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British Columbia Vancouver overdose emergency task force calls for expanded harm reduction, safe supply

Trey Helten, frontline worker for the Overdose Prevention Society, fills syringes with Narcan at the Overdose Prevention Society safe injection site in Vancouver's Downtown Eastside on Nov. 1, 2018.

Rafal Gerszak/The Globe and Mail

An emergency task force struck to address Vancouver’s overdose epidemic is calling for an expansion of harm reduction services throughout the city, including a second site for people to smoke substances under supervision and a mobile option to reach those outside of the Downtown Eastside.

The task force is also recommending an 18-month pilot project that would see overdose prevention sites in at least five private single-room occupancy (SRO) hotels, an expansion of these services in non-profit SROs and a review of overdose risk in both public and private SRO bathrooms.

Vancouver Mayor Kennedy Stewart, who established the task force in November, released its first report on Tuesday. It will go before a special council on Thursday.

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“This crisis is now in its fifth year and it shows no sign of slowing down,” Mr. Stewart said. “These recommendations won’t stop the crisis, but it will help further stabilize the situation.”

The recommendations are in direct response to data compiled by the BC Coroners Service, which has collected detailed overdose information for years and released it on a monthly basis. A recent review of almost 900 completed illicit drug overdose investigations from across the province found that 39 per cent had died from smoking a substance – just two percentage points behind injecting – but there is only one site in Vancouver for people to smoke under supervision.

And this year, 86 per cent of all illicit drug overdose deaths occurred inside – in private residences, SROs and shelters, the data show. This signals a need to reach drug users who do not seek out the city’s supervised sites.

Sarah Blyth, executive director of the Overdose Prevention Society, established Vancouver’s first overdose prevention site in 2016 in response to bureaucratic red tape that proved a barrier to opening federally sanctioned supervised drug-use sites.

While her operation has moved indoors and similar sites have opened around the city, local bylaws prevent people from smoking substances of any sort at those facilities. And so Ms. Blyth oversees a bare-bones outdoor site – two gazebos put together and wired with lighting – for people who smoke their drugs. It has logged more than 90,000 visits since April, 2017.

“The overdoses with smoking happen immediately … people just drop,” Ms. Blyth said. “So creating places where people can do all kinds of drugs is important.”

Vancouver Coastal Health currently funds overdose prevention services in 27 non-profit SROs. The report recommends funding another 10, which it says would require $1-million annually from the province.

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Another recommendation is to prioritize securing a space for a pilot project led by the BC Centre of Disease Control that would distribute the opioid hydromorphone to people who are at high risk of overdose from illicit opioids. Providing a clean supply would be a direct and immediate answer to the fentanyl-contaminated illicit supply that has devastated communities across North America.

Among a list of “actionable ideas” is the suggestion to provide low-barrier, rapid access to all opioid agonist therapies such as methadone, buprenorphine-naloxone (Suboxone) and hydromorphone without the requirement of witnessed ingestion.

“The evidence tells us that investing in treatment is going to be the way we’re going to protect people from dying, and that means getting people on opioid agonist therapy," said Patricia Daly, chief medical health officer at Vancouver Coastal Health.

The task force comprises 115 members. This includes the Vancouver Community Action Team – which involves the local health authority, police, fire and other organizations related to the overdose crisis – as well as local First Nations, union leaders, researchers and advocates.

From January to September of this year, at least 1,143 people died of illicit drug overdoses in B.C.

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