What is the program?
The Mobile Overdose Prevention Site (MOPS) is a peer-led, community-based program operated by Sunshine House in Winnipeg, Manitoba. MOPS runs out of a renovated mobile recreational vehicle (RV) that has a fixed location during the day and moves to various downtown locations in the evenings. At MOPS, people can access harm reduction information and supplies, get referrals to other health and social services, get their drugs tested and consume drugs in a secure space supervised by staff who are trained in overdose response. MOPS operates with the goal of keeping community members alive and as safe as possible by reducing risks related to substance use and providing information on sexual health.
Sunshine House is a community drop-in and resource centre focusing on harm reduction and social inclusion. It works to provide programming that fulfills people’s social, community and recreational needs.
Why was the program developed?
MOPS is Manitoba’s first sanctioned overdose prevention site (OPS). As a mobile service, MOPS aims to be as accessible as possible and reach people where they are in the community. A consultation and needs assessment conducted in Winnipeg in the summer of 2018 evaluated the needs and perspectives of people who use drugs regarding safer consumption spaces. Findings highlighted escalating rates of overdoses and deaths related to toxic unregulated drugs, increasingly complex drug poisoning reversals requiring many doses of naloxone and oxygen, and rising transmission rates of sexually transmitted and blood-borne infections (STBBIs).
Insufficient substance use treatment programs, inadequate support services, strained emergency services and overloaded community organizations were also noted as key gaps by respondents. Results of the consultation also underlined that participants’ needs for safe spaces extended far beyond places for drug consumption, signalling a lack of secure places to sleep, eat, meet with friends and access care services.
The consultation produced a series of recommendations, helping to ensure that the development of future safer consumption spaces would be considered desirable and safety enhancing by the community. In response to the stated needs of community members, MOPS was developed to provide a safe place to consume substances and access harm reduction supplies and to foster a sense of community and belonging.
MOPS has three primary goals:
- To reduce the risks of using drugs in isolation (e.g., mortality, non-fatal overdose, brain injury)
- To decrease the transmission of STBBIs through the distribution of harm reduction supplies
- To provide access to other services, training and education for people who use drugs
How does the program work?
MOPS is a peer-led, community-based program where people can access harm reduction materials, use drugs in a safe space supervised by trained staff, get naloxone training and kits, access drug checking services including drug testing strips and a Fourier-transform infrared (FTIR) spectrometry machine and connect with other health (e.g., primary care once per week) and social services. Immediately after receiving the required exemption from Health Canada, MOPS began providing services on October 28, 2022.
MOPS is delivered out of a mobile RV to be more accessible to people in the community. The space was designed to have a warm and “homey” setting and maintain an “auntie’s house” atmosphere where all people feel welcome and comfortable. The range of services and “feel” of the site is peer informed to ensure that the MOPS program matches what the community is asking for. A Peer Advisory Committee (PAC) composed of people with lived and living experience of substance use and Indigenous knowledge keepers is involved in each step of the process (e.g., planning, implementation, service delivery, evaluation).
The RV design is unique and easily recognizable by community members, featuring a colourful butterfly and a purple ribbon, representing overdose awareness. Heating and air conditioning are available inside the RV, providing spaces for people to warm up and cool down during extreme weather conditions.
During daytime and afternoon hours (Wednesday to Sunday), MOPS primarily operates from one fixed location in a parking lot beside 631 Main Street. In the last hour of daily operations, staff relocate the RV to another site around Winnipeg’s core area. MOPS staff consult with community members and the PAC to determine where the RV should be parked during mobile hours. Most of the locations selected are in private parking lots and connected to a local organization providing community services, which often serve as community gathering places.
Upon arrival, people are welcomed by a MOPS staff member at the RV’s sliding window. MOPS staff use a sign-in sheet to keep track of who is at the site and the services they access. At the RV window, a range of supplies can be accessed, including sterile syringes, glass bubble pipes, stems, condoms, lubricant, naloxone kits, rapid self-testing HIV and syphilis kits pregnancy tests and drug testing strips (e.g., fentanyl, benzodiazepine). People can also access education and training to increase their awareness of safer sex and substance use practices as well as receive overdose response and naloxone training.
Overdose prevention services
There are three stations inside the RV where people can consume their drugs by injection or ingestion. For people who smoke drugs, there is a pop-up tent outside the RV that is well ventilated and can be used for inhalation. After receiving their supplies, some people choose to leave the site while others ask to use the stations provided in the RV or the spaces available in the pop-up tent. The pop-up tent is designed to be set up, taken down and transported easily and uses milk crates as makeshift stools. Depending on the season and location, three to nine people can access MOPS drug consumption spaces at any one time. As part of the exemption granted by Health Canada, peer assistance is available at the request of participants (e.g., one person helping another while preparing and consuming drugs).
MOPS has written rules posted publicly that staff refer to when they need to remind people of the rules. Rules include no dealing or sharing substances as well as suggested time limits for using the overdose prevention stations. Having the rules explained in plain language and displayed publicly helps everyone understand and follow them. When people are disruptive, they are asked to leave and told they can come back later that day or the next day.
