As temperatures drop, the indoor supervised injection site planned for the Sandy Hill Community Health Centre didn’t open by the end of October, as hoped. 

The health centre’s Nelson Street facility has been undergoing preparatory work on the site, but it says it’s still waiting on provincial funding for renovations – and those behind the Health-Canada approved project are hesitant about setting a new target date. 

An outdoor injection tent in a Lowertown park is filling what organizers say is an urgent need in the overdose crisis. Another injection site, in a trailer at the Shepherds of Good Hope on Murray Street, could be open as soon as this weekend.

Rob Boyd, the health centre’s director of the Oasis harm reduction program, said the capital application was finalized about two weeks ago. The health centre had to get assessments on engineering and architecture before submitting the documents for provincial consideration.

Boyd, who didn’t have the capital cost estimate immediately at hand, had hoped to have the supervised injection site open by now.

Ottawa's Board of Health is recommending the temporary supervised injection site at 179 Clarence St. get a separate exemption from Health Canada so it can stay open as long as it takes to evaluate the need for a more permanent site.

Dr. Isra Levy, the city's medical officer of health, said it amounted to a technical detail in the exemption from the federal government that allowed Ottawa Public Health (OPH) to open the Clarence Street location while waiting for the permanent site at the Sandy Hill Community Health Centre to open.

Levy said the current wording of the exemption would force the Clarence location to close as soon as Sandy Hill opened, despite the Board of Health's instruction to evaluate it after four months of operation.

"The original intent was that we do do that, we show up here again with recommendations based on data, based on our experience in the first four months," Levy said. " We didn't want that to be interrupted based on a technical administrative issue."

OPH told the board there were 82 clients and 359 encounters at Clarence Street in its first 26 days of operation. 

Ottawa’s largest permanent supervised injection site could be open in a Lowertown trailer as soon as this weekend.

The trailer, to be operated by Ottawa Inner City Health and located outside Shepherds of Good Hope on Murray Street, will be open 24/7 and serve a population of between 100 and 150 injection drug users, said Inner City Health executive director Wendy Muckle.

Ontario’s Health Minister Eric Hoskins has endorsed the site in a letter to federal Health Minister Ginette Petitpas Taylor, his office said Monday.

“Inner City Health has proposed to expand existing community outreach work to support those most at risk of overdose and connect people with vital health care supports, including substance use treatment and counseling,” Hoskins said in a statement.

Rideau-Vanier, he noted, has the highest geographical proportion of people who use drugs in Ottawa “by a large degree.”

Hoskins noted that 40 residents died in Ottawa in 2016 from opioid overdoses.

Workers on the front lines of Ottawa's opioid crisis say allowing drug users to consume drugs at supervised injection sites is not enough to prevent overdose deaths — so they are going one step further.

Ottawa Inner City Health began providing a small group of users with "clean" drugs in September following a rapid rise in the number of overdoses from street drugs contaminated with fentanyl over the summer.

"They're bringing in drugs that are laced with fentanyl, so the thought would be, if we're going to have supervised safe drug injection sites, why would we allow them to still inject poison?" said Dr. Jeff Turnbull, the chief physician for Ottawa Inner City Health, which provides health care to the homeless.

"Why would we not allow them to inject pharmaceutical-grade medications?"

Seven patients began receiving a combination of oral and intravenous doses of the painkiller hydromorphone, or Dilaudid, last month, and Turnbull wants to increase that to 40 users over the next month.

Turnbull said the number of overdoses in Ottawa was four cases a month in June. Now it has risen to four a day, he said.

"We've seen a dramatic change over the last three or four months," he said. "We've had many deaths. So our job right now, what we're struggling to do, is just keep people alive."

The city's health board wants approval from the federal government to keep the interim supervised injection site in Lowertown open longer than originally planned and possibly make it permanent. 

In a report to be tabled at the board of health meeting next week, staff recommend the medical officer of health apply for an exemption from Health Canada to operate the site at 179 Clarence St. 

The interim site was set up in late September as a response to the growing opioid crisis, using an exemption already approved for the Sandy Hill Community Health Centre at 221 Nelson St. 

The temporary site opened just a few blocks away from an illegal supervised injection site run by the Overdose Prevention Ottawa group, which has seen regular visits from drug users over the last couple months.

Ottawa Public Health (OPH) had previously agreed to assess what to do with the interim site after 120 days of operation, but now staff are recommending the health department act sooner. 

One week last winter changed everything.

On the last day of February, a woman in her mid-40s was found dead of a drug overdose in her bed at Shepherds of Good Hope, a homeless shelter at the corner of Murray Street and King Edward Avenue.

Three days later, a woman in her 20s, a beloved member of the shelter community, was discovered showing no vital signs during an hourly bed check. She was given naloxone, CPR and rushed to hospital, but to no avail.

Until then, drug deaths at the shelter had been extremely rare. Two in a week had never happened before in the three decades that staff there have ministered to the city’s homeless in the ByWard Market.

