Supervised Injection Site Needs Assessment & Feasibility Study

The Supervised Injection Site (SIS) Needs Assessment and Feasibility Study (PDF, 4 MB) determines whether or not supervised injection sites would be an effective harm reduction solution for Hamilton.

Study recommendations

  1. Hamilton would benefit from one or more supervised injection sites.
    Epidemiological and community data describe a need for additional strategies to decrease death and disability as a result of injection drug use and its consequences. The Hamilton community largely supports SISs as a strategy to support people who inject drugs and community members who inject drugs would be willing to use an SIS.
     
  2. Hamilton should implement one integrated supervised injection site located in the area flanked by Queen Street (west), Barton Street (north), Ferguson Ave (east) and Main Street (south).
    a. The site should be integrated within an existing health or social service agency that already provides harm reduction services to people who inject drugs.
    b. The lead organization of the site should determine optimal hours of operation based on resources, capacity, and need, understanding that surveyed users would prefer to access a site between 8 a.m. to 12 noon and 8 p.m. to 12 midnight.
    c. The site should provide harm reduction and basic health services.
     
  3. Additional integrated sites should be considered based on implementation of the first site, monitoring for need, and the interest and willingness of service providers and users to have additional locations.
    a. Potential areas to monitor include the East End and Mountain.
     
  4. Geographic areas outside of Hamilton’s downtown core could be serviced with a mobile supervised injection site.
    Injection drug use is a city-wide issue. While a fixed site in the downtown core will serve many, strategies to address equity of access should be considered.
    a. Further investigation should be conducted to understand the optimal route and timing
    b. Ways to incorporate integrated services into a mobile service delivery model should be further explored.
    c. The potential for additional mobile units should be considered based on monitoring for need and the interest and willingness of service providers and users to have additional units.
     
  5. Implementation and evaluation plans should be developed by the lead service agency for the SIS in consultation with other service providers, potential clients, and the community.

Timeline

  • May 1, 2017: Study began
  • August 2017: Completion of data collection
  • November 29, 2017: Study released
  • December 4, 2017: Study and recommendations presented to Board of Health
  • December 8, 2017: Study and recommendations endorsed by City Council

Resource tools

Supervised Injection Sites resource tools:

 

What are the risks associated with injection drug use?
Injection drug use affects us all. Harms associated with injection drug use are many and include the spread of infectious diseases, accidental death and injury from overdose, poor mental health, unstable housing, injection-related litter, and the degradation of public spaces. 

What are Supervised Injection Sites?
Supervised Injection Sites (SISs) are locations where people take pre-obtained drugs and inject them in a clean environment under the supervision of trained medical staff. In addition, individuals are provided with:

  • Sterile injection supplies
  • Education on safer injection practices, overdose prevention and intervention
  • Medical and counselling services
  • Referrals to drug treatment, housing, income support and other services 

What is the purpose of a Supervised Injection Site?
Supervised injection sites are part of a larger harm reduction approach that support health equity and health as a human right. Research has demonstrated benefits of SIS for communities and people who inject drugs. These services have four main goals: 

  • Save lives by reducing the number of fatal and non-fatal drug overdoses
  • Reduce the spread of infectious diseases like HIV and hepatitis C amongst people who inject drugs
  • Connect people who use drugs with primary health care services, addictions treatment, and social services like housing and other supports
  • Create a safer community by reducing drug us in public spaces and publically discarded needles

How do these services work?
Clients arrive at a program with pre-obtained drugs. Each person will be assessed to ensure they are eligible for the program. They will be given sterile injecting equipment and instruction on safer injecting practices. A nurse will then supervise their injection in a room dedicated for this purpose, and intervene in the case of medical emergencies. Once the individual has injected their drugs they will be directed to a waiting room where they will continue to be observed for any negative drug reactions. They will also receive information and referrals about other health and social supports and services at the agency or elsewhere in the community.

Are Supervised Injection Sites legal?
Yes. In Canada, the legal operation of a supervised injection site requires Federal Government approval, granted by the federal Minister of Health  for legal exemption under section 56 of the Controlled Drugs and Substances Act (CDSA). 

Are there other supervised injection sites?
Yes. There are more than 90 supervised injection services worldwide. There are over 25 sites (not including interim sites) approved for exemption in Canada – 16 of which are currently operational and offering services in Canadian cities. In Ontario four sites have been approved in Toronto and three in Ottawa.

