British Columbia has opened several government-sanctioned drug-injection sites, without waiting for legislative changes or approval from Ottawa, to combat the province's worst overdose crisis on record.
The move puts pressure on the federal government to amend Harper-era legislation posing barriers to opening new supervised drug-consumption sites and provides a possible blueprint for other provinces that have long asked for federal permission to open such sites with no response.
Three sites opened in Vancouver's Downtown Eastside on Thursday at existing social service sites. Victoria and Surrey will each open two next week, and more are planned for Vancouver and Victoria.
B.C.'s top health officials decline to call the locations "supervised injection sites," opting instead for "overdose prevention sites." Like Insite, Vancouver's 13-year-old public supervised injection site, users bring their own drugs and are revived by staffers in the event of an overdose. Some facilities, if not all, will provide harm-reduction supplies such as clean needles.
The move comes as overdose deaths in B.C. reach a level not seen in more than 30 years of record-keeping. As of the end of October, 622 people had died of illicit drug overdoses, with the synthetic opioid fentanyl being detected in 60 per cent of them. Carfentanil – a large-animal tranquilizer many times more toxic than fentanyl – reached B.C. this fall and is suspected to be behind another recent surge in overdose deaths.
From 2000 to 2010, B.C. recorded an average of 273 illicit drug overdose deaths each year. The death toll for this year is expected to surpass 750.
B.C. Provincial Health Officer Perry Kendall noted the new sites are simply bringing injection drug users and the growing number of people trained to administer naloxone – a drug that reverses the effects of an opioid overdose – together, indoors, as temperatures drop.
"I think if we had sat back and had not done anything to respond … that we would actually be culpable, because we know there are things that we could have done," Dr. Kendall said Thursday.
Since September, activists have operated two "pop-up" supervised injection sites in the Downtown Eastside – bare-bones tents in back alleys with folding tables attended by volunteers with naloxone. Dr. Kendall described this latest initiative as simply putting a roof over their heads.
Patricia Daly, chief medical health officer and vice-president of public health for Vancouver Coastal Health, underscored that people who are severely addicted will continue to inject and that the new sites serve to ensure they do not die.
"We are very concerned that with the cold weather, they will go indoors, to single room occupancy hotels," she said. "They won't be in a place where someone will see them if someone overdoses."
The idea of "overdose prevention sites" was first raised in guidelines developed by Vancouver Coastal Health over the past year, and B.C.'s Joint Task Force on Overdose Response discussed the idea at a meeting two weeks ago.
From a hotel room in Victoria in the early hours of Wednesday morning, B.C. Health Minister Terry Lake decided it had to happen.
"I woke up between 4 and 4:30 a.m. and I could feel the cold in the hotel room," he said in an interview Thursday.
"It's not the first time I've been kept awake by the fentanyl crisis. I started thinking about people on the street, and the pop-up tents, and was almost overcome by how inhumane that is. We need to do something that will keep people warmer and safer."
A flurry of phone calls followed that morning; the first sites opened the next day.
Under the Respect for Communities Act, any group seeking to open a supervised consumption site must go through a lengthy and costly process of applying for an exemption from federal drug laws.
The act, enacted in June of 2015, is widely seen by critics as a deliberate effort to curb all supervised consumption sites. The Harper government had introduced it after fighting Insite all the way to the Supreme Court, which sided with the Downtown Eastside facility.
Rona Ambrose, the previous Conservative health minister, said at the time the legislation was necessary to ensure community members are consulted "when groups want to allow addicts to inject dangerous and addictive street drugs in their neighbourhoods."
Liberal Health Minister Jane Philpott signalled for the first time last month that legislative changes are forthcoming but there has been no apparent movement to date aside from promises to prospective site operators that applications would be expedited.
B.C. sought legal advice before proceeding and was assured the sites would not run afoul of the federal Controlled Drugs and Substances Act, Dr. Kendall and Mr. Lake said. Health Canada did not weigh in on the matter on Thursday, but pointed to a statement from January that noted supervised consumption sites require federal approval to ensure public health and safety requirements are met.
Reached for comment on Thursday, Dr. Philpott's press secretary, Andrew MacKendrick, said the federal Health Minister had just learned of B.C.'s decision and recognizes that the province feels a need to take action amid an extraordinary situation.
Mr. Lake said Premier Christy Clark supports the initiative; Dr. Daly said Vancouver police are "100 per cent supportive" as well.
Also announced on Thursday was the stationing of a mobile medical unit in Vancouver's Downtown Eastside, at what until recently was the site of a homeless encampment. Starting next Tuesday, the unit will provide another location to care for people who have overdosed, creating capacity in local emergency departments. Physicians will also be on hand to connect patients with opioid addiction treatment.
From Jan. 1 to Nov. 26, Vancouver Coastal Health emergency departments recorded 6,016 overdoses.