Setting The first regulated supervised inhalation site (safer smoking room) in North America has opened in Lethbridge, Alberta, as part of a supervised consumption site addressing all routes of consumption. When designing the service, we felt it was important to accommodate not just injection drug use but also inhalation because (1) it is not the method of drug use that kills but the drug itself, (2) all people who use drugs deserve service regardless of their mode of use, and (3) people who use drugs should have the opportunity to use the method with the lowest risk. Intervention We received approval from Health Canada to offer supervised inhalation services in addition to supervised injection services. Based on a European model, we worked with a local commercial heating, cooling, and ventilation (HVAC) company to create rooms with ventilation systems that complied with Canadian health and safety regulations. Outcome People who use drugs by inhalation have repeatedly told us that they want to use indoors and will do so given the option. Since opening the supervised consumption service at the end of February 2018, the response has been overwhelming and both of the inhalation rooms are constantly in use. Implications Supervised inhalation services provide an alternative to public drug use and an opportunity for people who use drugs to engage with harm reduction services. Other supervised consumption services in Canada may also wish to pursue exemptions for this service. Résumé Lieu Le premier site réglementé d'inhalation sous supervision (fumerie à moindre risque) en Amérique du Nord a ouvert à Lethbridge, en Alberta; il fait partie d'un site de consommation sous supervision pour tous les modes de consommation. En concevant ce service, nous avons jugé important de permettre non seulement l'utilisation de drogue par injection, mais aussi par inhalation car : 1) ce n'est pas la méthode de consommation qui tue, mais la drogue; 2) les personnes qui consomment de la drogue ont le droit d'être servies peu importe leur mode de consommation; et 3) ces personnes devraient pouvoir utiliser le mode de consommation le moins dangereux. Intervention Nous avons obtenu l'accord de Santé Canada pour offrir des services d'inhalation sous supervision en plus de services d'injection sous supervision. En nous inspirant d'un modèle européen, nous avons travaillé avec une entreprise locale de chauffage, ventilation et climatisation (CVC) à créer des salles dotées de systèmes de ventilation conformes à la réglementation canadienne de santé-sécurité. Résultats Les consommateurs de drogue par inhalation nous ont dit à plusieurs reprises qu'ils veulent consommer à l'intérieur et qu'ils le font s'ils en ont la possibilité. Depuis l'ouverture de notre site de consommation sous supervision la fin de février 2018, la demande est massive, et nos deux salles d'inhalation sont constamment utilisées.

SETTING: Alberta is a prairie province located in western Canada, with a population of approximately 4.3 million. In 2016, 363 Albertans died from apparent drug overdoses related to fentanyl, an opioid 50-100 times more toxic than morphine. This surpassed the number of deaths from motor vehicle collisions and homicides combined.INTERVENTION: Naloxone is a safe, effective, opioid antagonist that may quickly reverse an opioid overdose. In July 2015, a committee of communitybased harm reduction programs in Alberta implemented a geographically restricted take-home naloxone (THN) program. The successes and limitations of this program demonstrated the need for an expanded, multi-sectoral, multi-jurisdictional response. The provincial health authority, Alberta Health Services (AHS), used previously established incident command system processes to coordinate implementation of a provincial THN program.OUTCOMES: Alberta's provincial THN program was implemented on December 23, 2015. This collaborative program resulted in a coordinated response across jurisdictional levels with wide geographical reach. Between December 2015 and December 2016, 953 locations, including many community pharmacies, registered to dispense THN kits, 9572 kits were distributed, and 472 reversals were reported. The provincial supply of THN kits more than tripled from 3000 to 10 000. IMPLICATIONS:Alberta was uniquely poised to deliver a large, province-wide, multi-sectoral and multi-jurisdictional THN program as part of a comprehensive response to increasing opioid-related morbidity and mortality. The speed at which AHS was able to roll out the program was made possible by work done previously and the willingness of multiple jurisdictions to work together to build on and expand the program.KEY WORDS: Fentanyl; take-home naloxone; harm reduction; opioid overdose La traduction du résumé se trouve à la fin de l'article.

Due to a recent increase in opioid overdoses in Canada, new harm reduction strategies are emerging. One of these strategies is take-home naloxone (THN) kits for individuals who use drugs being released from correctional facilities. Given the efficacy of naloxone for overdose reversal, the distribution of this medication to drug users upon release from incarceration has the potential for an impact on the incidence of drug-related death among this population. This group is at risk of overdose post-release due to lowered opioid tolerance and drugs of unknown strength. In this article, we report on the findings of a THN kit program for newly released inmates. This pilot project embodied a strong collaborative spirit between a provincial corrections facility and a not-for-profit harm reduction agency. Due to the success of this pilot project, this program was rolled out provincially in correctional centres across Alberta, overseen by the provincial health authority.

Background Peer assistance is an emerging area of study in intravenous drug use. When Canada’s first supervised consumption site (SCS) opened in 2003 in Vancouver, BC, clients were prohibited from injecting their peers; only recently has this practice been introduced as a harm reduction measure at these sites. In Alberta, a government-sanctioned SCS recently received federal exemption to allow peer-assisted injection in their facility, under the Controlled Drugs and Substances Act. Literature pertaining to peer-assisted injection, while scant, addresses several topics: interpersonal relationships between the injector and recipient; the roles of ritual and pragmatism; and gender inequality. Methods In this qualitative, descriptive study, participants were interviewed about their experiences in a peer-assist program at an SCS regulated by Health Canada. Results Participants expressed being moved by compassion to help others inject. While their desire to assist was pragmatic, they felt a significant burden of responsibility for the outcomes. Other prominent factors were social connection, trust, safety, social capital, and reciprocity. Participants also made suggestions for improving the peer-assist program. Conclusions These findings reveal the humanity within a cohort of at-risk individuals, often dehumanized at the societal level. Relational equity and mutuality were evident, in contrast to other studies. Regular use of the SCS, and access to its resources, enabled participants to make healthier choices and practise lower-risk injections. At the federal level, there is considerable room to advocate for allowing clients to divide drugs safely within the SCS, and to increase capacity for safer alternatives such as inhalation.