Safe space to use opioids without stigma considered for Halifax

A building in north-end Halifax could be one of Atlantic Canada's first overdose prevention sites — a safe space where people can inject opioids and get help if they overdose — as the province looks to reduce drug-related deaths in the city.

The executive director of Direction 180, a community-based methadone clinic, said the sites reduce the risk of infection, disease transmission and overdosing.

It's a place where clients can go without fear or stigma "instead of rushing in a bathroom where the lighting isn't good in a business in the community, instead of hiding in the bushes and using more quickly than they normally would for fear of being caught, and then maybe overamping or using too much," said Cindy MacIsaac.

Overdose prevention sites are a relatively new tool in the fight against the opioid crisis. 

They can be opened within weeks and are considered temporary facilities to address an urgent need — unlike safe consumption sites, which are permanent facilities that take years to open because of a lengthy, complex application process with Health Canada that requires extensive community consultation. 

• What's the difference between a supervised consumption site and an overdose prevention site?

Discussions started last month

MacIsaac said the idea was broached last month when Dr. Rob Strang, the province's chief medical officer of health, asked whether an overdose prevention site could be housed at Direction 180 on the corner of Gottingen and Cornwallis streets.

She said she was surprised and excited to hear the province was interested in an overdose prevention site "so quickly" after talk about a safe consumption site in Nova Scotia fizzled.

"We're very fortunate in that Rob Strang gets it," said MacIsaac. "He understands the issues, the realities, and the risks associated with drug use and the current opiate crisis."

A spokesperson for the Department of Health said in an email the government's first priority is preventing overdose deaths. The department is "actively looking at models for safer consumption/overdose prevention and what makes sense in the Nova Scotia urban and rural context."

In the first seven months of 2018, there were 21 confirmed and 18 probable opioid overdose deaths in Nova Scotia. The province is on track to record its deadliest annual toll from opioids since 2014 when 66 people died.

In spite of these numbers, progress is being made in combating Nova Scotia's opioid problem. This week Direction 180 announced it was retiring its methadone bus. When the bus first launched five years ago it was reaching people with addictions who were waiting up to three years to enter an opiate treatment program. Now those wait times for treatment have been virtually eliminated. 

• Nova Scotia's Opioid Use and Overdose Framework

A safe place without stigma

Mainline, the city's needle exchange just up the street from Direction 180, is also involved in planning. A contractor has already looked at renovating the basement of Direction 180 to build an overdose prevention site. 

• It's the end of the road for Halifax's methadone bus

MacIsaac said there's space for five booths where people can shoot opioids. Peer support workers would be on hand to monitor them and a nurse to inject naloxone in case of an overdose.

Her hope is that all the necessary approvals from Health Canada will be secured for a site to be up and running by December, in time for winter. Clients have indicated they'd like the site open 24 hours a day, but MacIsaac said it would likely be six hours daily.

• Province confirms first suspected carfentanil-related overdose in N.S.

• Med students scour Halifax streets for drug needles — and understanding

Critics of overdose prevention sites

In Ontario, the facilities are controversial. The government put applications for new overdose prevention sites on hold earlier this month after Doug Ford campaigned against them during the election.

• Change your stance on overdose prevention sites, health groups urge Ford

• Ontario to review safe injection, overdose prevention sites, health minister says

But MacIsaac said for many people the alternative — abstinence and forced rehabilitation — doesn't work.

"'Just say no' doesn't work. It's a shame despite all of the evidence, there are people who continue to look at people who use drugs with judgment."

Public meeting planned

Today marks International Overdose Awareness Day. It's a day when harm reduction workers, opioid users and loved ones remember people who have died, and call for support and programs to reduce the number of overdose deaths.

An overdose prevention site is one of those programs.

Community consultation to open an overdose prevention site is not required, but MacIsaac wants to involve the neighbours anyway. A public meeting with an expert panel is planned on Sept. 20. She said the goal is to alleviate concerns and build community support.

Direction 180's work has faced neighbourhood opposition before. But MacIsaac is hopeful the north end will get behind this idea.

"I think there are a lot of folk that have businesses that are [conscious] of the work that we do, and are aware of the importance of the work, and accept that we co-exist in this community and there's a need for that."