Supervised Consumption Sites (SCS)
The situation:
Supervised Consumption Services (SCS) have had a considerable impact in the communities and business where they are located, since their incorporation in the province in October 2017.
SCS in Alberta are in four cities: Calgary, Edmonton, Lethbridge, and Red Deer. Each city has raised specifics concerns in regards of the impact these sites have created, the following are the most common mentioned:
· Increment in violence.
· Panhandling.
· Petty theft to property crimes.
· Drug trafficking — illicit substances.
· Overdoses near SCS sites — deaths.
· Social disorders.
· Harassment in Public areas.
· Fraud.
· Prostitution.
· The increasing use of Methamphetamine in SCS locations.
· Needle debris in public areas creating hazardous situations for the community.
· SCS lack of accountability.1
· SCS lack of standard operating procedures (SOPs).2
The SCS program in the province is based on four points: Prevention, Enforcement, Treatment, and Harm Reduction. Alberta’s SCS is more focused on Harm Reduction.
Although, the program has great benefits for its users, such as prevention of bacterial infections (i.e., HIV, Hepatitis C), reduction of discarded needles (in parks, school, sports facilities, public places), decrease on the risk of overdoses, providing — in addition — services like counselling, social work, and addiction treatment, unfortunately the negative impact outweighs the benefits of the program.
On March 5, 2020, Alberta created a committee to evaluate the social and economic impacts of the SCS in the province. The report clearly expresses the impact in all four cities, the following is an excerpt of the report: “On the negative side, it was asserted that the SCS serves as a magnet that attracted drug users and drug dealers into the neighbourhood.”3
During the research, the communities and business close to these sites have divided opinions against and in favor of the SCS, which clearly depicts a complex issue at hand. Alberta started experiencing an opioid crisis starting January 2016, which is why the province did implement the SCS program starting 2017, as a measure of control.
Based on the “Impact: A Socio-economic review of supervise consumption sites in Alberta” founds in the report issued buy the Alberta’s committee, it deemed the opening of new ‘mobile’ SCS sites not immediately needed.
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1–2 Impact: A Socio-economic review of supervise consumption sites in Alberta — page 20.
3 Impact: A Socio-economic review of supervise consumption sites in Alberta — page 6.
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Who is involved:
The following are the parties that are involved:
· Long-time drug users that are the main visitors to these sites (unique visitors).
· Inexperienced users, who are not regular visitors, which need SCS services for diverse reasons.
· Communities (neighborhoods) where the consumption sites are located (property & business).
· Health professionals that support customers in these sites.
· Police personnel that attend the areas where the SCS are located.
· EMS (Emergency Medical Service).
What is the environment:
This takes place in four cities in Alberta: Calgary, Edmonton, Lethbridge, and Red Deer.
In Calgary, the situation is developing at Sheldon M. Chumir Health Centre which operates under the umbrella of Safeworks Harm Reduction Services. Which operates with two teams: Safeworks Outreach and Safeworks Connect.
The problem is:
The Negative Impact of the Supervised Consumption Services (SCS) in Neighborhood(s) and local community.
Reframe the problem
1. Write the problem in a single sentence:
Negative impact of SCS in communities
2. What will CHANGE if a solution is successful?
Decrease in overdoses all over the city.
Reduction in vandalism so business can operate better, and people will feel like they can visit business and invest in the community.
Decrease in drug trafficking in and out of the SCS sites, decrease in crimes in general.
All users will get the need they need and treatment to leave the dependency.
3. What are three things you do to guarantee FAILURE?
a) Ignore that drug dependence is an issue in the city
b) Stop providing services to drug users (SCS, AHS, EMS)
c) Outcast — punish drug users due to their addiction, leaving them dealing with their own issues with no weight on the society.
4. IMAGINE, ten years in the future, that the problem is solved beyond your wildest expectations. What will the news headlines say?
- Thanks to SCS success ten years ago, today Alberta is the first province with no Opioid users in North America
- Alberta has trained all its population to help in case of Opioid overdose, and after 10 years, the province has reported No deaths related to drug use!
5. CREATE several “How Might We” for this problem.
· HMW get the community more involved in this drug crisis? As no one knows someone else’s reality
· HMW convince Opioid users to accept social services?
· HMW convince Opioid users to trust the system? (ID issues at SCS sites)
· HMW make people aware about the help users need for their Opioid dependence?
· HMW get the SCS programs more accessible for users to receive treatment such as social, mental, psychological help, together with supplementary income for basic needs (no drugs)?
· HMW create safe zones for recovery or treatment of drug addiction without the negative connotation from communities?
Human Center Design
After reviewing the negative impact of the Supervised Consumption Services (SCS) in the community and based on the detailed study from the province of Alberta, it is useful to shift the point of view and to analyze the problem from the user’s perspective.
