A total of 23 participants representing 21 different businesses or similar organizations were interviewed, and their demographic information was collected (Table 2). No participant was removed from analysis
Negative incidents for businesses within and outside 100 m of an SCS
Participants with businesses more than 100 m away from an SCS were more concerned with individuals using substances in bathrooms (44.4%) compared to those within 100 m of an SCS (16.7%) (Fig. 1). Businesses 100 m away from an SCS were also more concerned with human waste on the ground (22.2%) than those near an SCS (16.7%). This was also true for threats where those near an SCS were affected by this more (14.3%) than those further away (9.5%). In all other instances, those within 100 m of an SCS had higher levels of concern than those further away from an SCS, especially in the case of needles (66.7%) and drug-related garbage (58.3%) on their property, people using substances beside their property (58.3%), and general garbage (50%).
[Insert Fig. 1 here] Fig. 1: Negative incidents experienced by businesses within and outside 100m of a Supervised Consumption Site (SCS). n = 21
Table 2
Demographic information of the participants.
N | 23 |
Median age | 40 |
Gender |
Men | 6 (26.1%) |
Women | 17 (73.9%) |
Province |
British Columbia | 3 (13.0%) |
Alberta | 5 (21.7%) |
Saskatchewan | 1 (4.4%) |
Manitoba | 1 (4.4%) |
Ontario | 7 (30.4%) |
Quebec | 2 (8.7%) |
Novas Scotia | 3 (13.0%) |
Yukon | 1 (4.4%) |
Community type |
Urban (> 100K) | 15 (62.2%) |
Medium (10-100K) | 8 (34.8%) |
Present at business before the SCS was established |
Before | 14 (60.9%) |
After | 9 (39.1%) |
Median years in the community | 30 |
Median years at the business near the SCS | 8 |
Median years at the business before the SCS was established | 7 |
Theme 1: Diversion from SCS would be helpful for often overburdened SCSs but could also reduce public substance use
Most participants agreed that overdose response hotlines and apps would be beneficial if they could help divert PWUS from the local SCS, but their reasoning for this varied. Those who supported harm reduction considered their local SCS to be overburdened and low on resources necessary to accommodate the large volume of clients. There was a perception that PWUS from other cities or neighbourhoods would occasionally move to an area with an SCS specifically to access new harm reduction or social supports, further burdening the local SCS. Most believed that overdose response hotlines and apps would benefit an SCS and the surrounding neighbourhood by diverting any SCS clients suitable for the use of these virtual platforms (i.e. has technology like a phone or smartphone as well as a home), as then the SCS could better serve higher-risk, unhoused populations.
I'm guessing [the SCS] have to deal with a lot of people who are in distress, so if there are more resources for people who are in distress, this would affect them very positively- Participant #23, man, aged 32, Quebec
“…I know that they were very surprised at the [SCS] at the amount of people with standard social lives using their services. They keep telling me it's really impressive to know how many people are drugging themselves but are very functional and have a regular life and come here because either they're hiding it from their family or whatever, or they just need a safe place to go for that.”- Participant #22, woman, aged 32, Quebec
Another major concern associated with working or owning a business near an SCS was the disruptive behaviours occurring near the facilities. Participants reported a similar experience of how PWUS would congregate outside the SCS and create an informal community gathering space and marketplace where loud arguing, physical violence, open substance use, intoxication, prostitution, and drug trafficking took place. Other participants mentioned that being near the main walking route to the SCS could put their business at higher risk for unwanted attention or crime.
