{"id":52339,"date":"2020-06-29T14:13:38","date_gmt":"2020-06-29T18:13:38","guid":{"rendered":"https:\/\/www.phsd.ca\/?page_id=52339"},"modified":"2026-07-30T17:58:23","modified_gmt":"2026-07-30T17:58:23","slug":"nafsreport","status":"publish","type":"page","link":"https:\/\/dev-phsd.madhatter.co\/community-drug-strategy\/community-drug-strategy\/research\/nafsreport\/","title":{"rendered":"A study to explore the need for and feasibility of implementing supervised consumption services in the City of Greater Sudbury"},"content":{"rendered":"

\u201cWe respectfully acknowledge the traditional territory of Atikameksheng Anishnawbek and Wahnapitae First Nation, as well as the Robinson- Huron Treaty on which this study was conducted. These lands encompass strong and vibrant communities of the Anishinabek and the many other Indigenous Peoples who reside in these communities. Their enduring presence and resilience is felt throughout our shared history and in present day. We strive for respectful relationships with all Indigenous Peoples. We are committed to honour our shared history and ensure healthier communities for all.\u201d<\/q><\/p>\n

Executive summary<\/strong><\/h2>\n

The Community Drug Strategy for the City of Greater Sudbury undertook a study to determine the need for and the feasibility of implementing supervised consumption services (SCS), in Greater Sudbury. Supervised consumption services are monitored spaces where people can consume drugs under supervision with sterile supplies. The study was completed between April 2019 and June 2020. The study consisted of a survey with people who inject drugs (PWID), a survey of Greater Sudbury community members, focus groups with community partners and stakeholders, and secondary data analysis.<\/p>\n

The City of Greater Sudbury would benefit from supervised consumption services.<\/h3>\n

Although there are existing harm reduction services in Greater Sudbury, the health harms associated with injection drug use are significant and rising. Sudbury and districts i<\/sup> (2018) ranked twelfth in the province for opioid-related emergency department visits, seventh in the province for confirmed opioid-related deaths, and tenth for hospitalizations, based on rates per 1000 population. The frequency of emergency medical service (EMS) calls for suspected opioid overdose have more than double in 2019 compared with 2018. Three-quarters (75.0%) of respondents from the survey of people who inject drugs (PWID) said they had injected drugs in public. More than half had overdosed in their lifetime.<\/p>\n

From the perspectives of law enforcement and health care providers, drug and substance use creates pressures on social services, police, paramedic, and hospitals. The need for EMS workers and police officers at overdose sites means that they are pulled away from other community needs.<\/p>\n

Supervised consumption services may be a feasible strategy for the City of Greater Sudbury, but there are some concerns that need to be addressed.<\/p>\n

Potential clients (89.0%) say they would use SCS if available and among community survey respondents, 59.8% believed that these services would be helpful in Greater Sudbury. All three groups of study respondents identified that the greatest benefits of SCS would be the prevention and treatment of accidental overdoses and the ability to access sterile injection equipment.<\/p>\n

Additional benefits identified by all three groups of study respondents include less public drug use on streets or in parks, fewer used needles on the streets or in parks, and less risk of injury and death from drug overdose. Concerns expressed in the community survey were related to neighbourhood safety, an increase in crime and drug use, and more drug dealers targeting the area. Although some respondents did not support the idea of SCS and did not respond to the question about mitigation strategies, others felt that some concerns could be addressed through strategies such as evaluating the services, sharing results with the community, and then taking action (58.2%), providing information about the goals and benefits of SCS (48.7%), and having a community group to work on issues about SCS (33.9%).<\/p>\n

If SCS are considered in Greater Sudbury, all those consulted suggested that a location should be carefully chosen. The most common suggestion was a centralized location in the downtown core, in proximity to, and integrated with, existing harm reduction services and the majority of health care and social services. A mobile service was also proposed by some respondents.<\/p>\n

i <\/sup>When Greater Sudbury data are not available, data from Sudbury and districts are used.<\/em><\/p>\n

Highlights<\/h2>\n

Supervised consumption services (SCS) are monitored spaces where people can consume drugs under supervision in an environment with sterile supplies.<\/p>\n

The Community Drug Strategy for the City of Greater Sudbury undertook a study to determine the need for and the feasibility of implementing SCS. The study consisted of a peer-led survey with 190 people who inject drugs (PWID), an online survey responded to by 2251 Greater Sudbury community members, and focus groups with 52 community partners and stakeholders. In addition to these primary sources of information, the researchers also consulted secondary data on population health information, drug use, opioid harms, prescription patterns, opioid toxicity, and opioid overdoses.<\/p>\n

