Much of Heather Hobbs’s job as a harm-reduction co-ordinator involves showing people how to inject the opioid inhibitor naloxone to reverse the effects of drug overdoses.
This year alone she has trained nearly 800 people — illicit-drug users and their parents, shelter staff and support workers — to administer naloxone and has given out 843 kits.
At least 555 people have died from drug overdoses in B.C. so far this year. Many of the deaths involve the powerful, cheap opioid fentanyl. The situation led to a public health crisis being declared in April. While the death toll has gone down slightly thanks to wider distribution of naloxone, overdoses are still happening at alarming rates.
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“So what does an overdose look like?” Hobbs asked the half-dozen staff at Together Against Poverty Society, who help some of the poorest people in the city with everything from housing to social-assistance issues.
“They might look blue or grey around their lips, ears and fingernails from the lack of oxygen,” said Hobbs. “People will look dead.”
She explained how to stimulate a response by rubbing knuckles on the sternum or pinching the fingernail beds. If there’s nothing, call 911.
She showed how to administer naloxone, breaking a glass vial, loading a syringe and, using a sponge to demonstrate, stabbing with enough force to pierce a pair of jeans and a muscle.
“Keep giving injections until you run out or the person wakes up,” she said, adding it takes only a few minutes without oxygen to cause brain damage and death.
“It’s very stressful,” Hobbs said later at her AIDS Vancouver Island office. Since January, her staff has saved more than 40 people. One staff member crushed a glass vial of naloxone in her hand trying to save someone.
Kitchen timers beep every five minutes to remind staff to check the drop-in centre’s washrooms, in case someone has gone there to take drugs and has overdosed.
While no one has died at AIDS Vancouver Island, a client died in Odeon Alley outside after being turned away when the drop-in centre was closed briefly to deal with an overdose.
Taylor Teal, a staff member at AIDS Vancouver Island, described an overdose in a washroom where a young man was revived and taken out to wait for paramedics.
“I went back to the bathroom to collect his belongings and heard this ringing. He dropped his phone in the sink and when I looked, the caller ID showed ‘Mom, ” she said, choking up. “He was somebody’s kid. If he hadn’t overdosed in our bathroom, he might be dead.”
It’s not only workers at AIDS Vancouver Island who are affected. Staff at nearly every social-service agency are getting naloxone training, along with many clients. Police, firefighters and paramedics are equipped with the nasal spray and injection antidote. They are being called to twice as many overdoses at social agencies, many of them in washrooms, according to a recent study from the University of Victoria’s Centre for Addictions Research of B.C.
In August, Our Place communications director Grant McKenzie found a man in his 50s who overdosed and died in a washroom. McKenzie said the man was a well-liked regular at the shelter and he had no idea he used drugs.
Hobbs said many service providers are operating as de facto safe-consumption sites, but without appropriate space and supports. “We would very much like to run these services with the right supports,” said Hobbs, adding they have approached Island Health with the idea. The health authority is working on an application for federal exemption to open safe-consumption sites in the city — but it could be months or years before one opens.
Before dawn, volunteers from the Society of Living Illicit Drug Users scour downtown streets for used needles and drug supplies, and provide clean needles.
“I give out way more needles than I pick up. People are more responsible [with discarding them] than they get credit for,” said Jack Phillips, 46, a former user.
From July to September, the organization gave out a monthly average of 11,590 clean needles. They collected 5,037 used ones themselves and had another 5,993 returned in safe boxes.
In a search for discarded needles, Phillips walked down side streets to areas users hang out — a tucked-away platform or stairwell. Within a block he picked up half a dozen syringes and a yellow biohazard bucket of used needles.
“See, there’s an etiquette. People will make an effort to keep this stuff off the street,” he said. It has been about four years since he used. He lives on a disability pension and is a busy dad. Volunteering is what he can do to give back.
“It feels useful to be out here. To be doing something, not just talking about it behind the bureaucracy,” he said.
Pandora Avenue is a hub for users and dealers, with Our Place and the social-assistance office on one block. Various empty lots double as camp sites; hidden stairways are places where people can inject themselves without much notice.
Phillips stood in front of a man passed out on the ground, chin-to-chest, and then moved on.
“I was counting his breaths,” he said. One of the signs of a fentanyl overdose is slowed breathing, which leads to respiratory shutdown. All volunteers for the Society of Living Illicit Drug Users are trained to use naloxone, also known by the brand name Narcan.
He said fentanyl was not nearly as available when he used drugs, although he did inadvertently try it once.
“Dealers now buff up their drugs, make it more potent,” he said. For users, the appeal is cost saving. One fentanyl-boosted hit can cut the cost of heroin in half.
“What’s in the drugs. That’s the scary thing these days. It could be anything,” he said.
He approached a couple cuddled under a tree between a grocery store and new condo development. They gave him some used gear and asked for 30 needles and a crack pipe.
“That’s how it should be. Friendly, ask how they’re doing,” Phillips said, recording each interaction on paper.
He stopped at Our Place to check in with regulars and grab coffee.
Wolf Madge, outreach supervisor for Society of Living Illicit Drug Users, was there. He said the prevalence of fentanyl and overdosing is hard on drug users, outreach workers and everyone around them.
“I’ve Narcanned three people, two in my own building,” he said. Several users live in and frequent his building. When he received the naloxone training, he put a sign on his apartment door that reads: “Need Help? I have Narcan.”
“It’s very stressful. But nobody seems to care. Nobody wants to do anything, just sweep the problem under the rug.”
