A review of supervised inhalation services in Canada

Key take-home messages

• Reports from different Canadian provinces (British Columbia, Ontario, and Alberta) indicate that more individuals overdose by inhaling opioids (including fentanyl) compared to those who overdose via injection drug use. This is an apparent shift from previous years, where injection was the route of drug consumption causing a greater proportion of overdose deaths.
• Supervised consumption services (SCS) in Canada that receive a federal exemption to operate must also navigate provincial and municipal legislation required to maintain public health and safety if offering inhalation as a method of consumption at SCS. However, there is considerable regional variation in policies that guide these harm reduction services.
• A safe place to smoke drugs may minimize an individual’s exposure to violence, offer protection from law enforcement, provide a place to inhale safely, foster a sense of recognition and create equity among people who smoke drugs as programs are mainly injection-focused, and engage people who smoke drugs with harm reduction services or other drug treatment options.
• There appears to be a high degree of willingness to use SCS that include inhalation services, especially among individuals who are unstably housed and/or who identify as a racialized person and/or sexual minority.
• In Canada, quantitative data from SCS offering inhalation is limited; most available data is aggregate, describing the number of visits to these services and/or overdose statistics based on route of consumption.
• More research regarding non-injecting routes of drug consumption is required to ensure high-quality harm reduction service provision, especially surrounding supervised smoking services. Additional program planning and evaluation outlining the risks and benefits of non-injecting drug use is necessary to promote the health and safety of people who inhale drugs.

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Housing
  • Health services
  • Stigma/discrimination
• Population(s)
  • People who use drugs
  • General HIV+ population
  • General HIV- population
• Prevention, Engagement and Care Cascade
  • Prevention
• Prevention
  • Drug use behaviours/harm reduction
• Health Systems
  • Governance arrangements
  • Delivery arrangements