The City of Greater Sudbury would benefit from supervised consumption services.<\/h3>\n
    \n
  • For 2018, per 1000 population, Sudbury and districts ranked twelfth in the province for opioid-related emergency department visits, seventh in the province for confirmed opioid-related deaths, and tenth for hospitalizations. Within Sudbury and districts, there were 199 opioid-related deaths between 2010 and 2018.<\/li>\n
  • The negative health outcomes are increasing: The frequency of emergency medical service (EMS) calls for suspected opioid overdose was higher in 2019 (468 calls) compared to 2018 (200 calls). Deaths due to opioid-related overdoses in Sudbury and districts increased in 2019, with approximately the same number of deaths in the first half of 2019 (28 deaths) as were experienced in all of 2017 (34 deaths) or 2018 (32 deaths).<\/li>\n
  • People who inject drugs do so frequently; 43.0% of PWID survey respondents inject several times per day.<\/li>\n
  • Drugs mixed with other substances can pose a risk because the user may experience an unexpected or adverse reaction. The majority of PWID surveyed, 85.2%, indicated that they have taken a drug they believed was mixed with another substance.<\/li>\n
  • Accidental overdose is a common experience among PWID in Greater Sudbury. Among the PWID surveyed, more than half had accidentally overdosed in their lifetime. Injecting drugs alone poses increased risk of adverse consequences. The large majority of PWID surveyed (83.2%) said that they have injected alone.<\/li>\n
  • Injecting in public may demonstrate that there is a need for designated supervised space for injecting. Three-quarters (75.0%) of respondents said they had injected drugs in public.<\/li>\n
  • One-third of respondents (32.6%) indicated they have used a needle previously used by someone else, placing them at greater risk of contracting blood borne infections such as HIV and Hepatitis C.<\/li>\n<\/ul>\n

    From the perspectives of law enforcement and health care providers, drug use creates pressures on social services, police, paramedic, hospitals. The need for EMS workers and police officers at overdose sites means that they are pulled away from other community needs.<\/p>\n

    Supervised consumption services may be a feasible strategy for the City of Greater Sudbury, but there are some concerns that would need to be addressed.<\/h3>\n

    The majority of PWID (89.0%), indicated that they would be willing to use SCS. Among those PWID who would use SCS, their single most important benefit was access to sterile injection equipment (27.5%), or that overdoses can be prevented (20.9%) or treated (20.3%).<\/p>\n

    Among community survey respondents, 59.8% believed that these services would be helpful in Greater Sudbury, while 33.6% of respondents did not believe these types of services would be helpful, and 6.1% were neutral or unsure.<\/p>\n

    Stakeholders identified benefits for people who inject drugs, the community and services.<\/h6>\n

    “The benefits of having a SCS is that it\u2019s located in one area, access to other services, so whether it\u2019s drug information or access to other social workers or nurses, or people, I guess ultimately the idea is that if you got a user in front of you, you can try and help them.”<\/p><\/blockquote>\n

    The following potential benefits were identified by community respondents:<\/h6>\n
      \n
    • less public drug use on streets or in parks (62.3%)<\/li>\n
    • fewer used needles on the streets or in parks (62.3%)<\/li>\n
    • less risk of injury and death from drug overdose (60.1%)<\/li>\n<\/ul>\n

      There are concerns and challenges associated with supervised consumption services<\/h4>\n

      Although 89.0% of PWID indicated that they would make use of SCS, those who responded that they would not use these services, or may not use them frequently, expressed concerns about anonymity and fear of police, or noted that they were self-sufficient and not in need of these services.<\/p>\n

      Business owners and community members expressed concerns about negative impacts around the area of SCS, with effects on perceived neighbourhood safety and desirability, a potential increase in crime and drug use, and more drug dealers targeting the area. Approximately one-third of survey respondents had concerns that SCS could lead to more drug use, more drug selling or trafficking in the area, and more people who use drugs in the area.<\/p>\n

      There are possible mitigation strategies to address the concerns<\/h4>\n

      It was felt by some focus group participants that many concerns are due to lack of knowledge about the benefits and effectiveness of SCS and lack of understanding about mental health\/illness and the link to addiction, and that increased awareness could mitigate some of the concern. Community residents felt that some common mitigation strategies could be helpful:<\/p>\n

