Characterizing 'Atmosphere' - exploring determinants of regular service attendance amongst integrated supervised consumption site clients in Vancouver’s Downtown Eastside

Sep 29, 2026

Research examines barriers and facilitators to supervised consumption sites (SCS) in Canada, yet limited evidence explains why individuals initiate and repeatedly attend particular SCS when multiple options exist. This study characterizes structural, contextual, and operational determinants of regular attendance during the ongoing overdose crisis. Rapid-ethnographic fieldwork was conducted at an integrated SCS in Vancouver’s Downtown Eastside, combining observation, community consultation, focus groups, and semi-structured interviews to identify key drivers.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

Context of Canada’s overdose crisis

Role and history of Vancouver’s Downtown Eastside

Evaluations and research gap

Scher etal. Harm Reduction Journal (2026) 23:3 [https://doi.org/10.1186/s12954-025-01272-2](https://doi.org/10.1186/s12954-025-01272-2) Harm Reduction Journal RESEARCH Open Access Characterizing ‘Atmosphere’: exploring determinants of regular service attendance amongst integrated supervised consumption site clients in Vancouver’s Downtown Eastside Benjamin D. Scher 1 , Benjamin W. Chrisinger 1,2 , David K. Humphreys 1 and Gillian W. Shorter3,4,5* Abstract Background Research has explored barriers and facilitators to supervised consumption sites (SCS) in Canadian settings. Despite this, little is known about what factors drive individuals to initiate and repeatedly attend specific SCS where multiple SCS options are available, such as in Vancouver’s Downtown Eastside (DTES) . The aim of this study was to understand the structural, contextual, and operational determinants of regular SCS attendance during Canada’s ongoing overdose crisis. Methods Rapid-ethnographic fieldwork was conducted over a six-week period at an integrated SCS in Vancouver’s DTES. This comprised an initial five-week period of non-participant observation (≈200 h) followed by a community consultation regarding the research design and question protocols. Qualitative data were then collected through five focus groups (n = 25) and 20 semi-structured interviews with regular service attendees with data analysed using thematic analysis. Results Our findings highlight four important factors related to regular service attendance. The service had a regular clientele who described their attendance as routinized, which they attributed to four distinct factors: (1) the accessible location,(2) the on-site auxiliary health and support services,(3) the diversity of harm reduction provision, and (4) the atmosphere. Exploring the concept of atmosphere in more depth showed that it was characterized by the safety, familiarity, and inclusivity experienced within the service. Together, these factors facilitated a strong sense of belonging among attendees regarding the service and its community of staff and clients. Conclusion Within the context of an ongoing overdose crisis, our findings highlight SCS service characteristics which facilitate routinized engagement including accessibility, wrap-around support, comprehensive and tailored harm reduction, and an inclusive welcoming atmosphere. These insights can inform policy makers and service providers in scaling and developing effective, client-centred SCSs to reduce harm and promote wellbeing. *Correspondence: Gillian W. Shorter [g.shorter@qub.ac.uk](g.shorter@qub.ac.uk) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/.)[.](http://creativecommons.org/licenses/by/4.0/.) Scher etal. Harm Reduction Journal (2026) 23:3 Introduction In 2023, there were a total of 7162 drug-related deaths in Canada [1], placing it third in the world for overdose deaths per million, just behind the United States and Scotland [2]. The province of British Columbia (BC) has experienced approximately a thi

FAQs

What was the aim of the study on regular supervised consumption site attendance?

The study aimed to understand structural, contextual, and operational determinants of regular SCS attendance during Canada’s ongoing overdose crisis.

How was the research conducted at the integrated SCS in Vancouver’s Downtown Eastside?

Rapid-ethnographic fieldwork was conducted over six weeks, including non-participant observation, community consultation, five focus groups (n=25), and 20 semi-structured interviews analyzed using thematic analysis.

What four factors did participants identify as drivers of regular attendance?

Participants described four factors: accessible location, on-site auxiliary health and support services, diversity of harm reduction provision, and the atmosphere.

What does the paper mean by “atmosphere” in the service context?

“Atmosphere” was characterized by safety, familiarity, and inclusivity experienced within the service, supporting a sense of belonging among attendees and staff.

Sep 29, 2026

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