Satellite Sites: Providing harm reduction from the homes of people who use drugs

The term “satellite sites” is used to refer to informal harm reduction hubs operating out of the homes of people who use drugs. Operating in Toronto for more than 20 years, these sites offer access to sterile drug use supplies outside of more formal settings like health centres. Although many satellite sites offer much more than this – including naloxone and overdose response training, needle disposal and referrals to healthcare services. Satellite programs emerged from the recognition that people who use drugs were already doing this work within their communities, operating informally to meet harm reduction needs and respond to a range of other health needs.

As it has been the case with many other harm reduction initiatives (naloxone distribution, needle and syringe programs and supervised injection sites), people who use drugs forged these models in response to the neglect from healthcare institutions and the barriers they confront when accessing existing services. Satellite programs aim to support these informal mutual aid networks by offering support, recognition and remuneration for this important work.

Parkdale Queen West Community Health Centre and South Riverdale Community Health Centre have both been operating a harm reduction program called Satellite Sites for more than 10 years. We recently created a program guide based on our experience operating these sites.

Why Satellite Sites?

We need programs that address structural barriers people face when accessing services. Many people cannot or choose not to access harm reduction services at health centres or more traditional settings because of stigma, lack of privacy or concerns around criminalization. Satellite sites are a way of addressing some of the structural barriers that prevent people from accessing what they need.

We need more overdose prevention in residential settings. Across Ontario, 76 percent of people who died from opioid overdose between July 2017 and June 2018 were in a private residence at the time. People are more likely to use alone in residential settings and there is a lack of overdose prevention initiatives in private homes. Satellite sites are a way of filling this gap.

We need to scale up responses led by and for communities of people who use drugs who are most affected by the drug war and the overdose crisis. Women of all backgrounds and racialized people – particularly Black and Indigenous community members – are disproportionately targeted for criminalization and policing and are less likely to access traditional harm reduction services. Satellite sites provide discreet and community-based harm reduction access points for marginalized and criminalized people who can’t safely access mainstream or traditional harm reduction services.

Satellite programs are adaptable and transferable to less connected settings and communities. Satellite programs offer a model that could be easily applied to rural, remote or other non-urban settings. Satellite programs can also be tailored to the needs and contexts of specific communities that are often disconnected from existing health or harm reduction services (for example, gay and queer men who use drugs at party and play or in chemsex settings).

Integrating HIV and hepatitis C prevention with overdose response programs is more effective. HIV and hepatitis C prevention is not always the top priority of community members who need to focus on subsistence and survival, or who are in the midst of contending with the ongoing devastation of the overdose crisis. Satellite workers are trained to offer information about HIV and hepatitis C that is embedded in peoples’ realities and drug use practices. Integrating these priorities is more effective and enables programming that speaks to the specific needs and preoccupations of people who use drugs.

We need to be able to get information out quickly. Sharing information quickly about bad batches of drugs circulating in particular areas, for example, can be critical and life-saving, and satellite workers are especially well placed to access people who are harder to reach through regular communication channels. Satellite sites are also a great way to gain information about what is happening in community (for example, drug trends) to inform service delivery.

Satellite sites present an adaptable model that can be responsive to emerging health crises, such as the novel coronavirus disease (COVID-19). When COVID-19 hit, many services and programs shut down, leaving the burden of responsibility on communities of people who use drugs to continue to respond to intersecting health crises. Satellite sites continued to operate, shifting their service delivery model (where possible) to door service with necessary precautions, supply drop-offs and witnessing injection or use remotely through phone or video chat.

Years into the overdose pandemic, we must recognize and support the labour of people who use drugs in shouldering this crisis. Too often, the labour of people who use drugs, whether formal or informal, is not recognized or sufficiently valued. People who use drugs are experts on drug use and harm reduction, particularly in their homes and other community and residential settings. As community agencies, we must recognize the central role that people who use drugs play in the provision of critical and life-saving services to friends and neighbours. This includes proper compensation and support. Satellite programs offer some initial steps toward more meaningful engagement.

A guide to help you in your outreach

Harm Reduction Satellite Sites: A Guide for Operating Harm Reduction Hubs from the Homes of People Who Use Drugs captures our experience operating these programs. We gathered these learnings in the hope that they will be helpful for community-based service providers who would like to develop similar programming, or explore other models of providing health and harm reduction services to people who use drugs, particularly in residential and other community settings where they are most needed.

It includes things to consider when setting up satellite programs, including evaluation of needs, recruitment and promotion. It provides an overview of different models for running a satellite site and necessary resources and trainings. The program guide also details how to support people who use drugs who operate satellite sites, including support with tenancy, criminalization, grief and loss, safety and privacy.

Satellite programs are not only effective health initiatives for people who use drugs, but a tool to build community power. Initiatives such as satellite programs that seek to build community power provide a vital mechanism for harm reduction organizations to seek leadership – and learn – from people who use drugs. This program guide is an attempt to capture some of the vast wealth of knowledge among the satellite workers and people who use drugs who have shaped the program and been generous in sharing with us their experience.

Liam Michaud has worked in Montreal and Toronto in harm reduction for roughly 15 years, providing support to prisoners, conducting outreach and mobile case management, and developing outreach programs in street, residential and shelter settings. He has organized alongside the Association Québécoise pour la promotion de la santé des personnes utilisatrices de drogues (AQPSUD) and the Toronto Overdose Prevention Society. Liam has experience in program evaluation and qualitative and community-based research. He is currently a PhD student in socio-legal studies at York University, focusing on drug policy.

Gillian Kolla is a postdoctoral research fellow at the Canadian Institute for Substance Use Research, University of Victoria. She conducts community-based qualitative and ethnographic research to examine how to make health and social services more accessible to people who use drugs. Gillian is also a member of the coordinating committee for the Toronto Overdose Prevention Society, which opened and ran Ontario’s first overdose prevention site in Moss Park as a volunteer initiative in 2017-2018 as part of a community-led response to overdose deaths.

 Rhiannon Thomas has been working in harm reduction in Toronto for almost 20 years in drop-ins, shelters and community health centres, offering case management, trustee support, needle exchange and outreach. She is a founding member of the Toronto Harm Reduction Alliance and the co-chair of the Women’s Harm Reduction International Network. She is currently coordinating the COUNTERfit Harm Reduction program at South Riverdale Community Health Centre.