— Feature —

Are Injection Sites Safe?

As Edmonton prepares to welcome multiple injection sites, it is also staring down an opioid epidemic

Supervised injection sites are set to arrive downtown by the end of 2017 as the province, the city and health agencies all dig in to battle an opioid crisis that claimed 343 lives in Alberta in 2016 alone, and 80 in Edmonton in the first six months of 2017.

But are they safe? Yes, experts say— because they are safer than the alternatives.

“The main reason that we started looking into this was the health and safety of people,” said Marliss Taylor, program manager of Streetworks Needle Exchange, a roving injection-supervision service that operates primarily in the Boyle Street area. “Health and safety were our two big drivers. When people are injecting these substances outside, and it’s just poisonous out there, overdose is a huge risk factor.”

Community agencies including Streetworks and Moms Stop the Harm, along with researchers from the University of Alberta and the Edmonton Police Service, have all endorsed adopting supervised injection sites in Edmonton. But rather than a single location, as other cities have used, by the end of 2017 Edmonton will see multiple supervised injection sites within or close to downtown, including the Boyle McCauley Health Centre, Boyle Street Community Services, the George Spady Society and the Royal Alexandria Hospital (for inpatient treatment only).

Why multiple sites? Taylor said many potential users of the new sites told researchers they would only be willing to travel between four and 10 blocks to use them, meaning multiple locations were needed.

Unsurprisingly, some worry that the locations will draw people in from elsewhere—but it’s not the case, said one expert. “I know a lot of people are convinced we are going to be bombarded with people, but [research shows people will travel only] four to 10 blocks,” said Rosemary Fayant, a peer specialist at George Spacy Society. “You’re not going to go downtown, use a safe consumption site, and take a bus home— if that’s how you get around. You would do it in the comfort of your own home. But in the downtown area, there’s so much homelessness, that they don’t have that luxury.”

The locations also have other services in place, offering discretion for people wanting supervised injection. Taylor said 80 per cent of those surveyed said they were already injecting in public near the future sites as it is.

The model for Edmonton’s supervised sites is the layout of Dr. Peter Centre in Vancouver, a HIV day-health facility and 24-hour nursing care residence.

The Dr. Peter Centre and Insite, the first supervised injection site in North America, have both helped reduce the spread of HIV in Vancouver, with only 30 new cases reported last year (compared to 2,100 in 1996), as reported Insite’s website. They also state that users of the facility are 30 per cent more likely to receive treatment for addiction.

In Edmonton, the supervised injection sites will consist of three rooms: An intake, where a nurse obtains information about the person; a series of booths and a resident nurse, where the user injects; and a third room, where Taylor said, “the magic happens.”

Magic? Because the community member will be lucid and not going through withdrawal, the third room is where social workers will engage with them. If they are open to seeking treatment, Taylor said this is where trust will be built to facilitate those services.

During a presentation at DECL about the sites, Ann Galbradt, project coordinator with Access to Medically Supervised Injection Sites Edmonton, said community information nights have shown most downtown residents area are either supportive or neutral about the sites.

She said some are concerned the inner city will be bombarded with addicts, and that the risk of violence will increase.

But Taylor said a person injecting in a safe, sterile and calm environment versus in an alley, where they are scared, is comparable to enjoying drinks with friends versus having drinks at a tense family dinner. “When you’re injecting in a back alley, and you’re frightened, and it’s dark, and you’re just hoping to inject fast, you would have a very different reaction to the drug then if you are in a place where you feel safe and secure,” she said. “Our anticipation is that by the time they’re in the third room, they’ll be in a much better headspace, and the reaction to the drug will be different.”

During the meeting, Milap Petigara, DECL treasurer, said he worried the sites would give people another option to inject while also seeing them inject outside in an unsafe manner. He also expressed concern that this was further entrenching the homeless community into overburdened areas like downtown, as well as attracting traffickers who prey on addicts.

But Taylor pointed out that these people are already in the community, injecting near fences and behind dumpsters. This would allow them to inject safely to prevent skin infections, disease and death.

“That’s been the concern, we get a lot of ‘Oh my gosh, you’re going to be releasing people that are out of their minds in our neighbourhoods?’ But that’s kind of what’s already happening right now.”

Other cities in Canada have discussed safe injection sites, including:

VANCOUVER: Currently home to the only two operational supervised injection sites in Canada. Since 2010, there have been more than 1.5 million visits.

TORONTO: After nearly 200 drug-related deaths in the first half of 2016, the city received funding for three safe injection sites that will be opened within the year. Three-quarters of residents who inject drugs said they would use it.

VICTORIA: There are three proposed sites in the city after 622 reported fentanyl-related deaths in 2016. A pop up location built in late 2016 reached capacity in a matter of days.

The size of the crisis: Edmonton and fentanyl

By Kevin Pennyfeather

In the first six months of 2017, Alberta Health recorded 241 deaths caused by fentanyl overdoses — and 80 happened in Edmonton.

Elaine Hyshka is an assistant professor at the University of Alberta’s school of public health, and has devoted her career to tackling the opioid crisis. We caught up with her to chat about Edmonton and fentanyl.

Q: Is fentanyl a dominant street drug in Edmonton?
A: Yes, essentially we have a variety of opioids available on the illicit market, and the majority of them do tend to test positive for fentanyl. That implies that a lot of the opioids that are circulating right now are clandestinely manufactured and that they’re being produced with fentanyl. Sometimes they’re made to look like Oxycontin or Oxy 80 pills, or they’re these golden powders — and those powders are either identified as fentanyl or being sold as heroin.

Q: Why would substance users intentionally use fentanyl?
A: If it’s the only drug or opioid that’s the easiest to access, then people who have opioid use disorder, are going to use fentanyl because that’s all that’s available to them, or potentially all that they can afford — even though there may be knowledge that fentanyl is a risky substance.

Q: What misconceptions exist about the kind of people dying from opioid overdoses?
A: It’s pretty clear that overdose deaths are affecting people from across the socioeconomic spectrum and from all walks of life. If you look at the recent overdose report [released in August], it gives you a sense of the diversity of people who are dying. The easiest way to think about this is everybody is affected by overdoses — but if you are low income, you are particularly at risk.

Whereas before the quote was around 80 per cent are dying outside Edmonton’s core, now it’s 59 per cent. That’s significant, and I think it speaks to the need to provide overdose prevention services in the core, as well as in other parts of the city.

This entry was posted in 2017 Fall, Feature.