        \n
      • Provide information about the goals of SCS and how they can help the community.<\/li>\n
      • Have a community group to work on issues about SCS.<\/li>\n
      • Evaluate the services, share results with the community, and take action.<\/li>\n<\/ul>\n

        Supervised consumption services should be integrated with existing services<\/h4>\n

        Focus group participants said it was important to build on existing harm reduction programs in Greater Sudbury. Organizations that offer these programs were identified as having the appropriate approach\/model to support the needs of those who would use SCS and the needs of the larger community.<\/p>\n

        If supervised consumption services are considered, the most appropriate location(s) should be carefully chosen<\/h4>\n

        Community survey respondents had concerns about locating SCS in close proximity to schools or other community locations occupied by children. If SCS are considered, PWID were most likely to suggest the downtown core of Sudbury (65.8%) among possible locations. In general, among those who would consider SCS as an option, focus group participants and community survey respondents suggested one SCS site, located in a centralized location in the downtown core, although a mobile site was also suggested to provide services closer to wherever users live. The majority of health care and social services are located in the downtown core, and a downtown location would be in close proximity these supports.<\/p>\n

        Foreword<\/h2>\n

        Substance use impacts everyone. The rates of illicit drug use continue to be higher in Greater Sudbury than those for Ontario overall, and impact the health and safety of our communities. Based on rates per 1000 population for 2018, Sudbury & districts ranked twelfth in the province for opioid-related emergency department visits, seventh in the province for confirmed opioid-related deaths, and tenth for hospitalizations. Addressing the individual and societal issues associated with drug use requires the cooperation and collaboration of many community partners and private citizens. It is a multifaceted approach that requires diverse voices to help inform decisions.<\/p>\n

        The people impacted by substance use deserve a comprehensive approach to service delivery that is grounded in compassion and evidence. Public Health Sudbury & Districts and the Greater Sudbury Police Service, on behalf of the Community Drug Strategy for the City of Greater Sudbury, are pleased to share the final report of the Supervised Consumption Services Needs Assessment and Feasibility Study. The findings of the study inform local direction about supervised consumption services. These services are one component of our comprehensive strategy to protect the health of our community and reduce harms associated with drug use.<\/p>\n

        The study itself provided the community with opportunities to become meaningfully engaged and involved in the development, delivery, and evaluation of programs that are intended to serve them. We would like to acknowledge and thank the many people that took part in the community survey; those with lived experience who shared their important perspectives; and the health and social services agencies, friends and family of people who inject drugs, the business community, and local community organizations who all engaged in targeted focus groups. This report is a culmination of the voices of our community\u2014working together to improve the health, safety, and wellbeing of all individuals, families, neighbourhoods, and communities in Greater Sudbury.<\/p>\n

        We would also like to take this opportunity to thank the many researchers, policy experts, service providers, and community partners who have given so generously of their time and expertise to support the development of this report. And to all the members of the Community Drug Strategy for the City of Greater Sudbury\u2014 thank you for your ongoing support in this important work. We look forward to our continued efforts to provide access to appropriate, effective and acceptable services, and resources in our community. Together we will continue to build a healthier and safer community by lessening the harms associated with substance use.<\/p>\n\n\n\n
        Dr. Penny Sutcliffe, MD, MHSc, FRCPC Medical Officer of Health\/CEO Public Health Sudbury & Districts<\/em><\/td>\nPaul Pedersen, M.P.A., Dip.ED, C.M.M. III, C.M.I. VII Chief of Police Greater Sudbury Police Service\u00a0<\/em><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

        Introduction<\/h2>\n

        Supervised consumption services (SCS) are controlled spaces where people can consume drugs under supervision with sterile supplies. Spaces are supervised by trained staff, including health care professionals. People who use the service can also receive basic medical care and referrals to other health and social services1<\/sup>. SCS do not provide drugs to people. These services are legal in Canada with federal and provincial government approval2<\/sup>. SCS have been shown to reduce the mortality and morbidity associated with injection drug use, including infection and death3<\/sup>.<\/p>\n

        In the City of Greater Sudbury, the first comprehensive report \u201cCommunity Drug Strategy for the City of Greater Sudbury: A Call to Action4<\/sup>\u201d<\/q> was released in 2015, focusing on health promotion and prevention, treatment, harm reduction, and enforcement and safety. Since that time, the Community Drug Strategy for the City of Greater Sudbury, representing more than 25 community partners from community agencies including health, social services, education, police, justice and emergency services, have been actively working to improve community health and address drug-related issues by increasing public awareness of drug use as a health issue5<\/sup>. In 2018, the need to understand potential strategies to reduce drug-related harms, without requiring the cessation of drug use, was identified.<\/p>\n

