Despite evidence of their effectiveness in reducing overdose-related deaths, supervised consumption sites (SCS) are being targeted in Canada because of concerns that they cause public disorder, attract criminal activity, and threaten community safety.
Last August, Ontario announced that it would ban SCS within 200 m of schools and daycare centers, citing concerns over public safety. The decision was to affect 10 SCS in the province, which were scheduled to close on March 31. But an Ontario judge granted an injunction on March 28, following a lawsuit arguing that the decision of the province to ban SCS is unconstitutional. For now, the injunction is keeping the SCS operational.
“Our priority is to protect children and families from violent crime and dangerous public drug use occurring at drug injection sites located near schools and daycares,” said Hannah Jensen, a spokesperson for Ontario Health Minister Sylvia Jones, in a statement following the judge’s decision. The Ontario government plans to convert 9 of the 10 SCS to homelessness and addiction recovery treatment hubs.
In Alberta, the challenge to SCS has been launched on a municipal level. City councilors have called for the closure of SCS in cities like Red Deer and Calgary. Saskatchewan’s two SCS, one in Regina and one in Saskatoon, do not receive operational funding from the Saskatchewan government, which has said that its focus is treatment and rehabilitation.
Response to SCS
Ian Culbert, executive director of the Canadian Public Health Association in Ottawa, noted that staff at SCS can respond to situations to avoid overdoses. “We have had no deaths in SCS anywhere in the country because you’ve had the right tools available and the right people available to counteract those drug poisonings,” Culbert told Medscape Medical News. “If people are going to consume [illegal drugs], they are going to consume them with professionals around them, and they can receive medical attention immediately, so the possibility of death is eliminated.”
Another service that some SCS offer is drug testing that can detect whether the substance that a user will consume is toxic, noted Culbert.
The SCS also offer a touchpoint for patients who may be disconnected from existing health and social infrastructure in the community, added Culbert. “The interactions they [drug users] have with the staff in the SCS become their link back into society. A lot of these people are living on the fringes of society. It is their entry point into society’s larger systems.”
Impact on Emergency Rooms (ERs)
Sahil Gupta, MD, an emergency physician in Toronto and head of the Health Equity Committee at the Canadian Association of Emergency Physicians, stressed that the Ontario government’s move away from using SCS will inevitably affect the province’s hospital ERs, many of which are barely managing to meet patient needs each day.
“We face challenges every day in emergency departments,” Gupta told Medscape Medical News. “If ambulances are responding to overdoses in less safe spaces, like back alleys, the consequences of those are more serious. Someone who is found to have overdosed may require a stay in the intensive care unit, have a permanent disability, and face a long road of rehabilitation. That is extremely expensive to the system, which is one of the reasons why we should be keeping these sites open.”
As ERs must respond to various medical presentations, they will need to divert resources away from trauma or myocardial infarction if staff are forced to respond to drug overdoses, said Gupta. “This type of situation will overwhelm the system,” he added.
Another benefit that SCS offer is in minimizing the risk for HIV and hepatitis C transmission in the community through decreased reuse and safe disposal of syringes, noted Gupta. Emergency physicians’ concern is that the closure of SCS “will increase overdoses that happen in the community, as well as put people at higher risk for HIV transmission and hepatitis C transmission,” he said.
Data Support SCS
S. Monty Ghosh, MD, an internist, disaster medicine, and addiction specialist at the University of Alberta Hospital in Edmonton, stressed that cumulative data over 20 years reinforce the efficacy of SCS in decreasing deaths resulting from overdose.
“The body of literature that has been published overwhelmingly states that the sites save lives and positively impact communities,” Ghosh told Medscape Medical News. He cited a 2024 study of coroner’s data from Toronto that compared a 3-month period in 2017 with a 3-month period in 2019. The researchers found a 67% decrease in overdose mortality in neighborhoods that implemented SCS.
Ghosh suggested that community fears about public drug use and related issues ideally should be addressed by all stakeholders. “I have heard from others around concerns of public drug use and overdoses on their property and finding discarded drug paraphernalia. A joint solution with input from substance users, frontline staff at these sites, and community members affected by the sites should be worked on to help manage and mitigate these concerns appropriately.”
Culbert, Gupta, and Ghosh reported having no relevant financial relationships.