Mobile Medical Unit brings hope, relief to B.C. overdose victims

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The woman sits slouched in a black folding chair, slowly regaining her strength. She is recovering from her second overdose since being released from jail just four days earlier and physicians are watching her closely. She is crying.

The woman is at the Mobile Medical Unit (MMU), a satellite emergency room established in the Downtown Eastside in mid-December to help deal with the city's surge in overdoses and relieve crowded emergency rooms. Instead of St. Paul's Hospital, paramedics take patients to the expandable trailer parked on the former site of a homeless encampment, where they are seen immediately by physicians and nurses.

But the temporary facility, a legacy of the 2010 Winter Olympics, is proving to be more than just an overflow space where overdose victims are treated and released. Every patient brought in is presented with long-term treatment options they can start right away; on a particularly busy day in late December, half agreed.

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Among them was the woman, who told physicians through sobs that she had been doing well on Suboxone – a combination pill of buprenorphine and naloxone, used to curb cravings and treat opioid addiction – but had been tapered off while in jail, despite her protests. Upon her release three weeks later, she returned to the Downtown Eastside, the only neighbourhood in which she could secure housing, and relapsed.

It was easier to get street drugs than it was to get help, she told addictions physician Keith Ahamad.

"We restarted her on Suboxone and she was so happy," Dr. Ahamad recalled. "It was all she wanted. She said, 'It makes me feel normal and I don't use [illicit drugs when I'm on it]. I need to be on it. I can't find it anywhere. Why is it so hard to get?'"

As part of the local overdose response, the MMU is offering the treatment options to anyone who needs it, free of charge.

A whiteboard outside the MMU advertises its services: medical treatment for active overdoses, same-day provision of Suboxone and methadone and free take-home naloxone kits for drug users. Seeing the sign, a visibly agitated man enters the facility and tells physicians he is on the brink of relapsing. He had been on Suboxone back in Ontario, but he could not afford it in British Columbia, he says.

Dr. Ahamad started the man on Suboxone on the spot, which appeared to surprise him. Before leaving, he turns around and addresses staff in the room: "Thank you so much. You guys are awesome."

Perhaps most notable is the mood inside the MMU. It was established to address an exceptionally grim reality – an unprecedented surge in overdoses – and yet the vibe inside is relatively light. Smiling physicians and nurses chat freely with patients, their friendly demeanours bringing some levity to the situation: "How are you doing, sweetheart? Are you hungry? Can I get you a sandwich?"

Physicians and nurses at the MMU have all signed up to be there.

Emergency-room physician Frank Scheuermeyer said it is important for patients to know that they are cared for.

"Maybe part of the reason they ended up here is because they felt like nobody cared," he said. "Everyone here is really nice. They'll bring [patients] sandwiches and juice and give them a warm blanket if they need it. Hopefully, we can make a tiny difference in somebody's life that they remember."

From January through November, there were more than 6,000 drug overdoses, either from illicit substances or of unknown origin, presenting to Vancouver Coastal Health emergency departments, with nearly three-quarters of them at St. Paul's hospital.