Pubdate: Fri, 25 Aug 2017
Source: Ottawa Citizen (CN ON)
Copyright: 2017 Postmedia Network Inc.
Author: David Reevely
Page: A1


Advocates say they can't wait any longer and will open a
safe-injection location

Drug users are dying while politicians fill out forms and wait for
approvals for supervised injection sites, says a group promising to
open a guerrilla injection tent of its own somewhere in Ottawa Friday.

Overdose Prevention Ottawa, which has only existed for a matter of
days, is taking the delicate political compromises that have let
harm-reduction efforts lurch forward here and kicking them aside.
Because waiting is costing lives, the group says.

The group has cautious support from Ottawa Public Health, which is
resisting political pressure to shut its plans down.

Supervised injection sites are meant to be places where drug addicts
can inject chemicals like heroin and have health workers available to
react immediately if they overdose. Overdose Prevention Ottawa is
pushing against a boulder that's already moving a little: After years
of opposition from the federal Conservatives when they were in
government, the Liberals have approved several across Canada. One is
due to be added to the Sandy Hill Community Health Centre soon but
isn't open yet.

"We force people to use alone. They don't have a safe space in
Ottawa," said Marilou Gagnon, a nursing professor at the University of
Ottawa and vocal advocate for the idea that drug users benefit more
from safe drug supplies and access to non-judgmental health workers
than from prohibitions on their drugs.

Gagnon and other members of the group spoke at the Human Rights
Monument, on the grounds of city hall at Elgin and Lisgar streets, as
members of Mayor Jim Watson's staff looked on from his office windows.
Although Overdose Prevention Ottawa members plan to open their site in
a tent somewhere downtown on Friday, they wouldn't say where yet.

Unlike a full health clinic, Gagnon said, the group's site will have
volunteer health workers only to monitor drug users who inject there
and respond to overdoses with naloxone, a drug that can reverse them.
They're crowdfunding to cover costs. It's not meant to be a substitute
for an emergency room or a community health clinic, just better than
nothing. Because that rock is not shifting fast enough. People are

"Six months? A low figure? Twenty five people," said Robert Jamison, a
former drug user who volunteers helping current drug users in and
around Chinatown. That's how many people he can personally name who've
died of overdoses, he said. "It's great that there are going to be
these bigger sites, I'm all for that, but we can't wait any longer. We
don't have the luxury."

Fentanyl and carfentanil, massively potent opioids that are easier to
smuggle than heroin or morphine, are being cut into the street drugs
available in Ottawa. They're killing users who have to take what they
can get and end up injecting much more powerful drugs than they
expect. Ottawa Public Health has begun releasing regular statistics on
overdoses and the report for June shows that 135 people were taken to
emergency rooms here in that month, the highest number in
two-and-a-half years.

"We had two years. I've been going around with my fellow outreach
workers for two years, warning that this is going to hit. And now it's
here. We've had a lot of time to prep for this and we didn't," Jamison
said. So he's burying friends, administering naloxone, even going into
an apartment where a mother had overdosed and died while her baby slept.

The governments' talk is nice, he said, but so far just

"Alls I can relate to is what my last 30 days on my little block have
been like," Jamison said. "I'm not seeing these words on my block."

Similar groups in Toronto and Vancouver have opened "popup" injection
sites that Overdose Prevention Ottawa considers good models.

Vancouver has seen 232 lethal overdoses so far this year, twice as
many as in all of 2016. There, tiny injection sites have been given
official sanction from the provincial government as part of an
emergency response to an epidemic. Toronto's pop-up injection site
opened earlier this month and has been tolerated by authorities there,
though Toronto's public-health unit also just opened a stripped-down
version of a full supervised injection site that was due to open later
this year anyway.

Ottawa's chief medical officer of health, Dr. Isra Levy, supports
supervised injection sites. Earlier this year, he convinced the board
of health that oversees the unit to support them, too - in general
terms, subject to community consultations, run by experts in places
like community health centres.

That's been the compromise route through a political situation that
has many local leaders, including the mayor, rhetorically opposing
safe injection sites but willing to stand down as long as they're not
asked to vote for them directly. They look elsewhere while the health
unit runs needle exchanges and tells drug users not to use alone and
to have naloxone kits (distributed free by pharmacies, funded by the
province) on hand.

The pop-up plan upends that compromise.

College Coun. Rick Chiarelli wrote Levy a letter Thursday demanding
what he'd do to intervene.

"Some have drifted into the believe (sic) that if they don't like a
law or legal requirements they can just ignore it all. It is not ok,
and a danger to the public, to put up an unlicensed medical facility
just because it is inconvenient to do all the paperwork," Chiarelli
wrote. "Please advise me as quickly as possible regarding the steps
that will be taken to prevent this from happening."

He compared the activists' planned tent to an unlicensed
plastic-surgery joint that the health unit closed in his ward. "We
shut that down, but only after residents had been permanently
disfigured. When dealing with opioids the consequences can be even
worse than disfigurement. What happens if someone dies? Who is
liable?" Chiarelli wrote.

The health unit won't charge in, Levy replied, in writing. Though the
details are still scant, he wrote, the plan sounds more like a form of
peer support than a medical intervention, and that means the health
unit can (cautiously) support it.

"I have asked members of my team to reach out expeditiously to
individuals associated with this initiative to offer assistance in
ensuring responsible and high quality peer support, aligned with the
work being done by (Ottawa Public Health) ‎and our partners in
the community," Levy wrote.

Somerset Coun. Catherine McKenney, who is a member of the health
board, clenched her teeth at Chiarelli's analogy in an interview.

"People don't die from lack of plastic surgery," she said. "People do
die if they're not being supervised using opioids."

McKenney agreed that the cumbersome process for opening a legal
injection site has taken much too long. She would prefer to see a
response more like Toronto's, with the health unit setting up its own
quick supervised site or supplying nurses whose drug-treatment
qualifications are beyond question, she said, but she understands the

"There are people who are seeing their friends, their kids, their
family members dying of preventable overdoses and they want to take
immediate action," she said.

David Gibson, the executive director of the Sandy Hill Community
Health Centre here, said in a phone interview that his clinic's
supervised site is due to open in late October or early November. The
provincial government has approved its floor plan and the centre is
finalizing its budget. It has indeed been a slog, he said.

"From my standpoint, I totally appreciate the frustration. It took us
five years to get to where we've got and that's only because of change
in federal government. The intention to save a life and prevent an
overdose is one I totally support," he said.

Gibson worries mainly about the people manning the pop-up.

"They are putting themselves in a tight position vis-a-vis
enforcement, because they are not sanctioned," he said. "And as well,
in the event that there is a medical issue that is beyond their scope.
And that's the difference in terms of the formalized process with
Health Canada … What we have at Sandy Hill Community Health Centre is
we have the capacity to deal with those emergencies beyond just an OD
and giving naloxone."

Jill Skinner, a deputy chief of the Ottawa police, watched the news
conference wearing civvies and sunglasses. She'd just heard about the
pop-up plan earlier Thursday, she said, and had rushed to research the
models it's copying. Her immediate reaction was careful, though she
implied that the police will wait to see how the pop-up works before
deciding whether there's anything that needs busting.

"We've been saying all along, 'This is a public health issue.' We want
to ensure public safety," Skinner said. "What we've seen in Vancouver
and Toronto is they've put a professional process in place to see as
much public safety as possible, and that's all we want . ... We are
not the United States, we do not arrest people who overdose, we get
them medical attention."

The health unit will have to deal with the public-health implications,
Skinner said.
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