McMaster researchers have found that a space in Hamilton for women and gender diverse people who use drugs is saving lives through its holistic, wraparound supports.
Their research, published in the journal Health & Place, shows that the safer-use space (SUS) at the YWCA Hamilton reduced the harms associated with opioid and toxic drug crises, particularly for people whose gender makes them more vulnerable.
The key to helping women and others using drugs is SUS’s “therapeutic landscape” that supports overall health and well-being.
The bright and welcoming space offers wraparound services like addiction counselling, peer support, legal services, hygiene and reproductive health supplies, and housing services.
The holistic integration of the social, built, and symbolic environments that characterize the SUS address multiple needs for users, making the safer-use space successful, says health geographer Allison Williams, a professor of Earth, Environment and Society and the Tier 1 Canada Research Chair in the Care Economy, Aging and Policy.
“Many of the women and gender diverse people using this space have intersectional representation across multiple vulnerabilities — they’re all homeless, they all use drugs, and many of them come from diverse marginalized backgrounds,” says Williams, who co-authored the paper and supervised recently graduated student Xin Ke Law-Gallagher.
“The space gives clients a sense of control and agency by protecting them from violence and stigma as well as drug overdose,” says Williams. “It’s a de-medicalized environment that serves as a place of respite, oasis, and sanctuary where they can actually be themselves and not necessarily be judged or stigmatized for who they are.”
The safer-use site was established in April 2022 in response to an urgent public health need designation from Health Canada because there were an average of seven 911 calls a week being made for drug poisonings and overdoses in and around the building at MacNab and Hunter Streets.
Open only to clients of the YWCA, it’s one of just two gender-specific safer-use sites in Canada.
Since opening, there have been zero deaths at the site, with just seven calls to emergency services during that same time. The SUS has served more than 500 unique individuals, with more than 7,000 visits overall.
Researchers say the gender-specific nature of the SUS is a crucial component of its success, as women and gender-diverse individuals who use drugs are more likely to experience gender-based discrimination, aggression and violence.
Societal judgment is also a factor, says Mary-Elizabeth Vaccaro, a lecturer in the Department of Social Work and the third co-author on the paper.
“Women and gender-diverse people who use drugs experience pervasive stigma shaped by gender and morality and ideas about what’s right and what’s wrong in a way that is different from what men experience,” says Vaccaro.
“That type of stigma manifests in the ways that they access services, whether they’re mothers or pregnant or working in the sex trade.”
Accessible health care for a vulnerable population
“Safer Use Space means I have a completely safe, clean and non-judgmental place to use and not have to worry about being robbed, raped, kidnapped or left for dead,” wrote one client.
Another person wrote about the value of having staff on-site who understood their lived experience as drug users and expressed interest in taking a course to become a peer support worker.
The SUS provides tangible evidence for legislators and policy makers that closing safer-use spaces and safe consumption sites will directly harm an extremely vulnerable population, Williams says.
“When we talk about the idea of health promotion as outlined in the 1986 Ottawa Charter for Health Promotion, the research evidence we’ve gathered on the SUS addresses three of the key action areas in the Ottawa Charter: ‘building healthy public policy’, ‘creation of supportive environments’, and ‘reorienting health services.’ ” says Williams.
“It’s making health-care services more accessible for an extremely vulnerable population. It’s providing evidence for why we don’t want to be closing this space and others like it.”
The SUS continues to operate in the absence of government funding and finding ways to finance operations remains a challenge, says Chelsea Kirkby, vice-president of Strategic Initiatives and Program Development at YWCA Hamilton.
“What started as a place to have staff available while you’re using has turned into something much greater and much larger in terms of what it means to the community,” says Kirkby.
“It is truly lifesaving. People often think of these spaces as only offering supervised consumption, but it’s so much more than that: It’s a place where women and gender-diverse individuals can come to feel connected and safe without the threat of violence or sexual assault or whatever drug-related harm they might experience outside of the space.
“The wraparound supports and the relationships of trust that are built with our staff are key parts of this.”
Misconceptions about how safer-use spaces operate in conjunction with treatment and recovery are contributing to an increasingly difficult political landscape for ensuring their ability to operate, says Vaccaro.
The site is supporting people who use it through an entire continuum of care, including pathways to detox and treatment and diverting calls to emergency services, she says.
“Drug use isn’t something that’s going away, but when we push spaces like these out of our communities, we’re not doing anything to stop drug use in spaces that weren’t designed for people to be using drugs, whether that’s public bathrooms, libraries, or places like that. Closing these spaces has a huge ripple effect across society.”