VANCOUVER — Harm reduction advocates are calling on the government of British Columbia to expand the scope of its safe-injection facilities beyond supervising only intravenous drug use, but medical officials say the focus should remain on needles because they pose the biggest health risk.
B.C. has been wracked by an overdose crisis that has claimed more than 550 lives since the beginning of 2016. About 60 per cent of those deaths have been linked to the opioid fentanyl, which has been detected in virtually every type of street drug, regardless of how the substance is consumed.
Ann Livingston, a harm-reduction worker in Vancouver, said people with addictions should have a place to go where they can feel safe using, whether they snort, smoke or inject their drugs.
"Anyone who's doing anything needs to do it safely," she said.
Livingston helped create what has become known as a pop-up supervised consumption facility, located in an alley in the city's Downtown Eastside and around the corner from Insite, Canada's first supervised-injection facility.
The rudimentary station, which consists of little more than a white tarp set up over several fold-out tables, welcomes drug users regardless of how they use.
Sarah Blyth, who collaborated with Livingston on the pop-up facility, said the situation on the streets has become far more dangerous since the arrival of fentanyl.
"If anybody is overlooked and at risk of an overdose then we will do what we can to make sure ... that person is safe and doesn't lose their life," Blyth said.
"We're there to make sure that people don't die in the alley, in the streets if they don't need to."
In Alberta, where opioids have also taken a lethal toll, the government announced last Thursday it would invest $230,000 to explore opening a safe-consumption site.
Nova Scotia's top doctor sounded the alarm earlier this month after learning 70 people died of opioid overdoses in the first eight months of this year.
Dr. Patricia Daly, chief medical health officer with the Vancouver Coastal Health authority, said injection drugs remain her primary concern.
"It's not just about monitoring for overdose and overdose deaths," Daly said. "It's because we know injection poses a risk of severe infections like HIV and hepatitis C."
Injection drugs have "far and away" caused the most severe overdoses and deaths in Vancouver, she added.
Mark Tyndall, executive medical director with the B.C. Centre for Disease Control, said a supervised-smoking room would also pose ventilation challenges.
"If the main role of these sites is to engage people and connect with them, provide social services and medical care, then that would be relevant for any drug use," Tyndall said.
"But if we're actually interested in reducing hepatitis C and HIV and preventing overdose deaths, then the focus clearly has to be on people who are injecting drugs."
B.C. provincial health officer Dr. Perry Kendall declared the original public health emergency earlier this year after a spike in overdose deaths, and said work is being done to encourage the supervision of non-injection drug use.
He spoke about reaching out to residences where people are known to be using drugs and ask them to let people know, keep their door unlocked and have someone with naloxone check on them.
"Essentially, we're already trying to build what you might call low-level, supervised consumption into buildings that may already be at risk," Kendall said.
That brings the supervision to where people live instead of creating a facility where people bring their drugs, which requires an exemption under federal drug laws, he said.
