Across Canada, different forms of supervised consumption services have been implemented in response to the ongoing drug toxicity crisis. Among these are a small number of consumption services designed exclusively for women, non-binary and transgender people who use drugs, including one in Hamilton, Ontario. Previous research has found that women access mixed-gender consumption spaces at lower rates than men. Women who use drugs are more likely to experience risks to their safety in the form of gender-based discrimination, aggression and violence. In 2024, the gender-specific Safer Use Space (SUS) in Hamilton, which serves unhoused women who use drugs, received over 7000 visits, with clients returning an average of 25 times each. This study interviewed SUS staff to examine what aspects of the environment encouraged women who use drugs to return. Staff identified several key factors, including practicality and safety, the sense of control and agency of the SUS’ clients (who are referred to as “guests” in the space) and the site’s ability to act as a sanctuary.
Program description
The SUS is a supervised consumption service designed specifically to serve women, non-binary and transgender people in Hamilton, Ontario. Opened in 2022, the site was created to respond to an increased number of drug toxicity poisonings happening in the immediate area, especially among women and gender-diverse people. All guests of the SUS experience street-level homelessness.
The SUS is located within a gender-specific community hub building, which includes a variety of low-barrier holistic healthcare services (e.g., a transitional living program, drop-in programs for women experiencing homeless, gender-based violence counselling, a health clinic, arts and cultural programs). The SUS connects community members to programs and services offered by the hub, which contributes to the capacity of the program and reduces guests’ vulnerability.
The SUS occupies approximately 300 square feet of space and is intentionally designed to have a non-clinical layout. Staff say the space has a “living room” feel. The floor plan features two consumption spaces, a central table with chairs, other comfortable seating and a sink, along with a space for staff workstations and supply cupboards. The space is decorated with art and posters supporting 2SLGBTQ+ and Indigenous communities. The SUS is open 7 days a week, 365 days a year, from 10 pm to 5:30 am and from 10 am to 1 pm.
Guests can receive new equipment for injection drug use and consume substances in the SUS with staff supervision. General hygiene products such as soap and shampoo are available in the SUS for guests, as well as a sink and mirror. Reproductive and sexual safety products, such as condoms, pregnancy tests and prenatal vitamins, are available, as well as snacks. Several health services are provided within the SUS including reproductive and wound care, and staff make referrals to health services outside of the SUS (e.g., primary care, withdrawal management).
The SUS operates with two staff members at all times: a harm reduction worker and a peer support worker. The harm reduction workers’ backgrounds include college- and university-level education in social work and social service work. The peer support workers have lived/living experience of substance use. All staff are trained in overdose response and to operate from a trauma-informed lens. Staff in both roles receive training on how to connect guests to additional services available in the hub. A total of 14 workers are employed by the site (11 harm reduction workers, three peer support workers). Additionally, a registered nurse (RN) attends throughout the week and can provide services on site (e.g., wound care).
Results
This study explored staff perceptions of the factors that led to positive health outcomes for SUS guests and repeat utilization of the service. Eight interviews with staff took place between October and December 2024. Staff were between 25 and 35 years old; seven were cisgender women and one was non-binary. All had worked at the SUS for between one and three years. Three main themes emerged from the responses: practicality and safety; control and agency; and sanctuary and oasis.
Practicality and safety
The SUS provides safety for guests with respect to substance use. New injection supplies are provided to support safer drug use, and staff are trained to respond to overdoses that occur within the site. Staff discussed how the gender-specific nature of the site reduces the risks associated with co-ed consumption spaces, such as gender-based violence and exposure to possible exploitative relationships.
“SUS isn’t just a place that they come to use drugs. It’s a place that also feels comfortable like a home they’ve had. They’ve had a say in it, and that it helps them feel safer there.”
The SUS offers practical support directly by providing hygiene and sexual health products, along with the wound care and other services provided by the visiting RN. Staff described how being situated within a broader gender-specific services hub gives them the opportunity to quickly connect guests to a variety of practical services, such as counselling, legal support and housing services, to meet guests’ individual needs, including for social support.
“The collaboration that exists between SUS and [Emergency Shelter] is really helpful in being able to have conversations with service users about a lot of different kinds of compounding issues.”
Control and agency
Staff described efforts that were made to reduce the medicalized feel of the space and enhance guests’ sense of control and agency over the space. The goal of these efforts is to avoid triggering guests’ past traumatic experiences with healthcare and other institutions. Building more horizontal relationships between guests, staff and the space also helped create a less institutional environment. Staff used non-judgmental and non-authoritative communication styles, which they said contributed to the development of trust. Care was taken with the physical attributes of the room to ensure that it did not look like a clinical space, and staff dress casually to contribute to the non-clinical aesthetic. The walls are decorated by guests with artwork they have created.
“A lot of them express that having a space where they can be who they are, do what they do without judgment, and can have, like regular-shmegular conversations with the staff, and it not be about them being homeless, and it not be about them being substance users is a really big piece of that.”
Sanctuary and oasis
The desire to demedicalize the space was also reflected in how staff shaped the experience for clients. People who access the SUS are referred to as guests, and rules that might restrict a guest from accessing the space are minimized. Staff reported that these elements helped guests to experience the SUS much like a living room, where they had the ability to come and go, to gather or to experience privacy and solitude. Respondents commented that the low-barrier approach contributed to a sense of sanctuary for the SUS’ guests. In a collective form of grief, purple chairs in the space are signed by guests to memorialize dead friends.
“Women who have been reprimanded from accessing other shelters or spaces, for whatever reasons are welcome to come to our space. We put less restrictions on what they can and cannot do. And also, the ‘consequences’ of breaking some of our boundaries are far less harsh than that of the majority of other shelter spaces.”
What does this mean for service providers?
The study describes the factors that SUS staff perceived as contributing to positive health outcomes for guests and to repeat use of the service. The gender-specific nature of the SUS, combined with its co-location within a broader services hub, provided safety from the risks of gender-based harm that guests may experience at general consumption services, while also offering direct access to other health and wellness services. The program intentionally made operational decisions that built upon these benefits and positively influenced how guests experienced the space. The article provides examples of how the SUS designed the physical space (e.g., creating a living room feel), its organizational policies (e.g., minimal restrictions) and the social aspects of the space (e.g., staff referring to people accessing the service as guests). Service providers should consider how the physical and social aspects of services can be adapted, and how clients can be meaningfully included in these processes. Demedicalizing a space can promote engagement with health services for communities with high levels of health service-related trauma.
Related resources
Exploring gender in harm reduction: Toward more inclusive and responsive services – CATIE Prevention in Focus article
SisterSpace Overdose Prevention Site – CATIE case study
Women’s Support: A program for women living with HIV – CATIE case study
References
- Law-Gallagher X, Wlliams A, Vaccaro M-E. A place that is their own: understanding a gender-specific safer-use space as a therapeutic landscape. Health and Place. 2026;98:103604. Available from: https://doi.org/10.1016/j.healthplace.2025.103604
- YWCA Hamilton, Keeping Six and the Hamilton Social Medicine Response Team. Safer Use Space Zine. Winter 2024/25. Available from: https://ywcahamilton.org/web/content/7359?unique=60f2e41204f1088567eef4026bd8b2ae7d120e22&download=true