Skip to main content
SpringerLink
Log in

Characterizing Use of Supervised Consumption Services among Street-involved Youth and Young Adults in the Context of an Overdose Crisis

  • Original Article
  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

In response to an increase in overdose deaths, there was a rapid scale-up of supervised consumption services (SCS), including federally sanctioned SCS and low-barrier SCS known as overdose prevention sites (OPS), in Vancouver, Canada, beginning in December 2016. However, little is known about the use of such services among adolescents and young adults (AYA) in this context. We therefore sought to characterize factors associated with the use of federally sanctioned SCS and OPS among street-involved AYA who inject drugs in Vancouver during an overdose crisis. From December 2016 to March 2020, data were collected from a prospective cohort of street-involved AYA aged 14 to 26 at baseline. Using multivariable generalized estimating equation analyses, we identified factors associated with recent use of federally sanctioned SCS and OPS, respectively. Among 298 AYA who inject drugs, 172 (57.8%) and 149 (50.0%) reported using federally sanctioned SCS and OPS during the study period, respectively. In multivariable analyses, public injecting, negative police interactions, and residing or spending time ≥ weekly in the Downtown Eastside neighborhood were all positively associated with the use of federally sanctioned SCS and OPS, respectively. Additionally, ≥ daily unregulated opioid use and residential eviction were positively associated with federally sanctioned SCS use, while requiring help injecting was inversely associated. Self-identified female or non-binary gender was also positively associated with OPS use (all p < 0.05). Both federally sanctioned SCS and OPS successfully engaged AYA at heightened risk of adverse health outcomes. However, the lack of accommodation of AYA who require manual assistance with injecting at federally sanctioned SCS may be inhibiting service engagement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

Data cannot be deposited in a public repository as this is not permitted under the parameters of our research ethics approval. Anonymized data may be available by request to the University of British Columbia/Providence Health Care Research Ethics Board. Researchers who meet the criteria for access to this data may contact the research administration office of the British Columbia Centre on Substance Use (inquiries@bccsu.ubc.ca).

References

  1. Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid- and stimulant-related harms in Canada. Government of Canada: Ottawa. December 15, 2023. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/. Accessed 6 Mar 2024.

  2. B.C. Coroners Service. Illicit drug toxicity deaths in B.C. (January 1, 2012 - December 31, 2022). Office of the Chief Coroner: Burnaby, BC. 2022:1–24. https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug.pdf. Accessed 29 Aug 2023.

  3. O’Connor S, Grywacheski V, Louie K. Hospitalizations and emergency department visits due to opioid poisoning in Canada. 2018(38):244–247. 6136946580.

  4. Kerr T, Marshall BD, Miller C, et al. Injection drug use among street-involved youth in a Canadian setting. BMC Public Health. 2009;9:1–7. https://doi.org/10.1186/1471-2458-9-171.

    Article  Google Scholar 

  5. Roy É, Haley N, Leclerc P, Sochanski B, Boudreau JF, Boivin JF. Mortality in a cohort of street youth in Montreal. JAMA. 2004;292(5):569–74. https://doi.org/10.1001/jama.292.5.569.

    Article  CAS  PubMed  Google Scholar 

  6. Kerr T, Mitra S, Kennedy MC, McNeil R. Supervised injection facilities in Canada: past, present, and future. Harm Reduct J. 2017;14(1):1–9. https://doi.org/10.1186/s12954-017-0154-1.

    Article  Google Scholar 

  7. Government of Canada. Supervised consumption sites: status of applications. 2024. https://www.canada.ca/en/health-canada/services/substance-use/supervised-consumption-sites/status-application.html#a1. Accessed 1 Feb 2024.

  8. Kennedy MC, Hayashi K, Milloy MJ, Compton M, Kerr T. Health impacts of a scale-up of supervised injection services in a Canadian setting: an interrupted time series analysis. Addiction. 2022;117(4):986–97. https://doi.org/10.1111/add.15717.