Many workers were distraught. Frontline staff develop strong bonds to the damaged and vulnerable people who come to Shepherds as an island of safety in chaotic lives.

“That was really jarring for us,” said Caroline Cox, senior manager of transitional shelter services at Shepherds. “That really didn’t happen before. And then it happened twice in one week.”

Cox and her co-workers knew the deaths were not a tragic coincidence, but pointed toward a fundamental change in the city’s drug supply: the arrival of fentanyl. Staff feared that such overdose deaths would soon become the new normal.

“I can’t do this every week,” an assistant manager warned Cox.

As the fentanyl epidemic spreads across Canada, a pioneer of supervised injection sites says the country would be better prepared to deal with the opioid crisis if it hadn’t suffered “10 years of darkness” under the Stephen Harper government.

Independent Senator Larry Campbell oversaw the establishment of Vancouver’s first public safe injection site, Insite, in 2003 after being elected mayor, building on the work of his predecessor, Philip Owen.

Almost 15 years later another 18 government-approved safe injection sites are operating across Canada. 

But they have all opened since 2015 as the fentanyl crisis brought record overdose deaths, particularly in British Columbia. Almost 2,000 people in the province have died of overdoses since January 2016, with 1,103 deaths so far this year. 

Campbell says the Conservatives aren’t to blame for the arrival of fentanyl, but the Harper government’s opposition to harm reduction measures hampered Canada’s ability to respond to the crisis.

“Certainly if they had been more progressive in their drug policy I think we could have dealt with it, and if we had supervised injections sites and if we’d have had opioid treatment, I think it would have made a difference,” he said. “But it's all hindsight.”

Jonathan worries he may die before getting into an Ottawa treatment bed.

The 24-year-old has been going to the unauthorized supervised injection site since it opened this summer.

But for the last 10 days he's been coming to the Overdose Prevention Ottawa tents in Raphael Brunet Park looking for something more. He's been asking for help getting into treatment for his addiction.  

A volunteer at the tent, Matthew St. Jean, a recovering addict himself, has been calling the Ottawa Withdrawal Management Centre, to get Jonathan into one of 26 beds that serve the entire region from Pembroke to Cornwall.

The centre helps with withdrawal, and acts as one of the gateways into a longer-term program in a residential treatment facility.

St. Jean made a number of calls during an interview with CBC News, but each call went directly to voicemail.

St. Jean said he recently had success getting through for a user, only to find by the time the person got to the centre, the bed was gone.

"We're making the calls and making the calls," said St. Jean, who explained he's been trying to get Jonathan in for almost two weeks.

"He was good for the two weeks, but it's a slippery slope," he said. "You could end up using again. There's definitely not enough resources in Ottawa, at all."

A group of Ottawa parents concerned about the rise in opioid overdoses in the city is filling what they see as a gap in the system for helping drug addicted youth. 

We the Parents is starting a substance and opioid use pilot program to help teens in the city's west end who have drug issues discuss problems and find peer support. But executive director Sean O'Leary, who founded the group to find help for his 17-year-old daughter Paige, says he's frustrated money has been made available for harm-reduction strategies such as supervised injection sites and not treatment programs. 

Without government funding, We the Parents will rely entirely on corporate and private donors and, as of Thursday, had raised just under half of its estimated $287,000 yearly operating budget. 

In a meeting held Thursday night, O'Leary said he approached the City of Ottawa and Ottawa Public Health for $150,000. He hoped the money could come from provincial money handed over to the City of Ottawa, earmarked for the creation of more detox and treatment spaces, as well as to equip police and firefighters with naloxone kits.

Just before 11 a.m. on Thursday, John Sangster sat cross-legged on the pavement in a Lowertown parking lot with a needle filled with the opioid hydromorphone pressed into his arm.

A woman in a Porsche SUV pulled into the lot next to Saint Brigid’s Centre for the Arts looking for a spot as Sangster packed up a black plastic bag with syringes, a lighter and disposable wipes, got to his feet and walked back toward the Shepherds of Good Hope, one block away.

It’s a daily ritual for Sangster — finding a nook along a building or narrow space between two parked cars to get his next fix.

About two hours earlier at Shepherds, a truck delivered a construction trailer that could become Ottawa’s first 24/7 supervised injection site.

If the trailer receives Health Canada’s approval to operate as an injection site, Sangster plans to shoot his drugs in a safe, enclosed space under the supervision of health experts, instead of preparing a needle in the shadow of a deconsecrated church.

“It just makes you feel you’re not alone,” Sangster said. “It gives you a sense of normalcy.”

Shepherds isn’t waiting for Health Canada’s approval before preparing a supervised injection site at what one executive called the “ground zero” of Ottawa’s opioid crisis.

Deirdre Freiheit, president and CEO of Shepherds, said staff are “barely making it by the skin of our teeth” trying to keep clients safe, constantly scouring the block around the King Edward Avenue shelter for anyone who has overdosed.