Registed Nurses' Association of Ontario


Supervised injection services: New guideline’s recommendations to strengthen life-saving service


TORONTO, Feb. 28, 2018 – As more and more communities open supervised injection services (SIS) to tackle the opioid crisis, new evidence-based recommendations from the Registered Nurses' Association of Ontario (RNAO) will help ensure these life-saving services are delivered effectively, and provide equitable access to people who inject drugs.

RNAO's Implementing supervised injection services best practice guideline (BPG) was released today at a press conference in Toronto. It features 11 recommendations covering a range of topics, including integrating peer workers and health and social services into SIS programming, and aligning future SIS locations and operations to the needs of the local population.

Work on the guideline was first announced in July 2016, the same day Toronto city council approved a board of health proposal to address the city's rising overdose rates by opening Ontario's first SIS programs at three locations in the city. Sadly, opioid overdose numbers have continued to increase across the province. According to Public Health Ontario, more than 850 Ontarians died of opioid-related causes in 2016, up 136 per cent from 2003. These rising numbers have prompted the launch of emergency injection sites, and led other municipalities like Ottawa, Hamilton, Thunder Bay and London to bring SIS into their communities.

"Lives have been cut short and families have been torn apart by overdose," says RNAO President Carol Timmings, who is also chief nursing officer at Toronto Public Health, which operates an SIS program at its Victoria Street site. "Despite these tremendous losses, we are encouraged that SIS are now saving lives in our communities. And we know this robust guideline will help ensure services are implemented in a comprehensive and inclusive way, promoting health equity for people who inject drugs"

SIS are health-care settings where people can inject drugs under the supervision of trained nurses and other health workers who provide sterile supplies, overdose prevention and management, and other health and social services. According to the guideline, SIS are effective when embedded in existing health and social services settings where the physical space and operating hours are tailored to the needs of the local population.

"Nurses have to meet people where they're at, and make these services as accessible as possible if you want to develop trusting and respectful relationships with clients," says Marjory Ditmars, co-chair of the guideline's expert panel and RN at Insite, North America's first legal SIS site in Vancouver's Downtown Eastside. "Working to minimize stigma around drug use, providing non-judgemental care and treating people as experts in their health and health-care decision making are crucial to the work of nurses in SIS."

The guideline recommends that peer workers be integrated into SIS programs, and that people with lived experience deliver SIS education to health-care workers and students. SIS should also integrate other services into their programming, including blood testing, housing and social services, mental health care and primary care, according to the guideline.

"Many people who inject drugs face social and health inequities," says Dr. David McKeown, the panel's other co-chair and a major catalyst in bringing SIS to Toronto during his time as the city's medical officer of health. "To be effective and accessible, SIS must offer diverse programming responsive to their needs."

Like all RNAO BPGs, Implementing supervised injection services was developed using a systematic review of evidence and extensive consultation with the expert panel, which included people with lived experience, as well as RNs and other health professionals with clinical, administrative, and academic expertise. "The rigorous process used to develop the guideline ensures the best available evidence is used to create recommendations health professionals and decision-makers can rely on when delivering this essential health service," says RN Tasha Penney, who led the development of the guideline as implementation manager in RNAO's mental health and addiction initiative.

RNAO CEO Dr. Doris Grinspun notes that “nurses are on the front lines of the overdose crisis and are often the main health-care providers at SIS, thus nurses must influence both the policies and practices of SIS." Grinspun, who gave deputations to the Toronto board of health in 2016 in favour of SIS, adds that "We will continue to work tirelessly to protect the health of people who inject drugs, because their lives are as important as any. We are so proud to contribute our expertise by issuing the Implementing supervised injection services guideline."

To view the guideline and download it for free, visit

RNAO is the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the healthcare system, and influenced decisions that affect nurses and the public they serve. For more information about RNAO, visit or follow us on Facebook and Twitter.

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Daniel Punch
Senior Communications Officer/Writer
Registered Nurses’ Association of Ontario (RNAO)