Programming Connection

Supervised Inhalation Site at ARCHES 


Lethbridge, AB
2019

ARCHES (AIDS Outreach Community Harm Reduction Education Support) has opened North America’s first regulated supervised inhalation site (with safer smoking facilities) in Lethbridge, Alberta. The safer smoking facilities (SSFs) are part of a larger supervised consumption site (SCS) that offers all consumption options (i.e., injection, snorting and ingestion).

ARCHES is a harm reduction organization formed in 1986 that provides services for people living with HIV, hepatitis C and other chronic health conditions through programming such as community support, prevention, nursing, outreach and harm reduction supply distribution. ARCHES is well positioned to provide SCS services in Lethbridge. ARCHES built a case for opening SSFs in Lethbridge, which included (among other factors):

  • the ability to medically supervise the consumption of substances, regardless of the method of consumption, to help prevent overdoses
  • the ability to provide safer smoking supplies
  • the ability to decrease the risk of blood-borne infection
  • the ability to connect people who smoke drugs with a wide range of services, including harm reduction interventions and health education
  • the importance of equitable access to healthcare services regardless of the way a substance is consumed
  • the fact that people who smoke drugs will do so indoors if given the option

Program description

ARCHES received an exemption from Health Canada to offer supervised inhalation services, in addition to other supervised consumption services. A number of policies and procedures related to providing supervised inhalation had to be adopted; for instance, policies and procedures related to inhalation overdose intervention, emergency evacuation and workplace health and safety.

ARCHES worked with a heating, cooling and ventilation company, as well as an engineer, to design the SSFs. An important feature of the SSFs is their high-quality ventilation system, with an emergency smoke evacuation switch to quickly ventilate rooms if staff need to enter. Compliance with applicable smoking legislation was also required.

The safer inhalation services are promoted through community consultation, outreach programs and relationships with clients who have accessed other services at ARCHES. Clients also promote the service through word of mouth.

When clients enter the SCS they are asked which drugs they are planning to use and how they plan to use them. Staff then provide instructions to the client on the basis of their individual harm reduction needs. Separate injection and smoking facilities exist at the site and there are different SSFs for the consumption of different substances. Clients can use the SSFs with others using the same substances, as drug use is often a social event. Large demand has led to the SCS services being open 24/7 as of May 2018.

ARCHES consulted with existing clients about the development of the SSFs. They expressed interest in:

  • having different smoking rooms for the consumption of different substances (to avoid cross-contamination)
  • having the ability to inhale with others
  • having a place for smoking that is monitored by staff

Results

The SCS opened on February 28, 2018, and 654 unique clients visited in the first four months. Characteristics of clients included the following:

  • 38% were aged 20–29 years
  • 35% were aged 30–39 years
  • 58% were male
  • 61% identified as Indigenous

Usage by inhalation accounted for 41% of client visits to the SCS in the first month of operation (March 2018). The number of client visits to the SSFs increased every month from March 2018 to June 2018 (967 in March, 1653 in April, 2184 in May and 3576 in June). Sixty percent of the total number of unique clients who used the SCS in March 2018 used the SSFs at least once in that month; this proportion remained fairly consistent from April 2018 to June 2018 (71% and 70%, respectively).

Substances used in the SSFs included methamphetamine (85% of recorded substances), opiates (5%) and crack (rock) (4%). There were 11 overdoses from inhalation in the SSFs’ first four months of operation (seven related to opioids and four to methamphetamine). Overdose from smoked drugs accounted for 4% of total overdoes at the SCS.

If clients are interested in moving from inhaling to injecting substances, they meet with a member of staff to discuss the potential risks. ARCHES has helped clients switch to inhaling opioids (rather than injecting them) by providing education and equipment to individuals interested in this alternative.

What does this mean for service providers?

The ARCHES SCS demonstrates how safer inhalation services can be offered within an SCS that provides a variety of drug consumption options. Part of the opportunity identified includes the ability of ARCHES to help clients transition from consumption methods that carry more risk (e.g., injection) to smoking practices that can carry lower risks of overdose and HIV and hepatitis C transmission.

ARCHES provides a unique model of supervised inhalation services that other SCSs in Canada may want to consider adopting through a Health Canada exemption. It also provides example of the detailed procedures and high-quality facilities required to provide safer inhalation services within the context of a larger SCS.

Related resources

Bringing STBBI testing to people who use drugs – program element

keepSIX Supervised Consumption Service – case study

Reference

Borque S, Pijl EM, Mason E et al. Supervised inhalation is an important part of supervised consumption services. Canadian Journal of Public Health. 2019;110:2010-215.