Ottawa's health unit rushes to open its own supervised injection site

With opioid overdoses rising, Ottawa Public Health is scrambling to open its own supervised injection site in the ByWard Market, just weeks after a pop-up tent opened nearby in Lowertown.

Health officer Dr. Isra Levy said Tuesday that the opioid crisis has created an urgent need in the city to expand existing harm reduction services, including supervised injection sites.

“It is my intent to begin to offer these services as soon as we can responsibly do so, and we are aiming to achieve that within the next two weeks,” Levy told the board of health in a memo. Levy said he believes he has the authority to do it without direct approval from the board, but he’ll ask for a vote on his plan at the next health-board meeting on Monday.

The site would be in a health-unit building at 179 Clarence St. in the ByWard Market, but would be operated by the Sandy Hill Community Health Centre. That clinic, at Rideau and Nelson streets, is planning to open a permanent supervised injection site and has federal approval for it, but it won’t be ready to go until the end of October. And, Levy wrote, drug users are in danger now.

“To date in 2017, we are seeing an average of nearly 120 emergency room visits for suspected opioid overdose each month in Ottawa, compared with fewer than 100 per month in 2016,” his memo said.

“Starting in June 2017, there has been a significant increase in opioid overdoses in Ottawa. Ottawa Paramedic Services reported over double the number of naloxone (a drug that can reverse opioid overdoses) administrations during June compared with the monthly average during January to May. There has also been a 22-per-cent increase in suspected opioid overdose-related emergency department (ED) visits during June, July and August, compared with January through May.”

The problem is street drugs like heroin that have been laced with fentanyl and carfentanil. They’re all opioids, all with generally similar effects on users, but the latter two are much more powerful. They’re appealing to suppliers and dealers because they’re easier to transport and conceal, but dangerous to users who can’t be sure how potent their drugs are. The difference between a “normal” dose of fentanyl and a deadly one can be the size of a few grains of sand.

The trends in Ottawa “are very concerning,” Levy said during a press conference Tuesday. Not only are emergency room visits for suspected opioid overdoses increasing steadily, but community groups say there are increasing numbers of overdoses and opioid-related deaths that may not be seen by emergency departments, paramedics or police, Levy said. In 2016, there were 40 opioid-related deaths in Ottawa, a number that has gone up every year for the past five years.

“This is having a devastating impact throughout North America and it is impacting communities across Canada, including right here in Ottawa.”

A supervised injection site is meant to reduce the danger of drug use by having trained staff around to help if a user overdoses.

A group called Overdose Prevention Ottawa started its own “pop-up” injection site in Raphael Brunet Park two weeks ago. Copying models in Vancouver and Toronto, volunteers staff a tent in the park — a little patch of grass by a parking lot in Lowertown — for three hours a day. Levy’s health unit has chosen to treat the pop-up site as a form of “peer support,” an extension of the health unit’s efforts to teach drug users how to look out for each other.

Levy said the pop-up site was “part of the dynamic” in Ottawa Public Health’s decision to open an interim site on Clarence Street. He steered away from questions about whether the pop-up site should close down once the interim site opens, but he noted hygiene and safety are both better at regulated sites within buildings than sites set up in public spaces.

He also said it is clear there is a need for the service in the ByWard Market, but wouldn’t commit to whether the Clarence Street site should become permanent. “We will examine that question. We will be monitoring it closely.”

Since the Sandy Hill centre has permission from Health Canada to run a permanent supervised injection site, it would manage the temporary one at the Clarence Street building, Levy wrote, provided Health Canada is OK with stretching its approval to cover the health unit’s premises. He said the plan is to have the site open seven days a week, morning and night.

Mayor Jim Watson opposes supervised injection sites but has stayed out of the way as the board of health has given Levy the go-ahead to help outside groups like the Sandy Hill Community Health Centre start them (other community health clinics are interested in following). Not having the health unit itself run an injection site has been important to keeping city councillors on side.

On Tuesday, Watson applauded the initiative “to bring a more permanent place where people can go and get the help they need. My hope is the proper notifications and approvals can be achieved relatively quickly.”

Watson said he hopes the opening of the permanent site will mean the end of the pop-up site.

“My view is that the pop-up site is not legal, it’s not authorized, and my hope is they will cooperate and recognize there is a site in the geographic area that they are serving and that they work at the new site with public health and Sandy Hill.”

Levy’s memo noted that the situation is evolving quickly.

“As (health-board) members will appreciate, this situation is evolving rapidly. I am grateful for your confidence in enabling me to take the steps outlined above, which I have deemed necessary.”

By Elizabeth Payne and David Reevely
Source: Ottawa Citizen