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.
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 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.
TORONTO, ON (April 4, 2022) – Today, Casey House launched outpatient supervised consumption services (SCS), providing a second safe space for clients to use their own drugs while being monitored by trained staff who can provide emergency medical care in case of overdose.
A specialty hospital for people living with and at risk of HIV, Casey House is the first hospital in Ontario and third in Canada to offer on-site supervised consumption as part of its health care.
Expanding access to supervised consumption is critical, given the increasingly toxic supply of unregulated drugs and the growing risk of overdose, which has killed more than 24,000 people in Canada since 2016. Drug testing and supervision at an SCS substantially reduce the risk of overdose and death, and increase access to sterile equipment, education on safer use, and health and social services.
“You don’t have to be a harm reduction expert to understand this is an essential health service,” says Jennifer A. Dewling, Principal at Genova Private Management and chair of Casey House’s board of directors. “This new initiative represents an expansion of our overall holistic approach to health care and harm reduction.”
Casey House’s SCS are open to registered clients 24 hours a day for the inpatient unit and 10 a.m.-4 p.m. for outpatients, and are an extension of its regular health services. Clients can inject, snort or eat their pre-obtained substances at private consumption booths at two supervised locations. Because of the alarming overdose risk from smoking unregulated drugs, more than a third of Ontario overdose deaths in 2020 were attributed to inhaling substances, we built one booth to allow for safer inhalation and are working towards offering this service.
Substance use is frequently a coping mechanism for a myriad of challenges such as trauma and poverty that compound and create barriers to having basic needs met. Barriers faced by people who use drugs prevent them from getting equitable access to health care, which Casey House believes everyone deserves.
“Hospital-based supervised drug use and overdose prevention is something Casey House feels people should be entitled to as part of overall health care. Being able to safely use substances while on-site keeps people connected to health care,” says Dr. Ed Kucharski, chief medical officer at Casey House. “Drug consumption is a key component in understanding and managing someone’s health, and needs to be considered in our clients’ care plans.”
Casey House, known for more than 30 years for expertise in caring for people living with HIV, has recently started also serving those at high risk of HIV. This includes people excluded from traditional care systems, such as people who use drugs.
“Our hospital’s ongoing harm reduction work mirrors and supports the work we do with members of the community who frequently experience barriers to safe living, whether because of stigma, precarious housing, or access to health care,” says Joanne Simons, Casey House CEO.
Simons credits 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.
Funding for this new initiative was entirely provided by Casey House donors.
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Casey House is unlike any other hospital. We are a specialty hospital in Toronto providing ground-breaking care to people living with and at risk of HIV. Together with our clients, staff, peers and volunteers, we strive to create an inclusive environment where everyone feels safe. We offer a growing mix of inpatient, outpatient and community-based services that meet clients where they are in their individual journeys of health and wellness. Building on a legacy of advocacy and social justice, we actively dismantle barriers to care and safe living. We provide a community and sense of belonging that connects people to care. The humanity of each client is at the heart of everything we do.
See where and how Casey House offers its hospital-based SCS in a short video here.
To book an interview with Casey House chief executive officer Joanne Simons, or for more information, contact:
Cole Douglas
Narrative on behalf of Casey House
Cole.douglas@narrative.ca
416.460.5480
Resources
WHYSCS: Information about supervised consumption services in Canada https://www.whyscs.ca/
Casey House website https://caseyhouse.ca/
Changing circumstances surrounding opioid-related deaths in Ontario during the COVID-19 pandemic https://www.publichealthontario.ca/-/media/documents/c/2021/changing-circumstances-surrounding-opioid-related-deaths.pdf?sc_lang=en
In celebration of the 12 days of Casey House Christmas
1st day: One new website. This summer, Casey House launched caseyhouse.ca, an easy to navigate, informative hub with a more contemporary design. Explore caseyhouse.ca today.
2nd day: Two doses of COVID-19 vaccines. Our pharmacist and nurses have been providing clients with COVID-19 vaccines at Casey House, helping increase access to this vital health service.
3rd day: Three new position statements on harm reduction. Improving health care and outcomes for people who use drugs requires judgment-free, culturally-sensitive and trauma-informed care; increased access to a diverse range of harm reduction services and supports; and progressive drug policy that promotes the health, dignity and human rights of people who use drugs. Read the statements here
5th day: Top five health charities. Casey House was proud to be listed among Charity Intelligence Canada‘s top five health charities and top 100 charities in Canada. Read more here: https://lnkd.in/gbf9geq
6th day: Six recipients of The Casey Awards. The awards recognize leadership in HIV/AIDS and social justice. Read the tributes to Bob Leahy, Sean Hosein, Alphonso King Jr., Gregory Robinson, Prairie Harm Reduction, and Martha McCain.
