By Joanne Farrall
After 78 days of operations, Overdose Prevention Ottawa’s (OPO) controversial pop-up overdose prevention site has closed. OPO has been instrumental in shifting public health practice and discourse when it comes to opioid use in Ottawa.
The site provided clean medical equipment, condoms, food, juice, water and overdose kits to an average of 41 clients a night. They also offered two supervised tents to inject or smoke drugs and had naloxone, a drug that reverses the effects of opioids, on hand in case of overdoses.
The pop-up’s farewell party was at Raphael Brunet Park on Nov. 10. A group of OPO volunteers braved bone-chilling temperatures. They worked quickly to transform the small patch of grass at the corner of St. Patrick street and Cumberland into a welcoming space. Against a candle-lit backdrop, volunteers invited guests to write messages about the site to and hang them on a clothesline.
Colourful notes of gratitude blew in the wind. Some were general like “Thank you for existing!” Other messages were more specific. “Thank you for feeding me so many times.” Another read, “Thank you for keeping me sober and wanting to help others.”
Since pitching its first tents on Aug. 25, OPO has received 3,674 visits and reversed five overdoses. It has also become a local flashpoint for larger discussions about harm reduction, access to public space and the role of community in North America’s opioid crisis.
The Ottawa site was modeled after similar ones in Vancouver. Felix Gilliand, a frontline worker in Vancouver, says that “pop-ups disrupt the relationship between service providers and service users in a really productive way. Most [drug users] have had bad experiences with social work and tend to appreciate more community-based projects.”
The general public often assume that government-run facilities are better than ones run by volunteers, Gilliand says. “Fears around safety and cleanliness tend to be masks for policing legitimacy and are an attempt to maintain the status-quo rather than make radical change.”
The Leveller also spoke with Nick Ellan, a self-identified drug user and University of British Columbia graduate, about his thoughts on safe injection sites like the Ottawa pop-up. Ellan currently lives in the Downtown Eastside of Vancouver with his partner, both of whom have accessed overdose prevention sites as clients.
Ellan says the effects of pop-up injection sites ripple out far beyond their physical location. What these sites do, he explains, is to help make the culture of supportive community and safer drug use visible for distressed or at-risk users.
“The best sites are zones of safety, not just facilities,” Ellan explains. “Then users take that with them and you’re spreading a culture that makes buildings around safer too, and the streets, and so on.”
Access to clean supplies and naloxone are essential parts of this culture, he says. So is an accepting environment that reduces stigma because people who are frightened, stressed or ashamed, have less attention to focus on safety.
The Leveller asked Ellan about the difference between using in a government-sponsored facility and a volunteer-run pop-up. “You’re going to have a more sterile environment in the former. Threatening, businesslike.” At pop-up sites, “volunteers can take advantage of their casual nature to focus on preventative measures like dialogue and welcome.”
With volunteer-run sites, new clients can ask questions without feeling threatened. The relaxed environment helps people to inject more responsibly, Ellan explained. “They serve a specific clientele that would otherwise use alone and that is the most at risk demographic. It’s essential that they are welcoming spaces.”
The Ottawa pop-up site seems to have taken this to heart. In a video posted by Vimeo user “Action Indirecte,” Marilou Gagnon, a nurse and OPO volunteer, talks about the connections she has formed with clients.
One client in particular disclosed to Gagnon that he wanted to quit using and eventually stopped on his own. They made a deal that he would check-in every day to get a snack, help out and let her know how he was doing.
Gagnon says her relationship with clients at the pop-up site was very different from working in the medical system. As a nurse at the hospital she was “a representative of the system that causes them harm — especially at the emergency [room] which is not a place where drug users are respected.”
“I have been a nurse for 15 years” Gagnon says, “so, to be able to work in such a site and develop privileged connections with people who trust me, who want to teach me things, who ask how I’m doing, who care when I don’t show up at the [pop-up] site — it is special.”
She says that OPO’s pop-up provided a necessary, lifesaving service. People are dying, she explains, “and if this was happening to any other social group in society there would be tents like these everywhere — on every street corner… but now, because it affects folks who take drugs it is not considered important.”
Prior to the opening of the pop-up site, officials at the Sandy Hill Community Health Centre had been working hard to get a sanctioned supervised injection site for over four years. It was a daunting process to coordinate permission and funding from the federal and provincial governments, especially with little municipal support. A supervised injection site was opposed by Ottawa Mayor Jim Watson, Police Chief Charles Bordeleau and the chair of the city’s public health board, Councillor Shad Qadri.
Four weeks after the unsanctioned site popped up, an official supervised injection site joined it — run by Ottawa Public Health, using Sandy Hill’s temporary federal exemption. On Nov. 6, another site opened at the Shepherds of Good Hope, run by Inner City Health. The Somerset West Community Health Centre has also applied for a federal exemption for a supervised injection site.
For years, Mayor Jim Watson has been a vocal opponent of any kind of safe injection site. His stance shifted in 2016, after the city’s board of health overwhelmingly voted in favour of safe injection sites. At the time, he said he personally opposed the sites, but was going to defer to the health board.
In September, the Mayor also voiced strong opposition to the pop-up. But by Nov. 2, in a surprising reversal, Watson praised OPO’s efforts. He wrote to the federal Health Minister asking her to help speed up the approval of the safe injection site on King Edward Avenue. In the letter Watson said that OPO has proven the need for this kind of service and that “many lives have been saved by overdose reversals.”
When the province offered to provide the pop-up with heaters and military grade tents, however, the city did not accept the offer. Watson says he did not hear about the provincial offer.
A lack of support from the city and insufficient infrastructure are two reasons why the Ottawa pop-up site closed. In addition, OPO explains in their Nov. 7 statement that, thanks to their efforts, “there are now two supervised injection services operating within two blocks of our site.”
Without providing further details, OPO explained that they are going to continue with phase two of their project by redirecting their “efforts to address other failings in the healthcare system throughout Ottawa.” One of their goals is to advocate for safe sites for clients to smoke drugs as well as inject them. Representatives of OPO were unavailable for further comment on what this second phase of advocacy will look like.
Meanwhile, Gilliand sees many parallels between the current opioid crisis and the AIDS crisis. The echos are found both with government responses and activist advocacy. “And of course, the population is largely the same as far as IV drug users go,” he says. “A lot of people survived AIDS only to die of fentanyl.”
Gilliand says that in the late ’80s AIDS advocates worked hard to try and include marginalized people. This changed over time as the movement became less radical. He wonders how the fentanyl crisis would be different “if the AIDS movement had advocated more for drug users.”
Ellan, who suffers from PTSD, thinks that Canadians should rethink our ideas about the opioid crisis.
The crisis, he says, is not a singular event that began with the introduction of fentanyl into the supply. It is an ongoing problem of dehumanization that comes from a sustained legacy of colonial and sexual violence. It is “the result of an economic shift that has devalued our lives and agency, broken down old forms of community, and robbed people of traditional coping mechanisms.”
A holistic response is necessary, says Ellan. One that includes, but goes beyond, frontline work. He wants people to know that “crisis response is not a solution. Triage is necessary but no one should think we are finished with naloxone and rehab.”
This article first appeared in the Leveller Vol. 10, No. 3 (Nov/Dec 2017).
