September 1, 2017
Inner-city organizations continue their journey to bring safe injection sites to Edmonton
The first time there were serious discussions about opening a medically supervised injection site in Edmonton was in 2012, on the heels of the landmark Supreme Court decision to exempt Vancouver’s Insite — the first safe injection site anywhere in North America — from federal drug laws. Suddenly, the doors were thrown open for similar sites across the country, which is what brought the members of the Streetworks council together, to figure out how this concept might work in Edmonton.
“We sat around and looked at each other woefully and said, ‘I don’t know. This might take us a year,’” remembers Cecilia Blasetti, executive director of the Boyle McCauley Health Centre and a member of Streetworks, with a laugh. “That’s how the wheels grind.”
Five years later, those wheels are still grinding. But not for much longer. By early 2018, three different community organizations in Edmonton’s inner city will offer safe injection services: Boyle McCauley, Boyle Street Community Services, and the George Spady Society. In the process, the results seen at Insite for more than a decade will now have a chance to take root in Alberta, improving not just the lives of some of Edmonton’s most vulnerable populations, but also, hopefully, the community around them.
It’s not hard to see why Insite is a model worth emulating. Since 2003, the Vancouver facility has seen more than 3.5 million visits, from upward of 75,000 different clients, without a single death. The Edmonton sites might not see the same amount of traffic, but that harm-reduction approach — providing users with clean needles, in a safe and private space, with medical supervision and referral to other services close at hand — is one that has been championed by the community coalition Access to Medically Supervised Injection Services Edmonton (AMSISE) since 2012.
Currently, a handful of groups including Boyle McCauley, HIV Edmonton, and a mobile van run by Streetworks staff distribute clean needles to clients around the inner city. (The Streetworks van
is the most active site in the city, handing out more than 325,000 needles in the first half of 2016 alone.) But most of the people who inject drugs in public are also homeless, and the limitations of the current system are obvious to anyone who’s part of it.
“Right now, when somebody comes in, we give them a needle, and they have to go out to the back alley [to inject],” says Shelley Williams, executive director of HIV Edmonton and chair of both AMSISE and the Streetworks council. “It doesn’t make sense.”
The lack of a dedicated, medically supervised place to inject these drugs has led to unsanitary and unsafe conditions for users, as well as dangerous debris, in the form of thousands of discarded needles, left scattered around the surrounding neighbourhoods.
Edmonton’s safe injection sites will, however, have important differences from the Insite model. Rather than constructing a standalone building, as was done in Vancouver, the three sites here
will be incorporated into the larger suite of services already being provided by the parent organizations. Each site includes a reception area, an injection room monitored by a registered nurse, and a separate room where clients can be monitored post-injection and speak with staff about any health concerns they may have.
“Our position has always been that this is a group we’re already servicing in all kinds of ways,” Blasetti says. She doesn’t see safe injection services as being fundamentally different from any other services that Boyle McCauley has added over the years, from X-rays to foot and wound care, based on demand. “We see this as one more health service that we’re going to be able to provide.”
It isn’t a hard sell to potential users of the service, either. In 2014, researchers at the University of Alberta’s School of Public Health conducted a survey of 320 people in Edmonton’s inner city who use drugs. They found that in the previous six months, 47 per cent of respondents had difficulty finding clean needles, and 23 per cent had experienced an overdose. In addition, 85 per cent of respondents also reported unmet needs related to mental health and addictions — and a whopping 91 per cent said they would be willing to visit a safe injection site, were one to exist in Edmonton.
The medical case for safe injection sites may be clear, but the political case hasn’t always been. Even after the Supreme Court’s unanimous verdict in 2011, Canada’s Conservative government under Stephen Harper made things extremely difficult for potential new sites, passing legislation that made qualifying for the federal exemption all but impossible.
“There’s nothing to stop people from just opening safe injection services,” Blasetti says. “But the exemption guarantees that your staff, and the people who use it, will not be arrested while doing it.”
Despite these legal hurdles, AMSISE — whose members include HIV Edmonton, Streetworks, all three inner-city sites, and the Royal Alexandra Hospital, which will also offer safe injections as part of its inpatient services — never faltered in its belief that the service was needed. A $9,000 grant from Edmonton Community Foundation supported a feasibility study, while a $25,000 grant aided with the early days of AMSISE’s research.
“What we’re saying is: This is a health service,” Blasetti says. “There isn’t any other health service where you have to go to your community and ask if you can provide it.”
The Harper administration may have kept safe injection sites in gridlock for the better part of a decade, but it wasn’t just the election of Justin Trudeau’s Liberal government that allowed the issue to move forward again. Advocates also believe the recent opioid crisis has rapidly broadened the conversation about substance use in Canada, which has given Edmonton’s safe injection sites new leverage about the necessity of services like theirs.
“I don’t think I’ve heard anybody who has said, ‘There should be absolutely no supervised injection,’” Williams says. “What I’m hearing is, ‘How does the model get designed in a way that’s helpful
and beneficial to all the members of the community?’”
One of the ways the entire community benefits is by each site continuing to offer what they call “wraparound supports.” People might visit Boyle McCauley, for example, just to use the new safe injection facilities — but while they’re there, staff will slowly build relationships with them, asking about other health concerns and offering a range of other critical services, from psychiatry to dentistry.
“We think any door is the right door when it comes to accessing health care,” says Blasetti. “It’s one more opportunity to connect with people and support them in making better health choices.”
Still, the model does have its detractors, many of whom are concerned about safe injection sites eroding the quality of the surrounding neighbourhood and becoming magnets for drug users around the city. This argument in particular makes Blasetti bristle.
“You put services where the problems are,” she says. “When we define the problem as public injection — not injection in general, but public injection — the research we’ve done has shown that this is where the biggest concentration is.” Boyle McCauley, Blasetti says, has changed its mandate several times, most recently 14 years ago, toward vulnerable populations who face multiple health barriers. But changes are always made in response to the evolving health needs of the community.
“I am as horrified as any resident here about the depths of poverty and homelessness that we are experiencing, and the level of need,” she says. “But we didn’t change the community. McCauley changed, and we responded.”
“We know supervised injection services aren’t a magic bullet,” adds Williams. She readily admits there’s still a need for treatment, and supportive housing, and progressive social policy. But safe injections are one critical element in the larger network of issues — and one that isn’t covered anywhere else in the current health landscape. “We’re taking one little slice here,” Williams says. “It’s part of a continuum of service.”
And even that one little slice can have profound results for the people who use it.
“It’s not about letting people do whatever [they want],” Williams says. “It’s about making sure that people stay healthy and safe, providing dignity in service, and deepening those relationships so we can address some of the stigma attached to injection drug use.
“It’s about keeping people alive.”