7th day: Seven days a week of inpatient care. Casey House offers inpatient clients 24-hour care by doctors, nurses and allied health care professionals, including social work services, mental health support and supervised consumption services.
8th day: Eight days left to qualify for a 2021 tax receipt. Give generously before year-end and your donation will qualify for a 2021 charitable receipt. Donate now
9th day: Nine medical students are doing a community-based learning student placement at Casey House, learning about our philosophy of engaging compassion to deliver our holistic approach to health care.
10th day: Ten weeks until June’s HIV+ Eatery. We’re smashing stigma again in March with three nights of delicious food made with the help of a team of HIV+ chefs. Get a taste of June’s here.
11th day: Eleven dimensions in our new Multipurpose Resilience Assessment & Evaluation Tool. This custom client inquiry guide enables clinical staff to assess resilience in diverse aspects of an individual’s life such as Access to health care, Impacts of substance use, and Food access & nutrition, which helps them create holistic care plans for each individual.
12th day: Clients grew more than 12 varieties of plants in the Love Family Healing Garden on our rooftop as part of the day health program garden group which supports multiple aspects of mental health, including: carrots, bok choy, sweet pea, zucchini, cucumber, melon, peas, beans, corn, ground cherries and herbs. The produce is incorporated into meals by the kitchen crew, and also sent home with delighted clients, helping address food insecurity
Canada votes on Monday, September 20, 2021! In addition to voting, you have an opportunity to raise issues you care about with all candidates vying for a seat in parliament. To help you engage with political hopefuls in your community, Casey House is sharing five questions to ask any candidate about issues related to HIV, harm reduction, and compassionate, socially-just health care.
1. Canada’s blood donation policy continues to exclude the 2SGBTQ/MSM community
In order to donate blood in Canada, men who have sex with men must be abstinent for three months before donating. As Casey House’s chief medical officer Dr. Ed Kucharski explains, “This thinking is not only outdated and discriminatory, it ignores science. The current evidence makes it clear why 2SGBTQ/MSM should be eligible to donate blood in Canada”. While Canadian Blood Services intends to recommend this policy change by the end of the year, the federal government can and must act sooner.
Question for candidates: Will your party mandate Health Canada to immediately end Canada’s discriminatory blood donation policy?
2. HIV continues to be highly stigmatized in Canada
One in five people living with HIV are denied health services because of stigma and discrimination. This affects people’s willingness to be tested and then to seek treatment and support, and fuels misinformation about HIV and the impact it has on those who live with it. Speaking up against HIV stigma makes a difference, and we need more people to know the facts, correct misinformation, and use language that empowers people living with HIV.
Question for Candidates: How will you correct misinformation and insist on language that empowers people living with HIV?
3. Canada’s overdose epidemic is a national crisis
More than 21,000 Canadians have died of overdose since 2016 due to the toxic drug supply. Providing access to harm reduction services (such as safer drug use and consumption services) and a safer supply of regulated drugs, as part of comprehensive mental health and addictions care, is essential to reduce the risks of drug use, save lives, and improve health care for people who use drugs.
Question for Candidates: What will your party do to ensure that harm reduction services and safer supply programs are more available, as part of mental health and addictions care?
4. Racialized communities are disproportionately impacted by HIV infection rates
Systemic barriers to health equity and access to health care mean that disparities exist in HIV diagnoses and outcomes. In 2019, almost half of new HIV infections were among Black people (25.5%) and Indigenous peoples (24.7%), despite these communities accounting for a much smaller percentage of the country’s overall population.
Question for candidates: How will your government formally acknowledge and address racial inequality in health care, and address disproportionate rates of HIV in Black, Indigenous and racialized communities?
5. Canada’s fight against HIV is chronically underfunded
Since 2003, community-based programs that connect people living with, or at risk of, HIV to vital services have been underfunded, to the tune of more than $123 million in commitments that were never delivered. As a result, many organizations have closed or discontinued programs. With 62,050 Canadians living with HIV and 2,122 new HIV diagnoses reported in 2018, Canada’s HIV response needs to be adequately funded. On World AIDS Day 2020 Senator René Cormier introduced a motion that called on the federal government to increase HIV-specific funding to $100 million annually.
Question for candidates: How will your government apply the lessons learned from the COVID-19 pandemic to deepen the federal government’s investment in the HIV epidemic and reduce new HIV infections?
Every Canadian citizen has the right to vote. When you exercise this right, you help choose who represents you in government.
Are you registered to vote?
If you’re not already registered (or if you’re unsure and need to check), use Elections Canada’s Online Voter Registration Service OR visit any Elections Canada office by Tuesday September 14, 6:00 p.m. If you’re a newcomer to Canada, learn more at settlement.org.