        As noted in an evidence review by the British Columbia Centre on Substance Use6<\/sup>, evaluation research on SCS consistently demonstrates the following outcomes: reducing morbidity and mortality associated with overdose7,8,9,10<\/sup>; reducing risk for infectious disease transmission and increase harm reduction practice such as reduction in syringe reuse11,12,13,14,15,16,17,18<\/sup>; \u201cimproving contact between a highly marginalized \u2018at-risk\u2019 population and the health care system\u201d<\/q>19<\/sup>; enhancing recruitment into medical care and addiction treatment and withdrawal management20,21,22,23,24,25,26,27<\/sup> and methadone therapy28,29,30,31,32<\/sup>; reducing pressures on emergency services33<\/sup>; reducing public drug use34,35<\/sup>, syringes discarded in public, and other injection-related litter36,37,38<\/sup>.<\/p>\n

        While there have been concerns that SCS encourage and foster drug use, there has been no increase in the number of people using drugs intravenously in localities where such facilities operate39<\/sup>. Further, evaluation work undertaken in Vancouver revealed that the opening of Insite was not associated with increased crime or rates of initiation into injection drug use40,41<\/sup>. These facilities have also been found to be highly cost-effective42,43<\/sup>.<\/p>\n

        Research purpose and objectives<\/h3>\n

        The overall purpose of this study was to determine the need for and the feasibility of implementing SCS in the City of Greater Sudbury, from the perspective of all community stakeholders (including people who inject drugs, Greater Sudbury residents, community partners, and other key stakeholders).<\/h6>\n

        Specifically, the study addressed the following objectives:<\/p>\n

          \n
        1. Determine the need for SCS in the City of Greater Sudbury;<\/li>\n
        2. Determine the conditions under which SCS would be used and judged as suitable or attractive by program deliverers and potential clients;<\/li>\n
        3. Determine the extent to which SCS are seen as helpful by community stakeholders and the community;<\/li>\n
        4. Identify concerns\/challenges\/barriers that might be associated with SCS in Greater Sudbury and discuss potential mitigation strategies to address them;<\/li>\n
        5. Determine how SCS could be integrated with existing harm reduction services in Greater Sudbury; and<\/li>\n
        6. Determine potential locations for SCS.<\/li>\n<\/ol>\n

          This report summarizes the findings related to each objective.<\/p>\n

          Data collection methods<\/h3>\n

          Needs and feasibility studies of SCS from similar-sized communities in Ontario, such as Thunder Bay44<\/sup>, London45<\/sup>, and Waterloo46<\/sup>, were reviewed in the development of surveys and focus group questions for this study. Ethics approval for all parts of this research was received from the Public Health Sudbury & Districts Research Ethics Review Committee and the Health Sciences North Research Ethics
          \nBoard.<\/p>\n

          Public Health Sudbury & Districts led the study on behalf of the Community Drug Strategy for the City of Greater Sudbury. The study was supported by the City of Greater Sudbury, the North East Local Health Integration Network, the Canadian Mental Health Association, and Public Health Sudbury & Districts. A Community Advisory Committee and a Research and Technical Working Group provided guidance on the study. A Northern Ontario School of Medicine (NOSM) research team collected the data, and analyses were completed by NOSM and Public Health Sudbury & Districts.<\/p>\n

          The following primary data collection methods were used to address the research objectives:<\/p>\n

            \n
          1. a peer-led survey with people who injected drugs within the last six months<\/li>\n
          2. a community online survey<\/li>\n
          3. focus groups with community partners, including those working in harm reduction, health promotion, treatment, enforcement and justice, local businesses, non-profit and other community organizations, and family and friends of people who inject drugs<\/li>\n<\/ol>\n

            In addition to these primary sources of information, the researchers also consulted secondary data on population health information, drug use, opioid harms, prescription patterns, opioid toxicity, and opioid overdoses.<\/p>\n

            Respondents<\/h3>\n

            People who inject drugs (PWID) survey participants<\/h4>\n

            This peer-led survey with people who inject drugs was conducted throughout the month of July 2019. A total of 190 participants completed all or a portion of the survey; all participants had injected drugs within the previous 6 months prior to the survey, were at least 16 years of age, and were able to give free and willing consent to participate.<\/p>\n

