What an Increase in Fentanyl-Related Deaths Means for Vancouver’s Safest Injection Site

As fentanyl's reign of terror worsens, Vancouver's famous injection site remains open around the clock.

December 15, 2016

By Danielle Egan / Photo: Vancouver Coastal Health

It’s Wednesday afternoon on the 100 block of East Hastings, where about a half-dozen people sit on cardboard rugs, prepping needles. Some are already slumped over, as if their puppet strings have been severed. One elderly man still has the needle in his arm.

They’re injecting on what’s perhaps the city’s safest block—at least for them. The reason is Insite, the nearby safe injection site—a 13-year-old institution that may be more desperately needed now than ever before. Since 2007, drug-related fatalities in Vancouver have increased  by 125 percent. In the first half of 2016, B.C. rates surged again by 74 percent to 433 deaths (including 78 in Vancouver). These stats aren’t lost on the staff at Insite, who in August began a six-month pilot project to stay open around the clock from “welfare Wednesdays” until Fridays, when overdoses increase by 50 percent. I ask a staffer if they’ve been busy with the extended hours. “Yeah,” he says, “but we’re always busy.”

The recent spike in deaths is primarily due to fentanyl, a synthetic opioid that hospitals use as an anaesthetic and painkiller. By CDC estimates, it’s 80 to hundreds of times more potent than morphine and heroin. Fentanyl is a controlled drug and available only by prescription, but cheaper illicit versions have increasingly been detected in many street drugs. It’s odourless, colourless and can be added to any powder or pill—from ecstasy to Oxycontin.

prepping-rig
Photo: Vancouver Coastal Health
Across B.C., fentanyl was linked to 238 deaths in the first half of 2016, a surge of 250 percent over the same period last year.

Yet even two grains of fentanyl can be deadly, shutting down the central nervous system within minutes. The result has been a national health crisis that extends from the streets to the suburbs. In Delta this past September, the drug likely caused nine overdoses at four different homes within a 20-minute period (all recreational users who likely bought cocaine from the same local dealer). Across B.C., meanwhile, fentanyl was linked to 238 deaths in the first half of 2016, a surge of 250 percent over the same period last year. In one week this summer, fentanyl was detected in more than 90 percent of the street drugs brought to Insite.

The reception area at Insite is a sterilized version of what’s outside its doors. Two people sit on bolted-down chairs, their bodies folded over, arms dangling. Nearby, a man lies on his back, his chest moving reassuringly. Through a secured door are 13 booths available for visitors to shoot up street drugs with clean needles (since Insite opened in 2003, it has hosted three million injections). More than 5,000 overdose interventions have occurred here, but under the watchful eye of staff, not one has resulted in a fatality. This is in large part because Insite uses naloxone, an injectable drug that quickly reverses the deadly impact of opioids.

In 2012, health authorities in B.C. began providing the public with overdose training and take-home naloxone kits for drug users. Within two years, the program saved more than 125 lives. In 2016, Health Canada removed naloxone’s prescription status, making it available over the counter at pharmacies and among rescue responders, whose overdose calls in Vancouver increased 28 percent between 2012 and 2015.

insite_001
Photo: Living-Learning Programs

Hugh Lampkin, a Downtown Eastside resident, is a board member and past president of the Vancouver Area Network of Drug Users. Lampkin has benefited from the public training program and often carries around a naloxone kit. He says he’s used it roughly 30 times in the past few years. “Once I had to give a guy three shots before he regained consciousness,” Lampkin says. “But there’s no better high than saving someone’s life.”

Nine years ago, I came here to die, but this neighbourhood saved my life.

Outside Insite, a woman and man are sitting on the sidewalk. They’re both maybe 30 and look like typical Vancouverites. She has a pretty face and golden skin, with a gym bag at her side, looking like she could be en route to work, yoga or coffee with friends. Instead, she’s shooting up. Within minutes, she’s slumped over like a rag doll. The man pleads, “Wake up!” He nudges her shoulder, but she doesn’t respond. “OD!” he calls out.

Lampkin snaps to attention, crouching down to cradle her head. She’s not breathing and he can’t feel a pulse. “Get the kit!” Lampkin yells. A man is already emerging from Insite with an oxygen tank and a hard-backed case. Lampkin lays her flat on her back. Her tortoiseshell headband falls from her head and rolls toward the curb. I scramble after it and place it on her duffel bag as the Insite staffer fixes an oxygen mask to her mouth. Lampkin opens the case and grabs a clean needle and tiny vial of naloxone. He fills the needle and then injects it through her clothing into her thigh.

Two minutes later, she’s still un-responsive. Lampkin thinks this is taking too long. “Call 9-1-1,” he says. A woman approaches, and I ask if she knows her. “No,” she replies. “But I work down here. This happens way too much lately.” (Three overdoses will occur that day, necessitating Insite interventions.) Paramedics arrive and gauge her vitals. A minute later, she awakens, squinting, her expression turning to panic until she sees her duffel bag. She places her headband back on her head.

As the rain sets in, Lampkin and I head for a café on Main Street. A crush of dealers and buyers haggle in front of the Carnegie Library. Lampkin moves through it with ease. This is his neighbourhood. “Nine years ago, I came here to die,” he says, “but this neighbourhood saved my life.” Residents in other communities may not be so lucky, he believes. “Rashes of fentanyl overdoses are happening in the suburbs and smaller communities in B.C.,” Lampkin says, “alone and behind closed doors.”

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