Ottawa Inner City Health

Check out the t-shirts we handed out for HRW Day! Happy Harm Reduction Workers Day from our team to yours! #harmreductionworks #hrw #peersupport

We have failed to match resources to the scale of this crisis and we have not adapted to the changes to the drug supply. So now it is going to be more expensive to take care of people and we need to manage our expectations about their recovery outcomes. #ToxicBrainInjury #SupervisedConsumption #HarmReduction #HighlySupportiveHousing

In Ottawa, the people who use drugs who were engaged in the efforts to protect the health of their community and to advocate for the services they and their community desperately needed to survive the toxic drug crisis are mostly dead now. Those that are not, are overwhelmed with survivor’s guilt, demoralized that not only were their efforts not enough to save their friends but that the services they advocated for are being blamed for causing the problems they set out mitigate. In the public discourse about community safety, the voice of people who use drugs has been absent. This is striking given that people who use drugs a) are part of the community and b) are far more likely to be victimized than any other stakeholder in the conversation and c) necessary for any sustainable solution to public safety issues. We worked with people who use drugs to develop and implement a survey around the safety needs of people who use drugs.  https://lnkd.in/eS3qgiDj Next we held focus groups to ask them what specific things in their current environment are causing them to feel unsafe and how we can address them together. When we talked to people who use drug about the impact of the toxic drug supply, they told us about the dope sickness, they told us about desperation, the fear and the “every person for themselves” attitude that was created. They did not like what had become of their community. They grieved the way things used to be before the drug supply became so toxic, before the pandemic. And they grieved the leaders they loved and respected who have been lost over the past 7 years. So we asked them what they wanted to do about it. What they told us was that they wanted to restore the positive aspects of street culture. That they wanted to be part of the solution to the concerns of neighbours and businesses. They told us that they wanted us to help them to address the things that were impacting their sense of safety. The Ontario Government’s decision to close supervise consumption sites in Ontario was rationalized by concerns about vulnerable children being exposed to drug use and discarded syringes. People who use drugs, many of whom grew up as vulnerable children who the system failed to protect, couldn’t agree more! In fact, the first thing, they wanted to address was addressing drug use in front of kids, and within a week or two they restored the community norm of people shouting “kids up” whenever they saw a family with kids on the block and everyone putting their drugs away until after the family passed by and the kids were out of sight. There are policy alternatives to prohibitionist closures of consumption sites that would restore balance to communities and make safer downtowns for all. #HarmReduction #PublicSafety #DrugPolicy #ToxicDrugPolicy #ToxicDrugCrisis

Want to learn more about the Somerset St West Community Health Centre closure, and the Trailer’s Exemption Extension? Ottawa Inner City Health’s CEO, Rob Boyd was featured on Ottawa Now with Kristy Cameron. For more information, please click the link in our bio. https://lnkd.in/duvwS7Sz.

Today we honour the children who never returned home and those who survived the residential schools as well as their families and their communities. In our work at Ottawa Inner City Health, we are humbled and inspired by the strength and resilience of our indigenous clients.  They teach us every day about the power of culture, community and the indigenous world view. We acknowledge we are doing this work on unceded Algonquin territory. We recognize the Algonquin people have their own traditional ways of healing, and the bio-medical system perpetuates systems of colonialism and cultural assimilation. We commit to honouring a framework of cultural humility and recognize decolonization is not a metaphor; even if it means giving up some privileges that the bio-medical system affords us. #TruthAndReconciliation #CulturalHumility #Decolonization

#truthandreconciliation #everychildmatters #orangeshirtday #harmreductionsaveslives

https://lnkd.in/eK2GbKAy I love this piece by Matthew Bonn. This is what we hope for for people who use drugs…a system that supports them through their self directed journey to wherever it is they want to go and who they want to be. Discovery > Recovery This is achievable for everyone but it requires a radical restructuring of our disempowering and stigmatizing approach to substance use health. #SubstanceUse #HarmReduction

Like many of you, I read about the deadly assaults that took place out of Kingston’s Integrated Care Hub with horror and dread. I feel horror about the terrible, violent loss of life and the impact that these deaths will have on the community of people living in the encampment, on the loved ones of those who have passed in such a horrible way, on those who responded to the emergency who are people who hold a deep passion and empathy for the people they serve. And I feel dread about the potential policy response to this terrible incident. The hull has been breached, the ship is going down and people have fallen overboard.   Our leaky lifeboats are at risk of being swamped by the desperate needs of those in the water. Those that can swim are doing what they can, those that cling to bits of wreckage are making as much space as possible for others. While it is hard for bystanders to hear the screams for help, those screams will not stop because the people in the water are survivors, clinging to whatever hope they can for rescue. So, what should be our response? We have deployed a few leaky lifeboats like supervised consumption services and prescribed alternatives to the toxic drug supply, and we support those who manage to find refuge in the flotsam and jetsam of tents and encampments and other public spaces, building community under the direst of circumstances.  They do this because they understand that their chances of survival are better if they stick together. I am filled with dread because there is an ill-informed public debate about how to “save” people from this disaster. Some offer the unhelpful observation that it would be better if everyone could swim (i.e. go into “treatment”), others suggest our time would be better spend designing better lifeboats or new shipping routes, some suggest that we solve the problem of our existing leaky boats by scuttling them--closing consumption sites, disbanding encampments, prohibiting prescribed alternatives with their wraparound supports. In sea rescues, crews are taught to put all their efforts into pulling as many people out of the water as possible—and then the sea will take the rest. We know these are not perfect solutions but these are resources we have been given, despite calls for more.  We must deploy them to save as many people as possible. We cannot rescue everyone but we can, and should, be rescuing as many people as possible because time is running out for far too many. #HarmReduction #SupervisedConsumption #DrugPolicyFail #HousingCrisis #RescueMission

