Welcome to the sixth edition of IDPC's COVID-19 Stories of Substance newsletter!
Missed our previous editions? You can read them here.

Featured story: Safety and solidarity in times of crisis 

Safe consumption sites (SCS) come in different shapes and sizes, depending on where, how, and for which purpose they are set up. This diversity is also reflected in the way these spaces are named: Drug consumption rooms, supervised injection facilities, overdose prevention sites. At the heart of them all, however, is the idea of providing a safe space for people who use drugs, facilitating access to support by trained personnel, sterile equipment, naloxone, useful information and health and welfare programmes.

Notwithstanding their variety, safe consumption sites (SCS) and other related harm reduction services support people who use drugs (as well as those who don’t) to stay alive and well. Below are some examples of how they continue to do so despite the pandemic situation – though these stories represent only the tip of the iceberg.

Australia

In Sydney, Australia, the Uniting Medically Supervised Injecting Centre (MSIC) has remained open since COVID-19 hit, as depicted in this much-needed cheerful video. To comply with social and physical distancing guidelines, MSIC has had to reduce the number of clients using its injection space, and suspend the provision of refreshments at its aftercare area. As noted by Miranda St Hill, Service Operations Manager at MSIC, this means that ‘opportunities for engagement (and for referrals to treatment and services) are noticeably reduced.’


'Ever wondered what it's like to work in a supervised injecting centre?' Learn more from MSIC's video

Like other services across the country, MSIC has also had to conduct screenings that slow down the flow of clients into the building. While crucial for COVID-19 prevention, longer queuing times means clients 'feel more visible and more vulnerable to police attention.'

On the bright side, a number of progressive harm reduction and public health policies have been introduced by government agencies in recent months. These include guidelines around increased provision of takeaways for opioid agonist therapy, expansion of Buvidal access (including in some prisons), a push to increase provision of take-home naloxone, temporary accommodation for the homeless, mobile COVID-19 testing services for marginalised areas, tele-health, and online counselling. Unlike in other countries, harm reduction services have also been able to operate despite movement restrictions, and ‘MSIC has been designated an essential service by the government.’

As reported by Australian advocates in related sectors through IDPC’s COVID-19 survey, the pandemic has led to a growing demand for treatment services. The emergence of substances of lesser quality has also been noted – as similarly observed by MSIC staff. More people have recently found housing support, but certain communities of people who use drugs are still struggling – with some being fined for having to gather on the streets of Melbourne. Meanwhile, the dire prison situation in Australia – and people left behind bars during this crisis – remains a significant concern for many.

Mexico

The first safe consumption site established outside of the Global North was founded in 2018 in Mexicali, Mexico. Known as La Sala (or “the living room”), the site is operated by Verter AC. There is no legal framework for SCS in Mexico, but the fact that personal drug use, in itself, is not criminalised in Mexico has placed La Sala in a legally awkward position. On the one hand, they are not barred from the central government to operate as a SCS, yet they were once forced to shut down by Mexicali’s local government. After several months of legal battle, however, La Sala won the right to keep the doors open .

As briefly explained in our fourth edition last month, people who use drugs and other disadvantaged communities in Mexicali are severely hit by the pandemic – but perhaps even more so by the lack of coordinated response and assistance from public institutions. Verter AC and other organisations have been filling this gap. Interestingly, the lack of regulation around SCS has also made it easier for La Sala to remain open – without the same level of bureaucratic hurdles required to obtain permission for Verter AC’s community harm reduction centre, and other similar centres across the country. Thanks to this, La Sala continues to welcome people in need of safe spaces to use drugs, including for people to inject heroin (often contaminated with fentanyl) and methamphetamine.

Canada

Even before the spread of coronavirus, communities across North America were already in crisis. Overdose deaths have been on the rise for years, exacerbated by a deadly mix of adulterated substances, limited services, and prevailing punitive policies. Communities, service providers, and outreach workers have joined arms to expand life-saving programmes, and reach those in need. But such essential work is not always deemed essential by those in power. The busiest safe consumption site in Toronto, The Works, was forced to shut down at the beginning of the pandemic. After the city reported 19 overdose deaths in March alone, The Works was able to re-open, though the site – as well as others in Toronto – have to operate at a smaller scale in order to adhere to COVID-19 physical distancing protocol. 


A ‘safe inhalation site’ at Saskatoon’s all-inclusive consumption site. Photo: Prairie Harm Reduction (formerly AIDS Saskatoon)

The first Overdose Prevention Site in Atlantic Canada – known as HaliFIX – was in fact established in the summer of 2019, thanks to the work of the HaliFIX Overdose Prevention Society. Due to a lack of funding amid COVID-19, HaliFIX ended its operation in June 2020, but a new location was soon appointed for a new site to be located at the Brunswick Street Mission. This new site, officially referred to as the ReFIX Overdose Prevention Site (OPS), was officially opened in mid-August, with the hope that it would help prevent further overdose deaths and other harms, especially among communities hardest hit by the pandemic, such as homeless people.

In Canada, healthcare service delivery varies from province to province. To date, there is no clear indication that the provincial Nova Scotian government will ensure the sustainability of the site, which is absolutely essential. The province sees 50-60 overdose deaths per year and is in the middle of an HIV outbreak among people who use drugs. The current site functions within arms length distance of community-based organisations such as Direction 180, an opioid agonist therapy clinic and Mainline Needle Exchange, as well as the Halifax Substance User Network – whose personal stories can be found here.

Canada’s dozens of safe consumption/overdose prevention sites are a testament to the tenacity, ingenuity and expertise of communities impacted by the “war on drugs” and their allies. Under enormous pressure from detractors and the global pandemic, the Canadian harm reduction community continues to innovate for sustainable change – as shown by promising developments around initiating safe supply sites in the country. As Matthew Bonn from the Canadian Association of People Who Use Drugs (CAPUD) rightly said, ‘everyone needs a safe place to use, and a safe drug to use.’

We are grateful to Shay J. Vanderschaeghe from the Canadian Drug Policy Coalition, Matthew Bonn from CAPUD and the Canadian Students for Sensible Drug Policy, Miranda St Hill and Marianne Jauncey from Uniting Medically Supervised Injecting Centre (MSIC), Penny Hill from Harm Reduction Australia, and Said Slim Pasaran from Verter AC, for their valuable input, which contributed to the production of this piece.