An intravenous drug user holds onto a syringe of naloxone. The opioid crisis is not just a Lower Mainland issue

An intravenous drug user holds onto a syringe of naloxone. The opioid crisis is not just a Lower Mainland issue

City of Port Alberni expresses support for overdose prevention site

Medical Health Officer Dr. Paul Hasselback discussed the opioid crisis on Vancouver Island during Monday night’s meeting of council.

Port Alberni will be getting a safe injection site courtesy of Island Health Authority.

Island Health Medical Health Officer Dr. Paul Hasselback said the need for an overdose prevention site—he cannot legally call it a safe injection site—is as great in the Alberni Valley as it is in other British Columbian communities.

“We are now in a crisis, state of emergency, or a public health emergency in the state of British Columbia,” he admitted during a Port Alberni City Council meeting Monday night. Hasselback talked about the opioid overdose crisis in the health region and asked council for its support with the overdose prevention site.

He said that Vancouver Island has seen a “substantive” increase in the number of overdose fatalities that occurred between 2015-16.

A provincial state of emergency over the opioid crisis was declared in April 2016. This was escalated in August, and then again in December when the Minister of Health ordered that overdose prevention sites be established where there was justification for such.

Hasselback made some estimates of the current usage of substances within the community, based upon the Canadian population and then projected back down onto the Alberni Valley population in general. He estimated there are 160 regular injection users and 120 occasional injection users, as well as 275 regular users of illicit substances in a non-injection format in the Alberni Valley.

“All of those are individuals who can definitely benefit from a better understanding, or not using in a setting which puts them at risk of an overdose,” he said.

He said for each of the overdose fatalities that occur, Island Health is estimating 20-30 emergency room visits. “About an equal number are now occurring in the community where intervention is occurring with those individuals, either through formal processes but more often than not community members that now have naloxone available.

He added that a high number of overdoses, at almost 80 percent, are being reversed prior to the time that they arrive at the emergency department, if they come into the emergency department at all.

Hasselback said the strength of fentanyl and the quickly developing industry behind it has led to a very challenging environment, which means the whole community needs to be involved in the response.

“There’s no one piece of the puzzle,” said Hasselback. “Each of them is a fairly substantive investment or change in how we go about doing things, whether we’re talking awareness, prevention, destigmatization, engaging individuals in trusting relationships so we can manage further on treatment protocols.

“Certainly one of the things that I push is what are we doing to ensure that our youth have opportunity for meaningful employment so that they are contributing members of their communities, rather than looking for ways to cope using substances.”

Naloxone is now more widely available in the community, including access in some pharmacies. Hasselback also discussed supervised consumption, also known as overdose prevention.

“We’ve told our users it’s really important not to use alone,” he said. “We know these sites are a safe environment, a trusting environment where individuals can come to use in those sort of settings and should there be a tragic event occurring, they can reverse the effect in time.”

Hasselback said that they know from their work in Vancouver that overdose prevention sites do not lead to increase in drug use in the community. There are five sites currently operational on Vancouver Island, and another coming shortly. The sites have had about 6,000 visits since December, and no deaths.

“[There have been] few expressions of concern from neighbours and community members,” Hasselback said. “There hasn’t been the pushback. I think society’s been able to recognize that we have a crisis on our hands.”

Hasselback said that the Alberni Valley needs to work their way through this crisis collectively. “Council is one of the players that needs to be involved in that discussion,” he suggested. “What I would recommend to you is that council look at the issue of overdose prevention very specifically.

“Council can choose just to receive this information, you can choose to go ahead and express some support for this, you can certainly also go the extra step and direct that administration be more active in working with Island Health.”

Mayor Mike Ruttan asked if this initiative was being proposed in other communities on the Island, and Hasselback confirmed that discussions are underway in other North Island communities, including Cowichan.

Councillor Jack McLeman expressed some concern for overdose prevention, asking, “What is your experience if you have a supervised consumption that people will get off and go to withdrawal support? Because I don’t want to be enabling people to just carry on in this dangerous lifestyle forever.”

“I think that’s one of the key excellent questions,” said Hasselback. “Overdose prevention sites on the Island only have a history going back to December. I think we’re still in the process of establishing a trusting relationship which becomes the foundation for a therapeutic relationship going forward. There’s lots of good evidence that maintenance of that environment where a therapeutic relationship can start being developed is an integral first step in other things that need to be undertaken.”

Hasselback also commended Port Alberni in its efforts at low barrier housing. “It is one of the areas where other communities are not necessarily as successful. I stand up and I have no trouble sharing that we will not be successful in our therapeutic interventions if an individual does not have stable housing.”

Ruttan questioned whether or not the overdose prevention site would actually provide drugs for individuals, and Hasselback said that individuals had to bring their own supply, although the site may be a harm reduction site with clean needles and other supports.

In the end, council directed staff to work with Island Health to address the crisis and establish an overdose prevention site in the Alberni Valley. Council also expressed support for the potential overdose prevention site.

Hasselback did not give a specific timeline for the project, or a specific location, but he said the sites often go where overdoses tend to occur.

“We certainly know where, in this community, most of the overdoses tend to aggregate,” he said. “I wouldn’t be surprised if I put a map there and showed council, you’re probably already pretty familiar with where you think they’re happening; that’s where they are happening.”

At the end of the delegation, Ruttan asked about reports of 20-21 fentanyl-related deaths in the Alberni Valley over the last year, and Hasselback said these numbers were probably incorrect.

“One of the challenges we’ve got is that we’re not getting the information from the coroners in a timely fashion,” he said. “I do know we’re probably not up to 20. I’m going to say 21 would be about a five-year experience from the numbers that I’m looking at right now.”

Port Alberni RCMP Inspector Brian Hunter had some clarification on this issue, in that the term “overdose” is often being used synonymous with “death.”

“I think somewhere along the line there’s been some confusion,” he said. “Overdoses versus a death is completely different.”