Factors associated with willingness of people who smoke unregulated drugs to use supervised inhalation sites

BACKGROUND: Recent North American trends point towards increased smoking of unregulated drugs and decreased injecting. While supervised consumption sites (SCS) offer a monitored environment for people who use drugs (PWUD), these sites have been less likely to accommodate inhalation in Canada. The objective of this study was to determine the factors associated with willingness to use supervised inhalation sites. METHODS: We performed a cross-sectional survey of 499 PWUD in Edmonton, Canada. We used descriptive statistics to characterize willingness to use a supervised inhalation site and logistic regression to examine factors associated with willingness. RESULTS: Of 467 participants who reported smoking their drugs, the mean age was 43.7 years with 303 (64.9%) identifying as men and 320 (68.5%) identifying as Indigenous. A large proportion (64.9%, n = 303) of participants who smoked their drugs indicated a willingness to use a supervised inhalation site. While having overdosed by accident in the last 6 months (aOR = 2.70, 95% CI: 1.31-5.81) and having borrowed, lent or shared a pipe in the last 6 months (aOR = 2.22, 95% CI: 1.01-4.88) were both positively associated with willingness to use a supervised inhalation site, participants who stated that stimulants were the drugs smoked most frequently in the past 6 months (aOR = 0.43, 95% CI: 0.20-0.88) and those who reported always smoking in public places (aOR = 0.53, 95% CI: 0.28-0.97) were less likely to report willingness to use a supervised inhalation site. CONCLUSIONS: Our results outline significant interest among PWUD in supervised inhalation sites and suggest that individuals who have recently borrowed or shared a pipe or recently experienced an overdose would be more likely to use these sites. Implementation of these sites must include decolonizing approaches that create a welcoming space for Indigenous people.