Dr Hannah Carver was awarded an SSA travelling scholarship to visit harm reduction services in Canada that are ‘either limited or non-existent’ in the UK, including drug checking services, drug consumption rooms, and managed alcohol programmes. Here, she blogs about her trip – the people she met, the interventions she witnessed, and what she learned about harm reduction.
I’m a Senior Lecturer in Substance Use at the University of Stirling, Scotland, and my research over the last few years has centred on harm reduction interventions that are common across Canada, but either limited or non-existent in Scotland. I was awarded an SSA travelling scholarship to visit British Columbia, Canada, to explore drug and alcohol harm reduction approaches, develop my own expertise, and build my international networks. This travelling scholarship allowed me to visit several services to understand how they work in practice, and to bring back my learning to inform work in Scotland.
Shipping containers and supervised consumption
My journey to British Columbia began on 11 May 2023. After a long journey from Edinburgh, via London Heathrow, I arrived in Vancouver. I spent a day and a half exploring, took the ferry over to Victoria, on Vancouver Island, and arrived at my Airbnb – my home for the next two weeks.
On my first day in Victoria, I met up with researcher Bruce Wallace, who took me to visit The Harbour – Victoria’s only sanctioned drug consumption room. It’s a busy service with around 160 people visiting per day. We met some staff and service users and saw both the injecting and inhalation rooms, which were very different. The injecting room was a permanent room in the main building, which was very clinical – set up for about eight people at a time, with a row of mirrors, desks, and chairs for people to inject at. The inhalation room, in comparison, was a shipping container with graffiti over the walls, and a table for people to sit at. I learned that the service will be expanding the main building to accommodate the inhalation room.
[metaslider id=”37071″]Later that day, I visited a cannabis shop and cannabis substitution service run by non-profit organisation SOLID, and a temporary overdose prevention site in an old hotel, which had been turned into accommodation during the early days of the COVID-19 pandemic. The overdose prevention site was simple yet sufficient – a shipping container used for injecting and a wooden hut for inhalation, run by people living in the hotel.
Towards the end of the week, I presented our drug checking research in Scotland to the team at the Canadian Institute for Substance Use Research (CISUR), University of Victoria, and then had the opportunity to visit two drug checking services, which was interesting having spent the last two years reading all about the pros and cons of different types of drug checking equipment.
The team at Substance, Victoria’s drug checking service, uses fentanyl test strips, Fourier transform infrared spectroscopy (FTIR), and paper spray mass spectrometry (PSMS). I saw these machines in action, including the different outputs when substances were analysed. I was even able to test a sample (a very complex opioid) using the FTIR, which contained fentanyl, carfentanil, bromazolam, etizolam, sugars, lidocaine, and caffeine.
I also visited an example of a distributed model of drug checking, located in an overdose prevention site 90 minutes’ drive from Victoria in a town called Duncan. The overdose prevention site was much quieter than the service in Victoria, with only one person using the injecting room and around six to eight using the inhalation room outside. To facilitate drug checking, they collect samples from people who use drugs, test them using the FTIR, and send the results electronically to the team in Substance, who analyse and interpret the results, and later re-analyse the samples using the PSMS to give a fuller picture of the substance and its contents.
Cannabis as a way of managing alcohol dependence
In my second week, I presented our research on managed alcohol programmes in Scotland to CISUR staff, and then visited a managed alcohol programme in Victoria – a 10-bed residential service, which recently opened for Indigenous people within a larger residential service called House of Courage. The service includes cannabis substitution, where people can use cannabis as a way of managing alcohol withdrawals. I spoke to several staff and service users, including Marylin, the Elder in residence, who provides support to staff and service users. She talked about the service and the ways in which Indigenous cultural activities are embedded.
Following the visit to House of Courage, I returned to SOLID’s cannabis substitution service, where people who are dependent on alcohol can access free or at-cost cannabis products as a way of managing their alcohol dependence and withdrawal symptoms. I met two service users who talked about the benefits of cannabis substitution and the impact it has had on their lives, including helping to reduce their alcohol consumption, improving their appetites, and enabling them to take better care of themselves.
[metaslider id=”37080″]On the penultimate day of my trip, I gave a talk on Scottish drug policy at the University of British Columbia’s Centre for Health Evaluation and Outcome Sciences, followed by a visit to the Vancouver Area Network of Drug Users (VANDU) to meet with Aaron Bailey and George, a member of the Eastside Illicit Drinkers for Education (EIDGE) group. Aaron and George told me about the services before we walked along to the Drinkers’ Lounge, a non-residential managed alcohol programme, which has a brew co-op where members make their own wine and can swap non-beverage or illicit alcohol for wine. It was great to visit a service that I had read about back in 2018 when we were planning our initial research on managed alcohol programmes in Scotland.
I had a fantastic three weeks in Canada. I met wonderful people, visited amazing services, and learned so much about harm reduction. I also had time to squeeze in stand-up paddleboarding for the first time, hike in the Victoria trails, cycle along an old railway line to the beach, hang out in Beacon Hill Park, and generally enjoy wandering around Victoria. I am very grateful to Bruce Wallace and Bernie Pauly for facilitating my visit, and the CISUR team for making me feel so welcome. My time in Victoria, in particular, will really influence my research going forward.
The SSA travelling scholarship provides up to £2,500 to support travel to international meetings, visit laboratories or clinics, collaborate in research, and engage in further training.
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