            Approximately 60% were male, and the mean age of respondents was 40 years (with a range from 17 to 66 years); 88.4% spoke English as a first language; 86.3% reported being heterosexual; and 25.8% reported having any university\/college as highest level of education. The majority of PWID in this study either identified as Indigenousii<\/sup> (55.8%) or as Caucasian (42.1%). Although participation in the survey required all participants to have injected drugs within 6 months prior to the study, 86.8% reported using injection drugs in the previous 30 days.<\/p>\n

            Focus group participants<\/h4>\n

            Focus group participants were largely identified through membership in the Community Drug Strategy for the City of Greater Sudbury. A total of 52 community stakeholders participated in 13 focus groups held between September to November 2019, representing the following sectors and perspectives: addiction treatment (n=11); enforcement and justice (n=4); health promotion and prevention (n=11); harm reduction (n=7); business sector and other community organizations (n=10); and friends and family of people who inject drugs (n=9).<\/p>\n

            Community survey participants<\/h4>\n

            The community survey was available online through the Community Drug Strategy for the City of Greater Sudbury website from June through September 2019; paper copies were also available at community partner locations until the survey closed online. A total of 2251 respondents completed all or a portion of the survey; all respondents indicated they were at least 16 years of age, and were able to give free and willing consent to participate.<\/p>\n

            Among the 2251 respondents, 62.5% identified as female, and 55.0% of respondents were between 25 to 44 years of age. Of the respondents, 19.8% reported working in health care or being a first responder, 12.7% worked in the harm reduction field, and 6.3% reported being a business owner.<\/p>\n

            ii<\/sup> We recognize First Nations, M\u00e9tis and Inuit as three distinct cultural identity groups, each of which has a unique history, set of traditions and cultural practices, and governance structures. For the purpose of this document the term Indigenous will be used to encompass these populations. However, the term First Nations community will be used when referring to communities located on reserve.<\/em><\/p>\n

            Findings<\/h2>\n

            Context<\/h3>\n

            The City of Greater Sudbury<\/h4>\n

            The City of Greater Sudbury is located in Northeastern Ontario on the Canadian Shield about 400 kilometres north of Toronto47<\/sup>. With a population of approximately 162 000 living in a mix of urban, rural, and wilderness environments, it is the largest and most populated centre north of the Greater Toronto Area48<\/sup>. Greater Sudbury is geographically the largest municipality in Ontario, encompassing 3228 square kilometres49<\/sup>. It is a multicultural community, with 27.0% of the population reporting French as their mother tongue50<\/sup>. As per the Greater Sudbury census metropolitan area, Greater Sudbury is located on the territories of two First Nation communities, Wahnapitae First Nation and Atikameksheng Anishnawbek and is home of approximately 9.0% of people who identify as Indigenous, some of which are First Nation members of other First Nation communities51<\/sup>.<\/p>\n

            In 2016, 13.0% of the population of Greater Sudbury were living in povertyiii,52<\/sup>. A 2018 point-in-time count reported 1954 individuals who identified as either absolutely homeless, hidden homeless or at-risk of homelessness; an additional 224 were dependent children under the age of 18, of whom participants had custody53<\/sup>. One of the top reasons reported for homelessness was addictions54<\/sup>. Compounding homelessness, Greater Sudbury has a 5-year wait time for a one-bedroom subsidized unit, and a wait list of over 1000 residents for geared-to-income housing55<\/sup>.<\/p>\n

            Current local harm reduction responses and usage<\/h4>\n

            In the City of Greater Sudbury, several harm reduction strategies have been implemented to increase the safety and health of the community related to substance use.<\/p>\n

