Optimizing delivery of supervised drug consumption services: Implications of socio-structural environments, service design, and operating practices

Canada is in the midst of a growing overdose crisis which accounted for at least 3,996 deaths in 2017. Overdose deaths have been particularly devastating in British Columbia (BC), where approximately four people die each day from overdose. The crisis highlights the urgent need for life-saving overdose prevention interventions, including the expansion of supervised drug consumption services where people may use illicit drugs in the presence of health care professionals and other staff trained to intervene during an overdose. Diverse new models of supervised drug consumption services are being rapidly scaled-up across the province, including peer-run ‘overdose prevention sites,’ in-hospital sites, mobile vans, and services integrated within existing community health centers. The diversity of supervised drug consumption models currently being implemented in BC represents an unprecedented opportunity to examine how supervised consumption services may be designed and delivered across contexts to maximize their reach and public health benefit. As services are implemented in new settings, research is also urgently required to examine how features of the social and structural environment-including drug laws, regulatory environments, policing practices, and local drug use culture-influence the implementation and impact of supervised consumption services. This study addresses this gap by using ethnographic approaches to examine how emerging models of supervised drug consumption services (e.g. peer-run, in-hospital, mobile) interact with social and structural features of the implementation context to shape the social practices of people who use drugs and their onward risk of overdose. Findings from this study will contribute to the overdose response by identifying policy and programmatic changes to optimize the reach and public health benefits of supervised drug consumption services.