“Drugs don’t have age limits”: The challenge of setting age restrictions for supervised injection facilities

Abstract

Aims: People under age 18 who inject drugs represent a population at risk of health and social harms. Age restrictions at harm reduction programmes often formally exclude this population, but the reason behind such restrictions is lacking in the literature. To help fill this gap, we examine the perspectives of people who use drugs and various other stakeholders regarding whether supervised injection facilities (SIFs) should have age restrictions. Methods: Interviews and focus groups were conducted with a total of 95 people who use drugs and 141 other stakeholders (including police, fire and emergency services personnel, other city employees and officials, healthcare providers, residents and business representatives) in two Canadian cities without SIFs. Findings: We highlight the following thematic areas: mixed opinions regarding specific age restrictions; safety as a priority; different experiences and understandings of youth, agency and drug use; and ideas regarding maturity, “help” and other approaches. We note throughout that a familiar vulnerability–agency dichotomy often surfaced in the discussions. Conclusions: This paper contributes new empirical insights regarding youth access to SIFs. We offer considerations that may inform discussions occurring in other jurisdictions debating SIF implementation and may help remove or clarify age-related policies for harm reduction programmes.

• Age
• drugs
• harm reduction
• supervised injection facilities
• qualitative research
• youth

Acknowledgements

We are very grateful to our participants who offered their time and perspectives as part of this study. We thank the full Toronto and Ottawa Supervised Consumption Assessment (TOSCA) team including the following co-investigators and team members: Shaun Hopkins from The Works in Toronto; Janine Luce from the Centre for Addiction and Mental Health (CAMH); Patricia O’Campo, Naushaba Degani, Richard Glazier and Jennifer Jairam from the Centre for Research on Inner City Health, St. Michael’s Hospital; Benedikt Fischer from Simon Fraser University and CAMH; Susan Shepherd from the Toronto Drug Strategy Secretariat; Peggy Millson from the University of Toronto; Gregory Zaric from the University of Western Ontario; Christopher Smith from the University of Pennsylvania; Lynne Leonard from the University of Ottawa; Margaret Brandeau and Eva Enns from Stanford University.

Declaration of interest

This project was funded by the Ontario HIV Treatment Network. Dr Bayoumi was supported by a Canadian Institutes of Health Research/Ontario Ministry of Health and Long-Term Care Applied Chair in Health Services and Policy Research. For the first two years of this study, salary and infrastructure support for Dr Strike were provided by the Ontario Ministry of Health and Long-Term Care.

The views expressed in this article are those of the authors and no official endorsement by supporting agencies is intended or should be inferred. The authors report no conflicts of interest.

Notes

¹People who smoked crack cocaine were included because the larger study addressed research questions pertaining to supervised smoking facilities in addition to SIFs.