Envisioning youth-dedicated overdose prevention and drug consumption sites in Canada and Portugal

Background: A majority of the global population of people who use drugs are adolescents and young adults under the age 30 (hereafter “youth”), and overdose is now a leading cause of death among youth in North America as a result of an increasingly toxic drug supply in that setting. Amidst growing academic and activist calls to increase access to harm reduction programs and services for youth globally, there continues to be a focus on prevention- and abstinence-based approaches to addressing substance use among this priority population. Even in settings lauded for progressive drug policies such as Vancouver and Lisbon, young people who use drugs have very limited (most often no) access to youth-dedicated overdose prevention and drug consumption sites, essential and life-saving harm reduction interventions. Our objective is to advance our vision for youth-dedicated overdose prevention and drug consumption sites (serving ages 14 to 24, with dedicated hours for adolescents ages 14 to 18), and identify ongoing barriers to implementation in Canada and Portugal. 

Methods: We are a group of community and academic researchers and activists from Vancouver, Canada, and Lisbon, Portugal. Our vision for youth-dedicated overdose prevention and drug consumption sites is informed by our lived experiences of substance use, as well as research and service design expertise. 

Results: Youth-dedicated overdose prevention and drug consumption sites should have a non-clinical, relaxed feel to them, and include a welcoming drop-in space. There must be private spaces for safer injecting and smoking alongside indoor and outdoor chill spaces. These should be places where youth can access harm reduction supplies and education (e.g., about safer smoking and injecting and overdose prevention), as well as food and other basic necessities. They should be places of safety and connection: connection to other young people, to trusted providers and advocates, to shared causes and activities (e.g., making art), and to other kinds of help, including detoxification, treatment, and recovery programs. They should be staffed by a mix of peers and providers delivering non-judgemental care, support, and friendship to diverse youth, including Indigenous, Black, Brown, LGBTQ+, and migrant youth. The focus should be on relationship-, trust-, and future-building, not damage, deficits, and the past. Given the importance of safety and connection, there is significant potential to embed youth-dedicated overdose prevention and drug consumption sites within existing youth-dedicated frontline service settings (e.g., shelters, drop-ins).

Conclusions: It is past time to ensure youth have access to the full continuum of harm reduction programs, services and spaces. Our vision for youth-dedicated overdose prevention and drug consumption sites offers guidance for implementing and adapting this essential harm reduction service in our settings and elsewhere.