Vancouver health officials scrambling to slow drug-overdose deaths, government emails reveal

Vision Vancouver councillor Kerry Jang was caught off his guard when Downtown Eastside activists established an unsanctioned injection site last September.

“So you are saying this pop up SIS [supervised-injection site] is actually operating?!” he wrote in an October 12 email to health officials. “And that city staff were aware? And ‘keeping an eye on it’. If so, I am aghast. Are there plans to shut it down?”

That email is one document in several hundred pages of correspondence obtained via more than a half-dozen freedom-of-information requests filed by the Straight. Together, the documents depict officials with the city, the health authority, and the provincial government working frantically, at all hours of the day and night, to slow the rapidly rising body count associated with B.C.’s overdose crisis.

Late in the evening on December 20, for example, Vancouver Coastal Health’s chief medical health officer, Dr. Patricia Daly, informed the Ministry of Health on efforts to establish overdose-prevention sites inside Downtown Eastside hotels.

“Everyone is moving as fast as they can,” she wrote. “Housing providers are drawing up plans and proposals as fast as they can, and we are churning out contracts as fast as we can to ensure funding and insurance coverage.”

A December 5 email sent by VCH director of prevention Miranda Compton explains why Vancouver has established bare-bones overdose-prevention sites instead of supervised-injection facilities like Insite (which offer complementary services such as counselling and information on treatment options). The blame lies partly with the city, she wrote.

“Both [proposed supervised-injection] sites required renovations, and the permits have been delayed due to CoV’s [City of Vancouver’s] permit requirements,” the email reads. “At this point, we are looking at sites that do not require renovations. Very frustrating in the midst of a true crisis.”

A December 20 email exchange between Daly and the Health Ministry with the subject line “Your advice needed” discusses a problem where Vancouver’s morgues temporarily ran out of refrigerated space for bodies.

“Seems there is a challenge at VGH which may have further impact on the already increasingly ‘creative’ Coroners Service approach to locating crypt spaces”, it reads. A spokesperson for the coroners service told the Straight that situation was resolved with the assistance of private funeral homes.

Other emails reveal confusion and disagreements among agencies.

In a December 16 email, Daly expressed her disapproval of remarks made earlier that day by Mayor Gregor Robertson and Vancouver police chief Adam Palmer. At a news conference, they made an impassioned plea for the province to spend more on addiction treatment.

“The fentanyl crisis…is bringing a new level of urgency to address the lack of detox and treatment options available to people,” Robertson said.

Daly expressed concern for the pair’s emphasis on detox, explaining that from a medical perspective, that could actually be dangerous.

“Our addictions experts would not have called for an immediate expansion of detox beds as you know, since people coming out of detox currently are at a very high risk of overdoses and death,” she wrote, in reference to this group's tendency to relapse. “Many of our docs won’t refer those with opioid addiction to detox for this reason.”

In addition, in emails traded on December 15, health officials discuss provincial reporting requirements for overdose-prevention sites and make clear Vancouver did not intend to follow the rules as the Ministry of Health originally drafted them.

“Dr. Daly should clarify…under what authority she is declining to comply with the necessary provincial coordination and standardization of data collection,” one wrote.

“This escalated quickly,” another replied.

Some emails discuss ideas that were never implemented or have yet to be deployed.

Correspondence from November concerns the possibility of expanding access to prescription heroin, a controversial harm-reduction treatment for opioid addiction that’s offered on a small scale at Crosstown Clinic in the Downtown Eastside.

“Can you please give me the total costs of crosstown,” reads one such message. “Patty Daly wants to know as the MOH [Ministry of Health] is thinking of using a Crosstown model to address the OD crisis.”

(Earlier this month, the Straight reported that Vancouver and B.C. health officials all but unanimously agree that prescription heroin—that is, a clean supply of opioids controlled by the government—should be made more widely available, but Health Canada regulations prevent that from happening. “There are many obstacles for diacetylmorphine [prescription heroin] to expand beyond Crosstown,” the clinic’s physician lead, Dr. Scott MacDonald, said during an interviewed for that story. “If it is going to be available, those regulations need to be streamlined and some of the obstacles removed.”)

Last year, there were 922 overdose deaths in B.C. That was up from 513 in 2015 and 366 in 2014.

Many other emails obtained via Straight’s the FOI requests simply describe staff at every level and even the health-care system itself stretched to a breaking point. On December 20, Compton pleaded with the province for more clinical support in the Downtown Eastside.

“Insite is swamped and stretched,” it reads. “It is the entire system of care in the DTES [Downtown Eastside] that is swamped and stretched—the housing workers and peers have been doing an amazing job—they really have become 1st responders in this.”

Update: Vancouver's top doctor opens up about late nights through the fentanyl crisis and B.C.'s next steps