Government partners integrate injection-drug rooms into supportive-housing sites around Vancouver

“The third-floor door is always open,” Kimberly Corbett said as she walked up the Gastown Hotel’s narrow staircase. The program director for Atira Property Management proceeded down the hall to unit 310, the supportive-housing site’s “shared-using room”.

After a few minutes, a thin man wandered in. He sat down at a small table, began chatting with Corbett, and injected himself with a substance that was sold to him as heroin but which he conceded probably contained fentanyl.

“We don’t have a camera in the actual room but we have this camera, which looks at the door,” Corbett continued. “So we watch the camera and when we see that somebody is in here, we will come and do checks every 10, 15 minutes, just to make sure they’re okay. It’s pretty basic, as you can see.”

She explained the idea with a simple comparison of two scenarios: if someone overdoses in their room, where they’re alone, they can easily die. If they overdose in room 311, where there’s a very good chance that someone will revive them, they’ll likely survive.

In response to the worst overdose epidemic in Vancouver’s history, the city’s social-housing providers have essentially decriminalized drugs.

Since December 2016, four of Vancouver’s largest government housing partners—Atira Property Management, the Portland Hotel Society (PHS), RainCity Housing, and Lookout Emergency Aid Society—have all made spaces available inside their buildings to which tenants are told they should bring hard drugs to inject in relative safety.

According to the B.C. Coroners Service, the province is on track for more than 1,500 illicit-drug overdose deaths in 2017. From 2001 to 2010, the average number of fatal overdoses in B.C. each year was 204.

The creation of integrated injection rooms is, in some ways, a formalization of unwritten policies that Vancouver supportive-housing providers have had in place for some time.

The first official integrated rooms were opened by Atira. The organization’s executive director, Janice Abbott, recalled the week she was pushed to try something new. It was December 2016, and during the previous three months, Atira had lost 11 tenants to overdoses, more than the number that died after taking drugs during the previous 10 years combined.

“We had a tough fall, for me personally and for many of us,” she said. “We lost a couple of women who we’d known for a long time and who we were all very close to.”

B.C. Coroners Service data shows that this period was equally devastating across the province. There were 60 overdose deaths in September 2016, 75 in October, 135 in November, then 159 in December.

The Portland Hotel Society is best known for operating North America’s first supervised-injection site, Insite, but it also runs 15 Downtown Eastside supportive-housing buildings as well as two shelters. Its senior director of housing, Andy Bond, told the Straight that PHS housing staff now respond to more overdoses in those buildings than health-care workers do at Insite.

Bond said PHS buildings have areas that function very similar to Atira’s shared-using room but they generally operate a little less formally. For example, a space designated for the supervised consumption of injection drugs might consist of nothing more than a hallway, or staff might simply invite tenants to instead inject drugs in the building’s lobby office as opposed to doing so alone in their rooms.

He read from the organization’s harm-reduction and overdose-management policy: “Supported injection provides a person with safe supplies and a safe place to use. Staff are trained in overdose management and are able to intervene if needed.”

In Canada, supervised-injection facilities require an exemption from federal drug laws to operate legally. So-called shared-using rooms in supportive-housing buildings in B.C. opened without such exemptions. They operate in something of a legal grey area that was created in B.C. last December when the province’s health minister, Terry Lake, issued a ministerial order under the Health Emergency Services Act and Health Authorities Act for the government to “support the development of overdose prevention sites”.

Miranda Compton, director of prevention for Vancouver Coastal Health, said the regional authority was already discussing new ideas with partners like Atira and PHS when the ministerial order allowed for implementation.

“We’d been talking about the need for this in housing with many providers for a couple of months,” Compton recounted. “We were all on the same wavelength, Minister Lake and all of us. We all came to the conclusion, around the same time, that this was a necessary measure as part of our response.”

According to the latest B.C. Coroners Service report on illicit drugs, 88.1 percent of fatal overdoses occur indoors.

So the idea is to create safer spaces within housing," Compton said. "They are designated spaces for people to consume drugs where there is increased safety and a more organized response in the case of an overdose.”

The four housing providers discussed in this article all operate their spaces and track drug use slightly differently.

Atira has integrated injection rooms in 11 buildings in Vancouver and—since March 1, when it began to record statistics—has seen 15,499 injections in those rooms. It could not immediately provide numbers for overdose interventions.

The more ad-hoc approach that PHS has taken creating areas for supervised drug use in its buildings means it could not provide a number for how many of those spaces exist. (It's at least a half-dozen.) But Bond said that PHS supportive-housing staff responded to 2,026 overdoses last year and 567 during the first six months of 2017.

Lookout Emergency Aid Society has integrated injection rooms in three of its buildings in Vancouver. It declined to provide statistics for overdoses.

RainCity Housing was once operating injection spaces in three Vancouver shelters but has since suspended two of those programs (because those shelters are seasonal). It has seen 1,297 “witnessed” injections and staff in those facilities have intervened in 31 overdoses. RainCity has also performed “after-overdose monitoring” for another 193 people in situations where, for example, somebody overdosed outside of an integrated injection space but then was brought there to recover.

According to these four government partners and Vancouver Coastal Health, no one has died in any of these injection rooms or spaces.

At Triage Shelter on Powell Street, Catharine Hume, RainCity Housing’s co-executive director, emphasized the role that peers—the government’s term for past and present drug users—are playing in her organization’s response to the overdose crisis.

“They talk about harm reduction and safer use, and then they are available to witness use if people are concerned about overdose, and they respond if they need to,” Hume told the Straight.

She noted that some of RainCity’s shelters consist of private rooms and that those spaces remain a challenge for overdose response. Therefore, a new aspect of RainCity’s peer-led effort sees those volunteers given cell phones. Their numbers are posted around the shelters and RainCity’s clients are told they should call those numbers or send a text if they do choose to inject drugs alone in their rooms.

“Sometimes people are really uncomfortable coming to a common area but they may be willing to call and say, ‘I’m about to use’,” Hume explained.

“We’re in an epidemic situation where people are trying different things to see what will work.”