Drug checking
In addition to the use of drug testing strips to test for the presence of fentanyl and benzodiazepine in their drugs, people can ask to have their drugs tested by staff trained to use MOPS’ FTIR spectrometry machine. FTIR spectrometry machines allow for a small sample of a substance to be scanned to determine its contents, enabling people to make an informed decision about the drugs they use and how they consume them. The FTIR spectrometry machine is also portable and can be easily transported for drug checking at festivals during the warmer months.
Results from the FTIR spectrometry machine and from drug testing strips are fed into the SaferSites.ca drug alert system, a coalition website for accurate information on drugs and drug consumption sites. This allows for information about the unregulated drug supply to be circulated on social media and in the community via flyers and word of mouth.
Other on-site services
In partnership with Ka Ni Kanichihk (an Indigenous-led organization that provides learning and healing programs), a nurse joins MOPS staff every Friday. The nurse provides low-barrier access to primary healthcare services, wound care, STBBI testing, vaccinations and referrals to other health and social supports.
Staffing
MOPS staff include two directors, one peer support manager, three full-time and four part-time workers and five peer program guides. These staff are all trained in first aid, overdose prevention and emergency response but do not have professional medical credentials. Staff receive additional training on safer substance use and other harm reduction strategies, de-escalation techniques, and how to navigate grief, loss and trauma, as well as training on how to use the FTIR spectrometry machine and interpret its results.
The peer support manager works closely with the MOPS directors to support the peer program guides in their roles. A peer hiring program was developed to ensure the meaningful inclusion of people who use substances in program delivery as peer program guides. All peer program guides have lived and living experience of substance use and are hired because of the harm reduction work they are already doing in their communities. Peer program guides also serve on the PAC to help guide MOPS and bring important perspectives directly into the regular operations of MOPS. To balance life and work, peer program guides make their own schedules, and shifts are determined on a first-come, first-served basis. Peer program guides and other MOPS staff have regular meetings with the PAC to inform and guide the MOPS program.
Required resources
- Renovated mobile RV or trailer
- Well-ventilated pop-up tent
- Mirrors, sharps disposal bins, sanitizers and cleaning supplies
- Reliable heating and air conditioning
- Portable electric generator
- Harm reduction supplies for safer substance use and safer sex
- FTIR spectrometry machine
- Drug testing strips (fentanyl, benzodiazepine)
- Trained staff (e.g., directors, RV drivers, peer support manager, full-time and part-time workers, peer program guides)
- Occasional on-site nursing services facilitated through network collaboration
- Advisory committee of people with lived and living experience of substance use and Indigenous knowledge keepers
- Breathing masks used for rescue breaths during CPR
- Coffee, water and snacks
- Hygiene supplies and warm clothing
- Harm reduction educational pamphlets
Evaluation
Between October 28, 2022, and October 31, 2023, 26,154 visits to MOPS were recorded. Of these visits, 7,086 visits were to consume drugs under the supervision of trained staff, resulting in 20 overdose incidents, four trips to the hospital (at the request of the individual) and zero deaths. On average, there were 2,180 visits per month, with approximately 109 people visiting per day. The number of visits for drug consumption increased nine-fold over a 12-month period from 101 visits recorded in November 2022 to 953 visits in November 2023.
In its first full year of operations (November 2022 to November 2023), MOPS distributed:
- 3,623 naloxone kits
- 13,507 sterile syringes
- 2,536 glass stems
- 14,465 bubble glass smoking pipes
- 56 drug testing strips (e.g., fentanyl, benzodiazepine)
- 1,757 other safer substance use and safer sex materials (e.g., filters, cookers, condoms, lubricant, pregnancy tests)
The FTIR machine was used to check 285 drug samples. Over the 12-month period, alerts from drug checking done at MOPS were shared on SaferSites.ca and had 209,707 cumulative website impressions (i.e., the number of individual users who were reached by the content).
Interviews with people who use MOPS, staff and other community members revealed the success of MOPS beyond the numbers, featuring stories about the program saving and changing people’s lives, as well as building community and compassionate relationships.
“And no one has ever died there. And they are rarely using naloxone because they are creating conditions for substance use that prevent overdose.”
“MOPS has literally saved people that I love more than once.”
“It brings community together and builds relationships.”
Challenges
- Sunshine House faced political resistance to implementing MOPS. As a workaround, Sunshine House sought federal permission to obtain an exemption to open the site.
- MOPS operates with limited resources, and access to harm reduction supplies is a challenge, particularly in rural and remote areas. Funding constraints have also reduced MOPS’ hours of operation.
- Given the increased demand for supervised consumption services in Winnipeg, there is a demonstrated need for at least one fixed-site location accessible 24 hours a day, seven days a week.
Lessons learned
- Building community support is essential to providing effective services and resources that address the needs of people who use drugs.
- Training staff to administer oxygen offers an additional lifesaving measure that MOPS can provide to community members before paramedics arrive.
- MOPS staff note that operating the program out of an RV is challenging and unsustainable because it is not made to withstand harsh weather conditions, maintenance is costly and a portable electric generator is required to produce consistent power for heating and air conditioning. This further reduces capacity and service provision in extreme weather events.
Program materials
- Mobile Overdose Prevention Site: Evaluation 2023
- Winnipeg Safer Consumption Spaces Consultation and Needs Assessment
- Sunshine House Annual Reports and Publications
Contact information
Sunshine House Inc.
646 Logan Avenue
Winnipeg, Manitoba
R3A 0S7
(204) 783-8565
contact@sunshinehousewpg.org