THERE WERE CERTAINLY people who were working – who were coming in on their lunch breaks. I was asking them their route into street drug use and they were saying that they were originally prescribed pain medication – the kind of typical story you hear from America and Canada.
They’d become addicted after car crashes or after surgeries or whatever and then – the typical story you hear – they were on these pain meds and they’re cut off of them, and they’re addicted so they need to go to the street.
— As a senior manager of Dublin’s Ana Liffey Drug Project, Dawn Russell wasn’t shocked by what she saw during her daily shifts on a recent working visit to Vancouver’s Insite injecting centre.
The scale of the city’s drug problem was something she hadn’t witnessed before, however.
An opioid epidemic has claimed thousands of lives in Canada. In Vancouver, the crisis is concentrated in the Downtown Eastside area.
On her way to work at the injecting centre, she said:
I was walking through a very big community which was just ravaged by drug problems – it felt kind of like being in The Wire a little bit, in that most houses and most people looked like they had been just obliterated by drug use.
The problems in the area go back years. For decades, workers broken by Canada’s resource booms have ended up in cheap hotels in the Downtown Eastside, each with a pub on the ground floor.
Over time, they’ve been joined by drug addicts from across Canada, and the mentally ill left homeless after the government of British Columbia closed mental health institutions without providing community housing as promised.
Canada’s first medically supervised injecting site – the Insite centre – was opened in the Downtown Eastside in 2003 to help combat overdoses and curb open drug use in the area.
Fentanyl crisis
More recently, the area has been dealing with a flood of fentanyl – a drug about a hundred times more potent than morphine – into the drug market. Officials declared an emergency last spring, as the cheap synthetic opioid replaced expensive heroin and soon became mixed into most street drugs.
The scale of the crisis was clear to see on any given day at the injecting centre, Russell said.
Drug users, after checking in with front desk staff, sometimes needed to wait up to 15 minutes to enter the injecting room proper. As they waited, staff would engage – and the clients could take the opportunity to ring their GP or arrange a bed for the night.
There was always a large volume of people using the service during its hours of operation, she said.
“The dynamics in Vancouver are incredibly different to Dublin – in that they have a much larger drug problem, numbers wise. They have a much higher rate of overdose and they have huge numbers of people injecting.”
On a national level in Canada, decisions have already been made to increase the number of supervised consumption sites in response to the opioid crisis. Two years ago, there was only one. Now, there are 22 – plus three interim sites.
A senior Canadian minister recently cautioned, however, that such centres are not “a panacea or a silver bullet”. Jane Philpott insisted the centres are part of “a really broad range of tools that fall into the classic four pillar response” of harm reduction, prevention, treatment and enforcement.
“Almost everyone said to me they’d be dead without the place,” Russell said of the injecting centre’s clients. ”Most people I spoke to had had multiple overdoses on the street previously.”
“The professional people said that they felt able to come because it was a really professional service, they could come on their lunch break they could manage their drug use around their lives.
They felt safe because they knew that they would be taken care of whereas previously they might have driven off in their car on their lunch break and used in their car and if they’d overdosed they would have been found dead.
Or else they would have ended up going down alleyways or under bridges into a part of the world they usually wouldn’t go into, because they were trying to hide their use from family or bosses or wives.
In some cases, the people with jobs who came into the centre had become addicted to pain medication in the wake of an accident or operation. Other clients, however, said they had turned to drugs because of trauma or abuse.
And while the professional visitors may have stood out in the surroundings of the injection centre, “another element in Vancouver which was really visible when I was in the safe injecting room was First Nations people”.
In Vancouver there was an awful lot of First Nations people, people who were now more mixed with the white community but they had First Nations backgrounds – and for all the typical sociological reasons they’ve become marginalised, they’re homeless, they’re unemployed.
Day to day at the injecting centre, life was “very routine”, Russell said. “It’s less high intensity than working at a drop in centre.”
Most visitors are registered users of the facility. “Any new people are assessed by the team leader on site as to whether they are appropriate to be registered for the service – i.e. whether they currently inject drugs or not”.
Clients bring the drugs they have brought with them into a sterile injecting room, where booths are set up around the walls with stainless steel surfaces and a large mirror.
Clients are reminded to wash their hands – and staff intervene respectfully if they witness any dangerous injecting practices (like people licking traces of drugs from the tips of needles in advance of injecting).
Limited testing facilities are available to detect the presence of fentanyl and other substances. Staff also build up a store of knowledge about the substances being bought and sold on the streets on any given day.
“They would be able to say ‘we had a few cases earlier in the day and they were quick overdoses, so just mind yourself because there seems to be fentanyl’.
In terms of the mix of clients, some were well known to staff, “others, a nurse might say ‘I haven’t seen you in ages where were you?’ ‘I was in prison.’ ‘Oh your tolerance is going to be lower.’ So it’s about effective real-time harm reduction.”
If an overdose occurs, the nurse-led team can intervene immediately. Russell said the team dealt with about one overdose a day. “Most of them were slow ones that you had to monitor, and kick in at the right point”.
Nurses also provide additional healthcare services at the Insite centre, like wound care and immunisations. Information on withdrawal management is available too. Access to further steps, including detox rooms, is available at the same location.
In 14 years of operation, there have been no overdose deaths at the centre.
While Russell is well aware of the arguments against such facilities – that they promote or encourage drug use – she says centres like the one in Vancouver have shown that, along with helping save lives, they also free up health and law enforcement resources in surrounding areas.
So for our clients for example – the regular use for our clients would be four to six times a day. The maximum use that anybody has ever really told me about is 12 to 14 times a day.
So you could be talking about multiple overdoses a day that require ambulance call outs. Right now, if someone walked into Ana Liffey with a slow overdose we could manage it with a nurse and with oxygen on site – but if it gets to a very dangerous point we need to call an ambulance. In the injecting centre, they had everything they need - I didn’t see any ambulance being called at any point.
Police always get dragged into these things too because they’re often a first responder if an overdose happens on the street.
Dublin’s first supervised injecting centre is expected to open next year. In addition to the Ana Liffey project, Merchant’s Quay Ireland are also known to have applied.
Similar to Vancouver, according to Ana Liffey’s CEO Tony Duffin, people engaged in street based injecting in Dublin city centre “often have complex and multiple needs”.
He said the opening of the pilot supervised injecting centre in Dublin would provide a sanctuary – “a safe space to inject that reduces the health risks and removes stigma – at least for the time people are in the service”.
This breathing space will allow for genuinely meaningful relationships to be formed far quicker. The evidence is clear that when you open up such a service you get people through to treatment and rehabilitation faster than otherwise.
It’s expected there will be at least three bidders to host the Dublin centre, with a decision expected in December.
Legislation to allow the injection centre passed through the Oireachtas earlier this year.
- With reporting from AFP
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