What is the Program?

keepSIX is a supervised consumption service (SCS) in Toronto, located at the South Riverdale Community Health Centre (SRCHC). keepSIX is staffed by a multidisciplinary team including registered nurses, health promoters and harm reduction workers. It is part of a multi-service, multidisciplinary community health centre and is an extension of the COUNTERfit Harm Reduction Program, which offers a variety of harm reduction services.

keepSIX is a health service where people inject, snort or orally consume pre-obtained drugs in a safe, hygienic environment under the supervision of trained staff. This helps individuals to use drugs safely and securely without the fear of arrest or accidental overdose. The program also provides other services including primary care, education, counselling and health promotion. In addition, it refers people to drug treatment or other health and social services, as needed. Supervised consumption services can reduce the risk of transmitting blood-borne diseases, including HIV and hepatitis C, through use of safe, sterile injection supplies.

Why Was the Program Developed?

More than 9,000 people have died from accidental overdoses in Canada since January 2016 — 2,000 of them in the first half of 2018 alone, according to the Public Health Agency of Canada. In their community, SRCHC have seen rising overdoses and overdose deaths in recent years. In a 2014 study, SRCHC found that one in 10 of their harm reduction clients had experienced an overdose in the past six months. In 2017, they distributed over 5,000 naloxone kits.

Canadian and international evidence shows that SCS save lives and improve health. Research also shows that SCS are cost effective and do not increase drug use and crime in the surrounding area.

SRCHC planned and gathered input on a potential SCS for many years. This included consultations with staff, board members, people who use drugs, potential service users and organizational partners. They also did extensive community consultations with local residents, businesses, schools and other community groups, with a majority seeing the benefit of an SCS. A community liaison committee with broad stakeholder representation was created to ensure ongoing communication and engagement with the local community. keepSIX also has a community advisory committee made up of keepSIX service users and other community members who use drugs.

In 2016, the Toronto City Council approved three agencies to add permanent SCS facilities to existing harm reduction services. SRCHC’s service opened on November 27, 2018, after the organization submitted a proposal and got permission from Health Canada to operate under exemption from the Controlled Drugs and Substances Act.

How Does the Program Work?

keepSIX occupies a space on the first floor of the SRCHC, adjacent to the long-standing harm-reduction drop-in office. The service is open on weekdays from 9:30 am to 5:00 pm, with extended evening hours until 8pm on three days. The SCS consists of an intake area, a consumption room and a post-consumption observation (or “chill”) room. The space was designed to reduce stress by being welcoming and inclusive. A large mural on the wall of the post-consumption space was designed and created with service user input and incorporates LGBTQ2SIA and Indigenous imagery.

When they arrive, service users undergo a brief intake assessment process. First-time service users are asked to register and are given an orientation to the service. Service users can access the service anonymously or can use a confidential unique identifier code.

After intake, service users enter the supervised consumption room. The consumption room has three standard booths and one large booth (to accommodate a mobility device and/or more than one person), each with a chair, table, disposal bins and sharps containers. Staff are on hand to provide harm reduction supplies and education, training on safer injection techniques and strategies and more. In the event of an overdose, staff respond using oxygen and stimulation, or naloxone if needed.

After using, service users are encouraged to stay in the post-consumption or “chill” room. This provides a safe, comfortable space where individuals can stay after using and also an opportunity for SCS staff to continue to provide a variety of services and supports. These include:

• substance use and mental health support; informal counselling
• education and health promotion (on a variety of topics, including hygiene and nutrition)
• primary care including wound and foot care
• referrals and access to other programs and services (i.e., social workers, housing workers, hepatitis C treatment, opioid substitution services, detox and drug treatment)
• Indigenous cultural practices and supports

keepSIX is part of a multi-service, multidisciplinary community health centre. This means that many referrals can be made onsite, and in many cases, an individual can be seen immediately by a service provider. Service users have direct access to all of SRCHC’s onsite programs and services (e.g., healthcare, chiropody, seniors programs, midwifery) and established pathways to external services (e.g., treatment, hospitals, legal services, housing).

keepSIX is an extension of the COUNTERfit Harm Reduction Program, which for the last 20 years has offered:

• harm reduction supplies
• group programs (including women’s drop-ins and group programs like art making and cooking)
• mobile services
• satellite distribution locations in the community
• community clean-up and needle patrol
• education and workshops
• memorial services