On January 8, staff at an Ottawa community health centre found a woman unconscious and unresponsive in a bathroom. The nurse on duty quickly administered naloxone, the overdose reversing drug, but the woman was already turning blue. The nurse gave the injection three more times, but it was too late. The victim was pronounced dead on arrival at the hospital.

There are two Supervised Injection Sites (SIS) in Ottawa, both less than a 10-minute walk away. For reasons unknown, the woman decided it would be safer to use alone, locked in a bathroom.

Even as dozens of supervised injection sites open across the country, there are still massive holes in Canada’s drugs policy. It’s not enough to simply expand a medical system that sees and treats people who use drug as criminals. Instead of making it harder to get drugs, we need to make it easier—and cleaner and safer.

The opioid overdose crisis in Canada is getting worse. Based on preliminary data, there were more than 4,000 opioid-related deaths across the country in 2017. In 2016, there were 2,861.

In April 2016, British Columbia declared a public health emergency in response to a rapidly growing number of drug overdoses. More than 1,000 of the deaths in 2016 were in B.C. Along with the declaration, the provincial government increased naloxone distribution programs and pressured the federal government to approve two other SIS.

The epidemic of overdoses quickly spread east, but the rest of the country has been slow to respond. In Ontario, the next hardest hit province, there were 867 deaths from opioid use in 2016. By mid 2017, deaths had increased in the province by 86 per cent.

Despite urging from the Toronto Board of Health and health providers across the province, the Ontario government refused to declare a public health emergency. Yet the overdose crisis clearly dwarfs past public health emergencies. According to Pauline Voon of the B.C Centre for Substance Use, the government declared public health emergencies after 44 people died of SARS in 2003, and again in 2009 after 428 deaths from H1N1.

On August 20, a group in Toronto decided to take matters into their own hands. They opened an unsanctioned pop-up SIS in Moss Park, the fi rst SIS east of B.C. Three days later, a group in Ottawa did the same.

On August 20, a group in Toronto decided to take matters into their own hands. They opened an unsanctioned pop-up SIS in Moss Park, the fi rst SIS east of B.C. Three days later, a group in Ottawa did the same.

Overdose Prevention Ottawa forced the government to open two nearby SIS. After the second opened, which was a 24/7 heated trailer, the pop-up faced winter conditions with zero government support. The group then decided to suspend its services, while Toronto continues to operate.

Ottawa approves 26 new sites

Afterwards, however, Ontario appointed a provincial task force on the opioid crisis, which created an express process for funding temporary overdose prevention sites. At the same time, the federal government had begun to approve a wave of new SIS. In the last 12 months, the government approved 26 new SIS.

In less than two years, Canada went from one sanctioned site to 28, not counting the many temporary sites set to open under Ontario’s express process.

SIS are an important step. When done right, they permit drug users to inject with clean equipment with the guidance of staff trained in spotting and reversing overdoses. In fact, much of their benefi t lies in creating a stable and safe environment, which prevent overdoses in the fi rst place.

But SIS operate as an exception to the law. Possession, use and traffi cking of drugs remain illegal, but sanctioned SIS are granted a medical exemption to Canada’s Controlled Drug and Substance Act in order to allow people to use there. Outside and around SIS, police can and do arrest users.

Until the drugs are decriminalized, police will undermine and undo many of the benefi ts of SIS.

After Ottawa’s 24/7 SIS trailer opened, police arrested seven people and identifi ed 14 others to track for drug-related offences in the neighbourhood surrounding the trailer. The Ottawa Citizen reported that undercover police regularly enter the trailer, looking for people out on warrants or to catch someone selling. Trailer staff have been told to collaborate with police, presumably out of fear of losing the trailer’s exemption if they don’t. Now the number of visitors at the trailer has declined. For many, it has become less safe than using on the street or in private.

Just as important is how people are using is what they are using. Some SIS have began offering drug testing. Often, these are crude instruments that only indicate the presence of contaminants like fentanyl. More detailed testing can take weeks or longer, which is little help to people suffering from an immediate addiction.

Instead of trying to detect and manage contaminants, it would be far more productive to simply ensure a clean supply. More than 20 years ago, Dr. Bruce Alexander, a renowned psychologist and addictions researcher, advocated giving doctors the ability to prescribe certain drugs like heroin and cocaine.

Speaking to the Vancouver Sun in 1997, he said “It is wiser to give [drug users] a clean and safe drug in a clean and safe environment than allow the death toll from drug overdoses to continue to rise…. People are dying now. It’s not time to debate or do more research.”

Safety First

The largest driver of overdoses has been the increase of fentanyl — a synthetic pain killer 100 times more potent than morphine — that’s being used to cut drugs. Providing pharmaceutical-grade opioids would effectively eliminate toxic additives, allowing users to know exactly what they are taking and its strength.

It’s an idea that Canada has fl irted with, but never embraced. Several trials found prescribing heroin and hyrdomorphone — a synthetic opioid similar to heroin — to be far more effective than methadone in improving patient health and decreasing dependence. Since 2014, one clinic in Vancouver has been approved to prescribe it to a tightly controlled group of approximately 140 patients. The program has been amazingly successful, which lead to Ottawa to overturn the ban on physicians prescribing heroin in 2016. However, the program cost, approval process and strict patient criteria have prevented any other physicians from following suit.

Dr. Mark Tyndall, Director of the UBC Centre for Disease Control, is working on an alternative. In late December, Health Canada approved a three-year pilot project where outreach workers would be able to distribute hyrdomorphone to people without prescription. It may even be available over the counter in pharmacies.

Tyndall was clear about the need for such a move: “we will not get out of this crisis by simply improving on current prevention strategies. We must directly address the cause of the overdose epidemic: a toxic drug market.”

It’s an important step, but a limited one. The pilot will only apply to 200 people in Vancouver and Victoria. If there’s hope of reversing the overdose crisis, similar programs will have to spread across the country and fast. Only by removing the risk of arrest and providing clean drugs in safe environments can we hope to avoid many more unnecessary deaths.

James Hutt is the interim national director, policy and advocacy for the Canadian Health Coalition, and a writer, organizer and member of Overdose Prevention Ottawa. He is currently Our Time magazine’s climate-justice columnist. Twitter: @JamesRHutt

This article appeared in the Spring 2018 issue of Canadian Dimension (Whiteness & Racism).