Injection program to battle opioid crisis

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 location.

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 approach.

“We have done a lot, but fundamentally, someone has to look at changing the drug supply 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 trafficking.

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 her.

“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.