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Temporary Overdose Prevention Site (TOPS) and Supervised Consumption Facilities (SCF)


Carepoint Consumption and Treatment Service

As of August 5, 2019, the Carepoint Consumption and Treatment Service - formerly TOPS (Temporary Overdose Prevention Site) - will operate daily, including on statutory holidays, from 9:30AM to 9:00PM.

LOCATION:
Regional HIV/AIDS Connection
#30-186 King Street
London
519-434-1601

HOURS:
9:30AM-9PM (last injection is 8PM, providing aftercare until 9PM)
Open 7 days a week, including Statutory holidays.


Frequently Asked Questions:

What is a Temporary Overdose Prevention Site? (TOPS) What are the benefits of these services?

How do I access the Carepoint Consumption and Treatment Service?

Why do we need supervised consumption facilities in London?
Can I access other resources while at the Carepoint Consumption and Treatment Service? Will the Supervised Consumption Facilities increase crime in our neighbourhood or threaten public health and safety?
What is a Supervised Consumption Facility (SCF)? Won't these services just encourage more drug use?
What is the Difference Between a Temporary Overdose Prevention Site and a Supervised Consumption Facility? What else is being done to address drug issues in London and Middlesex?
How will these services work? Where can I get more information?
Are Supervised Consumption Facilities legal? Where can I share my support or concerns?
Are there Supervised Consumption Facilities in other cities? Who did the consultation with the community?
Where will these services be located? Is the Community Consultation Report available online?

What is a Temporary Overdose Prevention Site (TOPS)? 

A Temporary Overdose Prevention Site (TOPS) is a harm reduction program intended to prevent injection-drug overdoses. The TOPS provides a hygienic, stigma-free environment for people to inject pre-obtained drugs under the supervision of a nurse. This service is provided for people who inject-drugs. At the TOPS individuals are provided with sterile injection supplies, education on safer injection, overdose prevention and intervention, medical and counselling services, and referrals to drug treatment, housing, income support and other services. Medical providers are on site to assist with overdoses or other emergency situations.

Temporary Overdose Prevention Sites are opened under temporary exemption from the Provincial Government.


How do I access the Carepoint Consumption and Treatment Service?

The Carepoint Consumption and Treatment Service - formerly TOPS (Temporary Overdose Prevention Site) - is located at 186 King Street, London. The site can be accessed through the rear door of 186 King Street, which is located on the North side of the building facing Dundas Street. This is also the door that all clients who access site leave from.

LOCATION:
Regional HIV/AIDS Connection
#30-186 King Street
London
519-434-1601

HOURS:
9:30AM-9PM (last injection is 8PM, providing aftercare until 9PM)
Open 7 days a week, including Statutory holidays.


Can I access other resources while at the Carepoint Consumption and Treatment Service?

Yes. There are a variety of resources from partner organizations available at the Carepoint Consumption and Treatment Service to provide wrap-around support, such as medical and counselling services, and referrals to drug treatment, housing and income support. Some of these partner organizations include:

  • Addiction Services Thames Valley
  • Canadian Mental Health Association
  • London Intercommunity Health Centre
  • Middlesex-London Health Unit Outreach Team
  • London Cares

What is a Supervised Consumption Facility (SCF)?

Supervised Consumption Facilities are health services that provide a hygienic environment for people to inject pre-obtained drugs under the supervision of a nurse. This service is provided for people who inject-drugs. In addition to supervised injection, individuals are provided with sterile injection supplies, education on safer injection, overdose prevention and intervention, medical and counselling services, and referrals to drug treatment, housing, income support and other services.

Supervised consumption facilities have four (4) main goals:

  1. To reduce spread of infectious diseases (HIV and hepatitis C);
  2. To reduce the number of drug overdose deaths;
  3. To bring people who inject drugs into contact with other health and social and treatment services; and,
  4. To reduce issues in the community such as drug use in public places, and discarded needles.

What is the Difference Between a Temporary Overdose Prevention Site and a Supervised Consumption Facility?

