Canada is grappling with what its federal health minister called a “serious and growing opioid crisis”, which has caused an unprecedented rise in overdose deaths across the country. In the face of a slow response by authorities, some people are opening their own pop-up safe injection sites. Here’s the second of our two-part article looking into the overdose crisis. Read the first part here.
Over the course of 2016, the opioid crisis in the Canadian province of British Columbia began to snowball. In that year, 922 people died of an overdose of an illicit drug — marking a huge jump from 2015, when 513 people died. Frustrated with authorities’ slowness to get measures in place, some residents have taken matters into their own hands.
A community response
Supervised injection sites are places where drug users can go to use drugs, in a safe, sanitary, and monitored environment. Users need only bring their drug of choice – the site provides clean needles, tourniquets, cookers and other equipment they may need. The presence of trained staff means that in the event of an overdose, users can immediately be administered naloxone, an antidote that can reverse an overdose. And the stats show it works: at one supervised injection site, Insite, there were 4,922 overdoses in the 2015-2016 period, and no deaths because staff were there to intervene.
Insite is sanctioned and funded by Vancouver Coastal Health services. Local community activists have followed suit in launching their own supervised injection sites, but without official authorisation. Sarah Blyth and Ann Livingstone founded the Overdose Prevention Society (OPS) in Vancouver’s Downtown Eastside simply in response to what they saw as a pressing need to have a space where people could shoot up under supervision.
“We are running out of space in the morgues”
Fentanyl is a chemical preparation in kitchen labs. The amount needed to get high and to kill people is so tiny that it’s easy to smuggle into the country. I don’t think traffickers are trying to kill their clients, but the drug is so volatile. It’s impossible to have quality control. We have so many people dying in a day. And these deaths are on top of all of the other deaths we investigate. It has put a lot of pressure on our infrastructure. We have had to find additional space to store the deceased because the morgues are full.This graph from British Columbia's Coroners Service shows how dangerous fentanyl is in comparison with other drugs.
Scenes from inside one of the government-sanctioned overdose protection sites. Photo by Travis Lupick.
“No one saw this crisis coming”
There are people from all walks of life who are affected. There is what we call the ‘drug-entrenched street population’: those are people with challenging lives, who are living hand-to-mouth in temporary accommodation. But it’s not just them. We’ve seen nurses, teachers, professors, stay-at-home mums die. These people lead productive lives but they have a drug dependency and haven’t been able to stop. We are trying to get a comprehensive profile of the people who are dying in this province.A sign in the street directing drug users to a safe injection site in Vancouver.
We have had to establish a drug death investigation team focused solely on illicit drugs deaths. One of the challenging things is that nobody saw this crisis coming. We’re trying to keep ahead of it.
“We’re not going to stand around and watch people die”
Behind the market is an alley popular with druggies. I’ve worked at safe injection sites before, and we were seeing so many overdoses, so we just decided to throw up a small medic tent with some Narcan [the brand name for naloxone, an antidote]. People would come and we would watch them using, and if they had an overdose we could help them straight away. We didn’t have a choice. It was happening on our doorstep, right next to the market, and it was happening to people we know and love.Local community activists and residents protest against the government's inaction against the drugs crisis on February 21, 2017. Photo sent by our Observer.
The government wasn’t doing anything. We can’t wait for red tape, or a taskforce, or a bureaucratic process. We’re not going to stand around and watch people die in front of us. We put a guy with a cellphone in a tent with a Narcan kit, a chair and a table and we said here you go, if anyone comes round, we’re ready to save lives. Now the site sees 300 people a day.Volunteers working at the Overdose Prevention Society. Photo sent by our Observer.
Obviously, you can’t just set up a medic tent without a permit. Authorities became aware of what we were doing a couple of weeks after we started. Even though it was illegal, they realised that it’s better than letting people die. [OPS was running for about three and a half months before authorities officially gave it the green light on December 23, 2016.]
Safe injection areas are not where people are dying. People are dying in their houses, where they’re unsupervised. We’re trying to get people to come out of their houses and use in a safe space.
The government is in the process of passing a new bill that will make it easier for these community-run sites to be authorised quickly, and to continue doing the work that saves lives.