Compassionate Care: Increasing access to supervised consumption services

Casey House believes that reducing the risks of drug use through harm reduction in a judgment-free environment is an essential health service. We believe that health care should be thoughtful, tailored, and meet people where they are at, and that wide-ranging harm reduction services are needed as part of overall health care.

Casey House is unlike any other hospital. We build relationships through our harm reduction approach. We are committed to improving quality of life, creating stability and helping clients reach their health and wellness goals. We constantly look for ways to help more people overcome barriers that perpetuate health inequities and access care. In August 2021, Casey House became the first hospital in Ontario to provide on-site 24/7 supervised consumption services (SCS) as part of our inpatient unit. In April 2022, we expanded this service to include outpatient clients.

For many people, substance use is a way to cope with intersecting challenges such as trauma, poverty, homelessness and mental health concerns, which can create multiple barriers to having one’s basic needs met. The drug poisoning crisis, housing crisis, and COVID-19 pandemic all exacerbate the risks faced by people who use substances. Given the increasingly toxic supply of unregulated drugs and growing risk of overdose, the need for responsive programs like supervised consumption services is urgent.

In 2020 alone, there were 2,426 opioid-related deaths in Ontario (60% increase from 2019) and 1,671 apparent stimulant toxicity deaths (66% increase from 2019).

Reducing drug-related harms

For decades, harm reduction has been shown to prevent and reverse overdoses, promote safer drug use, and reduce infectious disease transmission. Supervised consumption services provide a safe space for people to use their own drugs under the care of trained health care staff – without judgment or requiring that they stop using substances. In addition to creating this supportive environment, SCS provide drug testing, sterile equipment and education on safer drug use and overdose prevention. Imbedded in our outpatient nursing clinic, SCS also helps facilitate seamless access to other health services. These services are a critical part of health care overall, and enable our clinical team members to deliver thoughtful, tailored care that meets people where they are at.

Fostering trust and connection to care

People who use drugs often experience significant barriers to care for a wide range of health needs, including those unrelated to their substance use. Many health professionals are not well equipped to understand and consider the realities of substance use when providing care, and stigma continues to be widespread. Entrenched attitudes to substance use in hospitals without a harm reduction approach can lead people to discharge themselves early, or be hesitant to access health care at all.

In Casey House’s experience, providing harm reduction care in a judgment-free environment helps: communicate openness; encourage people to speak with health care providers about their drug use; and increase the willingness of both clinicians and the people they care for to discuss drug-related harms. Research has shown that supervised consumption services have a unique opportunity to connect people to referrals and other programs, and help address health needs that may otherwise go unchecked. Providing SCS in a compassionate and judgment-free environment can help build stronger relationships with people who use drugs and keep them connected to the care they need.

A role for hospitals

Although harm reduction is a key pillar of Canada’s national public health approach to substance use, and while services are broadly available across the country, access remains a critical gap in many communities and harm reduction approaches are not yet common in hospital settings. Providing a diverse range of harm reduction services across the health care system enables people who use drugs to access care that is responsive to the reality of their lives, and research has demonstrated that SCS save costs for health systems overall. Hospitals have a unique and significant opportunity to increase access to harm reduction services, support destigmatizing policies and actions, and improve health care and outcomes for people who use drugs.

Casey House honours the tremendous work of the harm reduction community across the country, who laid the groundwork over many years for hospital-based supervised consumption to become a reality.

Casey House is committed to improving health care and outcomes for people who use drugs by advocating for judgment-free and trauma-informed care, access to harm reduction services, and progressive drug policy that promotes the health, dignity and human rights of people who use drugs. To learn more, visit Advocacy.