Pubdate: Fri, 04 Aug 2017
Source: Ottawa Citizen (CN ON)
Copyright: 2017 Postmedia Network Inc.
Author: Elizabeth Payne
Page: A1


Substitution site for addicts set for September

As a fentanyl crisis sweeps the country, medical officials in Ottawa
are moving quickly and quietly to open a supervised injection site for
opioid users.

The opioid substitution program, which will be the only the second of
its kind in Canada, is expected to formally begin in September at the
Shepherds of Good Hope in the By Ward Market area.

While attention in this city has been focused on a recently approved
supervised-injection site for illegal drug users, officials with Inner
City Health have been planning the managed opioid program, which will
open first.

It will be somewhat similar to the supervised injection site to be run
out of the Sandy Hill Community Health Centre, where injection drug
users inject their own illegal drugs under supervision in a sterile

Under the managed opioid program, however, participants will be
prescribed hydromorphone, provided by Inner City Health, which they
will either inject or take orally several times a day under
supervision. Because the drugs involved are legal when prescribed, the
program does not require a special exemption, as supervised-injection
sites for illegal drugs do. But Inner City Health has contacted both
the College of Physicians and Surgeons of Ontario and the Ontario
College of Nurses about the plan and for support.

Inner City Health, which provides health care to Ottawa's homeless,
has been thinking about introducing the program for some time, said
executive director Wendy Muckle, but the fentanyl crisis has made the
need urgent.

"We can't sit around and talk about this any longer. This is like you
are in a war zone, you've got to do what you've got to do," she said.

As she talked about the program Thursday morning, staff members from
Inner City Health were being dispatched with naloxone kits to check on
a large group of men shooting up on the sidewalk on Murray Street,
some of them lying on the sidewalk beside a construction site, near
the Shepherds of Good Hope.

This was the start of "cheque day," when government cheques are mailed
out. It's considered the worst day of the month for those working with
addicts because drug use and overdoses spike and scenes such as the
Murray Street "shooting party" become more common.

Drug overdoses have ramped up dramatically in Ottawa since the
beginning of the year, said Muckle. In June, the organization saw an
average of an overdose a day. In February, two of its longtime clients
died from overdoses.

Muckle said it became clear that the organization needed to change its

"We have done a lot, but fundamentally, someone has to look at
changing the drugsupply and the only way to change the drug supply is
to control it."

The goal of the managed opioid program is to prevent people from
seeking opioids on the street, where the drugs may be laced with
fentanyl and where they may encounter other dangers, in addition to
breaking the law.

Muckle said Inner City Health decided to move quickly after hearing
about opioid-replacement programs, and research supporting the use of
managed hydromorphone, at a conference in June. She said the police
are aware of the program. "You can understand from the police
perspective it is a winner." A ByWard market business owner asked
Inner City Health to introduce such a program to reduce the buying and
selling of drugs in the Market.

Although opioids are legal, if prescribed, buying them on the street
is illegal and those selling them can be charged with

On Thursday, Dr. Jeff Turnbull checked in on a client of Inner City
Health who is addicted to opioids and illegal drugs. She is being
given oral opioids in an attempt to get her off street drugs, part of
the early "ease into" the formal opioid-management program. But she
made it clear during a consultation that the drugs provided by Inner
City Health were not enough to stop her from topping up with street
drugs. Doctor and patient talked about increasing her dosage.

"We are trying to get it so you are not on the street," Turnbull told

"I know," she said, "a lot of my friends have died. There is fentanyl
on the streets."

Though relatively rare in Canada, opioid substitution is already done
in Vancouver and has long been in place around the world, said Muckle.
In most places, heroin is given as a substitute. She said Inner City
Health did not want to use heroin, in part because of the attention
that would receive. But she added that research has shown
hydromorphone, sold under the brand name Dilaudid, works just as well,
and better in some cases.

She said the program is intrusive, by definition. Every injection or
medication clients take has to be observed and recorded. As they
stabilize, she said, the hope is that they will choose less intrusive
options, such as methadone.

She also said there should be no fear that people will be lined up
around the block for the free opioids. "The program is not a
free-forall. It is a very restrictive program."

Meanwhile, Muckle said, opioids are "flowing freely" in the city.
Staff at Inner City Health check rooms and bathrooms at the shelters
every 15 minutes to make sure no one has overdosed.

"It is a full-court press. It just hit in February and it has been
crazy since."

In a statement, Ottawa Public Health said it supports the initiative.
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