By Catherine Hacksel
Last week, my neighbour and I talked about the fentanyl crisis in Ottawa. The conversation was prompted by a news story on the subject, featuring myself and other members of Drug Users Advocacy League. He told me he was surprised, and had not considered Ottawa a town with such a drug problem: It’s so conservative here.
Fentanyl, a synthetic opiate drug, is a powerful painkiller. Initially prescribed to cancer patients or those post-operation, the patch is meant to slowly release soothing drugs over a few days. However, people discovered the impact of smoking these patches, or boiling them down and injecting their contents. While patch-return programs at pharmacies (intended to prevent illicit sales and use) have begun to gain traction, powdered fentanyl has emerged from illegal drug labs across the country.
The drug market – arguably, capitalism at its most violent – is simple supply and demand. At the moment, Canada is the second-highest consumer of opiates in the world. They are being prescribed en masse, and sold illicitly across the country. There’s a lot of suffering out there.
Addiction is an illness characterized by isolation and feelings of worthlessness. For most, it’s a response to trauma or emotional neglect. As my friend Jordon has described it to me, drugs become your best friend. They don’t judge, and they’re always there for you. Despite dangerous or self-destructive behavior, addiction has a way of keeping you company in a downward spiral.
Helping someone overcome their addiction takes patience and empowerment. It requires hope and opportunities for advancement. People who inject drugs in Ottawa need much more than a safe injection site – but it’s a crucial piece of the puzzle. Meeting people where they are at and accepting them is the first step to building a constructive relationship with positive outcomes.
I know this first-hand. As a member of Drug Users Advocacy League (DUAL), I coordinate a weekly drop-in program for people who use drugs in Lowertown. For two hours once a week we provide fresh breakfast, nursing care, program referrals, and drug using equipment. But most importantly, we offer a space where people can just be themselves without judgment or punishment. This simple gesture of acceptance and welcoming is a rare commodity for many of our attendees. Our staff who cook and serve are all people with lived experience of drug use, and can offer peer support to those entering the space. Every week I am inspired by the team’s passion, knowledge, and contagious optimism. On a modest $50 budget, we employ two people a week and typically serve over 40 individuals.
Observing the nurses provided by Ottawa Public Health has taught me a lot about building trust in medicine. Nearly every week they are present to offer services, but it often takes a DUAL member to connect an attendee with care. Shame and judgment become so internalized during addiction that many who need medical attention avoid seeking it until the situation is dire. I am proud of the nursing services accessed in our space, the most popular being wound care, but also ranging in blood testing for infectious diseases and Naloxone training.
Naloxone is a drug that is made and distributed in an effort to reduce fatal opiate overdoses. The drug temporarily blocks the brain receptors affected by opiates, which during an overdose could cause an individual to stop breathing, suffer brain damage, or die. While largely hailed as a miracle drug, Naloxone is still inaccessible for many who could benefit from it. One immediate barrier is stigma – Ottawa Public Health will provide free Naloxone kits to anyone who identifies themselves as an opiate consumer. However, this program is not widely known and has only been accessed by roughly 200 people since its launch in 2012. For a city that hosts an estimated three to five thousand injection drug users, there’s still a long way to go. In addition, many people who are at risk of overdose are so caught up in their using that they don’t think to protect themselves with this program. Instead, partners, parents and friends seek it out, but cannot receive a kit if they themselves are not at risk.
While Naloxone has recently been recognized by Health Canada as a drug that should be available without prescription, that policy change has yet to trickle down to Ottawa Public Health. And on its own, Naloxone cannot curb fatal overdoses in this city. Why, you may ask?
Because too many people are using alone. I-Track, a national surveillance study on people who inject drugs across Canada, has found that the majority of respondents most commonly used drugs by themselves. Unless the individual has time to pre-load their Naloxone kit (it comes in an injectable fluid) and act immediately upon feeling an overdose, the situation can quickly turn for the worse. As a research assistant with University of Ottawa contracted to interview people for I-Track, hearing these stories firsthand blew me away; housing may take drug use off the streets, but it does not guarantee safety.
While they operate discreetly, Ottawa has fairly comprehensive harm reduction programs. Harm reduction is a series of strategies and services meant to alleviate the harms of drug use. Free Naloxone kits would be an example of such a program. In Ontario, we’ve been providing sterile drug using equipment for people who inject since 1991 to combat HIV and Hepatitis C transmission. We offer twenty needle exchange programs across Ottawa, over a dozen of which include safer inhalation supplies, and three mobile services. However, there are still obvious gaps – for instance, only one service operates after 1:00am, at the Shepherds of Good Hope shelter. For unstably housed or homeless drug users living outside the ByWard Market, this can result in shared equipment, but typically means buying supplies from those who exploit this gap in care.
Another obvious gap is the lack of sanctioned places for people to actually use their free city needles. Safe injection sites protect drug users from criminal prosecution during access, providing an opportunity for an individual to use in a clean environment with staff they can trust. There is no risk of robbery or rape in a safe injection site. These risks, however, exist elsewhere. In a safe injection site, one can take their time finding a vein, something very important if you’ve injected for a number of years. Many people who have injected drugs for a long time have collapsed veins and can turn to high-risk spots for easy access if the timing is tight – a good example of this is jugging, when an individual shoots into their jugular. This is high risk for overdose, and for cases of bacterial infection that go straight to the heart. It’s a scary option, but necessary if one needs to use quickly in a public place.
Instead of providing people a safe place to go, we reduce homeless drug users to public washrooms and parkettes. A conservative town, we don’t want to see the need in our streets. Needle Hunters scour Lowertown on a daily basis, cleaning up the evidence, while the Mayor deflects any calls for action. While detox and rehab are easy answers, people need to survive to seek treatment.
Harm reduction is health promotion. Amongst the vast research on Vancouver’s Insite, one of the most powerful findings was the uptake in self-care. People who used Insite were 30% more likely to enter detoxification programs than those who injected elsewhere. People who use Insite are more likely to practice safer behavior beyond the facility, wearing condoms and not sharing their needles. Harm reduction is about prioritizing health and dignity unconditionally; forcing people into dangerous situations does not deter drug use, only increases their harms.
We live in a country where we take pride in offering health care to all. None of us are perfect, but we all deserve an efficient and evidence-based health care system. Safe injection sites offer a stepping stone, and when effectively implemented reduce public drug use in the surrounding area. In Rideau-Vanier, the need is clear – 75% of city-wide drug litter is found in this ward.
As an advocate and community member working with people who use drugs, I know there is more we can do as a community and country. We need to treat addiction as an illness, not a crime. A safe injection site is not a cure-all, but it does offer one thing addicted people need most – hope.
Catherine Hacksel is a program coordinator for the Drug Users Advocacy League and a research assistant at the University of Ottawa