“Since Covid began, we’ve seen the highest number of overdoses since 2017”: What happens when the opioid epidemic meets a global pandemic? – Jason Altenberg, April 14, 2020
I’ve worked at the South Riverdale Community Health Centre for 15 years, and I just took over as CEO in January. It’s a heck of a time to be starting a new job. We offer health services to the city’s most vulnerable people: newcomers to Toronto, people who living in poverty and who use drugs, and the homeless community. More than half of the people who come to us are low-income, and two-thirds are living with mental illness. On an average week, more than 500 people come here for communal meals.
We’ve also been in a sustained crisis for years: our job is to keep people alive through the opioid epidemic. We provide a safe place where people can use drugs under the supervision of nurses and doctors, where they can access medical advice free from judgment, and where they can access naloxone kits, safe disposal supplies and clean syringes and pipes, and that work keeps them alive. We usual deliver harm-reduction supplies, too, in unmarked cars to people’s homes or coffee shops anywhere from Lake Ontario to Eglinton Avenue East, and from Victoria Park Avenue to the Don Valley Parkway. I have a long history with my staff: some of us have been through other outbreaks together, like H1N1 and SARS. I don’t know that I’ve had time to absorb it yet. We’re just trying to keep moving.
We’ve been watching Covid-19 since January, and making plans with an infectious disease specialist, focusing on implementing measures that would help keep people out of the hospitals. We have a respiratory therapist who is running a primary-care asthma program and getting people access to nicotine replacements. Our diabetes program is still running, because those are people at high risk for Covid-19 complications. We’re doing insulin initiation and adjustment over phone and video, and we’re still doing wound care in-person. For homeless people who don’t have phones, we’re accepting in-person drop-ins at the health centre for medical and social support. And we’re doing everything we can to keep our safe-consumption sites fully operational. It’s our job to keep people who are using drugs alive and ensure they don’t get Covid-19. Somehow we have to do both at the same time.
We run two safe consumption sites: one in Moss Park and the other in South Riverdale. Along with supervised injection services, we provide harm-reduction supplies like naloxone kits, drop-in nurse practitioner services and a hepatitis C clinic. We’ve had to cut down our hours, and we’re seeing people more slowly because of social-distancing rules. Before, these spaces were built by our members and decorated with paintings by the community. Two weeks ago, we turned the sites into scenes from a science-fiction movie. We had to. We separated the booths and taped up plastic tarps everywhere, to keep people safe and distant from one another. Our staff are wearing full protective gear. It looks like a field hospital. People are freaked out and distrustful: these are people who have been criminalized and stigmatized for years, so when the services start to feel like policing, that’s hard for them to take. And it’s hard for our staff, too. Some people are grateful, and thank us for giving out cloth masks and bagged meals. Others have told us it’s weird, that the space doesn’t feel like theirs anymore.
Every day, we approach each client in scrubs and masks to take their temperature. We have screeners asking questions at the door now, and every time someone shows up, we have to ask whether they’ve travelled out of the country, even if we asked them the same question the day before, and even though it’s utterly unlikely based on their life circumstances. To the clients, it feels like discrimination. To be able to socially distance is a privilege, but I know people are trying to respect the rules as much as their circumstances allow. One man is camping near a pavilion on Lakeshore Boulevard, and set himself up just outside the caution tape so he wouldn’t violate the bylaw, instead of setting up underneath the shelter. Another man tested positive for the virus and refused to go back to his shelter so he wouldn’t infect his friends; he slept on the streets instead.
The spaces that create any kind of normalcy in our clients’ lives have disappeared overnight. The libraries are closed, the drop-in centres are closed. The spaces they would go for a cup of coffee or a sandwich or to use the bathroom are closed. The things that would allow them some semblance of basic dignity are just not available. People are more desperate. People are hungry. We’ve seen more fights breaking out between clients. Two weeks after those closures, on March 31, the city had the highest number of opioid overdose responses since the crisis started in 2017. I wasn’t surprised at all. This is the new normal. The needs in the community are the same, but resources are scarcer. Drugs are harder to find right now, and they’re more expensive. Some of our clients are buying from new dealers, and the potency is incredibly unreliable. Just last week, there was a strange overdose warning: four people ended up in the hospital with opiate overdoses after using what they thought was crack cocaine. That’s very unusual. Covid-19 hasn’t hit the homeless and street-involved community with full force yet; this is not a community that travels, so it will emerge later. When it does, it will hit hard.
We’ve had to explain to people that we’re making these changes—adjusting and reducing our hours, changing our spaces—because we love them and we want them to be here in three months. We know that if we could offer people a predictable safe supply, overdoses would go down dramatically, overnight. We’re hoping to get funding to offer an individualized safe-supply care plan for anyone who is eligible. That may involve picking up a prescription for high-potency hydromorphone at a pharmacy on a daily basis, or supervision by a consumption site. On the Downtown Eastside in Vancouver, they’re moving on this. It’s a solution that makes self-isolation possible. We’ve seen the system respond with incredible speed, recognizing where the rules we have in place don’t make sense. There has been resistance, but innovation always has resistors. We have a proposal in to Health Canada right now, and I’m optimistic.
I’m worried about the compounded nature of the epidemic and the pandemic. I worry that we will lose people that we otherwise wouldn’t have. It’s in my head all the time. We’ve been hearing about other deaths in the community, people dying in stairwells who would normally be somewhere else, like at one of the city’s nine safe consumption sites. The horrible thing we’re trying to reconcile is that if we don’t continue to re-engineer how we’re offering our services, we could spread Covid-19 through the community, which would be horrific. We’re doing this crazy balancing act. As we pivot to prevent this virus, the social isolation and distancing are creating other harms. They’re necessary and they’re predictable. They’re also brutal, and we need to be ready to respond to them, too.
As I go to work every day, I stop at the drug user’s memorial project. It’s a monument on Queen Street East, an eight-foot copper flame, where people come to honour the memory of their friends who have died. I start every day there, stopping to see what someone has put in front of the memorial the night before. And now, every day, I have a lump in my throat about how many people we are going to lose because we aren’t able to be there for them.