Santé Montréal

Supervised injection services

SIS sites are easy to spot thanks to this pictogramA supervised injection service (SIS) is a place where injection drug users can go to inject drugs they bring with them.

The sites are

  • safe and clean;
  • supervised by qualified staff;
  • legal.

As part of the continuum of services in addiction, mental health and homelessness, SIS complement current services intended for people who use injection drugs; SIS also use an approach that is adapted to the needs of those marginalized individuals, who rarely use available health and social services.

In Montréal, SIS are provided at three fixed sites and in a mobile unit by the health and social services network—CIUSSS du Centre-Sud-de-l’Île-de-Montréal—in cooperation with community groups that have been working for many years with people who use injection drugs.

They are located in Montréal neighbourhoods where people who inject drugs are more likely to be.

Supervised Injection Services in Montréal

Frequently asked questions

Why offer SIS in Montréal?

Over the past few years, sexually transmitted and blood-borne infections, especially hepatitis C and human immunodeficiency virus (HIV), have reached alarming proportions among people who use injection drugs. This population is one of the most medically and socially vulnerable in our society.

Over the past 20 years, a number of concerns—such as stronger, more addictive substances that can be injected—have caused stakeholders working with people who use injection drugs to review their practices and come up with strategies adapted to the needs of their clients.

Among the solutions put forward, implementing supervised injection services is known to be effective. International experiences have shown the positive impacts of those services on public health and public order.

Who are SIS for?

Supervised injection services give priority to people who use injection drugs who

  • are the most marginalized and whose living conditions are the most precarious (e.g. homelessness, addiction, mental health problems, street prostitution);
  • are at greatest risk of dying from overdoses, and of contracting and spreading sexually transmitted and blood-borne infections, particularly HIV and hepatitis C;
  • rarely use network health services; and
  • are most likely to be sources of tension in public spaces due to injection drug use, intoxication in public and discarded syringes.

What are the advantages of having SIS?

To improve quality of life in neighbourhoods

Supervised injection services allow stakeholders to act to reduce

  • discarded syringes
  • injection in public spaces
  • calls to 911 involving citizen complaints related to injection

To improve the health and well-being of people who use injection drugs

Supervised injection services can

  • reach IDUs who are most at risk, that is, individuals who don’t use traditional health services, and provide screening, treatment and access to sterile injection equipment;
  • prevent overdoses and deaths, among other things, due to the presence of personnel qualified to provide prompt assistance in case of complications;
  • lessen injection equipment sharing (reducing HIV and HCV);
  • increase use of detoxification and addiction treatment services.

To improve service organization

Supervised injection services

  • complement current services intended for people who use injection drugs;
  • provide customized referrals to addiction treatment services;
  • reduce demand for ambulance services and hospital emergency admissions through on-site overdose management.

Who deliver SIS?

CIUSSS du Centre-Sud-de-l’Île-de-Montréal

Responsibilities:

  • Supervise injection and oversee services offered in injection rooms at all the sites; nurses employed by health and social services will be responsible for these tasks
  • Coordinate implementation of services
  • Develop a supervisory and monitoring framework

Community groups – CACTUS Montréal, Dopamine, Spectre de rue et L’Anonyme

Responsibilities:

  • Integrate supervised injection services into their services
  • Continue to provide existing services to people who use injection drugs:

    • Distribution and retrieval of injection equipment
    • Referrals to other services
    • Psychosocial interventions, etc.

What measures will be put in place to promote neighbourliness around the sites?

Collaboration with the police (SPVM)

  • To provide security outside and inside supervised injection sites, police officers will continue to perform their duties regarding drug control and criminal organizations including around supervised injection services, if necessary.
  • As is already the case in the vicinity of injection equipment distribution sites, drug trafficking will not be tolerated around supervised injection sites. Loitering and gathering outside will be discouraged, and users will be invited to enter the site or move on.
  • In addition, several indicators linked to criminal activity and areas in the immediate vicinity of the sites will be monitored. There will be continuous communication with people responsible for coordinating supervised injection services to prevent or resolve problematic situations linked to this coexistence. Therefore any new observable trends associated with reprehensible actions, for instance, will be discussed by both parties to ensure that rapid, effective and collaborative interventions be set up and bring about change.

Measures to promote harmonious cohabitation

  • A code of conduct with which users of supervised injection services must comply. The code includes rules prohibiting all forms of trafficking, solicitation and violence on or near the premises.
  • Neighbourhood committees, recognized as an effective social mediation tool to resolve disputes and promote cohabitation. The committees include residents and merchants located near the supervised injection sites.
  • Daily rounds by SIS employees to collect used syringes and other injection equipment in the vicinity of the supervised injection services.
  • Used syringe containers fixed to the walls of community group buildings where supervised injection services are offered.

Monitoring and Surveillance

  • A supervisory and monitoring plan will complement the SIS rollout; it will facilitate tracking services implementation from the first year onwards and making any necessary adjustments.

Why do SIS need an exemption before they can operate?

To set up supervised injection services, the facility responsible for supervising injection (CSSS Jeanne-Mance) must get an exemption from Health Canada, in accordance with section 56 of the Controlled Drugs and Substances Act (CDSA).

The exemption concerns possession of drugs and trafficking in locations chosen as supervised injection sites. Consequently, it protects users, staff and the facility against future legal action.

How do SIS work?

Reception/Registration
  • During the first visit, users meet with a member of the team, who explains how supervised injection services work, the services available, the behaviour expected and the consequences if they don’t comply with the code of conduct.
  • Users also have to provide certain information and sign a consent form for ambulance care and transportation in case of any medical complications. Site staff agrees to respect confidentiality and protect personal information at all times.
  • During subsequent visits to any of the sites, users just need to go directly to the reception desk, give their user code and inform the staff about the drugs they have used in the last 12 hours and the ones they intend to inject on site.
Waiting room/Injection room
  • If all injection spaces are occupied, users are asked to go to a waiting room until a space opens up. Once in the injection room, they are given the sterile equipment needed to inject safely. They can use the space for up to 20 minutes.
Treatment room
  • Before or after injecting, users have access to a treatment room for infection assessment and treatment, or sexually transmitted and blood-borne infection screening and detection.
Respite room
  • After injecting, users are directed to the respite room. A short stay in the respite room provides a calm and safe buffer zone inside the supervised injection service before returning outside. • If there are any complications, the nurse can assess the situation and intervene according to established protocols.
Leaving
  • Before users leave the supervised injection service, a community worker or peer supporter in the respite room evaluates their levels of intoxication using the observation checklist. Depending on the outcome of the evaluation, users still at risk of overdosing can be advised to stay at the site for extended monitoring.

Contact us

CIUSSS du Centre-Sud-de-l’Île-de-Montréal

Population services

Monday to Friday, 8:30 a.m. to 4:30 p.m.
Email: info.ccsmtl@ssss.gouv.qc.ca
Telephone: 514-842-7226

 

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Last Update : 23 August 2019