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Ottawa drug outreach workers fear looming powdered fentanyl crisis

Tara Finnessy got off fentanyl two years ago.

Before then, the Ottawa woman had been an off-and-on user since her fiancé’s accidental death in 1999. “I was in pain and I wanted to not be in pain. That’s how I started my journey with fentanyl,” she said.

She had been prescribed other opioids in the past, but very quickly turned to fentanyl, drawn to its potency.

“The fentanyl was everywhere and it was cheap at that time,” she said. “There were people getting prescriptions who didn’t quite know the street value of this drug. So I was able to obtain like 100 microgram patches for like $5. It was crazy. It was just crazy.”

If used as prescribed, one transdermal patch might last a patient 72 hours. Finnessy was using about one a day, she said, chewing it or extracting the drug and injecting it for a faster high.

Now she’s on methadone therapy and helping in outreach programs for other drug users. And from them, she’s hearing even more about fentanyl now than before – particularly the new form that’s causing so many deaths in Western Canada: powdered fentanyl.

Powdered fentanyl is a relatively new arrival to the nation’s capital, and it has local health authorities and outreach workers worried.

Thirteen years ago, Ottawa had 100 emergency room visits from unintentional drug overdoses. In 2015 it was 205 — something Ottawa Public Health attributes partly to fentanyl.

Why outsourcing the running of Ottawa’s safe injection sites works

While Canada has had one long-standing supervised injection site for hard-drug users in Vancouver since 2003 and Toronto has plans to fund three new ones next year, the key to opening such facilities in Ottawa, it seems, is to not follow either city’s model.

Ottawa Public Health is talking with more than 20 agencies that distribute clean needles to injection-drug users, including community health clinics, drop-in programs and shelters. They’ve all been identified as potential operators of supervised injection sites for Ottawa — where political necessity demands sites be run by outside agencies, not the health unit itself.

This consensus came about slowly, after years of opposition to the idea of supervised injection sites operating in Ottawa at all. Since Vancouver’s Insite opened in 2003, three Ottawa mayors have rejected the idea of bringing this harm-reduction model to the capital, all backed up by their respective police chiefs. A 2015 academic study, led by Ahmed Bayoumi at St. Michael's Hospital in Toronto, found Ottawa could prevent 360 HIV infections over 20 years with a single supervised injection site based on the Vancouver model.  But it attracted no real political support.

People who treat Ottawa’s drug users didn’t stop trying. After the Supreme Court ruled in 2011 that Insite could stay open, over the objections of the then-Conservative federal government, a community-health centre in Sandy Hill, on the east side of Ottawa’s downtown, forced the issue by making clear that it was going to apply for federal permission to open a site, no matter what.

Ottawa needs multiple supervised injection sites, researchers say

With supervised injection sites on the horizon and an increased number of overdoes in the mix, Ottawa should aim to have two or three supervised injection sites in locations most likely to be used by drug users, said Ahmed M. Bayoumi, a researcher and physician at St. Michael’s Hospital in Toronto.

Bayoumi, with a number of other researchers, helped conduct a recent study on the cost-effectiveness of supervised injection sites in both Toronto and Ottawa. They found that the optimal number for Ottawa was two.

But, with overdoses on the rise in Ottawa, Bayoumi said the study might have underestimated that number.

While one supervised injection site would be cost-effective for the city, Bayoumi said, it wouldn’t provide the maximum health benefits to drug users themselves.

Rob Boyd, Oasis program director at the Sandy Hill Community Health Centre, says a larger number of smaller sites would be more beneficial.

“We’ve been living with a serious opiate use epidemic, for the past 20 years, but the stakes have been raised by the powered bootleg Fentanyl,” said Boyd, who is a front-line worker with drug users.

“There is an urgency to do something quickly.”

Bootleg fentanyl creating overdose crisis in town

The number of calls to paramedics for overdoses in the city has more than doubled since 2012, and one drug, fentanyl, is the main suspect behind the surge.

And things might get even worse.

“I definitely think it is a crisis here,” says Rob Boyd, director of the Oasis clinic at the Sandy Hill Community Health Centre and a leader in the harm reduction field in Ottawa.

“I said going into the summer that I had a bad feeling about it. I really try hard not to be alarmist when it comes to this stuff, but I think powdered fentanyl is a real game-changer.”

The worrisome thing about fentanyl, first widely used in patch-form as a painkiller, is its potency. Described as 50 to 100 times more powerful than heroin, only a few grains can cause an overdose, sometimes fatal.

In some jurisdictions, police officers have overdosed just by handling the powder, among the shocking stories popping up all over North America.

Just last week, nine young people in a Vancouver suburb overdosed almost simultaneously after sharing cocaine that was spiked with fentanyl, with eight of them ending up in hospital.

The problem today is that fentanyl is widely available in powder form and is being mixed — in uncertain dosages — with all kinds of street drugs.

“From one dose to the next, you don’t know what the concentration is,” said Boyd.

Added Catherine Hacksel, a member of the addictions support group, DUAL, and the co-ordinator of a weekly drop-in program:

“With fentanyl, you can buy enough to kill you in a dime bag.”