Temporary Overdose Prevention Site (TOPS) Supervised Consumption Facility (SCF)
Temporary site, runs under temporary exemption from Provincial Government Permanent site that requires an application for Federal exemption from the Controlled Drug and Substances Act

 

Legally sanctioned

Process to open a TOPS does not require a community consultation process Process to open a SCF requires community consultation
London’s TOPS has received $130,700 in one-time funding from the Ontario Ministry of Health and Long-Term Care, for a three-to-six month period of operation, which is renewable if necessary. Upon approval, the permanent site is funded by the Provincial Government and approved by Health Canada based on the financial plan submitted with the application.
TOPS is open temporarily under Provincial exemption while the application for a permanent Supervised Consumption Facility is under consideration by the Provincial and Federal Government Application is reviewed and approved by Provincial government with a letter of support from the Health Minister and then approval from Health Canada.

 


How will these services work?

Clients will arrive at the program with pre-obtained drugs. Each person will be assessed to ensure they are eligible for the program. They will be given sterile injecting equipment and instruction on safer injecting practices. A nurse will then supervise their injection in a room dedicated for this purpose, and intervene in the case of any medical emergencies. Once the individual has injected their drugs they will be directed to a waiting room where they will continue to be observed for any negative drug reactions. There will be wrap-around services on-site so clients can connect to the services when they are ready. Clients can also receive resources, information and referrals about other health and social supports and services at the agency or elsewhere in the community.


Are Supervised Consumption Facilities legal?

Yes. In Canada, legal operation of a supervised consumption facilities requires an exemption under Section 56 of the Controlled Drugs and Substances Act (CDSA). Exemptions are granted by the federal Minister of Health. In 2015, the federal government passed the Respect for Communities Act, which outlines the process and criteria for applicants seeking a Section 56 exemption.


Are there Supervised Consumption Facilities in other cities?

The first supervised injection service opened 30 years ago in Switzerland. Today there are more than 90 Supervised Consumption Facilities worldwide, including in Europe, Australia and Canada. In Canada, there are Supervised Consumption Facilities in Vancouver, Surrey, Kamloops, Kelowna and several in Montreal, Toronto, and Ottawa.


Where will these services be located?

The exact location of Supervised Consumption Facilities has not yet been determined. Community consultations have assisted in gathering and analyzing input from the community about Supervised Consumption Facilities related benefits and concerns. It was important to document suggestions from stakeholders to address concerns. Services will either be a part of an already existing community organization that serves people that use substances or the support services will be provided at the site. Research finds people will only travel a short distance to use a supervised injection service.

From the Ontario Integrated Supervised Injection Services Feasibility Study as well as other related mapping Needle and Syringe Recovery Mapping and Geographic Distribution of Hepatitis C in People Who Inject Drugs in the City of London, it is likely that the Supervised Consumption Facilities will be located in some of these neighbourhoods:

  • Core/Downtown
  • Old East Village
  • SOHO
  • East-Hamilton

A mobile unit is also part of the overall harm reduction strategy.


What are the benefits of these services?

International and Canadian research shows that supervised injections services have benefits both for individuals using the services and for the community, including:

  • Reducing the number of drug overdoses and deaths
  • Reducing risk factors leading to infectious diseases such as HIV and hepatitis
  • Increasing the use of detox and drug treatment services
  • Connecting people with other health and social services
  • Reducing the amount of publicly discarded needles
  • Cost-effectiveness
  • Not contributing to crime or increased drug use in the local community

Why do we need Supervised Consumption Facilities in London?

Emergency Department visits have generally been higher in Middlesex-London than the province since 2003. Middlesex London rates have been increasing since 2014 and in 2016 we saw the highest number of 188.1

Hospitalizations for opioids have been increasing generally over time in both Middlesex-London and Ontario. In recent years, the rate of opioid-related hospitalizations in ML has been increasing at a higher pace than the province.2

Death rates have been fluctuating in Middlesex-London since 2005. The highest number of opioid-related deaths was seen in 2012. In Ontario the death rate has been slowly increasing. 3

There is a high demand for harm reduction services in Middlesex-London with over 2 million needles distributed yearly through the CounterPoint program. The number of naloxone kits distributed in Middlesex-London has steadily increased since 2014. There has also be a sharp rise the number of people reporting that they have administered a kit in 2017.4

Fifty-eight new diagnoses of HIV were reported in Middlesex-London in 2016, surpassing the total number of cases diagnosed in all of 2015 (42). Approximately 70% of new diagnoses are attributed to the “Injection Drug Use” category for 2016. Additionally, Hepatitis C continues to be an issue, with 231 cases reported in 2016. Invasive Group A Streptococcal disease has been on the rise in People Who Inject Drugs as well, with 7 cases in PWID in 2015 and 28 cases in PWID in 2016. Infective endocarditis also continues to be important health issue affecting PWID, with a case-fatality rate in the range of 30-40%.5


Will the Supervised Consumption Facilities increase crime in our neighbourhood or threaten public health and safety?

