 in 2016 to 121 in 2017 (City of Windsor, 3-1-1 calls)4.

Overdose Prevention Sites (OPS) and Supervised Consumption Services (SCS)

In December 2017, in response to overdose-related deaths, Health Canada announced that it would provide temporary class exemptions to provinces and territories demonstrating evidence of an urgent public health need. This allowed for possession and use of controlled substances on exempted sites, known as OPS. This provided a space for people to consume drugs in a safe environment, where staff or volunteers can provide overdose response measures as required. This interim measure allowed communities to plan for a long-term solution, such as a SCS.

 

A SCS is a legally sanctioned site that provides a location where people can bring their own illicit substances to consume under safer conditions and supervised by trained workers who can respond to an overdose as needed5. A SCS includes SIS, and offers treatment, health, and social services for people who are ready to stop or reduce their drug use. An OPS may not have these services in place as a temporary site, while a SCS aims to connect people who use drugs to health and social services. A SCS reflects harm reduction principles, which recognizes that individuals with substance use issues may not wish or be able to abstain from substance use, and thus, seeks to minimize the harms associated with drug use6. It is a part of Health Canada’s Canadian drugs and substances strategy. Benefits of SISs, as acknowledged by the Government of Canada7, include:

  • Reduced overdose-related morbidity and mortality8,9;
  • Reduced injecting and discarding of needles in public space9;
  • No evidence of increased drug-related crime or loitering or rates of drug use9;
  • Increased access to withdrawal management and treatment services and other health and social services5,9;
  • Reduced transmission of blood-borne infections, such as hepatitis C and HIV, through decreased needle sharing8,9; and
  • Reduced health care costs, ambulance calls, use of emergency departments, and hospital admissions8,9.

Prior to the establishment of a supervised consumption site (SCS) and also a requirement of Health Canada’s application for exemption under Section 56.1 of the Controlled Drugs and Substances Act, community engagement is essential to informing the need and feasibility for a SIS and predicting its success5.  Similar projects have been conducted in London, Toronto, Hamilton, and Waterloo in Ontario.  These projects similarly reflect such projects in British Columbia.

Locally, organizations have expressed interest in applying for a SCS in Windsor.

Current Initiatives

As part of the Windsor-Essex Community Opioid & Substance Strategy (WECOSS) under the Harm Reduction Pillar, the Windsor-Essex County Health Unit (WECHU) is leading the Supervised Injection Services Community Consultation Project (SIS-CC) to assess the need and acceptability of SIS in WEC.  The study will:

  • Explore the need for SIS in WEC;
  • Explore the design, potential locations, and conditions under which an SIS would be preferred by potential clients and stakeholders in Windsor; and
  • Assess community perceptions of SIS and identify any concerns and strategies to mitigate such concerns.

This project will involve a mixed methods approach (i.e., quantitative and qualitative):

  1. Analysis of local surveillance data. Existing surveillance data regarding morbidity and mortality related to opioid and substance use, including hepatitis C rates, public discarding of needles, health care service use related to opioid use, and harm reduction service use.
  2. In-person surveys with people who inject drugs (PWIDs). The 45-minute survey explores drug use and injection practices, perceptions of SIS and its implementation (e.g., policies, hours, location), experiences of overdose, health and drug treatment. Peer researchers will be trained to recruit and administer the survey. Peer researchers are hired staff who have had lived experience with injection drug use, and may more likely be able to build a rapport with potential participants to complete the survey.
  3. Public Online survey with the Windsor-Essex County community. The 5-minute online survey involves questions related to perceptions of drug use and SISs and its implementation. This survey may identify additional needs outside of Windsor, and thus, inform future community consultation projects.
  4. Interviews with key informants. A 30-minute interview will be conducted with identified key informants and community leaders including harm reduction service providers, local politicians, key leaders from community service agencies/organizations, advocacy groups and emergency services from Windsor.
  5. Focus groups with key stakeholder groups. A 1.5-hour focus group will be conducted with individuals from key stakeholder groups that have an interest in drug-using populations and can be affected by or affect policy and implementation (or non-implementation) of SIS.  These include first responders (police, fire, and emergency medical services), representatives from municipal government departments, community services agencies/organizations, and community, neighbourhood and business groups from Windsor.

The project will be promoted through social media and the Health Unit and WECOSS websites, which is currently being developed.  More information about SIS, SCS, OPS, and the project will be provided on the WECOSS website.

An application to the University of Windsor Research Ethics Board (REB) has been submitted and pending final approval we expect to launch the survey in late September with data collection continuing to the end of 2018.

References

  1. Windsor-Essex County Health Unit. (2017, June). Opioid misuse in Windsor-Essex. Retrieved from https://www.wechu.org/about-us/reports-and-statistics/opioid-misuse-windsor-essex-county.
  2. Windsor-Essex County Health Unit. (2018). Monthly infectious disease report – February 2018. Windsor, ON: Windsor-Essex County Health Unit.
  3. Data Source: Integrated Public Health Information System (iPHIS), Ministry of Health and Long-Term Care [extracted 2018 Jun 8]
  4. Data Source: City of Windsor, 3-1-1 calls [extracted 2018 Feb 05]
  5. Government of Canada. (2017, July 6). Supervised consumption site: Guidance for application form. Retrieved from canada.ca.
  6. Canadian Mental Health Association. (2018). Harm reduction. Retrieved from https://ontario.cmha.ca/harm-reduction/.
  7. Government of Canada. (2017, May 26). Statement from the Minister of Health – Health Canada authorizes four new supervised consumption sites. Retrieved from https://www.canada.ca/en/health-canada/news/2017/05/statement_from_them….
  8. Ng, J., Sutherland, C., & Kolber, M.R. (2017). Does evidence support supervised injection sites. Canadian Family Physician, 63(11), 866.
  9. Kennedy, M.C., Karamouzian, M., & Kerr, T. (2017). Public health and public order outcomes associated with supervised drug consumption facilities: A systematic review. Current HIV/AIDS Reports, 14(5), 161-183. https://doi.org/10.1007/s11904-017-0363-y

Approved by:

Theresa Marentette