To address ongoing high overdose death rates, St. Paul’s Hospital (SPH) in Vancouver implemented North America’s first hospital-based overdose prevention site (OPS) in 2018. The OPS offered a safe space for hospitalized individuals to inject drugs. Between July 2019 and February 2024, the OPS observed 6,660 visits and had the highest overdose rate (37.5 per 1,000 visits) among all OPS’ operated in the region, with no deaths occurring. As over 65% overdoses in the last year in British Columbia (BC Coroner's Report, 2024) are now due to smoked substances, there was a pressing need for supervised inhalation spaces. Accordingly, on May 13, 2024, SPH expanded the scope of services (and location) of its OPS to allow for both injection and inhalation, the first acute care setting in North America to allow inhalation on site. The site is entirely peer-run, with peers providing social connection, service navigation, and harm reduction education to patients.

Between May 13, 3024 and the time of abstract submission in September 2024, the new OPS has seen nearly 5,000 visits from hospital patients with 80% of visits being inhalation. This presentation will review key measures of success and lessons learned from the first hospital-based inhalation site, including an expected decrease in overdoses throughout other areas of the hospital during operating hours, decreased reports of unintended secondhand smoke exposure for staff, decreased security interactions related to substance use in the hospital, decreased Code Blue Team response hours for overdoses, and a review of patient and staff experience survey results. This presentation will include recommendations for hospital settings considering implementing inhalation services.