B.C.'s only supervised-inhalation site for drug users pressured to move out of its home in the Downtown Eastside

More than 4,800 people in B.C. have died of an illicit-drug overdose since 2013, the year that the dangerous synthetic-opioid fentanyl arrived.

In the epicentre of the crisis, Vancouver’s Downtown Eastside, residents have responded with community-led harm-reduction programs. Activists like Sarah Blyth established pop-up injection sites, where people could use drugs under the supervision of staff trained in overdose response.

After Blyth opened the first of these sites in September 2016, the province established several more and nonprofit housing providers integrated supervised-consumption rooms into buildings around the Downtown Eastside. But only one location in B.C.—and only two in all of North America—permits clients to smoke drugs in a supervised setting. That’s because, although supervised-injection facilities like Insite can get around Canada’s Controlled Drugs and Substances Act with a federal exemption from the law, they cannot avoid a provincial law that forbids smoking inside a workplace.

And so Vancouver’s only supervised-inhalation site exists outdoors, under a tent, at the back of a vacant lot at 62 East Hastings Street. (The other is in Lethbridge, Alberta.)

“We decided, ‘Whatever kind of drug you’re using, that’s fine, and we’ll figure out how to monitor you using.’ Because you can overdose by smoking, snorting, or anything,” Blyth, executive director of the independent Overdose Prevention Society, told the Georgia Straight.

According to preliminary data supplied to the Straight, the society’s facilities (both the injection room and supervised-inhalation tent) saw more than 94,500 visits between April 2017 and April 2018. Staff responded to 36 overdoses among people smoking drugs and 172 overdoses where someone was injecting. Every intervention was successful. No one has died at a supervised-consumption site in B.C.

Although there is evidently a need, Vancouver’s only supervised-inhalation program is receiving pressure to relocate or shut down.

The tent was pitched upon, and remains on, property that the City of Vancouver has designated for sanctioned street vending. The Downtown Eastside Street Market has patiently shared its space for two years, and the relationship has become strained, street-market staff told the Straight.

“It was supposed to be temporary,” Linda Lennie, a vendor and assistant to the market’s executive director, told the Straight. “Everything was supposed to move inside. But that never happened.”

In December 2017, the Overdose Prevention Society’s supervised-injection services did move indoors, into a building at 58 East Hastings, two doors down from the market. But due to smoking laws, the supervised-inhalation component remained on the market’s property.

The market’s executive director, Constance Barnes, stressed that its members do not want the inhalation site to close. “We absolutely support what she [Blyth] does,” Barnes told the Straight. “But where should it go?”

Lennie noted that many vendors who sell goods at 62 East Hastings—herself included—are recovering addicts who are trying to get away from drugs.

“I’m an ex-addict, and smells trigger me,” she explained. “There are a lot of people who have smells that trigger them. And there is a lot of smoke [at the supervised-inhalation site].”

Both Blyth and Barnes said a solution would be for the regional health authority, Vancouver Coastal Health (VCH), to work with the Overdose Prevention Society to move supervised-inhalation services indoors.

“We don’t want people dying in the street,” Barnes said.

Blyth revealed that an architect has already sketched rough plans for a powerful ventilation system that could allow drugs to be smoked indoors safely. But even with such a system, the bylaws would remain in the way.

“We are trying,” Blyth emphasized. “But it [a move indoors] could take years to figure out.”

Dr. Mark Lysyshyn is VCH’s lead on harm reduction and substance use. While declining to comment on specific complaints about the site, he expressed support for the inhalation facility as it exists now.

“Here’s a solution that works, is not bumping up against bylaws, and it’s acceptable from an occupational-health-and-safety point of view,” he said. “They are supervising inhalations, have supervised tens of thousands of them; they are reversing overdoses, and nobody is dying.”

Lysyshyn acknowledged that inhalation services could move indoors, but cautioned that would come with significant costs—money that, five years into a health crisis, he noted is already stretched thin.

“You can create indoor spaces that work, and they have done that in Lethbridge. But it’s about where we invest our money,” Lysyshyn said. “This is why we love the overdose-prevention sites, because the people in the community are so innovative. They found a solution that works.”

Blyth argued that the Downtown Eastside Street Market should retain its character as a space for harm reduction. She noted that High Hopes, a small dispensary that previously offered cannabis as an alternative to harder drugs, was forced out of the market last month. Now Blyth said the community is at risk of losing its supervised-smoking site.

Barnes and Lennie did not dispute that is the direction they hope the market is taking. “The market was never about harm reduction,” Lennie said.

Blyth maintained the tent that faces the alley at the back of 62 East Hastings is unique and therefore needs to be protected. “In B.C., where four people are dying every day, it lets people come and have a safe space, to use, and to have a connection,” she said.