“But the congregation makes it like a community of people hanging out, everyone sharing drugs. Everyone knows each other. It's like what happens around this injection site is it builds a community. It even builds a community with the people who work there because you can't work side by side with people, see them on a daily basis and not develop some sort of rapport. So I don't want to say it becomes a party, but it becomes a hangout. It gives them a place to go and where they can do their drugs. And for the drug dealers, it's a gold mine… I like the idea of [virtual harm reduction services] because it would keep people apart from one another, which to me is where [the] brawls come”. - Participant #16, woman, aged 40, Ontario
“You see a gang of people usually hanging out there. Then there's another area not too far, maybe a five-minute walk where the homeless shelter is and people gather there. I don't believe it's open during the day, so they just kind of gather on the sidewalk there.” - Participant #19, woman, aged 26, Nova Scotia
“I think it's only positive. So if it's able to help people to the degree that these other sites are, then giving people more access outside of having to go to these places is going to help them theoretically, and it's going to help us because it's going to make it not so much of a congregation.” - Participant #9, woman, aged 56, Ontario
“It would depend on how many people are actually using them, and then not having to go to the actual location. We get to that point where there is a reduction of physical bodies going to a location and throwing their litter everywhere along the way. So do I think it could: absolutely.” - Participant #13, woman, aged 43, Ontario
Theme 2: Bathroom access has been a common source of conflict between PWUS and business community members
Many participants shared daily encounters with PWUS using or seeking access to a business bathroom. The source of concern for business owners was fear of PWUS using substances in the privacy of the bathroom, which could lead to distressing overdose situations. Other concerns included the victim being locked in the bathroom or performing first aid on a person who was undressed. Secondary concerns were related to finding substance paraphernalia, like needles, in washrooms, as well as occasional PWUS aggressively demanding access to the bathroom, both of which were frightening for staff and customers. This was especially true when someone had overdosed in the bathroom and staff were locked out.
“People inject in our bathrooms or on our grounds, and then they become unconscious and require some kind of monitoring or something.” - Participant #3, man, aged 59, Alberta
“They’re almost a daily occurrence that we have folks using in our restrooms and have been the case for as long as I can remember.” - Participant #10, woman, aged 34, Alberta
“...but they had passed out, taking all their clothes off in the bathroom and then we couldn't get the door open so we just called the police.” - Participant #9, woman, aged 56, Ontario
Human waste on the property was another issue faced by businesses. Most incidents occurred on the exterior of the building or when people secretly entered overnight. A few participants noted that denying PWUS a bathroom had occasionally resulted in them passing waste publicly in the store. The staff were shocked and distressed to find, witness, or clean the mess.
“We had a gentleman come in the other day screaming at us to use the washroom and somebody was in it. And so he just took his pants off and went to the bathroom on the floor. [...] We can't keep our staff for very long because we're constantly turning over staff. If they have one of those experiences, a lot of them don't want to come back to work, which is understandable.” - Participant #9, woman, aged 56, Ontario
Theme 3: Public disruption from substance use and overdose events have been on the rise in most communities across the country, and litter associated with substance use has been difficult to manage
All participants felt that substance use, especially publicly visible substance use, had been increasing over the years. All participants acknowledged substance use was a regular occurrence in any community. Thus, they usually compared the level of public substance use in their business neighbourhood to their approximation of a community-wide average as a baseline of acceptability. Many participants felt there was a specific period when the prevalence of substance use began to increase, with the two main responses being sometime during the COVID-19 pandemic (March 2020-March 2022 in Canada) or immediately after the SCS opened.
“Where I work, it's quite rampant. It's extremely rampant. Actually, it's a lot more than what I was used to living in a different province” - Participant #7, man, aged 26, BC
“But you know, as COVID, reared its head, open drug use and severity of street drugs became a major issue” - Participant #4, man, aged 47, Alberta
“What I've observed in the last four years is that it's gotten much worse. Substance use has gotten more exposed during the day compared to maybe four or five years ago, I didn't see much substance abuse during the day.” - Participant #23, man, aged 32, Quebec.
An increase in litter, particularly substance-use litter such as needles and paraphernalia, was seen as being highly connected to the local SCS. The most common complaints voiced were that substance-use litter was dangerous, especially for children playing in nearby green spaces, which created concerns around neighbourhood safety. Others had provided or were seeking to provide sharps disposal containers in their business or bathrooms, but there were mixed results if PWUS used them or not.