              \n
            • The Needle Exchange Program (NEP, also known as The Point) is a free and confidential program that provides harm reduction supplies and services to people who use drugs, including provision of new needles, needle pick-up and disposal bins56<\/sup>. It aims to reduce the risks of getting or passing on infectious diseases, such as HIV and hepatitis C, and reduce risks associated with using drugs. In 2019, 1 495 919 needles were distributed through the NEP, including the fixed site at the Rainbow Mall and through outreach services across Sudbury and districts57<\/sup>. There were 900 visits to the Needle Exchange Program in 201958<\/sup>.<\/li>\n
            • Pre-assembled naloxoneiv<\/sup> spray kits are distributed to NEP clients who are at risk of opioid overdose and to friends and family members of those at-risk59<\/sup>. Naloxone is also distributed to eligible agencies and pharmacies to distribute to clients as part of the Ontario Naloxone Program. In Greater Sudbury, Public Health Sudbury & Districts, R\u00e9seau ACCESS Network, and pharmacies receive naloxone through this program. Training related to naloxone storage, administration and distribution is provided through the Naloxone Distribution Program by Public Health Sudbury & Districts to eligible agencies and is ongoing in the community. In addition, R\u00e9seau ACCESS Network provides training on naloxone storage and administration and distributes kits to those most at risk for overdose.<\/li>\n
            • Since May, 2019, the Sudbury Temporary Overdose Prevention Society (STOP Society) has offered periodic unsanctioned SCS at five pop-up sites in Greater Sudbury\u2019s downtown core60<\/sup>. They do not have a federal exemption to operate. STOP offers clients and the community the following services: community clean-up; harm reduction teaching; brief counselling; Indigenous traditional services; practical support; grief counselling; and medical care. Additionally STOP has provided referrals to the following: addiction services; harm reduction services; clinical service providers; mental health service providers; and other community-based service providers61<\/sup>. Over a seven month period, from May to November, 2019, STOP provided a total of 14 operational days and assisted a total of 140 clients62<\/sup>.<\/li>\n
            • The Sudbury Action Centre for Youth (SACY), in partnership with Laurentian University, offers a drug testing program63<\/sup>. A spectrometer is used to assist in drug identification. As of March 2019, there were 10 samples being tested per month. SACY also provides harm reduction services in the form of outreach and the provision of supplies and services to promote clean and safe use of drugs64<\/sup>.<\/li>\n
            • As part of the Community Drug Strategy, Public Health Sudbury & Districts has been issuing drug alerts and warnings since 201765<\/sup>. The alerts and warnings are issued to notify the community of increased opioid-related incidents or of new toxic drug trends in Greater Sudbury. The alerts are released as a result of ongoing data surveillance, ministry notices, and information from community partners. Since its inception to May 2020, 12 drug alerts have been issued in the City of Greater Sudbury66<\/sup>.<\/li>\n
            • Police Services: the Greater Sudbury Police Service (GSPS) has implemented visibility strategies to address issues in the downtown core. In 2018 to 2019 there has been a 14.0% increase in downtown bike patrols67<\/sup>. GSPS continues to target enforcement towards drug suppliers, employs drug recognition experts, provides education and issuance of naloxone and supports advocacy efforts for appropriate sentencing as it relates to illicit drug suppliers and users.<\/li>\n
            • Mobile Crisis Response Program: the Program is in association with the Crisis Intervention Program, Greater Sudbury Police Service, Greater Sudbury Paramedic Services, and Health Sciences North\u2019s Emergency Department68<\/sup>. Various health services such as health checks and mental health and addiction supports are provided in social settings (e.g. housing buildings, and shelters) to best meet the needs of individuals.<\/li>\n
            • Rapid Mobilization Table (RMT): Community Mobilization Sudbury (CMS) comprises 25 partner organizations from diverse sectors such as health, children\u2019s services, policing, education, mental health and addictions, housing, and municipal services that coordinate to utilize existing systems and resources69<\/sup>. Representatives from CMS partners meet twice each week at the RMT. Participants collaboratively identify situations involving those who are at high risk of harm. All necessary agency partners participate in a coordinated, joint response \u2013 ensuring that those at risk are connected to appropriate, timely, effective, and caring supports.<\/li>\n
            • Canadian Mental Health Association\u2019s Harm Reduction Home Residential Program works to support individuals who are homeless or at risk of homelessness and who are also impacted by alcohol dependence70<\/sup>. The program provides access to a managed alcohol program where individuals are supported with housing and addressing primary care and mental health needs.<\/li>\n
            • Ontario Aboriginal HIV\/AIDS Strategy provides outreach and support to Indigenous people who use drugs71<\/sup>. They provide free access to sterile drug use supplies, while supplying traditional medicines and resources to access traditional supports through community networks.<\/li>\n
            • R\u00e9seau ACCESS Network provides harm reduction services through The Street Outreach Program, which operates seven days a week72<\/sup>. Outreach workers provide safe injection\/inhalation supplies, referrals to addiction treatment centres, testing services, HCV treatment, referrals for HIV treatment, support and counselling and advocacy and accompaniment. Their outreach includes education to prevent harms of drug use, naloxone training and distribution, and distribution of safe supplies.<\/li>\n
            • Shkagamik-Kwe Health Centre is an Aboriginal Health Access Centre, which provides community-based programs that are delivered in a culturally safe environment free of judgment73<\/sup>.<\/li>\n<\/ul>\n

