Saundra was just looking for a pipe when she wandered into SOLID Outreach Society a few months ago. The mother of five, whose last name has been omitted to protect her privacy, moved to Canada in 2014 with her partner before relocating to Victoria three years ago. 

Since her chance encounter with SOLID, Saundra has become a regular user of the organization’s temporary overdose prevention site (OPS) on Pandora, which offers users a choice between receiving their drugs intravenously through injection or orally through inhalation. 

While there are nine overdose prevention sites in Greater Victoria, the availability of inhalation services is proving an issue for Victoria’s drug users, as SOLID’s Pandora location is one of only two sites in the region to offer both, with the other located in Rock Bay and run by Cool Aid Society. Most sites only offer injection, despite BC Chief Coroner Lisa Lapointe’s annual report noting in February that a majority of BC drug users are ingesting their drugs through smoking rather than injecting. Across the province, there are 38 OPS, but only 13 offer supervised inhalation.

Service providers such as SOLID say they would love to expand their services. But they say resistance by Victoria residents, increased costs, and residual WorkSafe concerns are preventing most new sites from opening.

‘Moral distress’

It has now been six years since BC first declared the overdose crisis a provincial emergency. In that time, over 8,500 people have lost their lives to toxic drugs in the province. In 2021, there were 2,232 fatal overdoses, more than in any other year since the crisis began.

The COVID-19 pandemic exacerbated the crisis by forcing in-person services by Island Health and aid organizations like Cool Aid Society to shut down. At the same time, the Ministry of Mental Health and Addictions put out warnings beginning in March 2020 about an increase in the toxicity of the province’s illicit drug supply.

The provincial government has made efforts to expand services and reduce stigma by increasing the number of treatment beds and awareness campaigns. But Karen Ward—formerly of the Vancouver Area Network of Drug Users (VANDU) and now an advisor to the City of Vancouver—says overdose prevention services and safe supply are the real answers, not incremental increases to treatment beds. 

Safe supply is ultimately where advocates and experts like Ward would like to see the government end up. Implementing safe supply would mean that physicians, and possibly aid organizations, could distribute uncontaminated versions of illicit substances to users, and reduce reliance on the illegal drug trade. 

“This is about basic health care,” said Ward. “I'm hopeful that family doctors … look at this and say ‘Oh that's how, oh it's not that complex.” 

BC has made steps towards the implementation of safe supply by expanding the availability of opioid agonist therapy (OAT) whereby physicians can prescribe certain substances, like methadone, in order to try to wean drug users off more addictive opioids. 

There have also been efforts by aid groups such as Portland Hotel Society (PHS) to set up services whereby users can purchase fentanyl powder capsules. At the price of $10 for a tenth of a gram, PHS is distributing the capsules through their clinical sites on the Lower Mainland. Mixed with dextrose and caffeine, each capsule is based on the client’s tolerance. PHS is hoping that this program can straddle the line between prescription-based safe supply and regulated drug sales.

Full-scale safe supply, however, is still opposed by some physicians and politicians worried that safe supply would exacerbate the crisis by adding more drugs to the mix.

“What is difficult about ‘safe supply,’ and what causes me and others moral distress, is that the same pills that one patient insists are needed to save their life may bring harm to another patient of mine, or one I have not yet met,” wrote Dr. Vincent Lam in an op-ed in the Globe and Mail in November. “In medicine we are taught primum non nocere, first do no harm.”

Victoria city councillor—and mayoral candidate—Stephen Andrew shared the article in a tweet, noting, “If we in [Victoria] want to find solutions to opioid use, we need to change our thinking. ALL of us.”

Critics of the op-ed, including other physicians, noted that “safe supply” encompasses a broad approach to drugs, only part of which is the actual prescription of opioids like hydromorphone. Overdose prevention sites are another major part of the picture.

These sites provide an important way for drug users to do what they need to do without the fear of stigma or criminalization that normally hounds them.

