Injection site scales back physical distancing rules to prevent ODs

A health agency that works with drug users in Ottawa says it's relaxing some physical distancing rules at the city's busiest supervised injection site out of fear they're doing more harm than good.

Ottawa Inner City Health, which runs a supervised consumption site on Murray Street in the Byward Market, has been limiting access to the site since mid-March as part of stepped-up infection-control measures meant to prevent the spread of COVID-19.

But the reduced capacity led to a backlogs at times, and Inner City Health says some people are overdosing on the sidewalk because they can't get inside in a timely manner.

The situation has become so worrisome that starting this week, the agency's staff will provide surgical masks to everyone who enters the facility so that the site can get back to full capacity — even if that means having people closer than two metres.

"There is the risk of COVID-19, and then there is a very real risk of people dying," said Inner City Health CEO Wendy Muckle.

The situation highlights the intersection between the COVID-19 pandemic and the ongoing opioid crisis, and how public health measures designed to prevent the spread of disease could be making things worse.

About 'balancing the risks'

All four of Ottawa's supervised injection sites have reduced the number of visitors as they implement physical distancing measures in accordance with guidance from the provincial health ministry, Ottawa Public Health said in a statement.

Staff at the sites now wear full personal protective equipment, and visitors have to wash their hands when entering and exiting.

The Murray Street site, located inside a cramped trailer in the parking lot behind the Shepherds of Good Hope homeless shelter, normally has 12 booths where people can inject previously-obtained drugs under the supervision of health workers who stand ready to revive them if they overdose.

Since the pandemic began, staff have blocked access to every second booth so that users can maintain a safe distance from others. 

The site is the busiest of the four supervised consumption sites in the city, with over 16,000 visits between January and April of this year.

Muckle said the decision to open the closed booths was made after weighing the need to prevent the spread of disease with the need to prevent unnecessary overdose deaths. 

"It is a case of balancing the risks and figuring out how we can reduce all of the risks so we get the best outcome," said Muckle.

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The Sandy Hill Community Health Centre, which runs a supervised injection site through its Oasis harm reduction program, has also had to limit its capacity, closing two of its five booths and reducing the number of hours it's open each day.

Rob Boyd, director of the Oasis program, said the clinic's capacity is being stretched thin.

"Since we implemented these measures, it's pretty much always been full," said Boyd. "We've always had three people in the room, with very few times when there's there are fewer than that."

'Some folks just walk off'

Mélanie Stafford, a harm reduction advocate with Overdose Prevention Ottawa, said the added stress of waiting for a spot can be overwhelming for drug users experiencing withdrawal symptoms.

"Some folks just walk off," said Stafford. "If there's a one-hour wait to get into the safe consumption sites, they're just going to leave."

Muckle and Boyd both say the pandemic has coincided with a new batch of bad drugs on the street, including an orange-coloured fentanyl more potent than a previously more common strain of purple fentanyl.

Data from two of the city's four supervised consumption sites show a spike in overdoses since March, even though there are fewer people visiting.

Overdoses at Inner City Health's Murray Street injection site jumped from 1.6 per cent in February to 7.4 per cent in March, before falling back to 2 per cent in April. At the Sandy Hill Community Health Centre's injection site, the overdose rate more than doubled from 1.4 per cent in February to 3.1 per cent in April.