We knew that the arrival of the toxic drug supply in Ontario would lead to an exponential rise in the number of drug toxicity deaths due to the failure of governments to dedicate the resources to match the scope and scale of the crisis.   What we hadn’t anticipated was how the toxic drug supply was going to impact the substance use patterns of people who drugs.   Different opioids have different levels of toxicity, but also of duration. Hydromorphone’s duration is 1-2 hours while fentanyl’s is 30-60 minutes, meaning that you need to dose as much as 4 times more frequently. The substance use cycle went into overdrive:   Use fentanyl and experience relief from suffering--begin experiencing withdrawl (dopesickness)-- acquire money to buy drugs--source their next dose--find a safer place to use, then repeat the process.       This leaves little time for anything else, even when the person is motivated to make changes in their life. They are dope sick all time, which many report as “feeling like they are dying”.   With higher potency, shorter duration opioids—people started smoking stimulants (crack cocaine, crystal methamphetamine) in association with injecting their fentanyl to both balance and prolong the relief the were seeking through substance use.   More recently, people who had previously injected fentanyl, began to smoke fentanyl, possibly due to poor venous access from years of high frequency injecting and possibly due to the mistaken belief that smoking fentanyl was less risky than injecting fentanyl from an overdose perspective.   Since 2020, approximately half of opioid toxicity deaths had evidence of inhalation. No sites in Ontario have been approved to bring the smokers inside, away from the public spaces and we now respond to more drug toxicity events in the immediate vicinity of our site than we do inside. Neighbours are right to complain, but it is critical to understand that we have been asking to allow people to smoke in our sites and it has been denied.   Under the prescription opioid crisis the drug trade was primarily conducted within the community of people who use drugs in Ottawa. Diverted oxycontin was sold by one person who uses drugs to another as a means of making money to maintain their own use. Community norms were well established and violence was limited.   When the toxic drug crisis overtook the unregulated, non-prescribed drug supply, it was people from outside the community who were selling drugs which led to more violence and an escalation in the intensity of violence. Drug debts became more common and that invariably leads to more violence.   Unregulated drugs create an ideal business model. They are easy to acquire, with low risk of detection from enforcement, extremely high profit margins and public policy shifts that limited access to prescribed alternatives, creating a steady market, even when thousands die each year in Ontario. #ToxicDrugSupply #HarmReduction #DrugPolicy #Overdose #SupervisedConsumption

On August 9th 2015, we got our first warning that something was changing to the drug supply in Canada. 16 overdoses in one day in Vancouver sent alarm bells to harm reduction agencies across the country. Government policies to address the prescription drug crisis led to massive deprescribing of pharmaceutical opioids and resulted in thousands of Canadians who were dependent on these medications to the streets to source drugs to ease their pain and the drug they found there was powdered fentanyl. This day marked the end of the prescription opioid crisis and the beginning of something much, much worse—the toxic drug crisis. https://lnkd.in/erusiAuw Around this time in Ontario we were watching as the first wave of the toxic drug crisis was making it’s way from west to east and Ontario was not ready. The tools we needed but didn’t have in place were take home naloxone, low barrier access to opioid agonist treatment, and supervised consumption services. These services were just getting up and running when the toxic drug crisis hit Ontario in the spring of 2017. And we were immediately overwhelmed by demand. Fentanyl is a short acting opioid, meaning that people needed to dose more frequently to maintain the effect and that they were in withdrawal more frequently. While all opioids carry risk of overdose, fentanyl was by far the highest risk and so people wanted more of their injections supervised. Our sites were not big enough to meet the demand and so people did the next safest thing they could do which was to inject just outside of our doors, knowing that we were there to respond if they overdosed. Going two blocks away was potentially lethal. We saw a rapid shift in our communities away from injecting unregulated drugs to smoking them and we were not prepared for that. When we were planning the sites, people were primarily smoking crack cocaine in Ottawa and there was no contamination of the cocaine supply in the pharmaceutical opioid crisis. And so people began to smoke their drugs around our sites for the same reason as above. It was not just consumption sites that were impacted. Naloxone wasn’t as effective in reversing opioid overdose and multiple doses were required to revive people. Opioid agonist treatment, the gold standard in treating opioid use disorder was also less effective in the face of a toxic drug supply.  https://lnkd.in/efQXZgYe The toxic drug supply had outflanked us and we needed more tools.