Supervised consumption services: An essential part of the spectrum of substance use services

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Over the past decade, supervised consumption services (SCS) expanded rapidly in response to the drug toxicity crisis in Canada, although their availability is now declining. These services are supported by a large and growing body of Canadian and international evidence that shows they reduce harms for people who use drugs. SCS prevent overdose deaths and reduce infections and other harms. They are also an important entry point to other health and social services that support the well-being of people who use drugs.

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Recently, opposition to SCS — from some politicians, media and community members — has increased. In some provinces, SCS have been defunded, have been forced to close or have struggled to open. In this context, it is important to understand what SCS are, the roles they play in the spectrum of substance use services, what the evidence has demonstrated, and their barriers and limitations. 

What are supervised consumption services?

SCS are places where people can use drugs they already have in a safe, supervised and hygienic space. Staff at SCS are trained to respond to overdoses and other medical emergencies. They can also support people to access primary healthcare (e.g., wound care, vaccinations), social services and substance use treatment either on site or by providing referrals. 

SCS have operated internationally for four decades. The first sanctioned SCS opened in Switzerland in 1986.1 Canada’s first sanctioned SCS opened in Vancouver in 2003. These services did not expand further in Canada until the drug toxicity crisis began accelerating in 2016. Since then, multiple models and types of SCS have been implemented across the country. This includes standalone sites, SCS integrated into existing health services (e.g., community health centres, hospitals) and mobile SCS.2 Overdose prevention services (OPS) are also a type of SCS that are generally lower barrier, may be temporary and can be standalone or integrated into shelters, housing or other services. Globally, approximately one-third of SCS allow smoking,3 but most SCS and OPS in Canada are primarily intended for people who inject drugs, with few permitting smoking.4 This is despite smoking being the most common route of drug consumption and route associated with overdose in Canada.4

SCS have been implemented unevenly across the country, in part because political support for these services has varied between regions and over time. In the context of growing opposition to SCS, understanding the role these services play in the lives of people who use drugs and the broader spectrum of substance use services is increasingly important. 

SCS provide safety, support and connection to care 

SCS primarily serve people who face significant barriers to health and well-being,5 including people who are at high risk of overdose and infections such as hepatitis C and HIV, as well as people who are experiencing social and structural inequities, such as homelessness or unstable housing, or who are engaged in survival sex work.5 Many people who use drugs also experience stigma, discrimination, violence and dehumanization in their daily lives, including when accessing healthcare.6–9

In contrast, SCS are places where people who use drugs report feeling accepted and treated as fully human, challenging internalized stigma that can act as a barrier to accessing care.7,10 As a result, SCS are often experienced as spaces of safety and sanctuary,7,11,12 which provide protection not only from harms related to drug use but also from stigma and other forms of violence.1,11

This sense of safety and belonging can help people develop meaningful and trusting relationships with service providers, sometimes for the first time.7 These caring relationships can themselves be therapeutic and may act as a starting point for significant social changes in peoples’ lives.7 They are also key facilitators in connecting people who use drugs to other health and social services.13 SCS support people to reduce harms related to substance use (e.g., overdose response, safer substance use education, naloxone distribution), but the support they offer is not limited to these services. For example, SCS can facilitate access to primary care and substance use treatment (either within the SCS or through referrals), and they can help people to meet their basic needs (e.g., food and clothing), address the social determinants of health (e.g., employment, shelter, housing) and foster connection to community, friends and family.7,10–12

How effective are SCS at improving health outcomes and healthcare system and community outcomes?

Research has demonstrated that SCS are effective at supporting improvements in health outcomes and health care system and community outcomes.

Health outcomes 

SCS reduce overdose deaths

SCS prevent overdose deaths by providing a safe, supervised space for people to use drugs, where staff can quickly respond to medical emergencies such as overdose. Systematic reviews of SCS around the world have found that they reduce overdoses and overdose deaths among people who access them.5,14,15 In Canada, staff reversed over 68,000 overdoses within SCS between January 2017 and November 2025.16

Research has indicated that SCS can also reduce overdose deaths in the area surrounding the service. In Vancouver, implementation of an SCS was associated with a 35% decrease in fatal overdoses in the area near the site, compared with a 9% decrease in the rest of the city.17 More recently, implementation of SCS in Toronto was found to be associated with a 67% reduction in overdose deaths in neighbourhoods near these services.18 The protective effect of SCS on overdose deaths extended up to five kilometres away from the services.18

