Housing-based syringe services programs to improve access to safe injecting supplies for people who inject drugs in Vancouver, Canada: A spatially-oriented qualitative study

Background: Housing environments shape injecting drug-related risks and harms, and thus represent a critical implementation setting for syringe services programs (SSPs). As critical harm reduction measures, SSPs provide sterile injecting supplies to people who inject drugs (PWID). Vancouver, Canada has a well-established syringe distribution policy, whereby PWID have low-threshold access to unlimited syringes and related injecting equipment, including through social and supportive housing and single room occupancy hotels. We examined the role of housing-based SSPs in distributing sterile syringes to PWID in Vancouver.

Methods: Between January and March 2020, semi-structured, in-depth interviews were conducted in Vancouver with 26 PWID. Interviews were audio-recorded, transcribed, and coded. Salient themes were identified using inductive and deductive approaches.

Results: Many participants accessed SSPs in housing facilities and expressed preference for these programs over those offered at other locations and through other health and social services. Three major themes emerged to explain this preference. First, most participants injected in buildings where they resided, and housing-based SSPs made sterile syringes available when and where they were most needed. Second, many participants preferred to avoid carrying syringes outside of the places where they inject due to fears that syringe possession may lead to criminal charges or confiscation of syringes and/or illicit drugs by law enforcement. Third, for some participants, anti-drug user stigma and concerns over unwillingly disclosing their drug use hindered access to SSPs outside of housing settings. Programs operated within housing facilities often offered greater client anonymity along with more supportive and less stigmatizing environments, particularly in the presence of peer staff.

Conclusion: The current study advances understanding of access to sterile syringes in a setting with a city-wide syringe distribution policy. Our findings underscore the benefits of housing-based SSPs and encourage the expansion of such services to maximize access to harm reduction supports for PWID.