SCS staff on front line of city drug crisis
CONFIDENTIALITY AND DIGNITY IMPORTANT
In May this year, about three hours into a shadow shift he was doing prior to being hired at the city’s Supervised Consumption Site, Aidan Jensen-Holubowich was on scene for his first drug overdose.
It was an important moment, and it changed what Jensen-Holubowich thought about overdose response.
A newly-graduated registered nurse, JensenHolubowich was unprepared for the emotions involved.
“It was just so raw,” he said. “(The client) was in there with his buddy, and the guy was crying (and apologizing) His fear was real.
“I hear a lot about how people who use drugs aren’t afraid of overdosing.
“But they are. I’ve seen quite a few overdoses, and never are they ‘just fine.’ There are often tears. And there is a lot of loneliness.”
At first, he kept track of the overdoses he was involved in, but then he stopped. Some days are better than others. Some days he will deal with eight overdoses. On rare days, none.
But this is what he signed up for. He wanted to save lives and make a difference.
“I’m very well supported here,” he said.
The facility is staffed in part with addictions counsellors, registered nurses, and harm reduction specialists. The three roles work together to provide holistic treatment for the SCS clients. This includes onsite counselling, referrals, and assessments, while registered nurses deal largely with the health and safety of the clients.
It’s a priority for all staff on site to be aware most of the 848 registered SCS clients are part of the city’s vulnerable population, and work to preserve a high level of respect, confidentiality, and non-judgement to encourage those people to continue using the site.
When a person comes into the SCS for the first time, they are subject to an intake interview, including questions about their previous drug use. In some instances, these are people who may have never injected drugs before and are looking to be safe about it.
“We don’t really love when people come in saying they have never injected before and are looking to see what the high is like,” said Jensen-Holubowich. “We’ll do an assessment there and try to see if they are interested in doing their drugs in a different way.”
There are a lot of rules for clients hoping to use the site, and those rules are carefully explained during the intake process.
“We have strict guidelines around how we can keep this site operational and efficient,” he said.
Confidentiality and dignity are also broached during the intake. Clients need to be made aware their right to confidentiality might not be possible in the event of a medical emergency.
New clients are then given a tour of the facility, and are told what the general expectations are surrounding use of the site.
Clients bring their own substances for use. The site does not provide any drugs for users. Nor is any drug dealing or other criminal activity on site allowed. The in-site drug use has been exempted.
What staff do provide is a clean space and sterile equipment so that clients can use their drugs with a lowered risk of infection. And they watch clients carefully for any signs of medical distress so overdoses can be handled quickly. Again, dignity is a key part of the process.
“We try not to stare directly into their eyes while they are using,” said JensenHolubowich, “It can make them uncomfortable. We want them to be as comfortable as possible and keep using the site.”
Staff watch for any abnormal signs in order to respond to potential medical emergencies immediately. They can look for clients who are not alert or becoming restless, turning blue, or sleeping and unresponsive, staff will intervene.
The clients finish using their drugs, clean their booth, and then move into an observation or “chill-out” room. It is a small, quiet space lined with chairs. The walls are adorned with art made by clients, poetry and poems largely about the power of inner strength.
The room is staffed at all times, and clients continue to be monitored for any signs of medical distress.
“Sometimes overdose reactions can be a bit delayed,” said JensenHolubowich.
And no matter how many people use the site at a given time, more seem to be waiting just outside.
“It’s amazing how many people use this site,” said Jensen-Holubowich. “I didn’t think we’d be this busy.”
Since the opening of the facility on Feb. 28, to Sept. 24, a total of 848 unique users have registered with the SCS.
It has seen steady growth in terms of usage. In March: there were 2,375 visits; April: 5,214 visits; May: 8,117 visits; June: 13,133 visits; July: 13,412 visits; and August: 13,544 visits.
The growth seen between May and June was caused by additional funding in order to open more booths for injection drug use. The total number of visits as of Sept. 24 is 64,730.
To date, there have been 619 medical emergencies that would have otherwise required an EMS response.
Oxygen has been administrated 600 times, and naloxone administered 244 times.
“I would argue that those 244 administrations of naloxone would have otherwise led to fatalities in our community,” Jill Manning, Managing Director of ARCHES told a Community Issues Committee earlier this week.
Superstition and ritual play a role in drug use, in many ways similar to how athletes make use of ritual when preparing for competition.
“The way they use the drug might have to be the same every time,” JensenHolubowich said. “It’s just something they feel they need to do to get the full effect of their substance. Or it might be a bit of superstition.”
In sports, these rituals can add confidence and a measure of control to a person’s performance. It is similar with drug users — especially those who live very chaotic lives, when a measure of control, no matter how small, is welcomed.
“It’s like wrapping your hockey stick with a couple different pieces of tape,” Jensen-Holubowich said. “Or it might be how you light the pipe the first time, or draw blood into a syringe. They just have their own way of doing it.”
It could be too early to know what the shelf life is for an RN working in a SCS, but burnout is something JensenHolubowich has wondered about.
“I’m not sure there’s been a lot of research,” he said. But there has been a lot of support for staff at the SCS.
“I don’t feel like I shouldn’t share what I’m feeling,” he said. “When I debrief, I get good feedback. But it really depends on your perspective going in. I think if you’re going to be morally frustrated, you’re going to burn out. It certainly takes a certain type of person.”
Something that has changed is how he deals with community anger over the site.
“I got rid of Facebook,” he said. “I couldn’t deal with the public outcry. But honestly, when I’m on a lunch break, I leave my nametag on.”
That’s because outside of social media, the community is supportive of their efforts.
“People will be like, ‘I know you’re getting a lot of shit, but you’re doing a really good job,’” he said.
“But it’s tough because the people against the site are often the loudest. And a lot of what they are saying is misconception. I get it if you are morally against this site. Our site does concentrate drug use, and it’s very unfortunate for the businesses in the area.
“(But) I think it will get better,” he said. “It has to, right? It has to just become normal.”
The system is complicated. A lot of the time, people who use drugs are written off as people who make bad choices. And while that may be partially true, it’s not the complete picture. For Jensen-Holubowich, it does not seem to be complicated at all.
“We’re just human beings just trying to save human beings right now,” he said.
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