Mobile safe-use site needed now to lower OD risks

Calgary unit available but being held back, Marilou Gagnon says.

The first case of COVID-19 was confirmed nearly four months ago and since then all eyes have been turned to this unfolding emergency.

However, let us not forget that Canada was already in the midst of an unprecedented public health emergency before COVID-19 — one that has taken the lives of more than 15,000 Canadians in less than four years and stalled our national life expectancy. The overdose crisis is not going away because of COVID -19. In fact, it is getting worse.

Many cities have been reporting spikes in overdoses and overdose deaths amid the pandemic. This is true for Vancouver and Toronto. It is also true for other cities, including Victoria, Guelph, Windsor, Red Deer and Calgary. Three factors have been contributing to this rise in overdoses and overdose deaths: reduction and closure of essential supervised consumption services, self-isolating requirements forcing people to use alone, and disruption of supply chains combined with the lack of access to a safe drug supply. Two of the most important measures governments can take now to address this dual public health emergency are to implement safe supply programs and scale up access to harm reduction services, including supervised consumption services.

This brings me to the situation in Calgary. In 2019, Calgary recorded the highest number of overdose deaths in the province. Despite this, there is currently only one supervised consumption site in operation in the city. Due to COVID-19, this site has been operating at reduced capacity, which has resulted in a drop in visits from 6,600 a month between December and February to 5,850 in March and 4,440 in April. At the same time, the site has been recording an increase in overdoses. Between December to February, staff responded to an average of 57 overdoses per month. In March, they responded to 83 overdoses and 87 in April.

A similar spike in overdoses has been reported at the city’s largest homeless shelter, the Drop-in Centre. On a regular night, before COVID-19, the Drop-in would see as many as 650 people per night. At reduced capacity, it now welcomes about 300. Despite this, staff were called to respond to 47 overdoses in the month of March alone, a 327 per cent increase from the month of February. This has contributed to high levels of moral distress and trauma among the staff.

Rapid implementation of a mobile site could address gaps in supervised consumption services in the city and, in turn, reduce the risk of overdoses and overdose deaths.

There is a mobile site available in Calgary, but Alberta has taken it off the table.

Unfortunately, in June 2019, the provincial government placed a moratorium on any new funding for supervised consumption services in Alberta. Prior to this announcement, a mobile supervised consumption site and pictures of the new and fully equipped van circulated in the media. It appeared to be ready but remains unused despite the challenges brought on by COVID-19 and spiking overdoses. This begs the question, why is a perfectly functional mobile site not being used and why is it not being deployed to support front-line workers in the middle of a dual public health emergency? What could possibly be a valid reason to withhold this essential, life-saving service? Knowing that front-line services are working at reduced capacity, why not implement a rapid solution to address gaps in services and reduce the strain on a health-care system that is already overextended?

Supervised consumption sites are preventive rather than reactive. They prevent overdoses and prevent overdose-related deaths or complications. They are also equipped to safely manage overdoses and other medical emergencies during the COVID-19 pandemic that do not require transfers to hospital.

For these reasons, they reduce health-care utilization and costs. They can also take pressure off overworked staff by preventing overdoses and helping more effectively manage them when they do occur. In turn, this reduces the risk of COVID-19 spreading to staff and clients — and to the broader community.

In a dual public health emergency, governments should be doing everything in their power to prevent overdoses, and reduce the risk of exposure to COVID-19.

This means deploying all the resources at their disposal, including a mobile supervised consumption site.

Marilou Gagnon is an associate professor in nursing at the University of Victoria and a scientist at the Canadian Institute for Substance Use Research. She is also the president of the Harm Reduction Nurses Association.