Canada’s overdose crisis (Part 2): 'Pop-up' injection sites

An overdose in an alley, Vancouver's Downtown Eastside neighbourhood. Photo sent by our Observer Sarah Blyth.
An overdose in an alley, Vancouver's Downtown Eastside neighbourhood. Photo sent by our Observer Sarah Blyth.

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.

Government advertising warning of the signs of an overdose and what to do next.

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.

The tent is a makeshift supervised injection site in an alley in Vancouver's Downtown Eastside. Photo by Travis Lupick.

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.

Outside the OPS. Photo from OPS Facebook page.

“We’re not going to stand around and watch people die”

Sarah Blyth is a former parks commissioner who works at the Downtown Eastside market nearby.

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.

Inside the OPS, with a volunteer monitoring users taking drugs. Photo from OPS Facebook page.

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.

“We are running out of space in the morgues”

Lisa Lapointe is the chief coroner for British Columbia. She told France 24 that fentanyl is being manufactured in China and smuggled through the country’s ports – hitting British Columbia first because of its coastal position. She says that regional services are struggling to keep up with the crisis.

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.

Not every overdose requires a shot of naloxone. As staff at B.C.'s 20 new overdose-prevention sites (OPS) have gained experience, they've learned that a lot of them can be reversed simply by administering oxygen. Here at the OPS attached to the Washington Hotel (Main and Hastings), I watched Sue and Kevin notice this man slowly fall into an overdose, where his brain essentially forgot to tell his lungs to continue breathing for him. A bit of gallows humour followed and they calmly went to work. Sue hugged him from behind, keeping him from falling from his chair. Kevin grabbed an oxygen tank and but the mask on him. Sue then began messaging his chest, somewhat roughly, up and down his rib cage in an attempt to keep the man awake. Kevin monitored his vital statistics and ensured nothing dipped too low. Then, with the oxygen mask still on and the vital-signs monitor clipped to his finger (ready to beep if the man's condition deteriorated), they dragged the man, still sitting up in his chair where Sue had caught him, over to one corner of the room, and let him sleep it off. That was it. Oxygen and a sound 30-minute sleep. When the provincial government flooded Vancouver with Narcan, people became a little too eager to use it. Drug users and peers working at the early OPS tents were injecting people with Narcan before there was any reason too. That no-doubt irritated a lot of users who lost their high. It also sometimes created problems because the people they injected, once instantly sober, would go find more heroin, significantly increasing their chances of a more-severe overdose. Now with a few months experience, and with health authorities making oxygen available at these sites, peers are reversing many overdoses without shocking people back to life with naloxone. #vancouver #dtes #downtowneastside #fentanyl #heroin #bcpoli #naloxone #narcan #harmreduction #addiction #drugs

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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.