University of Alberta researchers have found a link between increased visits to supervised consumption sites in Alberta and decreased fentanyl-related overdose deaths.
Using publicly available opioid-response reports from the Province of Alberta, the researchers looked at the number of fentanyl-related overdose deaths by quarter from 2017 to 2020, as well as the number of visits to supervised consumption services. They found a statistically significant association between the two measures, suggesting that increased visits to supervised consumption services play a role in a decrease in overdose deaths. When visits to these services decreased due to the COVID-19 pandemic, fentanyl-related overdose deaths increased by 118.4 per cent.
According to the data available in the reports, opioids were involved in more than 80 per cent of all drug-related deaths, with fentanyl involved in 94 per cent of those deaths. The data also highlighted that the services provided at supervised consumption sites accounted for 12.2 per cent of naloxone kits dispensed in the province, and facilitated more than 10,000 referrals to addiction treatment programs, information the researchers say showcases the sites’ various benefits.
“It’s really an entry point into a system that can provide health support. There are referrals to treatment, naloxone training, housing support, transportation and much more,” said Tyler Marshall, a U of A doctoral candidate in the Department of Psychiatry who led the study along with psychiatry professor Andrew Greenshaw.
Marshall added that the services staff a variety of trained professionals, including paramedics, registered nurses, licensed practical nurses and peer-support workers, all with the goal of supporting the individuals who come through the doors.
Though the findings only show a correlation at this stage, Greenshaw and Marshall said they identify the need for a larger discussion of these services, which have been operating in Alberta since 2017.
Though supervised consumption services offer access to medical professionals, Marshall said they also provide a more welcoming atmosphere than a hospital or clinic for potential visitors, making them more appealing to individuals with addiction who may fear judgment from typical health-care providers.
“Supervised consumption services are a good way to connect with some of this population that typically may not want to or be able to see a primary-care doctor,” said Marshall.
Marshall has held various roles that have provided him with first-hand experience in the way that supervised consumption services operate and assist individuals who use their services. In addition to his academic work, he was a volunteer at the Boyle Street Supervised Consumption Services, and he also serves as interim director of operations at Our House Addiction Recovery Centre, an addiction treatment centre for men in the community.
According to Marshall and Greenshaw, more peer-reviewed research on supervised consumption services is needed. One potential area to explore is the breadth of the supportive services available, such as the availability of sterile needles or of staff to help individuals find housing. Greenshaw noted that it’s difficult to determine which factors are driving the decrease in overdose deaths without more analysis.
“If you really want to develop good investment for harm reduction, you need to investigate those other components and try to find out to what extent they are important,” said Greenshaw, who is also a member of the Neuroscience and Mental Health Institute.
“The fentanyl problem isn’t going away, so we need to better understand how to support people. We need a patient-oriented or client-oriented approach to find out what’s of value in terms of their perspectives, and a very crude measure is reduction in overdose deaths.”
According to Greenshaw, the presence of federal initiatives such as the Canadian Research Initiative in Substance Misuse (CRISM), a five-year initiative funded by the Canadian Institutes of Health Research and modelled in part on the U.S. National Institute on Drug Abuse’s Clinical Trials Network, demonstrates that there is a need within Canada for more addiction research to translate scientific evidence into policy.
“There’s a lot of debate around this. It’s kind of seen as a moral issue rather than a health or disease issue, so we’re hoping to chip away at some of the stigma and discrimination,” said Marshall.
The study, “The Impact of Supervised Consumption Services on Fentanyl-Related Deaths: Lessons Learned From Alberta’s Provincial Data,” was published in The Canadian Journal of Psychiatry in collaboration with clinical colleagues Adam Abba-Aji and Robert Tanguay.