It’s too late to save the hundreds of Canadians who’ve already died this year from drug overdoses, but the Liberals’ proposed changes, which would make it easier to open safe-injection sites, will help cities come to grips with a crisis that’s cutting a tragic swath across the country. Absent full drug legalization (and the better health oversight it brings), the best we can do is try to minimize the harm of drug use.
“We need to take swift action on the opioid crisis to save lives,” said Health Minister Jane Philpott, having waited a year into her mandate to actually make it easier to open safe-injection sites.
The Liberals have proposed a five-step plan that, while repealing the more than two-dozen steps needed to open a safe-injection site, still maintains some troublesome elements from the last government’s policy, such as having to prove the need for a site (why wait for the body count to climb?) and gathering evidence about the effect on crime (rates haven’t gone up around injection sites already open).
The Sandy Hill Community Health Centre has asked the province for $1.4 million a year to operate a supervised injection site seven days a week, 12 hours a day in downtown Ottawa.
The estimated cost has more than quadrupled since a plan for the service was unveiled earlier this year.
Rob Boyd, director of the health centre’s harm reduction program, said costs have gone up as the service model changed in response to the public’s feedback — and to the quickening pace of the opioid epidemic.
Community members, he said, made it clear they want drug users to be able to access the centre’s medical, social and counselling services whenever they visit the injection site.
“They felt we needed to be open as many hours as possible: that this was not going to be a Monday to Friday, nine to five service,” he said. “What that does is scale up the cost of doing this.”
On Monday, the Liberal government tabled legislation that will remove many of the barriers to building safe injection sites that the previous Conservative government had established.
The current rules require a safe injection site to satisfy 26 criteria before getting federal approval, including a letter signing off on the proposal from the city and from the police chief.
But the new Liberal legislation will have just five criteria for approval, such as demonstrating the need for such a site, showing that community consultation was done, and assessing the effect it may have on crime in the area.
The federal Liberals are streamlining the process to allow communities to apply to set up supervised injection sites quicker, with less red tape and with less room for community objections.
Health Minister Jane Philpott introduced the bill that would clear out a long list of regulations and conditions for establishing sites that the previous Conservative government introduced.
Those conditions included a requirement to have the approval of a community’s council and its police chief. In Ottawa, both Mayor Jim Watson and Ottawa police Chief Charles Bordeleau have indicated they don’t support an injection site.
Philpott said the changes are necessary to deal with a public health crisis that is only growing.
“We need to take swift action on the opioid crisis to save lives. We need a renewed focus on harm reduction,” she said.
This past summer, Ottawa Public Health conducted a public consultation survey on enhanced harm reduction services in Ottawa. Over 2,200 people completed the survey, which was available online and in paper format in English and French. The survey was anonymous, confidential, and voluntary.
Survey results indicated that:
60% of respondents thought that offering harm reduction services in more areas of the city would be beneficial.
66% of respondents thought that longer hours would be beneficial.
62% of respondents thought that having harm reduction dispensing units available would be beneficial.
66% of respondents thought that having supervised injection services available would be beneficial.
When asked for recommendations on how to address community concerns, specifically regarding supervised injection services, the top three recommendations were:
Provide information to the community about the goals and benefits of supervised injection services (61%);
Evaluate services, share results with the community and respond to evaluation results (58%);
Establish a community advisory group to identify and address issues as they emerge (50%).
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.
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.
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.
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.”
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.