Supervised Consumption Facilities do not contribute to more crime. They are located in neighbourhoods where there is a demonstrated need, usually where drug use is already having an impact on the community. There is considerable research on this subject. For example, in the neighbourhood around InSite in Vancouver, there has been no increase in crime, and actual decreases in vehicle break-ins and thefts. Australian studies have found decreases in drug-related crime, public drug use and loitering.

Research has shown that harm reduction programs do not increase public disorder or threaten public safety. In fact, they tend to have the opposite effect. Harm reduction programs have a positive impact on public health and safety by:

  • Preventing blood-borne infections such as human immunodeficiency virus (HIV) and hepatitis C among people using drugs
  • Ensuring that more needles and syringes are disposed of safely through programs, rather than discarded in the community
  • Supporting agreements between police and harm reduction services that ensure drug trafficking laws are enforced. This creates an environment where open drug dealing is discouraged, and people who use drugs are encouraged to access needed services.

Won't these services just encourage more drug use?

People do not start injecting drugs because of the availability of Supervised Consumption Facilities. There is no evidence that harm reduction services promote drug use. Supervised Consumption Facilities are used mainly by people with a long history of injection drug use. Research has also found that Supervised Consumption Facilities do not cause people to relapse (e.g., start using drugs after a period of abstinence) or prevent people from stopping drug use altogether.


What else is being done to address drug issues in London and Middlesex?

Many organizations across the city deliver a broad range of services to reduce the harms of substance use. This includes prevention programs as well as withdrawal management and treatment programs. London and Middlesex are also working on a Drug and Alcohol Strategy that will provide a comprehensive approach to alcohol and other drugs based on the four integrated components of prevention, harm reduction, treatment, and enforcement. Action is being taken across each of these areas. Implementation of Supervised Consumption Facilities will not eliminate harmful drug use, but they are part of the range of strategies to reduce harm.


Where can I get more information?

Continue reading and browsing information about opioids on the Middlesex-London Health Unit website.


Where can I share my support or concerns?

Thank you to everyone who completed our survey or took part in our public consultation sessions. Your input, comments and suggestions are greatly appreciated.

If you’re interested in being involved in the next steps of the response to the local opioid drug crisis, please contact us so we can keep you up to date on developments and initiatives.

Contact Us


Who did the consultation with the community?

As part of the application process for Supervised Consumption Facilities, a community wide consultation with a broad range of stakeholders occured. The Centre for Organizational Effectiveness conducted the community consultation that included community meetings throughout the City, an online survey as well as meetings with people with lived experience and service providers. Consultation also occured with Indigenous communities.


Is the Community Consultation Report available online?

Yes. The Community Consultation Report is now available. The report includes data that was gathered from 334 people who took part in nine community consultations held in November 2017; as well as the more than 2,000 responses to an online survey and four focus groups that included 56 participants representing the Indigenous community, peers and professionals.

Download (PDF)

 
Date of creation: October 3, 2017
Last modified on: August 13, 2019

References

1National Ambulatory Care Reporting System (NACRS), 2003‒2016, Ontario Ministry of Health and Long-Term Care, IntelliHealth Ontario Retrieved from
https://www.publichealthontario.ca/en/dataandanalytics/pages/opioid.aspx
2Discharge Abstract Database (DAD), 2003‒2016, Ontario Ministry of Health and Long-Term Care, IntelliHealth Ontario Retrieved from
https://www.publichealthontario.ca/en/dataandanalytics/pages/opioid.aspx
3Ontario Opioid-Related Death database, Office of the Chief Coroner for Ontario Retrieved from
https://www.publichealthontario.ca/en/dataandanalytics/pages/opioid.aspx
4Regional HIV/AIDS Connection and Middlesex London Health Unit
5Supervised Injection Services Feasibility in Middlesex-London, Middlesex-London Board of Health, Report No. 005-17 Retrieved from
https://www.healthunit.com/uploads/2017-02-16-report-005-17.pdf