How can supervised consumption services and overdose prevention sites better meet the needs of racialized women and gender expansive people?

Supervised consumption services (SCS) and overdose prevention sites (OPS) are proven to reduce harms and save lives. However, certain communities like racialized women and gender expansive people (e.g., transgender, gender nonconforming, non-binary and Two-Spirit people) can encounter barriers to accessing these services. To find out what is needed to make SCS and OPS more accessible to these communities, CATIE spoke with Cassandra Smith, knowledge translation lead at the Dr. Peter Centre.

What are some barriers to SCS and OPS that racialized women and gender expansive people report?

One barrier I hear consistently is lack of safety. This could be in terms of not feeling safe accessing a site because there are men who also use it or hangout nearby. It could also be feeling like you’re under surveillance when you go to a site, whether that’s because there are police nearby or because you feel like staff at the site are policing the space. Any presence of police or feeling of surveillance leads racialized women and gender diverse people to feel threatened and generates a sense of mistrust of the SCS.

Another barrier is lack of privacy and anonymity when accessing sites. When we look at how some services are built, you see a beautiful centre, a sign, a door that opens straight onto a main road, sometimes a glass door that you can see right through. SCS and OPS might be in places where people go to access other services, like their family doctor, a senior’s program, or a food bank. That can be great because it makes the SCS convenient and accessible. But there’s a lot of stigma, fear and misunderstanding around substance use and this can be even more pronounced in racialized communities. So, I have heard people saying things like: “You’ll never catch me going somewhere like that. Somebody’s going to see me, somebody’s auntie or a neighbour, and they’re going to tell my family.” That’s a legitimate fear because drug use is associated with a lot of shame on your family, which can sometimes be dangerous and lead to a lot of isolation.

Can you give some examples of how SCS and OPS can respond to the needs of racialized women and gender expansive people?

Having an SCS or OPS specifically for women and gender expansive folks is something we’ve seen work well in places like Vancouver and Hamilton because these sites create spaces that are just for us. It provides opportunities to address needs around safety and prevent people from feeling like they’re under surveillance. There needs to be more SCS and OPS like these for women and gender diverse populations across Canada.

Existing services can adapt to better respond to the needs of racialized women and gender expansive people, but it’s complicated because resources are so limited, and services need to work within a lot of different regulations and limitations. Right now, adapting to meet these needs might involve recognizing that safety for some people might not involve using a formal SCS or OPS at all.

We often find that racialized women and gender expansive people would rather visit a less formal satellite site where they can get supplies and use with someone they trust, or stay safe by spotting each other or using a virtual overdose prevention hotline. Giving people access to a range of options that can help them stay safe can help service providers build trusting relationships with racialized women and gender expansive folks.  

How would you design an SCS or OPS specifically for racialized women and gender expansive people?

I think there are a few things you need before you even consider designing something specifically for racialized women and gender expansive folks. First, you need leadership and staff that reflect the communities you’re trying to serve. This is critical so that people feel connected, and they recognize that the space has been built by people who understand their community, their history, their priorities and their concerns. Second, you need to understand systemic barriers, meaning the history that Black and Indigenous peoples have with healthcare and the deep mistrust of the healthcare system that many people feel as a result.

I think once you have those factors in place, you need to be really creative and try new things, because what we have now isn’t being taken up by racialized folks or women and gender expansive people. We know what’s not working and we know why it’s not working. So, I think we need to create a new kind of space that doesn’t look like anything that’s out there right now.

For Black communities, maybe this could involve talking with business owners or faith leaders to see if there’s an opportunity to collaborate and build spaces that people will want to use. For example, maybe an SCS could be connected to a barbershop or hair salon, or maybe in the basement of a church – something like this could help people feel more comfortable walking in because it doesn’t explicitly signal drug use or have all the stigma attached to it.

But to get to the point where we could envision something new that meets our needs, we need to start talking about drug use in our communities. We need to address myths and misconceptions that community members, business owners and faith leaders may have about substance use and harm reduction. This is an essential first step if we want to get them to a place where they can imagine, understand and support SCS and OPS for racialized women and gender expansive folks.

To learn more about barriers that women and gender expansive people face to accessing SCS and OPS, read the Holding and Untangling: National Survey Report.

Cassandra Smith is a mother, harm reductionist, facilitator, advocate, researcher, and former manager of harm reduction and community engagement at the Black Coalition for AIDS Prevention. She has over nine years of experience providing health promotion and harm reduction expertise to diverse communities, as well as leading harm reduction teams. As a public speaker, she shares her personal lived experience and expertise being a racialized woman navigating systems such as the criminal justice and healthcare systems, as well as harm reduction and mental health services. Alongside Health Canada, Cassandra represented civil society organizations in the Canadian delegation at the United Nations 65th and 66th Commission on Narcotic Drugs in 2022 and 2023.