It was a misty murky morning as we pulled up at the community health centre in the Sandy Hill suburb of Ottawa. We’re here to visit the Oasis project which provides services for people with a serious drug problem. At the core is a consumption room where people can inject their own drugs in a safe manner supervised by trained medical staff.
On first impressions this looks like any medical centre I’ve ever been to. A bright reception desk with staff in uniform behind. Corridors leading to treatment rooms. Easy chairs in the waiting area. Posters and leaflets everywhere.
We’re met by the programme director Rob Boyd; gentle, quiet, middle-aged, determined. He leads us down the stairs and asks that we walk through the consumption room to a meeting point beyond. We don’t linger but get a good impression of what’s going on.
And the impression is very much of a medical facility. There’s nothing recreational about what goes on here. Stainless steel counters hold small plastic crates full of vacuum-packed medical paraphernalia. Booths are created from shoulder high partitions. Eight that I can see. In the end one it looks like someone is getting treatment, but I can’t see exactly because of the partition.
As we move on to the meeting room and sit down for a discussion, I can’t help wondering what all the fuss is about. This just seems like a normal health care facility. But it isn’t. What we’ve just seen is the product of years of political argument and controversy.
Ottawa is the Canadian capital. It is in Ontario, the biggest of ten Canadian provinces, with a population about three times that of Scotland. Last year over a thousand people died from drug use. Most from overdoses – nearly all of them accidental.
The experts we met don’t talk of an opioid crisis, they talk of a contaminated drug crisis. Over the last few years illicit street drugs have been cut with fentanyl and carfentanil, synthetic opioids far more powerful than heroin. As a result, deaths have spiked as users are unaware of the potency of what they are taking.
It is to prevent people dying that facilities such as this one have been established all over Canada. Rob Boyd is clear that his job here is not to get people off drugs but to keep them alive long enough so that other interventions might make that choice possible.
The role of the centre is threefold. First, people can inject their own drugs with a trained professional watching them. If they have an adverse reaction to the drugs – respiratory failure is common – then they will get treatment. This might mean giving them naloxone or oxygen. Rarely it will mean emergency referral to hospital. In the last two years they’ve have more than 14,000 visits to this centre. No-one died.
Secondly, making sure people use clean needles and that the drugs are administered hygienically means there’s no risk of getting HIV or Hep C – the other big cause of death.
Thirdly, health staff aim to build a relationship with their clients. Building confidence and establishing trust means they can then suggest other services that might help. About half are referred to other health services, a third to housing and social services. And one in four are referred to addiction services to help them control, reduce or stop their drug use.
The people who use this centre are at the sharp end of the drugs epidemic. They are often vulnerable, have a range of health problems, and are struggling just to keep it together. Here they get treatment not judgement.
But anyone involved in a place like this will tell you it’s only part of the answer. We also need extensive advice and information, mental health services and agencies that will help people get work and shelter to put their lives back together.
Health care in Canada is delivered by provincial government, not dissimilar to the way in which the Scottish government runs our NHS. But there, as here, drugs laws are a federal matter. The Controlled Substances Act operates in much the same way as the UK’s Misuse of Drugs Act and makes possession a criminal offence. So for these drug consumption rooms to operate they need federal permission – an exemption from the law.
For years the Canadian government refused but with the election of Trudeau’s liberal government at the end of 2015 attitudes changed. Now exemptions are usually granted although the federal government can, and does, impose strict conditions on how facilities can operate.
The success of these facilities and the fact that they have reduced consumption in public, making communities feel safer, means that the controversy has subsided. The debate no longer divides parties. These projects began in Ontario under a liberal administration, but last year the conservatives won the provincial elections. They show no signs of wanting to change or reverse the policy.
Canada is way ahead of Scotland in tackling problem drug use. That should shock and shame us. Why? Because in Scotland the rate of death from drugs is three times what it is in Ontario. And we haven’t even met carfentanil yet.
Written for the Daily Record - Friday 21st June 2019.