Five B.C. cities now seeking injection sites
Insite boss says facility has handled 6,000 overdoses without one death
With overdoses claiming the lives of more than 550 British Columbians so far this year, at least five cities hope to open supervised injection sites — and B.C. health experts are pleading with Ottawa to make it easier for them to do so.
This drama is unfolding in the only province in Canada with injection sites — the stand-alone Insite, which opened in 2003 in the Downtown Eastside, and a smaller facility in the Dr. Peter Centre used by people with HIV-AIDS.
Dr. Ron Joe, the physician who runs Insite for Vancouver Coastal Health, provided Postmedia with a spreadsheet he’s been keeping since 2004 — a statistical history of the facility’s 3.6 million visitors. Three-quarters of those came to inject drugs and none have died.
“When Insite first opened, we were seeing about an overdose a day and now there is an average of three or four overdoses a day,” Joe, associate medical director of addiction services in Vancouver, said in an interview.
“We’ve now successfully reversed about 6,000 overdoses without a death, and I think that is a really key detail when the province is dealing with the prediction of close to 800 deaths this year in terms of overdoses from opioids.”
Insite’s record has prompted Victoria, Kelowna, Kamloops and Surrey to pursue similar facilities, and this week Vancouver announced it had applied to open two more injection sites in existing health centres in the Downtown Eastside.
But even though Insite has been operating for 13 years, Health Canada has not granted approvals to other locations, except the Dr. Peter Centre in January, which had been unofficially offering that service to a small community for years. The federal Liberals campaigned on embracing harm reduction, but have been slow to reverse a law enacted by the previous Conservative government that makes it difficult to open new sites.
In a letter in August to Health Canada, Vancouver Mayor Gregor Robertson, B.C. Health Minister Terry Lake and other top medical officials complained the legislation was “flawed, mean-spirited and ineffective.”
Federal Health Minister Jane Philpott has so far only said the Tory law may have to be revisited if it is a barrier to communities that want these sites.
The Insite numbers tell the story of why other jurisdictions should not be delayed, Joe said, because all health officials want to prevent deaths.
Overdoses at Insite have more than quadrupled from 170 in 2004 (when Joe started keeping statistics) to 772 in 2015. In the first eight months of 2016, there were 508. Nurses were present to help in all cases. The use of naloxone, which reverses the effects of opioids, has increased at the same pace as the overdoses. Naloxone has been administered 2,028 times so far, nearly half of those in the last two and a half years.
There have been 2.6 million injections at Insite. In 2004, the drugs of choice were primarily heroin and cocaine. Since 2010, however, cocaine use has plummeted and methamphetamine use soared. In June 2016 alone, there were 8,000 injections of heroin, 3,000 of meth and 1,000 of cocaine. A recent health authority report said 86 per cent of drugs at Insite were laced with fentanyl, typically without the knowledge of the drug users.
The busiest month since Insite opened was August 2013, with 36,000 visits by 2,670 different people. The busiest day that month had 1,338 visitors. Visits to Insite peaked in 2012 and 2013 but have fallen slightly since then. Joe isn’t sure why that is, but suspects it is
because meth users inject fewer times a day than cocaine users and therefore visit Insite less often.
Three-quarters of Insite visitors come to use the injection room. The rest come to get clean injecting equipment or to see staff, friends, nurses and counsellors.
Insite has provided injection education to 40,000 visitors between 2004 and 2015, most of it on vein care or location, cleaning of injection wounds, and tying off limbs. In 2015, it made more than 5,000 referrals to other social and health services, and nearly 500 referrals to its affiliated detox facility.
The average length of a visit to Insite has increased from an average of about 20 minutes in 2004 to around 30 minutes in 2016 because, Joe said, methamphetamines cause more distress to users, and therefore users tend to
require more attention from staff immediately after injecting.
Nearly 300,000 visitors have left over the years without getting help because of long waits for service.
A quarter of Insite visitors are women and 20 per cent are aboriginal.
The 110 overdose death sin Vancouver during the first nine months of 2016 are on pace to match or exceed the total for 2015, 133. But cities such as Victoria, Kelowna and Kamloops have already far surpassed last year’s numbers, according to the B.C. Coroners Service.
The city with the second-highest number of overdose deaths, with 71 as of Sept. 30, was Surrey, where advocates have pushed for a supervised injection site. Mayor Linda Hepner, who was initially lukewarm to the idea, said in an email Thursday that while she does not
support a stand-alone facility such as Insite, she could back one inside an existing support service, such as a homeless shelter.
Fraser Health, which had the highest number of overdose deaths among B.C.’s five health authorities this year, hopes to open a supervised-injection site, medical health officer Dr. Shovita Padhi said in an interview. The region is identifying the best location — Surrey is likely top of the list — and continues to collect other data before it submits an application to Health Canada.
Health Canada told Postmedia it is reviewing three completed applications for new supervised consumption sites — one in Montreal, and the two additional ones for Vancouver — and is helping other cities with the application process. In a statement, the federal government said it will not “hinder or delay” this process, saying evidence shows these sites “have the potential to save lives and improve health without increasing drug use and crime in the surrounding area.”
Back in B.C., where in April officials declared a public-health emergency over fentanyl-related overdoses, Joe said the issue is the single-most preventable cause of accidental death in the province. And it has changed the reason Insite was opened in the first place.
“During the course of the 13 years Insite has been in operation, the HIV epidemic has actually cooled down,” Joe said, “but we’ve seen the overdose numbers go up, and that is not something we anticipated when we opened.”
During the course of the 13 years Insite has been in operation, the HIV epidemic has actually cooled down, but we’ve seen the overdose numbers go up, and that is not something we anticipated.