City survey finds huge support for safe injection sites in Ottawa

An unscientific survey by Ottawa’s public-health unit over the summer found two-thirds of us support new supervised drug-injection facilities aimed at helping addicts survive overdoses.

The survey, an online questionnaire, was a consultation meant to gauge the public’s attitude toward such sites, which Ottawa Public Health thinks would work best added to existing community health centres and other agencies that operate needle exchanges and methadone clinics. Anybody could go to the health unit’s website and fill the survey out — so it’s more like an Internet version of a public meeting than a poll.

According to the health unit, more than one-quarter of the participants identified themselves as either health practitioners or people who work at agencies that help drug users. They also gave out paper copies to people at existing drug clinics; five per cent of respondents said they’re current or former users of harm-reduction services. The result is what the health unit calls a “a convenience sample,” people who were easy to reach.

Nevertheless, 66 per cent of the 2,263 people who took part said they believe supervised injection sites would be beneficial in Ottawa, against 27 per cent who oppose the idea. The most support came from the wards where injection sites would be likeliest to open — Somerset, Rideau-Vanier, Capital, River and Kitchissippi, where support ranged from 77 to 90 per cent.

Support grows for Ottawa safe injection site

Support for a safe injection site in Ottawa is growing, particularly among younger people, a new poll shows.

The Forum Research poll shows 58 per cent of those surveyed on July 22 said they approved of a safe injection site for intravenous drug users in downtown Ottawa, up four percentage points from when the same question was asked in May.

Support was highest among those aged 18-34 (58 per cent), those with postgraduate degrees (68 per cent), and those who lived with marijuana dispensaries in their neighbourhoods (67 per cent).

Ottawa's health board backs supervised injection sites

Ottawa’s board of health voted 9-2 Monday night to encourage supervised-injection sites to open in the city.

“Listen to, more than anything, the people who live this,” Capital Coun. David Chernushenko told skeptics. He’d come into the health-board meeting not knowing how much he didn’t know about addiction, and treatment, and what it’s like to be a drug addict, he said.

The board heard from several, all begging the board to say it supports the notion of opening supervised facilities where addicts can inject drugs in the presence of nurses who can rescue them from overdoses. People like Darren Noftall, twitchy, tense, out of place at the formal table in city hall’s committee room, who said his life had been saved twice at Vancouver’s Insite. He overdosed at Canada’s first safe-injection site and the nurses saved him.

He left Vancouver, thinking he’d be better at home in Ontario. It hasn’t worked out that way yet.

“I live alone. I use alone. That puts me at high risk to die alone,” he said. “When I go home, I’m going to do that hit tonight, I don’t know if I’m going to be alive in the morning.”

Supervised injection site up for debate Monday at Ottawa health board meeting

Ray Harrison has seen people shoot up using water from toilets and puddles.

He's pulled friends who were overdosing in the street to a phone booth to call 911, so they wouldn't be tracked by police.

Now Harrison — a former drug user himself who says he's been clean since the New Year's Day 2014 — says it's time for Ottawa to open a supervised injection site.

He believes they will help prevent people from spreading disease and give them a reason to access health care services, which could start them on a road to breaking their addictions.

"You need to be able to start somewhere and not necessarily when you hit rock bottom, when you get incarcerated," Harrison told CBC News ahead of tonight's Ottawa Board of Health meeting.

The city's medical officer of health, Dr. Isra Levy, is expected to make his case at that meeting for why Ottawa should have supervised injection sites, and why Ottawa Public Health should support agencies that propose to set them up.

Community health centres will be at tonight's Ottawa Board of Health meeting to offer Levy their full support, and Harrison is planning to be there, too.

"I think the safer injection site will save a lot of people, and the community, a lot of grief; along with the police [since] they're not having to chase these people down in somebody's backyard," Harrison said.

Downtown Ottawa councillor welcomes safe injection site

An Ottawa councillor says he welcomes a safe injection site downtown – but only if there are similar services across the city.

On Monday, Rideau-Vanier Coun. Mathieu Fleury, and five other councillors on the board of health, will debate a staff report that recommends opening a supervised injection site in the city.

Given that the Sandy Hill Community Health Centre has already consulted on its plan to provide such a service, a safe injection site will likely go in his ward.

“I can support a model that is holistic, that makes sense, that supports a drug user in their community, and if that means they’re in my community, for sure,” said Fleury.

Sandy Hill not only neighbourhood centre looking at offering supervised injection

Not one but four community health centres in Ottawa are looking at the idea of offering supervised injection services to drug addicts.

The Sandy Hill Community Health Centre is currently looking to set up a supervised injection site, the city's first such service, at its Nelson Street location.

The health centre's board could start a process next week to ask for a federal exemption so its staff and clients wouldn't be charged with possessing an illegal substance.

But the Carlington, Centretown and Somerset West community health centres are also exploring whether that makes sense for them too.

Somerset West executive director Jack McCarthy said the point of the preliminary investigations is to stop the spread of disease and prevent people from possibly overdosing in alleys or other secluded places.

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