Supervised consumption sites, which include supervised injection and inhalation sites, provide sterile supplies and a safe, hygienic space for PWUD to consume previously obtained unregulated drugs under the observation of health care providers or other trained staff.372 While supervised consumption sites had long operated without the approval of the federal government, Health Canada began issuing exemptions under section 56.1 of the CSDA to allow supervised consumption sites in Canada to operate legally, with Insite receiving the first exemption in 2003.373,374  

Multiple systematic reviews have evaluated the relationship between the use of supervised consumption sites, specifically supervised injection sites, and individual- and community-level outcomes.85,372,375 Both 201485 and 2017372 systematic reviews found supervised consumption use to be associated with safer injection behaviours, including decreases in syringe sharing, syringe reuse, and public injection, and an increased use of sterile injection supplies. Moreover, supervised consumption site use is associated with an increase in referrals to treatment centres, withdrawal management programs, and OAT.85,372 Importantly, supervised consumption sites are associated with a decrease in fatal overdoses, and no fatal opioid overdoses have been reported at any supervised injection site.85  At the community level, the implementation of supervised injection sites is not associated with increased crime, violence, or drug consumption in the areas surrounding the site.85 

Most recently, a 2021 systematic review (N=22 studies) on the effectiveness of supervised injection facilities for harm reduction and community outcomes reaffirmed these findings.376 The authors found supervised injection facilities were mostly associated with significant reductions in opioid overdose morbidity and mortality (n=5), significant improvements in injection behaviors and harm reduction (n=7), significant improvements in access to addiction treatment programs (n=7), and no increase or reductions in crime and public nuisance (n=7).376 

Similar to supervised consumption sites, overdose prevention sites provide a safe, hygienic space for people to consume previously obtained unregulated substances under the supervision of trained staff, peers, and health care professionals. Unlike supervised consumption sites, overdose prevention sites in BC do not require an exemption from the federal government to operate. A provincial order issued in response to the opioid overdose public health emergency permits overdose prevention sites to operate temporarily.377 Overdose prevention sites generally have lower expenditures, can be implemented more quickly, and are often lower barrier compared to supervised consumption services. Evaluations of overdose prevention sites have yet to be completed, but data indicates these services are increasingly utilized by people who use drugs, and drug toxicity deaths at overdose prevention sites are extremely rare (two deaths recorded to date). 378

The BC Ministry of Mental Health and Addiction’s Overdose Emergency Response Centre and BC Centre for Disease Control have also developed a Provincial Episodic Overdose Prevention Service Protocol,  which provides guidance and support to staff members at a range of health care and social service settings who encounter people in need of episodic overdose prevention services on site. This service, which was developed in the context of the COVID-19 pandemic, is intended to support people at risk of overdose who have difficulty accessing a designated supervised consumption or overdose prevention site. The impact of this service has not yet been evaluated.