What has been the experience in other places?

SISs have been shown to:

  • Serve marginalized and high risk people who inject drugs;
  • Decrease fatal and non-fatal overdoses;
  • Decrease unsafe injection practices like syringe sharing;
  • Promote public order by decreasing public injection and injection litter;
  • Promote addiction treatment;
  • Be cost-effective; and,
  • Be successfully accepted by people who inject drugs, local residents, and the police.

SISs have NOT been shown to:

  • Shift drug use to different neighbourhoods;
  • Increase drug injecting;
  • Increase drug trafficking or crime in the surrounding area; and,
  • Decrease the overall number of people who inject drugs.

Where will these services be located?
The exact location of Supervised Injection Site in Hamilton has not yet been determined; it is recommended that an initial site be located in downtown Hamilton in the area of Barton (north), Ferguson Ave (East), Main Street (south), Queen Street (west). It is recommended that these services be integrated within an existing health or social service agency that already provides harm reduction services to people who inject drugs.

Why does Hamilton need a SIS?
The individual health and community impacts from drug misuse demonstrate a need for additional services and strategies in Hamilton.

  • Accidental opioid-related deaths have increased substantially each year in Hamilton. 43 Hamiltonians died in 2016 due to accidental opioid-overdose – 4 times more than in 2007.
  • Drug-related emergency department visits, hospital admissions have sharply increased in the last five years.
  • Between January and November 2017 there were 378 paramedic responses to suspected opioid overdose, with a high concentration of the calls responding in the downtown area.
  • Blood borne disease spread easily with injection drug use behaviours such as sharing needles. Hamilton’s rate of hepatitis C infection is 32% higher than the provincial average.
  • There is a high demand for harm reduction services such as needle syringe programs and naloxone kits. In 2016, 1.2 million clean needles were distributed through Harm Reduction programs

The addition of these services in Hamilton has the potential to effectively address some of these issues by decreasing unsafe injection practices like needle sharing that can spread disease, decreasing death and disability from overdose, and decreasing public injections and injection drug litter by providing a clean and safe place for people to inject drugs.

Do these sites encourage drug use?
No. SISs do not promote drug use. People do not start injecting drugs because of the availability of supervised injection services. There is no evidence that harm reduction services promote drug use. Supervised injection services are used mainly by people with a long history of injection drug use. Evidence shows that the majority of SIS users are long-time users and that the establishment of an SIS does not lead to an increase in first-time drug use.

Data from Insite show that the average length of time of SIS clients using injection drugs is 16 years.

What else is being done to address drug issues in Hamilton?
Many organizations across our community deliver a broad range of services to reduce the harms of drug and substance use. These services include prevention programs as well as harm reduction services, withdrawal management and treatment programs.

Public Health Services continues to support a comprehensive approach to drug and substance misuse. This includes:

  • Education to prevent the misuse of drugs
  • Support to people misusing drugs so they can connect with drug treatment
  • Offering harm reduction services, such as naloxone training and kits for people who use drugs
  • Promoting safer drug use practices

For more information visit www.hamilton.ca/drugs

Will these services bring more crime to the neighbourhood/area?
It is recommended that these services are located in neighbourhoods where there is a demonstrated need, where drug use is already having an impact on the community. Supervised injection sites do not contribute to more crime. There is considerable research on this subject. For example, in the neighbourhood around InSite in Vancouver, there has been no increase in crime, and actual decreases in vehicle break-ins and thefts. Data provided by Hamilton Police Service indicate that the highest rates of drug related crime occurred in downtown Hamilton. These crimes include possession, trafficking, and loitering events related to controlled substances that do not include cannabis.

Is the City of Hamilton opening a supervised injection site?
Public Health Services will work with interested agency/organizations to support a successful application by providing detailed scientific evidence, community stakeholder data and expertise, and if approved may provide in-kind support in the form of staff time to provide harm reduction services and/or provincially funded supplies.

The study process

The study is led by City of Hamilton Public Health Services in partnership with McMaster University Masters of Public Health program. It is supported by Master of Public Health students and peer research associates.

A Scientific Advisory Group and a Community Advisory Group have been developed to provide advice to the Study Team. 

The study uses mixed methods

  1. Quantitative (numbers) – infectious disease and crime data 
  2. Qualitative (opinions) – survey of people who inject drugs, focus groups and key informant interviews.

Contact us

Email: SIS@hamilton.ca