2. The rapid expansion of DCRs/SIFs in Canada in the context of a public health emergency
Abstract
British Columbia (BC) In 2002 Dr Peter Centre (day/residential facility for people living with HIV/AIDS) opened the first DCR in North America in Vancouver. Nurses, with support from the provincial nursing association, supervised onsite client injections as part of their scope of ethical practice. The first sanctioned SIF, (Insite) opened in BC, in 2003. An overdose public health emergency was declared in BC in April 2016; as overdoses continued to increase the BC Health Minister ordered regional health authorities to open Overdose Prevention Services (OPS) in November 2016. Currently there are >40 OPS in BC using various models including:
- Mobile vans
- Temporary structures
- In clinics with harm reduction services
- In supportive housin
- Tents for observed inhalation
Although the federal government provided temporary exemptions for OPS, access varies across Canada. Ontario In 2017, the first unsanctioned OPS opened in Toronto. This led to the expedition of exemptions and SIFs opened in Toronto and Ottawa. SIFs and OPS are located in diverse settings to fit local community need. Opportunities - People who use drugs have advocated and provided observed consumption despite personal risks. In response to an overdose crisis official OPS rapidly expanded/saved lives. Peers are essential in operating OPS across Canada, providing support to clients. Challenges – Peer workers often do not receive equitable remuneration and experience high workload and stress, particularly during COVID. Conservative political ideology in some provinces has resulted in facility closures in areas of great need.
Canada has achieved rapid expansion and flexibility of DCRs however greater investment in economic and social support for service providers, particularly peers, is urgently required. Overdose deaths continue to rise, and many communities have no services, despite the desperate need.