SCS reduce infections and connect people to care 

Certain injecting practices, such as sharing or reusing supplies, rushing injections and injecting in public places, are known to increase the risk of infections, such as hepatitis C, HIV and bacterial infections (e.g., infections to skin, blood, bone and other tissues).5,14 SCS help reduce these risks by supporting safer substance use practices.5,14,15 They do this by providing sterile injecting equipment, education on safer injecting practices and a space where people can take their time to implement these practices. A meta-analysis estimated that among people who use drugs, those who access SCS had a 69% reduced likelihood of sharing a syringe compared with those who did not access SCS.19 Using an SCS is also associated with an increased likelihood of engaging in safer injecting practices, such as using sterile water, properly cooking and filtering drugs, and safely disposing of used syringes.5,14

In addition to helping prevent infections, SCS provide low-barrier access to healthcare to treat infections that can be related to injecting drugs, such as bacterial infections, hepatitis C and HIV.5,14 Evidence from Toronto suggests that integrating SCS within broader healthcare settings, such as community health centres, increases engagement with hepatitis C testing and treatment as well as other healthcare services.20,21 In Vancouver, approximately one-quarter of SCS clients reported receiving care for a bacterial infection, and people who were referred to hospital for an infection by SCS staff were more likely to seek care and to have shorter hospital stays.5,14,15

SCS increase access to other health and social services, including substance use treatment 

SCS improve access to health and social services for people who use drugs, including substance use treatment.5,14,15 Between January 2017 and November 2025, SCS staff in Canada provided over 640,000 referrals to health and social services.16 Evidence suggests that among people who use drugs, SCS use is associated with increased uptake of substance use treatment services, including a 32% increased likelihood of accessing withdrawal management and a 57% increased likelihood of accessing opioid agonist therapy (OAT).5 In Vancouver, during the first two years following the 2016 expansion of OPS, engagement in substance use treatment programs increased by 4.5% a month.22 In addition, the availability of SCS in a community has not been found to reduce the rate at which people enter treatment or to increase the rate at which people return to substance use following treatment.5,14

Healthcare system and community outcomes 

SCS reduce costs for the healthcare system 

SCS have been shown to reduce healthcare costs and reduce the strain on healthcare systems. These savings arise in part from preventing overdose deaths and reducing the transmission of HIV and hepatitis C.5,14,23,24 In Canada, for example, the estimated lifetime cost of a single HIV infection is approximately $1.44 million.25

SCS may also reduce costs through decreased use of emergency and acute care services. In British Columbia, implementation of OPS was associated with reductions in overdose-related emergency medical services (EMS) calls and emergency department visits,26 suggesting potential downstream cost savings. Similarly, an Alberta study estimated that an SCS saved $1600 per overdose managed on site by avoiding EMS transport and emergency department care, while also freeing up emergency response capacity.27 Over two years, and after accounting for SCS operating expenses, the SCS was estimated to have saved $2.3 million in healthcare costs.27 In Montreal, SCS implementation was associated with a decrease in hospitalizations for injection-related infections, reducing costs associated with these hospitalizations.28 However, research findings are not entirely consistent. For instance, a study in Toronto did not detect an association between how frequently people accessed SCS and how often they accessed acute healthcare.29

SCS do not increase crime and can improve public order 

SCS generally do not increase crime and may improve public order in the surrounding neighbourhood. In terms of public order, systematic reviews of SCS have found consistent reductions in public injecting and discarded syringes and other supplies after SCS were implemented.5,14,15 Systematic reviews of SCS have found no change in crime after SCS were implemented.5,14 This includes no increases in reported thefts, drug selling or violence in the neighbourhoods where SCS were implemented.5,14 A recent study in Toronto found no change in the rate of homicides within 3 kilometres of SCS after opening.30 In fact, a few years after opening, homicide rates were lower in areas with SCS than in areas without SCS.30 Another analysis of the impact of SCS in Toronto on police-reported assaults and thefts found that there was no change in the number of crimes against people (i.e., assaults or robbery) within 400 metres of SCS.31 While this analysis did find that some types of property crime (i.e., theft from motor vehicles and break and enters) increased immediately after opening, monthly trends for assaults, thefts, break and enters and robberies declined over time.31 

Barriers and limitations

Multiple barriers and limitations can hinder the positive impacts of SCS on health outcomes and healthcare system and community outcomes, including the following:

Limited availability of SCS: The availability of SCS in Canada remains very limited, reflecting not only logistical and funding constraints but also uneven political support across jurisdictions. Regional support for SCS varies considerably and resistance in some communities has impacted the approval and sustainability of these services. As a result, significant gaps in access persist across the country.32 Even where SCS are operational, people may need to travel long distances to access them; limited service capacity and restricted operating hours further reduce accessibility and continuity of care.13