    Article  PubMed  Google Scholar 

  9. Wallace B, Pagan F, Pauly B. The implementation of overdose prevention sites as a novel and nimble response during an illegal drug overdose public health emergency. Int J Drug Policy. 2019;66:64–72. https://doi.org/10.1016/j.drugpo.2019.01.017.

    Article  PubMed  Google Scholar 

  10. Canadian Research Initiative in Substance Misuse (CRISM). National Operational Guidance for the Implementation of Supervised Consumption Services. Version 1. Edmonton, Alberta: Canadian Research Initiative in Substance Misuse; 2023.

  11. Kupp S, St. George K, Riley S. Overdose Prevention Site Manual 2022. Version 4. Vancouver, British Columbia: Vancouver Coastal Health; 2022.

    Google Scholar 

  12. Fraser Health. Overdose Prevention Sites. 2024. https://www.fraserhealth.ca/Service-Directory/Services/mental-health-and-substance-use/substance-use/overdose-prevention-site#.Y9WiuOzMLPY. Accessed 1 Feb 2024.

  13. Vancouver Coastal Health. Overdose prevention sites and supervised consumption sites. 2023. http://www.vch.ca/public-health/harm-reduction/supervised-consumption-sites. Accessed 1 Feb 2024.

  14. Kennedy MC, Karamouzian M, Kerr T. Public health and public order outcomes associated with supervised drug consumption facilities: a systematic review. Curr HIV/AIDS Rep. 2017;14(5):161–83. https://doi.org/10.1007/s11904-017-0363-y.

    Article  PubMed  Google Scholar 

  15. Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend. 2014;145:48–68. https://doi.org/10.1016/j.drugalcdep.2014.10.012.

    Article  PubMed  Google Scholar 

  16. Levengood TW, Yoon GH, Davoust MJ, et al. Supervised injection facilities as harm reduction: a systematic review. Am J Prev Med. 2021;61(5):738–49. https://doi.org/10.1016/j.amepre.2021.04.017.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kennedy MC, Hayashi K, Milloy MJ, Wood E, Kerr T. Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: a cohort study. PLoS Med. 2019;16(11):e1002964. https://doi.org/10.1371/journal.pmed.1002964.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wood E, Tyndall MW, Lai C, Montaner JS, Kerr T. (2006) Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Subst Abuse Treat Prev Policy. 1(1) https://doi.org/10.1186/1747-597x-1-13.

  19. Hadland SE, Debeck K, Kerr T, et al. Use of a medically supervised injection facility among street youth. J Adolesc Health. 2014;55(5):684–9. https://doi.org/10.1016/j.jadohealth.2014.04.013.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Stoltz JAM, Wood E, Miller C, et al. Characteristics of young illicit drug injectors who use North America’s first medically supervised safer injecting facility. Addict Res Theory. 2007;15(1):63–9. https://doi.org/10.1080/16066350601081090.

    Article  Google Scholar 

  21. Wood E, Stoltz JA, Montaner JSG, Kerr T. Evaluating methamphetamine use and risks of injection initiation among street youth: the ARYS study. Harm Reduct J. 2006;3:1–6. https://doi.org/10.1186/1477-7517-3-18.

    Article  Google Scholar 

  22. Bouvier BA, Elston B, Hadland SE, Green TC, Marshall BDL. Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study. Harm Reduct J. 2017;14(1):1–9. https://doi.org/10.1186/s12954-017-0139-0.

    Article  Google Scholar 

  23. Kennedy MC, Hayashi K, Milloy MJ, Boyd J, Wood E, Kerr T. Supervised injection facility use and exposure to violence among a cohort of people who inject drugs: a gender-based analysis. Int J Drug Policy. 2020;78:102692. https://doi.org/10.1016/j.drugpo.2020.102692.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bozinoff N, Small W, Long C, DeBeck K, Fast D. Still, “at risk”: an examination of how street-involved young people understand, experience, and engage with “harm reduction” in Vancouver’s inner city. Int J Drug Policy. 2017;45:33–9. https://doi.org/10.1016/j.drugpo.2017.05.006.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pilarinos A, Kennedy MC, McNeil R, Dong H, Kerr T, DeBeck K. The association between residential eviction and syringe sharing among a prospective cohort of street-involved youth. Harm Reduct J. 2017;14(1):24–24. https://doi.org/10.1186/s12954-017-0150-5.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Cheng T, Small W, Dong H, Nosova E, Hayashi K, Debeck K. An age-based analysis of nonmedical prescription opioid use among people who use illegal drugs in Vancouver, Canada. Subst Abuse Treat Prev Policy. 2018;13(1). https://doi.org/10.1186/s13011-018-0180-3..

