Insite's expanded hours will run for six months as part of a pilot project to tackle the surge in opioid overdoses.Rafal Gerszak
Finding time to keep the Insite safe-injection site clean is going to be one of the key challenges of a move to a 24-hour operation starting this week, says a senior health official.
"Insite needs downtime to completely clean down the site," Ron Joe, associate medical director of substance-abuse services for Vancouver Coastal Health, said in an interview on Sunday.
But starting this Wednesday, Insite will be open 24 hours a day on Wednesday, Thursdays and Fridays as part of a move to manage an increase in overdoses of opioids, which include fentanyl and heroin.
The new hours, extended from 18 hours a day, will run for six months as part of a pilot project.
Dr. Joe said he had no details on how the cleanup of bodily fluids and other contaminants will be managed. Insite, which opened in 2003, briefly tried round-the-clock service before he began his work with Coastal Health.
He said hospitals manage to run 24 hours a day, but it may be more challenging for an isolated site like Insite, North America's first sanctioned safe-injection site.
The B.C. Health Ministry said Sunday that it supports the 24-hour plan at Insite. "We look forward to seeing the results of the pilot project as we continue in our efforts to prevent overdoses and overdose deaths."
Coastal Health, in the first few months of this year, has tracked an increase in opioid overdose cases at emergency rooms in Vancouver hospitals when Insite is closed, Dr. Joe said.
The start of the pilot project is timed to monthly social-assistance payments that Coastal Health fears may be fuelling illegal drug purchases.
Insite has tracked a 50-per-cent increase in overdoses from January to May, 2016, specifically on the Wednesdays, Thursdays and Fridays of welfare-cheque distribution week, according to a Coastal Health statement.
"With these expanded hours, we're hoping that people who would be injecting in alleys or in their own residences will use the site to attain the supervision they need," Dr. Joe said.
Insite provides a clean venue with medical supervision for clients to use their drugs. Staff have acted in response to about 5,000 overdoses since Insite opened 13 years ago and there has never been an overdose death.
On average, according to a Coastal Health statement, there were 722 visits a day in 2015, with heroin used 54 per cent of the time, methamphetamine used 23 per cent of the time and cocaine used 10 per cent of the time.
Beyond Insite, there have been 433 overdose deaths to date in British Columbia this year, according to the B.C. Coroners Service – a 75-per-cent increase over last year.
In November, 2015, Insite shifted its daily opening back an hour to 9 a.m. to ease a crush of clients waiting to get in during the morning, which was a challenge for staff to monitor. "There were way too many people in the waiting booth wanting to get a booth, and they weren't able to. Some of them were walking out," said Dr. Joe.
They also pulled closing hours back from 4 a.m. to 3 a.m.
Beyond cleanup, Dr. Joe says challenges around the new hours will include security and staffing. However, he said Sunday that he didn't have any information on planned staffing changes.
He said the longer hours are part of a larger strategy that includes in-home addiction treatment for opioid addiction issues, expanded naloxone treatment, an intensive case-management team and an increased number of emergency beds at the Vancouver detox facility.
Ian Bailey