Visions Journal

Serving the community and making positive change

Melissa Middlemass

Reprinted from "Opioids" issue of Visions Journal, 2018, 13 (3), p. 29

The overdose prevention site in the city of Duncan on Vancouver Island opened on September 12, 2017, as part of a program funded by VIHA (Island Health) and operated by Canadian Mental Health Association’s Cowichan Valley branch. The decision to open the site was driven by the need to help address the growing number of overdoses in Duncan and the increasing concerns of local health care professionals and residents.

The overdose prevention site itself looks very much like a medical clinic—in fact, it used to be a doctor’s office. Currently, the site is staffed for six hours a day (from 1:00 to 7:00 pm), and two staff members are on-site at all times. On average, the site sees about 13 people each day, but this number fluctuates—and we tend to get busier on the days when welfare and support cheques are delivered. Client numbers have also increased as we become a familiar presence in town. In Duncan, an overdose prevention site is a completely new amenity, and at first the residents (potential clients and non-clients alike) were unsure about our presence. Over time, however, we have begun to build relationships.

At the site, when clients first come in, we greet them and try to make them as comfortable as possible. A local food bank donates muffins, and we offer snacks, juice and water. In fact, we try to have clients to drink water in front of us. Often, they come in very dehydrated, especially if they have been using heavily over the past several days.

Once clients are settled, we make sure they have the supplies they need (like sterile needles) to take the drugs they’ve brought with them. We don’t have any cubicles. just one small room with a stainless-steel table and mirrors. We had thought initially to separate the space into compartments, but we’re not sure now that we will. Many clients come in as couples or with friends, so they’re using together—generally injecting, although the odd client will snort cocaine (at this point we don’t allow smoking because we don’t have adequate ventilation).

When we first opened our doors, most of the clientele were women, but over the past several weeks we’ve started seeing more men. Now that we’ve been here a few months, we’re not only seeing people who live on the streets; we’re also seeing people from the community who have housing. Many of those who have housing come in for supplies, but some of them come in to use as well.

We definitely have regular clients, but recently we’ve also seen a lot of new faces. And a lot of those faces are young—our youngest clients are in their mid-teens. Our oldest clients are over 40, although it is often difficult to discern exact ages. Generally, the younger clients are chattier, and the older ones are more reticent. Most of our clients are in their 20s or 30s.

It’s especially distressing to see the younger people in here. To have access to shelter, you have to be 19, so these younger people have nowhere to go. I think that’s what frustrates me the most.

So far at the site, we haven’t had to use naloxone. We’ve had five or six overdoses, but we’ve actually been able to bring everyone back with oxygen. When we consulted with other site workers, we learned that the best approach is always to use oxygen first—and 90% of the time that’s all that is needed. Oxygen works: it gets the client talking, keeps the client stimulated. Of course, we’re right here with the client, so if something happens, we catch it immediately. We see what’s happening, and we react quickly to ensure they get oxygen as soon as possible.

One of the most satisfying aspects of working at the site is seeing the social connections that are slowly being made. One client used to hide in the corner; he would talk to us but he did not want us to see him using. Another asked if he could close the door, and we had to tell him that it was against our policy, so he would hunch over while he was injecting. He didn’t want anyone to see him physically using. At the other extreme, another client chats with us continuously the entire time, without a care in the world.

Over time, we’ve learned a lot about all of them, their likes and dislikes, and their past. And over time, we can see that the site has become a comfortable place for them. One of our clients has even gone into rehab; we haven’t seen him since. Another client has started asking about detox options. One couple comes in and gives us hugs and asks how we’re doing. It’s rewarding to help people, and it’s rewarding to see how appreciative they are. We’ve started building trust; our clients know we don’t judge them, and they’ve started opening up to us.

I think most people don’t understand the trauma that many of our clients have gone through to get to this point. Perhaps they had a work accident and became addicted that way; perhaps they had a difficult home life and turned to substances to cope. Negative stories in the news and on social media don’t help, and the community backlash at times has been difficult. While people might like the idea of a program that addresses the opioid crisis, they don’t always like the idea that such a program might be in their own neighbourhood. The concept of NIMBYism is pretty well entrenched.*

At the Duncan overdose prevention site, we’ve been lucky so far. We haven’t experienced too much in the way of negative judgement. A few visitors early on expressed concern, but we went out of our way to be open with them and to show them around, and they left feeling good. Another gentleman came in and told us that while he wasn’t initially happy to know we were in his neighbourhood, he has been pleasantly surprised: our presence is not as horrible as he thought it would be!

Bit by bit, I’ve even been able to convince a skeptical family member that the overdose prevention site is a positive presence in the community. As I tell him stories about our clients and their experiences, he’s begun to see things differently. Recently, he even donated a tent!

No one wakes up one morning and decides to be a drug addict. Open, non-judgemental listening can make a difference in someone’s life, and it can make a difference in our communities. My family member is finally listening. He’s coming around. And that’s huge. For me, that’s the sort of positive change that the Duncan overdose prevention site symbolizes.

*NIMBY is the acronym for the colloquialism “Not In My Backyard,” the idea that while people might support positive social change in the abstract, they may not feel comfortable seeing concrete changes implemented in their own communities or neighbourhoods.