              From the people who inject drugs (PWID) survey, it is evident that many of the existing harm reduction services in Greater Sudbury are accepted and well-used. In addition, there continue to be gaps and resource limitations.<\/p>\n

                \n
              • 76.8% of PWID indicated that they have exchanged or obtained needles through existing services in Greater Sudbury in the last 6 months.<\/li>\n
              • 93.2% of PWID were aware of take-home naloxone kits, and of those, 78.8% had their own kits. PWID indicated they had obtained naloxone kits through a methadone clinic (39.1%), the needle distribution program (38.3%), from outreach workers (36.2%), or a pharmacy (18.5%).<\/li>\n
              • Knowledge of naloxone was also demonstrated to come from existing services, with PWID indicating they had learned about naloxone from outreach workers and street nurses (45.8%), the needle distribution program (19.2%), or through a methadone clinic (18.1%).<\/li>\n
              • 55.5% of PWID accessed blood testing services for HIV, and 54.7% for hepatitis C (Hep C), from a wide range of local service providers including Public Health Sudbury & Districts, Health Sciences North, R\u00e9seau ACCESS Network, jail, pharmacies, and Indigenous programs.<\/li>\n
              • 74.7% of PWID indicated that they had been in a drug treatment program during their lifetime, and 60.0% indicated that they had been in a detox program.<\/li>\n
              • 29.5% of PWID had tried to access treatment programs but were unable.<\/li>\n<\/ul>\n

                iii<\/sup> The Low-income measure after tax (LIM-AT) is a fixed percentage (50%) of median adjusted after-tax income of households observed at the person level, where \u2018adjusted\u2019 indicates that a household\u2019s needs are taken into account.<\/em><\/p>\n

                iv<\/sup> Naloxone can temporarily reverse the effects of an opioid overdose that may cause a person to stop breathing.<\/em><\/p>\n

                Need for supervised consumption services<\/h2>\n

                Determining the need for SCS in Greater Sudbury was the primary objective of this research study. The following results describe aspects of the need for supervised consumption services in Greater Sudbury from the perspectives of people who inject drugs, key stakeholders, and Greater Sudbury community members. Indicators of need for SCS may include a sizable population that injects drugs; unsafe injection practices; significant negative outcomes such as overdoses, ER visits and hospitalizations; impact on emergency services and law enforcement; existing harm reduction supports, such as needle exchange programs that can complement SCS; gaps in support and referral options; and social and family
                \nimpacts of injection drug use74,75,76,77<\/sup>.<\/p>\n

                Drug use in the City of Greater Sudbury<\/h3>\n

                Harm reduction services, including needle and naloxone distribution, are already implemented in the City of Greater Sudbury. Distribution of needles remained constant between 2013 and 2016 at approximately 500 000 distributed needles annually. However, in 2018 the number of distributed needles increased dramatically to 1.5 million78<\/sup>. Since July 2018, Public Health Sudbury & Districts staff have trained 413 individuals from 63 community organizations to administer naloxone79<\/sup>. In 2019, Public Health Sudbury & Districts distributed a total of 6958 naloxone kits and refills to community agencies, while R\u00e9seau ACCESS Network and pharmacies distributed a further 3052 and 6438 kits and refills, respectively80<\/sup>.<\/p>\n

                1.5 million<\/span>
                \nneedles distributed in the City of Greater Sudbury in 2018.<\/span><\/p><\/blockquote>\n

                Although there are existing harm reduction services in Greater Sudbury, the health harms associated with drug and substance use are significant and rising81<\/sup>. There is a significantly higher proportion of individuals who have ever tried illicit substances in Sudbury and districts compared to the general population of Ontario; 53.6% compared to 40.6% respectively82<\/sup>. Based on Canadian Community Health Survey data from 2015 to 2017, it is estimated that in 2019 there were 1817 (95% CI 840\u20132795) adults in Greater Sudbury who have used illicit drugs (such as cocaine, amphetamines, opioids or hallucinogens), excluding adults using cannabis83<\/sup>.<\/p>\n

                Figure 1: Individuals who have tried illicit substances in Sudbury and districts and in Ontario (%)<\/h6>\n

