Injection sites may do little for fentanyl crisis, experts say

Facilities would need to include multiple forms of consumption, advocate explains

A proposal to establish Edmonton’s first supervised injection sites is good news for those invested in the effort to reduce overdose deaths, but those hoping the facilities may be the answer to the broader fentanyl crisis should keep their expectations in check, experts warn.

While provincial government support to establish the sites — including a $230,000 grant — has largely come as a response to fentanyl, it remains unclear what dent they can make in addressing a highly complex, widespread problem affecting people from all different ages, incomes and residences.

Experts behind Edmonton’s proposal acknowledge the facilities, though beneficial to a segment of the drug-using population, are not particularly practical for recreational users or those who live outside of the city core.

“Whether someone who is stably housed, who is going to work every day, is likely to come and use a supervised consumption service, I don’t think that’s necessarily realistic,” said Elaine Hyshka, a public health professor at the University of Alberta and part of the group proposing the injection sites.

“Supervised consumption services are a critical tool. They will save lives in Edmonton and they will absolutely meet a large unmet need in the inner city, but they are not going to reach everyone and they are not designed for that.”

Statistics from Alberta Health’s latest quarterly report on the opioid crisis show close to two-thirds of Edmontonians who died from a fentanyl-related overdose last year lived outside the inner city.

But even among inner-city users who are the focus of safe injection sites, questions remain on how much impact they can have in curbing the fentanyl epidemic.

That’s because many people who ingest fentanyl — knowingly or not — take it in pill form. As well, recent evidence suggest many street drugs that are inhaled or smoked, such as cocaine and methamphetamine, also have a good chance of being mixed with fentanyl.

Edmonton’s proposed sites may not help such users because the facilities, as currently envisioned, will serve only clients wanting to inject drugs.

Hyshka said her group, Access to Medically Supervised Injection Services Edmonton, is exploring the possibility of the sites accommodating other types of drug intake.

“We need to apply to Health Canada for multiple forms of consumption based on evidence and need,” she said.

She said no other Canadian city has yet sought approval to provide medical supervision for multiple forms of drug consumption.

Shanell Twan, a former addict who works with the Streetworks needle exchange program, said she thinks a more comprehensive drug consumption site would be valuable to inner-city drug users.

“I think people who are concerned that they might not know the source or the potency of what they were using, they would want to be somewhere where there’s someone to help them in a situation where a loss of life could occur,” she said.

Still, even if the proposed sites accommodate injectable drugs only, Hyshka said she believes they will still have a big impact in saving the lives of opioid addicts.

She said a large percentage of people who are openly using drugs in the inner city are injecting opioids. She noted provincial data from the first nine months of 2016 showed more overdose deaths in Edmonton were linked to other types of opioids than to fentanyl.

(Supervised consumption services) are not going to reach everyone and they are not designed for that.