Do you know who is running in your riding?
Visit elections.ca and type your postal code into the Voter Information Service box for information about your riding.
Learn about the many ways to vote, including accessible voting options for people with disabilities.
Read Casey House’s 2020-21 impact report, our annual compilation of outcomes and accomplishments from an unprecedented year. The report includes our response to COVID-19, initiatives in harm reduction and enhancing client care, as well as the pivot to virtual fundraising events.
Just before the pandemic kicked in last year Casey House welcomed its first clinical pharmacist – Jon Smith. While the plans for Jon’s first year were adapted due to COVID-19, what remained unchanged was his commitment to “meeting clients where they are on their health journey”.
Jon speaks passionately about his role, “Providing innovative and compassionate HIV care is challenging and rewarding work: in addition to dispensing medications and advice, I work with the clinical teams to assess each inpatient client’s medication history and health concerns. I also monitor their drug therapy each day, looking for medication-related issues and adverse effects.”
When a Casey House client is discharged from the inpatient unit Jon stays connected and involved. To ensure clients have everything they need to make a seamless transition back to the community Jon contacts their pharmacy to update prescriptions and review their specific needs.
Casey House is always looking for new and innovative ways to care for our community. Last fall, because Jon was on staff, we created an inventory of vaccines for flu, hepatitis B and pneumonia. We developed educational tools and presentations for the clinical team, and established a formalized reporting system to track potential adverse drug reactions. Jon also co-chairs a new drugs and therapeutics committee at the hospital, and started welcoming pharmacy students for six-week residencies.
Jon says it’s been a very rewarding first year. His contributions to our purpose of transforming lives and health care through compassion and social justice supports Casey House in developing relationships with clients that help them build health and stability in their lives.
Donor gifts help Jon and Casey House continue providing care for people living with HIV and AIDS. Contribute to that support- make a donation today.
There is considerable progress to be made on improving health care for people who use drugs. Stigma around substance use continues to be widespread and many health professionals are not well equipped to provide care within the context of people’s lives, choices, and circumstances; however, reducing the risks of drug use through harm reduction in a judgment-free environment is an essential health service. Hospitals have a significant opportunity to increase access to harm reduction and improve health outcomes for people who use drugs.
Harm reduction refers to the evidence-based policies, programs and practices that aim to minimize the negative impacts of drug use, and focuses on working with people without judgment or requiring that they stop using drugs in order to receive support. – Adapted from Harm Reduction International
A hospital-based response
While Canada is relatively progressive on implementing harm reduction, access to these essential services remains a critical gap in many communities and is not yet common in hospital settings. Harm reduction often includes health services such as access to safer drug use supplies, safer supply prescribing, and supervised consumption services, but it is much broader than service delivery; meaningful and effective harm reduction requires a philosophy of judgment-free, culturally sensitive and trauma-informed care.
Casey House is a sub-acute specialty hospital with a proud history of practicing harm reduction by delivering holistic health care in a welcoming environment, free from stigma. In partnership with Toronto Public Health, our harm reduction services have included providing 24/7 low-barrier access to safer injection and inhalation supplies since 2014, and access to safer crystal meth supplies since 2018. Distributing safer drug use supplies aims to reduce infectious disease transmission and other harms associated with substance use, alongside naloxone kits to reverse overdoses. Since 2020 this service has become more essential with the convergence of the overdose crisis, housing crisis, and the COVID-19 pandemic.
Pivoting in a pandemic
In the spring of 2020, when the COVID-19 pandemic forced many harm reduction and outpatient hospital services to close, Casey House continued to provide 24/7 barrier-free access to safer drug use supplies at our front door. This enabled our hospital to not only maintain access to this key service, but also identify and respond to evolving community needs:
Increased Demand: In the six months prior to the pandemic, Casey House distributed an average of more than 4,000 harm reduction kits per month. In the first six months of the pandemic, that average more than doubled to over 9,000 kits each month.
Peer Support: With more people accessing safer drug use supplies at the front door, Casey House expanded services to include support from peers with lived experience of drug use. Through meaningful conversations, peers connect with individuals picking up supplies and provide additional support and guidance based on each person’s need.
With more than 2,000 opioid-related deaths in Ontario in 2020, and a record 34 in Toronto in December alone, the need for harm reduction services continues to grow.
Emerging insights
Around the world, a wealth of harm reduction research and knowledge has been generated over several decades. Building on that foundation, Casey House collects quantitative and qualitative data to gain a stronger understanding of our hospital’s role, the services we provide, and how we can better meet the health needs of our community.
