Critical Gaps in Service Access for Young People in Lisbon, Portugal and Vancouver, BC

"In Vancouver and Lisbon, there are other critical gaps in harm reduction services and programs for YPWUD as well. In both settings, youth-dedicated safer injection, safer smoking, and overdose prevention sites do not exist. The COVID-19 pandemic prompted a scaling up of harm reduction initiatives in both Vancouver and Lisbon [9, 16]. And yet, in Lisbon, interventions such as a new shelter that includes access to a safer consumption space (via a mobile drug consumption room) was not designed to include youth. In Vancouver, even when YPWUD are allowed to use those safer consumption sites that do exist, they often don’t feel comfortable in these adult-oriented spaces.

"In our experience, adult-oriented safer consumption spaces can be intimidating for YPWUD, who don’t always feel like they can ask questions or get appropriate help in these places. In adult-oriented spaces, it can seem like everyone already knows what they are doing and what they want to be doing when it comes to their substance use, and many YPWUD feel like they have to imply that they are equally experienced and confident in their decisions about drugs when they are in these places. YPWUD may also worry that if they access adult-oriented safer consumption spaces, someone might report them to child protective services, or tell a family member, caregiver, provider, or worker that they were seen there. In Vancouver, we have seen YPWUD turned away from adult-oriented safer consumption spaces because they looked "too young" and “too healthy” to be using drugs intensively, or “didn’t have any track marks.” When YPWUD are uncomfortable or actively turned away, it can drive them even further away from life-saving care. It can also send the message that their lives are not worth saving.

"In Portugal, safer drug consumption spaces in general are not widely available (the first safer smoking and injecting sites were opened in 2021), and there are no youth-dedicated spaces. Drug checking is only available in Lisbon, and take-home naloxone kits and peer-to-peer overdose prevention (naloxone) programs are also not available despite ongoing advocacy. In both Vancouver and Lisbon, there has been a primary focus on connecting people who use drugs with OAT and sterile drug use paraphernalia. As others have argued, the focus is on mediating drug-related risks and harms (e.g., syringe sharing, blood borne infections), and treating substance use “disorders” via licit replacement therapies (e.g., methadone, buprenorphine-naloxone), rather than on making the use of substances such as heroin, fentanyl, crack, and meth safer via safe supply and harm reduction programs [11]. In both settings, a focus on substance use as either criminal or pathological undermines the self-determination of YPWUD in relation to their drug use, harm reduction, and care."