“ There's uncapped needles that are being used and just discarded wherever. I have a friend whose son is doing 3 months of blood work because he thought it was a pen. And he picked it up. I have another friend whose son is nonverbal autistic. He can no longer go [to the park] because he doesn't understand that he can't touch needles, and he puts everything in his mouth.” - Participant #20, woman, aged 36, Saskatchewan
“A lot of people using a lot of sketchy looking activity, we find needles in our parking lot on the street.” - Participant #1, man, aged 39, Alberta
“... the exterior of the building is probably one of our biggest challenges, given that there's graffiti, things are getting broken into, there's garbage and it's littered with needles and drug abuse paraphernalia that we clean daily. There's beer bottles left around, feces from people defecating, condoms.” - Participant #18, woman, aged 66, Nova Scotia
“We’ve had a lot of that or people when they come and use drugs leaving needles in the garbage, even though we provided a place for people to put needles in to try to keep the team safe, but it doesn't really help.” - Participant #9, woman, aged 56, Ontario
While most stated that needles and other paraphernalia had increased in the surrounding neighbourhood, some stated a noticeable decrease in the litter after the SCS opened.
“But when we do our lot walks and stuff, you know, came in conversation like ‘hey, did you guys notice like there's not as much sh*t around anymore.’” - Participant #6, woman, aged 61, Yukon
"But yeah, since the safe injection site has come around, it's like super quiet. Like we we even have less litter." Participant #14, woman, aged 41, Ontario
Theme 4: Business owners felt compassion fatigue when encountered with PWUS
Business members who were most negatively affected by PWUS mentioned that they felt sympathy for PWUS, but they were mentally and physically tired of interacting with them during negative encounters.
“It's so unfortunate, but it doesn't even make you sad anymore. It just makes you so pissed off. I'm a pretty empathetic person and what happens is it makes you lose your empathy and you start to dehumanize people” - Participant #9, woman, aged 56, Ontario
“I feel gross coming out from a financial perspective, but I feel like it does have a negative impact on this [...] I think there's some, not really compassion fatigue, but some kind of, ‘it's draining to be surrounded by that all the time.”- Participant #1, man, aged 39, Alberta
“Distressed behaviors, I'm quite used to nowadays, but I do worry again for younger people or children witnessing those. Because it might scare them and I just don't think it's right for the people to feel fearful just going about their daily lives”- Participant #11, woman, aged 55, Ontario
Theme 5: Views around harm reduction services were mixed by community members.
Most participants favoured harm reduction services and stated that more were needed in the community.
“I think by always having workers around it prevents a lot of bad things from happening ahead of time, and if there weren’t workers around, there would be so many instances where you'd find somebody in harm's way without the right medical attention.” - Participant #7, man, aged 26, BC
“I wish there was a lot more of [harm reduction services]. I mean, there's obviously a ton of need in this neighborhood. Like you could see that just from walking around, so if anything, I just wish that there was more.” - Participant #12, woman, aged 35, Ontario
“I think it's good. I think that maybe they have an opportunity to get other help there or at least get in contact with somebody who can maybe offer them some services that they might not get when they're shooting up behind a car” - Participant #6, woman, aged 61, Yukon.
“Whereas if people aren't being supervised at the site, there is more likely that death can occur and people are just found in parks or their needles and stuff could be left in parks and places like our business. So I think these safe consumption sites are… there should be more personally.” - Participant #8, woman, aged 40, Manitoba
“If that's where they are in their journey and really focusing on helping people where they're at and hopefully eventually getting the help that they need.” - Participant #10, woman, aged 34, Alberta
Some businesses also had positive views towards SCS as they reduced the amount of litter around the business.
“Since the safe injection site has come around, it's like super quiet [...] Like we even have less litter.” - Participant #14, woman, aged 41, Ontario
“Our parking lot used to be an ad-hoc consumption site. People were using in our parking lot all the time, and they are not as much anymore.” - Participant #12, woman, aged 35, Ontario
Some community members mentioned that harm reduction saves lives but also had negative perspectives towards these services as they could allow individuals to live distressed lives.
