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Brandon Kober, left, co-manager of Hamilton Urban Core’s consumption and treatment services, and registered nurse Elise Nagy are concerned that their clients will be burdened by an added stigma for their drug-related emergencies as hospitals focus on COVID-19 treatment.

Glenn Lowson/The Globe and Mail

When Elise Nagy called the Hamilton General Hospital in late March to give them a heads up about a patient en route with an infection, she said she was asked by the charge nurse on the other end of the line when her workplace – a supervised consumption site – would be shutting down.

Ms. Nagy, a registered nurse, replied that the supervised consumption site would not be shutting down. It is an essential service.

The charge nurse was “upset” by that, Ms. Nagy says, and asked her why one of their patients was “taking up” one of the hospital’s designated isolated rooms for COVID-19 cases.

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“I was speechless,” Ms. Nagy said in a recent e-mail to her higher-ups and shared with The Globe and Mail. “She then proceeded to tell me that their emergency beds ‘should be reserved for patients who make better life choices.’”

In a phone interview last week, Ms. Nagy said the response from that nurse – and other similar reactions by paramedics responding to overdose calls at the clinic – has been “really hard to swallow.”

She and other health-care workers who’ve been on the front lines of the opioid crisis in Hamilton fear the COVID-19 pandemic has amplified the stigma that drug users face when seeking medical help. They worry about what effect this confluence of public health emergencies is going to have on some of the city’s most vulnerable residents.

“I don’t think it’s COVID that is the scariest thing for [people with addictions] right now,” Ms. Nagy said. “I think it’s the extra lack of resources and health care that they have access to right now.”

In an e-mail response to The Globe, Hamilton Health Sciences did not address the specific exchange reported by Ms. Nagy. But the health network acknowledged the anxiety that these uncertain times has caused for many people and patient populations, including those with addictions.

Kaitlin Labatte, right, a harm reduction outreach worker with the AIDS network and Jessica Randall, volunteering as part of a co-op placement, set up an evening shift with the Van Program in Hamilton on April 2, 2020.

Glenn Lowson/The Globe and Mail

No one should feel alone. Now and always, we will continue to provide the best care for all of our patients and communities we serve,” spokesperson Thomas Perry said.

As is the case in cities across Canada, many of the resources available for people with substance use problems in Hamilton have been closed down or scaled back. The supervised consumption site Ms. Nagy works at, for example, has had its hours slashed – even as the opioid crisis rages on.

Since January, Hamilton paramedics have received more than 100 calls for suspected opioid overdoses. In the last week of March alone, there were more than 55 drug-related emergency room visits in the city – 27 of which were suspected overdoses.

“A month ago, [the opioid crisis] was sort of on everybody’s mind and recognized as a huge issue that we needed to do better with,” said Tim O’Shea, the internal medicine and infectious disease consultant with the Hamilton’s Shelter Health Network. “But [COVID-19] has definitely taken a lot of momentum away from that discussion.”

As more and more community programs have been forced to halt operations, others are stepping in to fill the gaps in the supports that people have come to depend on.

For example, Dr. O’Shea has noticed that access to harm reduction supplies “has definitely become a problem. I’ve heard from some of my patients that they’re reusing needles where previously they would never do that.”

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While he has been able to keep in touch with some patients, Dr. O’Shea fears the most vulnerable of them will fall through the cracks. They do not have cellphones, and as more and more public services are shut down, he’s concerned they will have nowhere to go.

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“They don’t know where to find me,” he said. “And I don’t really have a way to get in touch with them. ... There are certainly some that I haven’t heard from at all. And that is definitely a concern.”

One crucial service that has persevered through the pandemic – even doubling their hours, with help from the City of Hamilton – is the AIDS Network’s Van program, a mobile service that delivers clean harm reduction supplies to people across the city, confidentially and in discreet locations of their choice.

One recent evening, AIDS Network outreach worker Kaitlin Labatte and volunteer Jessica Randall stopped to chat as they restocked the van after a busy afternoon shift.

They’ve tried to adjust their practices to meet the COVID-19 guidelines. For example, clients can no longer climb into the van to peruse the supplies. They order what they want ahead of time over the phone, and the items are passed through the window.

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Ms. Labatte said they already had stops lined up for the coming evening shift that day. She feels as if it’s been busier since the pandemic began, but it’s hard to tell.

The Hamilton VAN program is prepared to provide it's comprehensive health service providing HIV testing, STI screening, Hep C testing as well as delivering new needles and harm reduction supplies and receives, for safe disposal, any used harm reduction supplies upon request.

Glenn Lowson/The Globe and Mail

“It’s never really slow,” she said.

Other grassroots organizations are also finding ways to fill gaps where they can. Grenfell Ministries, a local harm outreach organization founded by Rebecca Morris-Miller, has launched an overdose prevention hotline that people can call if they need to use drugs alone.

The line, which is monitored by harm-reduction volunteers who can talk with the drug user, or even just listen, while they take drugs to ensure they’re safe, started as a pilot project on Feb. 1. But when the effects of COVID-19 started to become clear, it took on a sudden urgency.

The call line is available from noon until 10 p.m. on weekdays, and from noon until midnight on weekends, to anyone in Ontario. Call takers are trained online, which Ms. Morris-Miller said has been convenient during a time of mandatory social distancing. So far, she said they have been getting roughly half a dozen calls a week – but calls have slowly started to increase during COVID-19.

It’s not a perfect system, she acknowledged. “Not everybody has a phone, we know that. This is a step down from the safe injection site for sure – but it’s also a step up from nothing, which is where we’re going to be if things keep getting closed down.”

Ms. Morris-Miller is pleased with the rapid response that has occurred in the face of COVID-19. She knows it’s necessary. But to some degree, after years of begging for help with the opioid crisis, she said, it hurts.

“I can see very clearly now, how fast the government will make change, how fast they will take something seriously, if it can affect them,” she said. “Watching how fast they can act when they want to, or when they feel like it’s something that they feel is important, is traumatizing.”

Christopher Mio and Meghan Hoople found themselves jobless and wanting to help in the wake of COVID-19 isolation in Toronto. After flyering their neighbourhood with a free-of-charge offer, they received an outpouring of support and requests from people in need. The Globe and Mail

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