the supervised injection site opening this number fell to below 1,000. there has been some attempt to standardise evaluation reporting across supervised injection sites in a type of core outcome set with researchers from the united states funded by drug policy alliance available; however, the intermediary process of how this consensus set was generated is unpublished. the expert advisory committee found that insite had referred clients such that it had contributed to an increased use of detoxification services and increased engagement in treatment. insite had encouraged users to seek counseling. funding has been supplied by the canadian government for detoxification rooms above insite. sis sites and social disorder a longitudinal study – urban social issues study (usis) – from january 2018 and february 2019 – undertaken by university of lethbridge's professor em m. pijl and commissioned by the city of lethbridge, alberta, canada explore "any unintended consequences" of supervised consumption services (scs) within the "surrounding community".: 16 the usis study was undertaken in response to a drug crisis in lethbridge that impacted "many neighbourhoods in many different ways." researchers studied the "perceptions and observations of social disorder by business owners and operators" in a neighborhood where scs was introduced.: 16 the report cautioned, that drug abuse-related antisocial behavior in lethbridge, in particular, and in cities, in general, has increased, as the "quantity and type of drugs in circulation" increases. as the use of crystal meth eclipses the use of opiates, users exhibit more "erratic behavior". crystal meth and other "uppers" also "require more frequent use" than "downers" like opiates.: 11 the report also notes that not all social disorder in communities that have a scs, can be "unequivocally and entirely attributed" to the scs, partly because of the "ongoing drug epidemic.": 11 other variables that explain increased anti-social behaviour includes an increase in the number of people aggregating outdoors as part of seasonal trends with warmer temperatures.: 16 philadelphia's wpvi-tv action news team traveled to toronto, canada in 2018 to make first hand field observations of several safe consumption sites already in operation. a drug addict interviewed by the reporter said she visits the site to obtain supply, but did not stick around and used the supplies to shoot up drugs elsewhere and acknowledged the site attracts drug users and drug dealers. a neighbor interviewed by the reporter said there was drug use before, but he reports it has increased since the site opened. wpvi-tv's chad pradelli narrated the news team's observation as: over the two days we sat outside several of toronto's safe injection facilities, we witnessed prevalent drug use out front, drug deals, and even violence. we watched as one man harassed several people passing by on the sidewalk, even putting one in a chokehold. one guy decided to fight back and security arrived. sydney, australia the sydney msic client survey conducted in 2005, found that public injecting (defined as injecting in a street, park, public toilet or car), which is a high risk practice with both health and public amenity impacts, was reported as the main alternative to injecting at the msic by 78% of clients. 49% of clients indicated resorting to public injection if the msic was not available on the day of registration with the msic. from this, the evaluators calculated a total 191,673 public injections averted by the centre. vancouver, canada observations before and after the opening of the vancouver, british columbia, canada insite facility indicated a reduction in public injecting. "self-reports" of insite users and "informal observations" at insite, sydney and some european siss suggest that siss "can reduce rates of public self-injection." alberta, canada in response to the opioid epidemic in the province of alberta, the alberta health services's (ahs), alberta health, indigenous relations, justice and solicitor general including the office of the chief medical examiner, and the college of physicians and surgeons of alberta met to discuss potential solutions. in the november 2016 alberta health report that resulted from that meeting, the introduction of supervised consumption services, along with numerous other responses to the crisis, was listed as a viable solution.: 1 the 2016 alberta health report stated that, sis, "reduce overdose deaths, improve access to medical and social supports, and are not found to increase drug use and criminal activity.": 3 according to january 2020 edmonton journal editorial, by 2020 alberta had seven sis with a "100-per-cent success rate at reversing the more than 4,300 overdoses" that occurred from november 2017 – when the first sis opened in the province – until august 2019. safeworks supervised consumption services (scs) safeworks was located at the sheldon m. chumir health centre, which operated for several months, as a temporary facility, became fully operational starting april 30, 2018 with services available 24 hours, 7 days a week.: 1 from the day it initially launched in october 30, 2017 to march 31, 2019, 71,096 people had used its services: 1 the staff "responded to a total of 954 overdoses.": 2 in one month alone, "848 unique individuals" made 5,613 visits to the scs.: 1 its program is monitored by the province of alberta in partnership with the institute of health economics.: 2 in the city of lethbridge's commissioned 2020 102-page report, the author noted that "calgary’s sheldon chumir scs has received considerable negative press about the "rampant" social disorder around the scs, a neighbourhood that is mixed residential and commercial.": 15 according to a may 2019 calgary herald article, the 250 meter radius around the safe consumption site safeworks in calgary located within the sheldon m. chumir centre has seen a major spike in crime since its opening and described in a report by the police as having become "ground zero for drug, violent and property crimes in the downtown." within this zone, statistics by the police in 2018 showed a call volume increase to the police by 276% for drug related matters 29% overall increase relative to the three-year average statistics. in may 2019, the calgary herald, said that health canada announced in february 2019 of approval for siteworks to operate for another year, conditional to addressing neighborhood safety issues, drug debris and public disorder. there has been a plan for mobile safe consumption site intending