Although, this is an overly complex issue where too many parties are involved, it is important to highlight the important labor that the SCS services in the community. Opioid use is a social problem we cannot ignore, or pretend that it will solve itself, unless action is taken from all of us as a society to be more compassionate.
Not all the users to arrive at these sites are regular users, persons landed in the world of drug addition due to unfortunate events, and the SCS services will provide a unique option to get people the help they need to control their addiction. Mental health and depression play a significant role when deciding using opioids.
An interesting article in Global news mentions the story of Ophelia Cara4, which after experiencing sexual assault in 2020, and during the pandemic, she started using opioids due to her personal unforeseen events that changed her life. This highlights the vital importance of the services provided by SCS, and how without this service, her story would have been completely different.
In this example, when analyzing the problem from the user’s perspective, it definitively changes the point of view and provides valuable tools to tackle the problem form different angles, I do consider Human Center Design a vital process to have a complete spectrum of the problem and now ways to see solutions.
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4 Supervised consumption site user says ID policy could be harmful to Albertans
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Empathy mapping:
The following are the main topics used for the Empathy mapping based on the user’s perspective:
What do they think and feel?
· Police punishment for drug addiction
· Forsaken from family/friends
· Left behind by the health system
· Outcast/Isolate
· No other way out to continue using
· Weight on society — no opportunity to be productive
What do they see?
· People are indolent to their issues
· No Way out!
· Too many questions to enter programs
· Judged by community
· No easy access to treatments
· Friendship only with drug-peers
· No housing available due to drug addiction
· Not welcome in any business
· Utilized by health system
What do they hear?
· All drug users are bad people
· Systems are in place, why don’t they use them?
· Disgrace for a society
· They do not get better because they do not want
· They bring more delinquency
· Drug addiction is their problem
· Responsibility is on them
· No need to treat them, they do not want help
What do they say and do?
· Angry with everything/everyone
· Feel discriminated
· Not useful / not wanted to change
· No one knows someone else’s reality
· Behavior changes depending on the drug they are using
· Stayin high makes them feel safer
Pain:
· No easy access to programs (wait list, delays)
· Lack of trust in health system
· Easy access to drug supply
Gain:
· Being able to get income for housing/food
· Being a productive citizen
· Leave drug dependency/better health
Customer Journey Map:
This customer journey map highlights the difficulties and advantages identified by users of the SCS, although there are too many factors involved, here are the most relevant:
The following are the three stages in the admission and treatment for the SCS sites:
Stage 1: User’s intention to use SCS services
Stage 2: User using SCS services
Stage 3: Users stay/leave
Actions:
They vary per stage. Stage 1: Once users approach the SCS, there is mistrust in the system, but they recognized that it is a safe place to use opioid under the supervision of professionals. Sometimes they decide to keep using by themselves until trust is gained and they feel comfortable to use the facilities.
When users decide to bring more than opioid into the facilities, like Methamphetamines, it is when the negative conduct impacts the SCS sites, business, and the community in general. Methamphetamine effects are agitation, aggressiveness, paranoia, frank psychosis, and bizarre behavior.
Touchpoints:
During the process, the police, paramedics, SCS personnel, social services, AHS, the community, and business are involved.
Customer thought:
At first, they feel afraid and judged SCS and community. They are reluctant to provide ID, so it is complicated to keep track of regular and inexperienced users unless SCS personnel knows them well and assign them a knows name. This has created a big issue as some users do not even have AHS card to provide medical care.
Opportunities:
The province, the city, and community can come together to create better policy to offer better treatment access, a better way to keep statistics, control in and out drug trafficking, better programs for housing, and more training in risky points of the city where overdoses may happen (use of Naloxone: drug to stop overdoses by opioids)
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Appendix I
Impact: A Socio-economic review of supervise consumption sites in Alberta
Opioids: Government of Canada
Methamphetamine: Government of Canada
Articles and resources:
Government of Canada — Supervised consumption sites and services: Explained — August 17, 2020
Less crime around Sheldon Chumir, but consumption site’s fate still uncertain Alana Smith — Feb 11, 2020
Canada’s hidden crisis: How COVID-19 overshadowed the worst year on record for overdose deaths. Alana Smith — Mar 29, 2021
UCP to close Calgary’s only supervised consumption site | Calgary Herald. Alana Smith — May 27, 2021
Alberta in talks to open overdose prevention sites | CBC News. The Canadian Press — Mar 02, 2022
Alberta speaking with shelters to set up smaller supervised consumption sites: sources. Saif Kaisar — Mar 2, 2022
New study suggests Calgary’s supervised consumption site saves taxpayers millions. Austin Lee — April 28, 2022
Supervised consumption site user says ID policy could be harmful to Albertans. Morgan Black — Jan 26, 2022