  27. Lima VD, Harrigan R, Murray M, et al. Differential impact of adherence on long-term treatment response among naive HIV-infected individuals. AIDS. 2008;22(17):2371–80. https://doi.org/10.1097/QAD.0b013e328315cdd3.

    Article  PubMed  Google Scholar 

  28. Kennedy MC, Milloy MJ, Hayashi K, Holliday E, Wood E, Kerr T. Assisted injection within supervised injection services: uptake and client characteristics among people who require help injecting in a Canadian setting. Int J Drug Policy. 2020;86:102967–102967. https://doi.org/10.1016/j.drugpo.2020.102967.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kennedy MC, Klassen DC, Dong H, Milloy MJS, Hayashi K, Kerr TH. Supervised injection facility utilization patterns: a prospective cohort study in Vancouver Canada. Am J Prev Med. 2019;57(3):330–7. https://doi.org/10.1016/j.amepre.2019.04.024.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Canêdo J, Sedgemore K-O, Ebbert K, et al. Harm reduction calls to action from young people who use drugs on the streets of Vancouver and Lisbon. Harm Reduct J. 2022;19(1). https://doi.org/10.1186/s12954-022-00607-7.

  31. Charlesworth J, Ryan-Lloyd K, Arril J. Youth substance use services in B.C. – An Update. March 24, 2020. 2020:1–78. https://rcybc.ca/wp-content/uploads/2020/03/RCY_YouthSubstanceUseServices-March2020.FINAL_.revised.pdf. Accessed 31 Aug 2023.

  32. Fleming T, Damon W, Collins AB, Czechaczek S, Boyd J, McNeil R. Housing in crisis: a qualitative study of the socio-legal contexts of residential evictions in Vancouver’s Downtown Eastside. Int J Drug Policy. 2019;71:169–77. https://doi.org/10.1016/j.drugpo.2018.12.012.

    Article  PubMed  Google Scholar 

  33. McNeil R, Fleming T, Collins AB, Czechaczek S, Mayer S, Boyd J. Navigating post-eviction drug use amidst a changing drug supply: a spatially-oriented qualitative study of overlapping housing and overdose crises in Vancouver Canada. Drug Alcohol Depend. 2021;222:108666–108666. https://doi.org/10.1016/j.drugalcdep.2021.108666.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Zivanovic R, Omura J, Wood E, Nguyen P, Kerr T, DeBeck K. Eviction and loss of income assistance among street-involved youth in Canada. J Public Health Policy. 2016;37(2):244–59. https://doi.org/10.1057/jphp.2016.12.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Collins AB, Boyd J, Mayer S, et al. Policing space in the overdose crisis: a rapid ethnographic study of the impact of law enforcement practices on the effectiveness of overdose prevention sites. Int J Drug Policy. 2019/11/01/ 2019;73:199–207. https://doi.org/10.1016/j.drugpo.2019.08.002

  36. Marshall BD, Milloy MJ, Wood E, Montaner JS, Kerr T. Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011;377(9775):1429–37. https://doi.org/10.1016/s0140-6736(10)62353-7.

    Article  PubMed  Google Scholar 

  37. Petrar S, Kerr T, Tyndall MW, Zhang R, Montaner JS, Wood E. Injection drug users’ perceptions regarding use of a medically supervised safer injecting facility. Addict Behav. 2007;32(5):1088–93. https://doi.org/10.1016/j.addbeh.2006.07.013.