Time and place are key to increasing access to safer drug use supplies
While many community health centres, public health units, and organizations that serve people who use drugs distribute harm reduction kits, Casey House’s location and safe 24-hour access are key reasons people visit our hospital for supplies. Most pick-ups are after 5 p.m. and on weekends, when many local services are not open. Our physical location is especially important: the majority of individuals travel by foot, are not accessing supplies at other locations, and are often picking up kits for more than themselves, extending our reach.
Harm reduction services can improve engagement with health care
Many people accessing safer drug use supplies at Casey House are not connected to health care or other harm reduction services. As well, many ask for information on additional supports, such as shelters, crisis support, clothing, first aid, naloxone, and food. In our experience, training staff and providing safer drug use supplies in a judgment-free environment yields several benefits: it communicates openness, encourages people to speak with health care providers about their drug use, and increases the willingness of both clinicians and the people they care for to discuss drug-related harms. Providing a compassionate space for conversation helps build stronger, more honest relationships which have the potential to deepen engagement and trust with health care overall.
Looking ahead
Our experience thus far points to the promise and potential for hospitals to improve health care for people who use drugs by embracing a harm reduction approach – particularly given the increasingly toxic supply of unregulated drugs and the growing risk of overdose. At Casey House, additional research is underway to dig deeper into the impacts of introducing harm reduction initiatives in clinical care settings. As we continue to enhance our role to meet community needs, we are working towards expanding our hospital services so we can continue to improve health care for people who use drugs.
Key resources
Miroslav Miskovic, Soo Chan Carusone, Adrian Guta, Bill O’Leary, Karen de Prinse, and Carol Strike. Distribution of harm reduction kits in a specialty HIV hospital. American Journal of Public Health. 2018 October. 108:1363-1365. Abstract available at https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304600
In celebration of the 12 days of Casey House Christmas December 18-29, 2020
1st day: One pharmacist. This spring, Casey House welcomed pharmacist Jonathan Smith to join the integrated team of health care workers caring for clients. Pharmacists play a key role in holistic approaches to health care.
2nd day: Two #smashstigma TV shows to expose HIV stigma. We wrote HIV into the lives of lead characters from two iconic TV shows after a survey showed people would rather see their favourite character die than be diagnosed with HIV. Visit smashstigma.ca
3rd day: Three nights of June’s HIV+ Eatery. Smashing stigma family-style with delicious food made with the help of 14 HIV+ chefs. Get a taste of it here.
4th day: In Canada, someone is diagnosed with HIV every 4 hours and Health Canada’s recent approval of an HIV self-test means there is finally a safe, simple and effective HIV testing option for Canadians.
5th day: Casey House research appeared in five peer reviewed research publications, contributing to a growing body of knowledge of HIV and judgment-free health care.
6th day: Six Untold Stories of Stigma, see the faces and hear stories of how stigma impacted six people living with HIV and how they learned to flourish at smashstigma.ca
7th day: Seven days left to qualify for a 2020 tax receipt. Donate now
10th day: Ten bed surge unit built in our dining room this spring. Our small but mighty contribution to Ontario’s hospital capacity during the pandemic.
11th day: The inpatient team accessed over $11,000 from our care and comfort fund to provide clients with much-needed necessities, such as a mattress to sleep on, a cell phone to remain connected with their community workers; and home cleaning for hoarding and bedbugs so they can move back into a safe and healthy space.
12th day: A 12 week group based physiotherapy exercise program– clients benefit from a a 60 min class 3x/week for 12 weeks led by physiotherapist and RN that includes warm-up, eleven circuits, cool down and stretches
In anticipation of increased demand due to COVID-19, Ontario hospitals were asked to consider how they could help expand capacity. In response, Casey House is admitting patients in need of sub-acute and palliative care from other hospitals and temporarily expanding.
In addition to offering space in our 14-room inpatient unit, we are reconfiguring the dining room and first floor of the heritage house to make room for 17 additional beds, ensuring each area enables us to replicate the compassionate and expert care for which we are known.
While keeping true to our mandate of specialty care for those with HIV, during this time Casey House is admitting patients who are HIV negative to support our community and allow other hospitals to cope with the anticipated surge caused by COVID-19.
In keeping with our history, we are responding to the pandemic just as we did in the ‘80s when Casey House began, filling a gap when we see one. And, while Casey House is pleased to be part of the solution, ideally these additional beds are never filled because Ontario manages to control the surge and additional hospital capacity is not needed.
Although on-site day health programming is suspended because of the pandemic, we continue to actively support clients in the community with food deliveries and telephone calls. The day health program remains a priority, because supporting people residing outside of hospital keeps people out of hospital.
To reduce the risk of COVID-19 infection for clients and staff our facility remains closed to all but essential staff and inpatient clients.