Dr. Jennifer Jackson, PhD, is a registered nurse and an assistant professor in the Faculty of Nursing at the University of Calgary. Dr. Katrina Milaney is an associate professor in community health sciences and the lead of the Social and Structural Vulnerabilities program of research with the O’Brien Institute for Public Health, University of Calgary.
Starting in January, Alberta is set to require people to show their health care card in order to access a supervised consumption site. This change will have a devastating impact on people who use such services.
The new rules, part of the province’s Recovery-Oriented Overdose Prevention Guide released this past April, call for new clients to provide their personal health number to use a supervised consumption site (SCS). Last week, the start date for the requirement was postponed to the end of January, pending a judicial decision in an emergency injunction hearing in a lawsuit challenging the constitutionality of the new rules.
According to Health Canada, overdoses have increased between 60 and 300 per cent across Canada since March, 2020. Limited access to supervised consumption is thought to be partly responsible for the increase, as sites have had to reduce capacity to allow for physical distancing during the pandemic. COVID-19 stressors have only added to a lack of overdose-prevention services more generally. Requiring personal health numbers to access an SCS will exacerbate barriers for people who already face structural and health inequities, and may result in increased overdose deaths.
Supervised consumption sites already have efficient documentation systems in place to support patient care and maintain comprehensive data collection, without using personal health numbers. All clients register with a health care professional to access an SCS. Demographic information, substance and method of consumption, as well as services offered to the client, are recorded with each visit. This information is tracked using a code unique to the client, but not linked to the person’s provincial health record. Maintaining anonymity is a key part of building trust between clients and health care professionals. By taking away this element, it challenges a fundamental aspect of the program.
There is a growing body of evidence that supervised consumption saves lives, reduces costs and is the way into other services such as detox facilities.
People who struggle with addiction do so for many reasons, including childhood trauma or a history of sexual abuse. In a recent study of more than 800 Albertans who are active substance users, 60 per cent had experienced or were experiencing homelessness, almost half had a mental-health diagnosis and 60 per cent did not have access to consistent health care.
When asked what types of supports they would prefer to access, more than 90 per cent said SCS. Two-thirds hoped to get support for their addiction, and almost 80 per cent wanted referrals to addiction programs through an SCS. These responses show that people with addictions want access to treatment and have a clear sense of what resources would work for them.
When asked about barriers to accessing an SCS, one of the biggest issues for people was the need to show identification. Results showed that 62 per cent of participants would not use the SCS if showing ID was a requirement. Many people with low income or who are experiencing homelessness do not have health cards, which would restrict them from accessing an SCS.
A requirement to show ID may also create a fear of incrimination or stigma if visits are recorded on the provincial health record. Clients may also fear repercussions from either the legal system or health care system if they are recorded as using drugs.
The potential impact of requiring health cards to access an SCS is not restricted to people who use drugs. Research conducted in Alberta demonstrates that supervised consumption helps to avoid costs elsewhere in the health system. The average cost to taxpayers of a visit to an SCS is $30 to $70, while an ambulance costs $385 and a visit to the emergency department starts at $1,200. Diverting people to an SCS for addiction health care is a better use of public resources than providing costly care after a preventable overdose.
Restricting access to supervised consumption does not stop people from needing health care – it shifts the service provision to a different part of the health care system. Albertans may have to wait longer for an ambulance or to be seen in the emergency department if an SCS is no longer able to provide treatment outside these settings and people with addictions don’t have access to services outside the ER.
It is well known that the top predictor of satisfaction with health services is wait times in emergency departments. Policies that could increase emergency wait times could anger the public, especially in the context of COVID-19, when hospitals already face considerable strain.
Embracing better access to supervised consumption would be consistent with the provincial government’s policy of allowing people to make their own choices about their health care. Rather than creating barriers to care, a better strategy would be to rename and rebrand SCS as part of comprehensive mental-health and addiction services. There are opportunities to expand the services that are available at an SCS and facilitate referrals to other services. There could be mobile SCS, which could reduce community concerns, such as discarded needles.
Supervised consumption sites, and the staff who work there, are supporting some of Alberta’s most vulnerable citizens. These clinics offer a chance to help people with addictions and they are an excellent opportunity to reach and connect with people who face considerable stigma.
Relying on abstinence-only treatment as the solution for those who use substances to deal with trauma and hardship is going backwards. History has shown that many of the successes related to addiction treatment have been found in public-health approaches that were specifically designed for – and with – vulnerable populations. We should heed these lessons.
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