    Article  PubMed  Google Scholar 

  38. Fairbairn N, Small W, Van Borek N, Wood E, Kerr T. Social structural factors that shape assisted injecting practices among injection drug users in Vancouver, Canada: a qualitative study. Harm Reduct J. 2010;7:1–7. https://doi.org/10.1186/1477-7517-7-20.

    Article  Google Scholar 

  39. McNeil R, Small W, Lampkin H, Shannon K, Kerr T. “People knew they could come here to get help”: an ethnographic study of assisted injection practices at a peer-run ‘unsanctioned’ supervised drug consumption room in a Canadian setting. AIDS Behav. 2014;18(3):473–85. https://doi.org/10.1007/s10461-013-0540-y.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Cheng T, Kerr T, Small W, et al. High prevalence of assisted injection among street-involved youth in a Canadian setting. AIDS Behav. 2016;20(2):377–84. https://doi.org/10.1007/s10461-015-1101-3.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lloyd-Smith E, Rachlis BS, Tobin D, et al. Assisted injection in outdoor venues: an observational study of risks and implications for service delivery and harm reduction programming. Harm Reduct J. 2010;7(1):6–6. https://doi.org/10.1186/1477-7517-7-6.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lamb S, Kral AH, Dominguez-Gonzalez K, Wenger LD, Bluthenthal RN. Peer-to-peer injection: demographic, drug use, and injection-related risk factors. Int J Drug Policy. 2018;61(3):44–51. https://doi.org/10.1016/j.drugpo.2018.07.001.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Boyd J, Collins AB, Mayer S, Maher L, Kerr T, McNeil R. Gendered violence and overdose prevention sites: a rapid ethnographic study during an overdose epidemic in Vancouver Canada. Addiction. 2018;113(12):2261–70. https://doi.org/10.1111/add.14417.

    Article  PubMed  PubMed Central  Google Scholar 

  44. McNeil R, Small W. “Safer environment interventions”: a qualitative synthesis of the experiences and perceptions of people who inject drugs. Soc Sci Med. 2014;106:151–8. https://doi.org/10.1016/j.socscimed.2014.01.051.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Darke S. Self-report among injecting drug users: a review. Drug Alcohol Depend. 1998;51(3):253–63. https://doi.org/10.1016/S0376-8716(98)00028-3.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the study participants for their contribution to the research, as well as current and past researchers and staff. The authors also gratefully acknowledge that this research took place on the unceded traditional territories of the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), and sel̓íl̓witulh (Tsleil-waututh) Nations. This work was supported by the US National Institutes of Health [U01DA038886] and the Canadian Institutes of Health Research (CIHR) [PJT 175162]. Mary Clare Kennedy is supported by the Canada Research Chairs program through a Tier 2 Canada Research Chair in Substance Use Policy and Practice Research [2021-00272]. Thomas Kerr is supported by a CIHR Foundation grant [20R74326]. The funders had no role in study design, data collection and analyses, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada

    Kiera Lee-Pii, Kora DeBeck, JinCheol Choi, Kali-olt Sedgemore, Thomas Kerr & Mary Clare Kennedy

  2. Department of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada

    Kiera Lee-Pii

  3. School of Public Policy, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, BC, V6B 5K3, Canada

    Kora DeBeck

  4. ‘Namgis First Nation, Alert Bay, BC, Canada

    Kali-olt Sedgemore

  5. Coalition of Peers Dismantling the Drug War, Vancouver, BC, Canada

    Kali-olt Sedgemore

  6. Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    Thomas Kerr

  7. School of Social Work, University of British Columbia - Okanagan, 611-1628 Dickson Ave, Kelowna, BC, V1Y 9X1, Canada

    Mary Clare Kennedy

Authors
  1. Kiera Lee-Pii
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kora DeBeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. JinCheol Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kali-olt Sedgemore
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Kerr
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mary Clare Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mary Clare Kennedy.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee-Pii, K., DeBeck, K., Choi, J. et al. Characterizing Use of Supervised Consumption Services among Street-involved Youth and Young Adults in the Context of an Overdose Crisis. J Urban Health 101, 233–244 (2024). https://doi.org/10.1007/s11524-024-00849-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-024-00849-9

Keywords

Search

Navigation