Supervised inhalation is an important part of supervised consumption services

Abstract

Setting The first regulated supervised inhalation site (safer smoking room) in North America has opened in Lethbridge, Alberta, as part of a supervised consumption site addressing all routes of consumption. When designing the service, we felt it was important to accommodate not just injection drug use but also inhalation because (1) it is not the method of drug use that kills but the drug itself, (2) all people who use drugs deserve service regardless of their mode of use, and (3) people who use drugs should have the opportunity to use the method with the lowest risk. Intervention We received approval from Health Canada to offer supervised inhalation services in addition to supervised injection services. Based on a European model, we worked with a local commercial heating, cooling, and ventilation (HVAC) company to create rooms with ventilation systems that complied with Canadian health and safety regulations. Outcome People who use drugs by inhalation have repeatedly told us that they want to use indoors and will do so given the option. Since opening the supervised consumption service at the end of February 2018, the response has been overwhelming and both of the inhalation rooms are constantly in use. Implications Supervised inhalation services provide an alternative to public drug use and an opportunity for people who use drugs to engage with harm reduction services. Other supervised consumption services in Canada may also wish to pursue exemptions for this service. Résumé Lieu Le premier site réglementé d'inhalation sous supervision (fumerie à moindre risque) en Amérique du Nord a ouvert à Lethbridge, en Alberta; il fait partie d'un site de consommation sous supervision pour tous les modes de consommation. En concevant ce service, nous avons jugé important de permettre non seulement l'utilisation de drogue par injection, mais aussi par inhalation car : 1) ce n'est pas la méthode de consommation qui tue, mais la drogue; 2) les personnes qui consomment de la drogue ont le droit d'être servies peu importe leur mode de consommation; et 3) ces personnes devraient pouvoir utiliser le mode de consommation le moins dangereux. Intervention Nous avons obtenu l'accord de Santé Canada pour offrir des services d'inhalation sous supervision en plus de services d'injection sous supervision. En nous inspirant d'un modèle européen, nous avons travaillé avec une entreprise locale de chauffage, ventilation et climatisation (CVC) à créer des salles dotées de systèmes de ventilation conformes à la réglementation canadienne de santé-sécurité. Résultats Les consommateurs de drogue par inhalation nous ont dit à plusieurs reprises qu'ils veulent consommer à l'intérieur et qu'ils le font s'ils en ont la possibilité. Depuis l'ouverture de notre site de consommation sous supervision la fin de février 2018, la demande est massive, et nos deux salles d'inhalation sont constamment utilisées.

To what extent do supervised drug consumption services incorporate non-injection routes of administration? A systematic scoping review documenting existing facilities

“…The level of reported detail on SCS varies considerably by jurisdiction, and appears to be impacted by political climates [80]. In recent years, an increasing number of Canadian SCS permitted intranasal and oral consumption [81], and Lethbridge, Alberta opened the first SCS in North America to permit all routes of consumption (injection, inhalation, intranasal, oral) in February 2018 [17]. However, limited data has been published on these SCS to date [82].…”

“…People engaged in public non-injection drug consumption report experiencing violence when using in public areas, from police and others [ 15 , 16 ]. SCS that incorporate non-injection routes of consumption have the potential to reduce the risk of these harms through provision of emergency medical care, a safe environment, and sterile smoking and intranasal consumption supplies [ 17 – 20 ]. Additionally, providing access to SCS that incorporate non-injection routes of consumption may reduce the risk of transitioning to injection [ 21 ].…”

“…While the characteristics of people who consume drugs through non-injection routes of consumption have been described [ 23 – 26 ], less is known about the subpopulation of people who access SCS for oral, intranasal, or inhaled drug use. Recent evidence from a supervised consumption service in Canada demonstrated that program participants were predominantly Indigenous, male, and between the ages of 20–39 [ 17 ]. Whether these demographic characteristics are consistent in other SCS that offer non-injection routes of consumption is currently unknown.…”

‘Resurgent’, ‘twin’ or ‘silent’ epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America

“…In a survey of clients (n = 654) and related service visits (March -June 2018) of a new supervised consumption service comprising multiple routes of administration in Lethbridge, Alberta, increasing monthly client ratesfrom 60 to 70% -utilized inhalation services. 82.0% of inhalation service visits involved methamphetamine, 11.3% opiates and 3.1% crack-cocaine; in the injection facility, 57.1% involved opiates, 29.9% methamphetamine, 12.4% 'speedballs' (fentanyl/methamphetamine combination) [71]. Furthermore, recent key informant data on supervised consumption services in Alberta suggested that the most commonly used drug "changed from opioids and cocaine, to methamphetamine" among service users; in addition, many were "polydrug users and were consuming both opioids and methamphetamine" (p.13) [72].…”

Stimulant safe supply: a potential opportunity to respond to the overdose epidemic

“…DCTs are also often implemented in supervised consumption sites (SCS), which themselves serve as overdose prevention interventions. Within North America's limited number of SCSs, these have largely focused on injecting and only one regulated supervised inhalation site exists [25], rendering people who smoke stimulants vulnerable to overdose and other harms associated with unsupervised drug use.…”