Calgary Supervised Consumption Site Closure at an Impasse

Amid substantially rising opioid-related deaths and other harms in Canada, the city of Calgary is grappling with the potential closure of the Sheldon Chumir supervised consumption site. The site, and others like it, provides “a place where people can use preobtained drugs in a monitored, hygienic environment to reduce harm from substance use” while receiving medical care from health professionals and getting connected to recovery-oriented services, according to Alberta Health Services.

But some Calgarians say the site “has been a magnet for concerns about crime and safety” since it opened in 2018 in response to the rising opioid crisis. A recent CityNews poll found that slightly more than half (52%) want the site to close.

Given the conflicting views, the provincial government, which is responsible for delivering health services, asked the city of Calgary to decide for itself whether the site should close.

“Basically, the government said, ‘City of Calgary, if you don’t want this site, just tell us, and we’ll close it,’” Elaine Hyshka, PhD, Canada research chair in health systems innovation at the School of Public Health, University of Alberta, Edmonton, Alberta, Canada, told Medscape Medical News. “After debating a motion to do so, the city council refused to take a position on the site’s future, stating that it was unfair of the province to pass the buck to the city,” she said. The stalemate enables the site to remain open for now.

“From a scientific perspective, I think it’s pretty clear that where it’s been independently evaluated using rigorous study designs, these sites don’t contribute to additional crime or substance use in the neighborhoods where they’re implemented,” she added. “They tend to be implemented in areas where there already are those problems. And closing the site won’t solve them.”

Driving a Backlash

Evidence notwithstanding, “the city deems that the site is unsafe, that it’s not supporting individuals, and that there’s too much needle debris,” said Monty Ghosh, MD, an addiction specialist and faculty member at the University of Calgary, Calgary, and the University of Edmonton.

Instead of focusing on supervised consumption, Dan McLean, a councilor for Calgary’s Ward 13, said the province should increase its investment in drug prevention and recovery services, a position Ghosh said is supported by the mayor.

But pitting supervised consumption against recovery services is based on a common misperception that the two approaches are mutually exclusive, when in fact, “they go hand in hand,” Ghosh said.

“Then there’s the simplistic idea that if we close these services, the problems will go away, and that’s driving a backlash against these services,” Hyshka added. “But these problems won’t go away. They would probably get worse because the people that go to that site every day for support would no longer have access to a supervised environment where they could use in safety and have access to referrals to treatment and other essential healthcare.” 

Marliss Taylor, RN, director of Streetworks in Edmonton, has worked with supervised consumption and related services for close to 30 years. At Boyle Street Community Centre, the supervised consumption site that was closed by the government for lack of funds in 2021 “was the quietest place in the whole building,” she said. “A supervised consumption site is not a magnet for terrible things to happen. It’s layered on top of a lot of issues across North America of houselessness and of these people being more visible.”

If the Sheldon Chumir site closes, “there’s going to be more public substance use,” she said. “It’s not going to solve the situation around houselessness or the perception of crime and disarray. In fact, it’s going to be more apparent. If anything, you’ll be seeing teams running around trying to resuscitate people. It’s going to put a lot of strain on the system. I believe that if we could deal with the houseless issue across North America, then we would deal with a lot of the problems that we’re seeing.”

Like Emergency Departments 

Another misperception is that all substance users are similar and have similar needs. But people use substances “for all kinds of reasons,” Taylor said. “Sometimes it’s problematic substance use, and perhaps those users want to get into treatment, and we are happy to help them try to do that. But there’s a significant number of people who can’t go to treatment or who don’t need treatment. So, substance use varies from person to person.” 

Furthermore, she said, “we are in the middle of a drug toxicity crisis right now. And where we get into trouble is thinking that an addiction issue is a drug poisoning or overdose issue, when they’re two separate things. It’s like trying to treat diabetes with seizure medication. It’s not the same problem, so you can’t have the same response to it. Someone who’s not using in an addictive way will benefit from safety measures such as supervised consumption or naloxone programs to guard against drug toxicity and overdoses. They don’t need recovery programs.” 

“My niece is a 20-year-old university student, and if someone convinces her to take a pill on Saturday night, then a recovery program is not going to do her any good,” she said. “She needs safety at that point. She needs to know what’s in that substance. She needs to know what to do, and she needs people around if there’s a situation where she might overdose. Recovery and other measures are also important, and supervised recovery centers can refer people to the appropriate resources.” 

“To me,” added Hyshka, “supervised consumption sites are almost like an emergency department for people who are using drugs because they provide immediate access to life-saving care and referrals to many other evidence-based treatments and services that are effective in improving health outcomes. Canada is experiencing a significant epidemic of drug poisonings and deaths. To talk about closing an emergency department in the midst of a crisis just doesn’t make sense.” 

What Next?

Despite potential advantages, many supervised consumption sites have a significant drawback. As in the United States, Canadian users are switching from injecting fentanyl and other novel synthetic opioids to smoking them. 

The shift happened over the past 5 years, “but in Alberta and in most of Canada, the supervised consumption sites don’t accommodate people who are smoking. They only accommodate injecting,” Hyshka explained. “We’re seeing people increasingly using drugs outside of these services because they can’t use them inside. They’re hoping to be in the vicinity of healthcare, so if they do have an overdose, someone will come outside and help them. If we allow supervised consumption sites to accommodate people who are smoking, those who are using in public will be able to go there instead of being on the street.”

To enable inhalation, the sites need to be retrofitted with a way to ventilate the space quickly to protect users and staff. “We know how to fix the infrastructure to do that, but Alberta, as a policy decision, is not allowing the sites to adapt,” she said. “We need to be able to update our services to be more responsive to the needs of people that are using.”

Instead of closing supervised consumption sites, Ghosh suggests decentralizing them by making use of existing centers such as Alpha House, where people are already using, and creating semipermanent supervised consumption sites (for example, temporary sites at train stations). “This would be a way to ensure that we don’t have such a large concentration of individuals at one site, which may cause the community to perceive that there are problems,” he said.

Ghosh does not think that the Calgary site should close. “But if we’re being forced to shut it down, on top of shutting down the Red Deer site in Edmonton, we need to evaluate the outcomes. How many people are dying as a result? How many people are using healthcare services? How do closures impact the service system? How do they impact the justice system? Are we seeing even more public drug consumption arrests because there are no alternatives? 

“Red Deer and other cities have failed to recognize and acknowledge that one of the big solutions to this is housing,” he added. “If you want a decrease in visible homelessness and visible substance use, then we need to create more housing, including harm reduction housing.”

The fact that 48% of respondents to the CityNews poll said they disagreed with or weren’t sure about closing the Chumir site shows that the sites are not universally unpopular, Hyshka said. “There is potential to generate better understanding of the essential nature of these services, and in many cases, the public is ahead of our politicians when it comes to wanting to take a pragmatic approach that recognizes the utility of multiple tools and options to support their neighbors, their friends, and their loved ones to stay alive and achieve recovery or even just better health.

“That’s what I hold on to as I keep working in this area: Knowing that most people don’t want to see people die from drug poisoning, and most people are generally open-minded about solutions,” she said. “If we can implement a comprehensive approach that is tailored to diverse needs in the population, just like with any health service or health issue, I think we have the potential to make a lot of progress on this difficult topic.”

Hyshka previously served as the co-chair of the Alberta Minister of Health’s Opioid Emergency Response Commission between 2017 and 2019 and has previously received peer-reviewed research grants and contracts from the Canadian Institutes of Health Research, Alberta Health Services, and Alberta Health to study supervised consumption services. Ghosh is the main evaluator for the National Overdose Response Service. Taylor reported no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.