“We've seen positive impacts in a very short period of time,” SOLID’s Manager, Operations Fred Cameron told Capital Daily. 

The temporary site run by SOLID was opened in October, and, according to Cameron, in that short period, it has become a key service for members of Victoria’s drug-using community. He estimated that 110 people use the site on a regular basis. He also says that since the site has been there, he has seen a decrease in police presence and fewer ambulance calls. 

Cool Aid Society declined to comment on its services at the Rock Bay site.

As for the coroner’s report that the vast majority of drug users prefer inhalation rather than injection, Cameron says he doubts the data suggesting this is a new phenomenon.  

He also says it is important for policymakers to resist the urge to separate the two groups, as many users overlap in their consumption methods. He would like to see a combined approach to safe consumption.

“This is a community of people that interact with one another,” he said. “By trying to divide and separate groups, I think we have had negative impacts in our attempts to solve problems.”

Community opposition front and centre

Victoria has a long history of opposition to change, and residents of the provincial capital are not shy to voice their concerns when it comes to new developments.

This is a reality that the provincial government and groups like SOLID say they will have to deal with regarding service provision moving forward.

Cameron says both SOLID and Island Health would love to make the temporary Pandora location permanent, but that community members are voicing complaints about the number of services already operating on the street and are against opening any more. 

While he gets their concerns, Cameron says it makes no sense to relocate the site to a location without any of the other wraparound services available on Pandora, like shelter and washroom services at Our Place and Portland Hotel Society, to go along with outreach services.

At the moment SOLID and Island Health are looking for a permanent location that meets the needs of the community. They are also considering the expenses that go into such a site. As opposed to injection sites, where the drug and its residue are contained, inhalation service areas require strict safety measures, including proper ventilation, which can increase the price tag: the province says setting up an indoor inhalation site or adding the service to existing sites is, on average, four times more expensive than an injection-only site. 

An outdoor model used by both SOLID and Cool Aid reduces the cost—but doesn’t fix the concerns WorkSafe BC has with exposing workers to the gases from an inhalation site.

WorkSafe says that they are not involved in the setting up of new sites and rely on the guidance of public health officials for what needs to be in place in order to ensure a safe working environment.

“Where there is a risk of exposure arising from chemical agents, WorkSafeBC requires employers to identify the routes of potential exposure, assess the risk and, where needed, implement control measures to effectively mitigate the risk,” spokesperson Yesenia Dhott said in an emailed statement.

Cameron says that SOLID has been working with WorkSafe to make sure any future sites adhere to their requirements and doesn’t foresee it being an issue for long. Figuring out how to install proper ventilation was the main hurdle, and with the success of the Pandora site, Cameron believes they know how to meet the requirements at new sites moving forward.

“With an inhalation service, the staff watches from outside or through a window,” he said. “You have to build the structure specifically to be managed in a way that the staffers are not constantly inhaling smoke.”

Ongoing benefits

In the meantime, the two existing overdose prevention sites on Pandora and in Rock Bay with existing inhalation services will continue serving as many people as they can. 

Shortly after her initial encounter with the inhalation site on Pandora, Saundra suffered an overdose and reached out to an outreach worker for help.

“I told him like I don't want to go directly to the helpline because I was scared that it was going to reach my family,” she recalled.

Once she got through, Saundra says that SOLID helped her get back on her feet through help with cleaning, food provision, and child care.

“It was really that hard because it's mixed up with depression, with so many things and just the everyday problems, and you're just digging this hole deeper and deeper and deeper,” she said. “And before you know it, you're at rock bottom.”

Without the support she has received from SOLID, Saundra says she likely would have died. And as her drug of choice is crack cocaine, without inhalation services she would not have been able or willing to use the site with injection as the only option.

“Every day when I wake up and I'm sober that's another great day,” She said. “if I have an urge I know I can go somewhere safe.” 

With files from Brishti Basu