“When we see the state of the people that are coming in there, they're not even alive humans anymore. They are so gone and in such a horrible state. I don't know if providing places for them to continue to do safe drugs…I don't know what “life” you're providing for somebody” - Participant #9, woman, aged 56, Ontario
“You're not going to be [Interested in changing] if you have a place to go every day where everyone gets together and pools their pills or whatever it is, and they all can do drugs together.” - Participant #5, woman, aged 49, Nova Scotia
Theme 6: Virtual harm reduction services were seen as additional and valuable tools, particularly for those with phones or underserved areas with disadvantages like only being available for those with phones and no immediate help available
Most participants were in favour of overdose response hotline and app services and believed that the potential negative impact on healthcare and EMS services would be low.
“Well, it gives people a chance to call them if they decide to. It gives people an option. If you get the right person on the other end of the line, maybe somebody could connect with you in a way that makes you have some type of revelation.” - Participant #5, woman, aged 49, Nova Scotia
“We have a positive impact again, just that there's more resources and that net to support people and catch them as they overdose and catch them as stuff is going awry. It’s better because I do think it's an issue of scale. There is so much out there happening that the resources we have in place right now aren’t sufficient to address the issues of the neighbours.” - Participant #1, man, aged 39, Alberta
“Sounds great. An app that you could just use to contact assistance that isn't 911 or an emergency call would be great [...] You wouldn't have the ambulances going all the time. You would have more programs assisting with that” - Participant #3, man, aged 59, Alberta
“100% positive. They're literally helping people connect to services and help” Participant #14, woman, aged 41, Ontario
“But my hope is also to see people heal from their cause of addiction- as a former addict myself. I mean because of these apps, people can ensure their safety and overdose prevention.” - Participant #20, woman, aged 36, Saskatchewan
“They take some calls off [Emergency Services] shoulders that they aren't equipped to handle.” - Participant #1, man, aged 39, Alberta
Participants also stated that these services are better suited for those with homes and access to cell phones who use drugs recreationally or secretly. Stigma was also seen as important for those who have their own place of residence compared to those who live in shelters.
“You would never have thought that person who used drugs had a proper job, at a house, and family and all the stuff. I think that there may be some stigma about people going to a [SCS] that not everybodyl will feel comfortable going there. And so if [virtual harm reduction services] is one way that they could protect themselves, then it should be made available to people that want to use it.” - Participant #6, woman, aged 61, Yukon
“That's sort of what I was saying with the people that are not using drugs [regularly] and they're using them recreationally. Yes, I think there's stigma. They're not going to go to [an SCS] necessarily” - Participant #9, woman, aged 56, Ontario
“But people that live further from an available site or people that for whatever reason don't want to access those sites. I think it would be great for them to have an option” - Participant #12, woman, aged 35, Ontario
“Maybe this would be more of an advantage for people, especially within the pandemic or after the pandemic that we were just in. It's literally meeting people where they're at, which is my description of harm reduction. So it's being creative with the ways to connect with folks.” - Participant #2, woman, aged 36, Alberta
Despite some optimism about virtual overdose prevention services, business members were simultaneously sceptical about the effectiveness of virtual harm reduction services. This was due to the inaccessibility of technology and the benefits that physical harm reduction sites provide, such as wound care.
“I think the first disadvantage is what I previously said about a lot of vulnerable people that don't have access to a phone.” - Participant #17, woman, aged 26, Ontario
“So like a lot of addicts that utilize [SCS] don't have phones. They don't have phones or tablets or anything to access these so I mean, there needs to be a way for people to access these apps who don't have phones.” - Participant #20, woman, aged 36, Saskatchewan
“For a lot of people having access to data and a phone and all these things. It seems like it's quite easy for our regular, like my demographic, but for a lot of the people, especially the houseless folks, it's not as easy.” - Participant #7, man, aged 26, BC