Lack of supervised inhalation: Smoking has become the most common route of drug consumption, resulting in drug toxicity death in many regions.4 Despite this, most SCS in Canada are unable to accommodate smoking within their facilities.4 It is common for SCS in other countries (e.g., Germany, the Netherlands) to permit smoking,3 but regulatory barriers and a lack of funding have prevented the majority of SCS in Canada from adapting to this change in community need.33

Lack of gender-responsive services and adaptations: Evidence indicates that most SCS service users are men.5 Women (including trans women) have reported a number of barriers to accessing SCS, including: feeling like SCS are masculine, unwelcoming spaces; fear of being hassled, judged or assaulted by men when accessing SCS; and lack of assisted injection at some sites.1,34,35 However, limited resources have constrained the ability of service providers to adapt to these needs (e.g., implementing women-specific SCS or women-only hours at SCS).1,13

No one intervention, on its own, can end the drug toxicity crisis.26,36,37 SCS need to be complemented by a range of other interventions and services. This includes a spectrum of substance use services (e.g., other harm reduction services and voluntary, evidence-based treatment services) and interventions that address the primary drivers of drug toxicity deaths, such as the toxicity of the unregulated drug supply itself.38 In addition, interventions that address fundamental social determinants of health for people who use drugs, such as adequate shelter and housing, are urgently needed to support individual and community health and well-being. 

SCS can play a critical role as part of the spectrum of services, acting as entry points to additional services and supports for people who use drugs. But for SCS to be effective in this role, these additional services need to be available, well resourced and accessible for people to be able to benefit from them.33

Implications for service providers

SCS are essential, evidence-based components of the spectrum of substance use services. SCS provide people with safety from harm, including harms related to substance use and broader harms such as stigma and violence. They also connect people who use drugs to care, enabling the development of trusting relationships that can be fundamental to supporting people to access other health and social services, including substance use treatment. 

In the context of increased opposition to SCS, service providers can attempt to respond in a number of ways, including the following: 

  • They can engage in community organizing and public education about the roles SCS play in the spectrum of services, including their role supporting access to health and social services such as housing and substance use treatment.
  • They can provide public education highlighting the fact that, despite perceptions in some media and political discourse, there is public support for SCS and harm reduction interventions as part of a public health response to the drug toxicity crisis.39–41
  • They can recognize that community concerns about SCS are rarely reactions to SCS alone and often reflect broader concerns about public space and safety. This underscores the need for dialogue between people who use drugs and the broader community to develop approaches that meet community needs.42,43
  • They can advocate for decision-makers to support SCS as an evidence-based, cost-effective part of a public health approach to substance use.
  • They can advocate for resources to address barriers to existing SCS (e.g., lack of smoking, limited capacity) and underlying structural vulnerabilities (e.g., lack of adequate shelter and housing). These barriers and challenges may be contributing to community concerns about public drug use outside SCS.
  • They can advocate for improvements to other parts of the spectrum of substance use services (e.g., safer supply, OAT) and other supports that can reduce harms for people who use drugs (e.g., housing). 
  • They can provide education about safer substance use practices (e.g., not using alone), naloxone training and distribution, and virtual spotting options to reduce the risk of overdose if people are using alone.
  • In contexts where SCS are under threat of closure, they can prepare service users as well as possible for the loss of service. This can include ensuring that they are aware of other health and social services in the area, developing plans to ensure continued availability of overdose response and harm reduction supplies, developing opportunities to keep people engaged in care, and providing spaces to grieve and debrief the impacts of impending service closures. 

Additional resources

Anti-Stigma Toolkit: Communications resources for health providers working with people who use drugs (CATIE)

CATIE statement on the need for a spectrum of substance use services (CATIE)

WhySCS: Information About Supervised Consumption Services in Canada (CRISM) 

Twelve characteristics of client-centred supervised consumption services (SCS): A toolkit for service design, delivery and evaluation (Rudzinski K, Ceranto A, Strike C, et al., 2022)

References

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Externally reviewed by: Elaine Hyshka 

Production of this article has been made possible through a financial contribution from Health Canada's Substance Use and Addictions Program. The views expressed herein do not necessarily represent the views of Health Canada.

About the author(s)

Magnus Nowell is CATIE’s manager, substance use health and harm reduction. Magnus has previously worked in harm reduction research, community organizing and housing. He has a master’s degree in health promotion.