Every five minutes, for seven hours a day, seven days a week, staff members at a downtown Victoria harm-reduction site check the two single-stall bathrooms for people who may have overdosed.
Sometimes, they will discover an unresponsive client and be forced to act quickly: perform rescue breathing, administer naloxone, call 911. Five minutes later, as per the white kitchen timers they keep for just this purpose, they check again.
According to a new report from the University of Victoria's Centre for Addictions Research of BC, places like this facility, AIDS Vancouver Island (AVI), are becoming "de facto consumption sites" amid the ongoing opioid crisis.
In the absence of legal facilities for supervised consumption in the region, people who use illicit drugs are increasingly doing so in the bathrooms of local social-service providers, turning staff into front-line responders should anything go wrong.
Researchers surveyed 80 adults, in two different time periods, at three downtown Victoria agencies that provide drop-in or shelter services, finding that 43 per cent reported using substances in the bathroom of such a site in the past 12 months. The figure nearly doubled between the first and second waves of data collection in 2015, from 11 (28 per cent) to 23 (58 per cent).
Asked why they use agency bathrooms, the respondents cited safety reasons – a recognition that it is less safe to consume drugs alone, outdoors or elsewhere out of sight.
"It's safer; there's people around if something bad happens," said one.
Said another: "Staff are there if problems occur."
Bruce Wallace, who co-authored the report with fellow UVic researcher Bernie Pauly, said the true figure is likely higher, as some people are reluctant to admit doing something that is prohibited.
He called on the provincial and federal governments to act more urgently on opening new supervised consumption sites in light of B.C.'s soaring rate of overdose deaths.
"A public-health crisis really demands a lot more than the meetings and monitoring that have been happening," Dr. Wallace said. "We really need some emergency responses. We can't ignore the evidence of the responses that we know could be preventing these deaths."
At AVI – which offers services such as a drop-in clinic, counselling, clean needles and peer support – staff have responded to more than 40 overdoses this year. This compares to 19 in all of 2015, and eight in 2014. None of the overdoses was fatal.
Heather Hobbs, co-ordinator of harm reduction services at AVI, said the Vancouver Island Health Authority (VIHA) required the agency to post signs on bathroom doors making clear that the facility is not a supervised-injection site.
"Like every other service organization in town, people use in our bathrooms and we're not an injection site," Ms. Hobbs said. "We tell people that, but we also come from a harm-reduction perspective where our program exists specifically to serve people who use drugs. We're giving them clean supplies and many of our clients are homeless; where do people expect them to go?"
The fact that clients have to hide their drug use increases the risks of disease transmission – from hurried injections in unsanitary conditions – and overdose.
"Because we're not an injection site and we're finding people in our bathrooms, people are already in respiratory distress by the time we find them," Ms. Hobbs said. "At somewhere like Insite, if someone is using in front of you, you can monitor them and see how they are reacting. You can see those early signs of respiratory distress and respond immediately. Here, we're responding because somebody doesn't answer our call at the door. They could have been down for a matter of minutes."
Asked for comment on the report, VIHA reiterated that it is "actively working with community partners to submit applications for supervised consumption services on Vancouver Island, with an initial focus on Victoria."
The health authority anticipates submitting applications before the year's end, VIHA spokeswoman Kellie Hudson said.