to operate in the forest lawn, calgary, alberta, however in response to the statistics at the permanent site at the sheldon m. chumir centre, community leaders have withdrawn their support. by september 2019, the number of overdose treatment at safeworks spiked. the staff were overwhelmed and 13.5% of their staff took psychological leave. they have had dealt with 134 overdose reversals in 2019 which was 300% more than the same time period from the previous year. the center's director reported they're dealing with an average of one overdose reversal every other day. arches (closed august 2020) in response to the mounting death toll of drug overdose in lethbridge, the city opened its first scs in february, 2018.: 15 the controversial scs, known as arches was once the busiest scs in north america. the province defunded arches after an audit ordered by government discovered misuse and mismanagement of public monies. around 70% of arches funding comes from the province, and it chose to shut it down on august 31, 2020 after the funding was revoked. the audit found “funding misappropriation, non-compliance with grant agreement inappropriate governance and organizational operations.” the alberta government requested that the site be investigated for possible criminal misuse of funds. shortly afterwards, lethbridge police service announced that the funds, which had previously been reported as missing, had been present and accounted for in bank accounts belonging to the scs. acting inspector pete christos stated that the initial auditors did not have the means to determine whether money was missing, and confirmed that, during police interviews with arches staff, all spent funds had been accounted for. police chief shahin mehdizadeh told reporters that the alberta justice specialized prosecutions branch supported the police's findings and were not recommending criminal charges. the city of lethbridge commissioned a report that included an urban social issues study (usis) which examined unintended consequences of the sis site in lethbridge. the research found that in smaller cities, such as lethbridge, that in communities with a scs, social disorder may be more noticeable. the report's author, university of lethbridge's em m. pijl, said that news media tended to the "personal experiences of business owners and residents who work and/or live near an scs", which contrasts with "scholarly literature that demonstrates a lack of negative neighbourhood impacts related to scss.": 14 impact on community levels of overdose over a nine-year period the sydney msic managed 3,426 overdose-related events with not one fatality while vancouver’s insite had managed 336 overdose events in 2007 with not a single fatality. the 2010 msic evaluators found that over 9 years of operation it had made no discernible impact on heroin overdoses at the community level with no improvement in overdose presentations at hospital emergency wards.: 19–20 research by injecting room evaluators in 2007 presented statistical evidence that there had been later reductions in ambulance callouts during injecting room hours, but failed to make any mention of the introduction of sniffer dog policing, introduced to the drug hot-spots around the injecting room a year after it opened. site experience of overdose while overdoses are managed on-site at vancouver, sydney and the facility near madrid, german consumption rooms are forced to call an ambulance due to naloxone being administered only by doctors. a study of german consumption rooms indicated that an ambulance was called in 71% of emergencies and naloxone administered in 59% of cases. the facilities in sydney and frankfurt indicate 2.2-8.4% of emergencies resulting in hospitalization. vancouver’s insite yielded 13 overdoses per 10,000 injections shortly after commencement, but in 2009 had more than doubled to 27 per 10,000. the sydney msic recorded 96 overdoses per 10,000 injections for those using heroin. commenting on the high overdose rates in the sydney msic, the evaluators suggested that, “in this study of the sydney injecting room there were 9.2 (sic) heroin overdoses per 1000 heroin injections in the centre. this rate of overdose is higher than amongst heroin injectors generally. the injecting room clients seem to have been a high-risk group with a higher rate of heroin injections than others not using the injection room facilities. they were more often injecting on the streets and they appear to have taken greater risks and used more heroin whilst in the injecting room. people living with hiv/aids the results of a research project undertaken at the dr. peter centre (dpc), a 24-bed residential hiv/aids care facility located in vancouver, were published in the journal of the international aids society in march 2014, stating that the provision of supervised injection services at the facility improved health outcomes for dpc residents. the dpc considers the incorporation of such services as central to a "comprehensive harm reduction strategy" and the research team concluded, through interviews with 13 residents, that "the harm reduction policy altered the structural-environmental context of healthcare services and thus mediated access to palliative and supportive care services", in addition to creating a setting in which drug use could be discussed honestly. highly active antiretroviral therapy (haart) medication adherence and survival are cited as two improved health outcomes. crime the sydney msic was judged by its evaluators to have caused no increase in crime and not to have caused a ‘honey-pot effect’ of drawing users and drug dealers to the kings cross area. observations before and after the opening of insite indicated no increases in drug dealing or petty crime in the area. there was no evidence that the facility influenced drug use in the community, but concerns that insite ‘sends the wrong message’ to non-users could not be addressed from existing data. the european experience has been mixed. financial impropriety by scs service providers audit of lethbridge arches scs by deloitte accounting firm ordered by the alberta provincial government found the scs had $1.6 million in unaccounted funds between 2017 and 2018; additionally they've found led $342,943 of grant funds had been expended on senior executive compensation despite the grant agreement allowing only $80,000. beyond this, an additional $13,000 was spent on parties, staff retreats, entertainment and gift cards, and numerous other inappropriate expenditures. the lethbridge police service and alberta