                \"Individuals<\/p>\n

                In 2018, per 1000 population, Sudbury & districts ranked twelfth in the province for opioid-related emergency department visits, seventh in the province for confirmed opioid-related deaths, and tenth for hospitalizations84<\/sup>. In 2018, Public Health Sudbury & Districts area was the eleventh highest Public Health region for opioid prescribing for overall and new individuals, with a rate of 140.6 per 1000 population85<\/sup>. Within Sudbury and districts, there were 199 opioid-related deaths between 2010 and 201886.<\/p>\n

                199<\/span>
                \nopioid-related deaths between 2010 and 2018 within Sudbury and districts.<\/span><\/p><\/blockquote>\n

                The frequency of emergency medical service (EMS) calls for suspected opioid overdose was higher in 2019 (n=468) compared to 2018 (n=200), and was higher in every month87<\/sup>.<\/p>\n

                Deaths due to opioid-related overdoses in the Sudbury and districts increased in 2019, with approximately the same number of deaths in the first half of 2019 (28 deaths) as were experienced in all of 2017 (34 deaths) or 2018 (32 deaths)88<\/sup>.<\/p>\n

                Opioid-related toxicity and opioid-related deaths disproportionately affect Ontario\u2019s Indigenous populations and more greatly impact Indigenous people living off a First Nations community89<\/sup>. Recent data demonstrate that the rate of opioid related toxicity (both emergency department visits and hospitalizations) is almost 4.5 times higher for Indigenous people living off a First Nations community and almost 2.5 times higher for Indigenous people living on a First Nations community compared to the general population90<\/sup>. Moreover, the rate of opioid-related mortality is 4.25 times higher for Indigenous people living off a First Nations community and 2.25 times higher for Indigenous people living on a First Nations community compared to the general population91<\/sup>. The greater inequities observed by these data exist in a context of colonization, historical and current trauma, and systemic racism. First Nations communities are at a higher risk of experiencing opioid-related morbidity and mortality due to the intergenerational impacts of colonialism, including residential schooling and the historical erosion of First Nations culture92<\/sup>.<\/p>\n

                From the perspective of people who inject drugs<\/h3>\n

                Living situation<\/h4>\n

                The large majority of people who inject drugs (PWID) survey respondents (91.6%)
                \nlived in Greater Sudbury. In terms of housing, 43.4% reported that during the last 6 months, the place they lived most of the time was in their or their partner\u2019s house or apartment; 12.7% indicated that they lived where people gather to use drugs (e.g., a crack house), 38.0% of PWID respondents reported being homeless in the past 6 months.<\/p>\n

                Two-thirds of respondents (67.4%) lived below the poverty line\/low income threshold (broken down, 38.4% earned less than $10,000 in the previous year and 29.0% earned between $10,000 to $19,999), while 11.6% earned between $20,000 to $29,999; only 9.0% earned $30,000 or more. Additionally, 8.9% reported having a regular job, 11.0% reported being temporarily employed, and 11.0% being self-employed. The most common source of income was Ontario Works (OW) (42.6%), followed by Ontario Disability Support Program (ODSP) (38.9%), and GST rebates (14.7%). Some respondents reported criminal activity as sources of income: 21.6% reported selling drugs, 16.3% reported theft\/robbery\/stealing, while 9.5% reported each of the following activities: selling sex, cigarettes\/tobacco, and other criminal activities.<\/p>\n

                Drug use<\/h4>\n

                The average age when survey respondents began using drugs was 22 years (with a range between 9 to 40 years) (among those 93 respondents who answered this question).<\/p>\n

                Survey respondents who inject drugs do so frequently, with almost two-thirds (66.8%) reporting that they used injection drugs on a daily (43.2%) or weekly (23.7%) basis, while the remainder of respondents indicated that they used injection drugs on a monthly or less frequent basis (24.2%). On average, for those who responded on frequency of injecting during a day (n=105), 94.3% inject drugs multiple times a day; only 5.7% of users reported injecting once during the day. Others indicated that they injected on average 3 times a day (10.5%), 4 times (9.5%), 5 times (11.4%) or more than 10 times per day (22.0%).<\/p>\n

                Types of drugs used<\/h4>\n

                A variety of drugs are consumed by people who use drugs in Greater Sudbury. Cocaine is the most common drug of choice, with \u2018hydros\u2019 (e.g., HydroMorphone, Contin, Dilaudid), crack, heroin, fentanyl, morphine, amphetamines, crystal meth, and speedballs as other drugs of choice. Overall, opioids are slightly more consumed than stimulants.<\/p>\n

                Table 1: Drugs most often injected during the last six months (more than one response permitted)<\/h6>\n