The Current

Tainted drugs are fuelling Thunder Bay's opioid deaths, say advocates. They want a safe supply to fight it

Thunder Bay is the tip of the iceberg in the opioid crisis across the country. Advocates say a safe supply of drugs and decriminalization are needed to curb the death toll, but the health minister warns there is no "silver bullet."

A safe supply of opioids 'would mean less death,' says CEO of NorWest Community Health Centres

Juanita Lawson, CEO of NorWest Community Health Centres in Thunder Bay, Ont., says the federal government and provinces need to work together to institute a safe supply of drugs. (Sinisa Jolic/CBC)

Inside the only supervised injection site in Thunder Bay, Ont., nurse practitioner Josh Fraser has reversed so many opioid overdoses that he says the lives saved are "too many to count."

"It's not about trying to stop it," Fraser said of drug use in the northwestern Ontario city. "I think it's about providing a safe place and meeting people where they're at."

There were 44 opioid-related deaths in Thunder Bay in 2018. A 2019 Ontario Public Health report analyzing 2017-2018 data says Thunder Bay had the highest per-capita rate of fatal opioid overdoses in the province. For every 100,000 people, there were nearly 23 deaths, the report found.

There were 1,474 deaths across Ontario in 2018, and 4,614 across Canada. From January to June 2019, deaths in Ontario increased 48 per cent to 937, up from 633 in the same period of 2018

"There's a lot of potentially contaminated drugs that are causing harm to people," Fraser told The Current's Matt Galloway.

In the first six months of 2019, government statistics estimate that 95 per cent of nearly 1,000 opioid-related deaths in Ontario were accidental.

Nurse practitioner Josh Fraser has saved more lives than he can count, by reversing overdoses with Naloxone at a supervised injection site in Thunder Bay, Ont. (Sinisa Jolic/CBC)

The NorWest Community Health Centres' supervised injection site, where Fraser works, is part of a wider call by the Alliance for Healthier Communities — a network of community-governed health-care providers — asking the federal government to address contaminated drugs in the illicit market, and provide a safe supply for opioid users.

NorWest CEO Juanita Lawson says people who don't access their services are "continuing to inject alone, by themselves, with substances that they don't know what's in them."

In the first six months of 2019, the provincial coroner recorded 21 opioid-related deaths in Thunder Bay, but Lawson says from what she has observed, the rest of the year could yield a "record number."

A safe supply "would mean less death," but would require the federal government to collaborate with the provinces on a national strategy, Lawson said.

In a statement to The Current, the AHC says it will submit a budget proposal to Queen's Park later this month advocating for the expansion of safe supply.

The statement added that while the AHC meets with the provincial government regularly to discuss supervised consumption sites, their work with the ministry on safe supply "is really just beginning."

Lawson said given the severity of the epidemic, advocates would like to see action on safe supply "take place sooner than later."

Dr. Scott MacDonald says provincial governments should be providing more funding for safe supply measures. (Rafferty Baker/CBC)

Safe supply saving Vancouver lives: doctor

There are already several clinics offering safe supply schemes in Canada, including the Crosstown Clinic in Vancouver. 

The clinic started offering the opioid hydromorphone in 2014, and diacetylmorphine — prescription heroin — in 2017. It now treats 110 patients with injections daily, and another 15 orally, 365 day a year.

Dr. Scott MacDonald, who runs the clinic, says the program has shown to "improve care, reduce societal costs, reduce mortality, and reduce crime."

Patients "have reconnected with families, completed schooling programs and many are working now, some even full time," he said.

The Crosstown Clinic is funded by British Columbia as part of its health budget (similarly, NorWest is funded by Ontario). Federal exemptions under the Controlled Drugs and Substances Act permit supervised consumption or safe supply.

MacDonald says provincial governments should provide more funding for safe supply.

"If we've shown that this is better care, at reduced societal costs, it should be funded," he said.

"We need every tool in the toolkit."

Health Minister Patty Hajdu worked in harm reduction in Thunder Bay before entering politics in 2015. (Sinisa Jolic/CBC)

Minister of Health Patty Hajdu says the Liberal government is working on finding "community-based" safe supply solutions.

"The safer supply piece is really important, and we're taking steps, and strong steps with communities that are ready to do that, that have the support to do that," she told Galloway.

In November, Vancouver Mayor Kennedy Stewart said Prime Minister Justin Trudeau appeared open to the city's application for $6 million to fund a safe supply for heroin users. 

"[Trudeau] wants to work together … and is open to having a conversation and then looking to us to lead, with health-care professionals, to try and figure out the best solutions to these problems," Stewart told The Canadian Press.

Decriminalization not a 'silver bullet,' says minister

Alongside the push for safe supply, advocates have called for the decriminalization of all drugs.

During last year's federal election campaign, Trudeau rejected the Conservatives' claim the Liberals would decriminalize all drugs if re-elected (the party previously discussed the idea, but rejected it in favour of focusing on cannabis.) ​​​

Hajdu told Galloway that the legalization of cannabis showed that conversations around drugs can be shifted to being "much more based in health … rather than in criminality and in law enforcement."

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When asked if it is inevitable that wider decriminalization will eventually be discussed, she said "society's always evolving, so I wouldn't rule anything out."

But she warned that decriminalization would not "eliminate all of the problem."

"It is not the silver bullet that I think many advocates are saying that they think it would be," said Hajdu, the MP for Thunder Bay-Superior North. 

Before entering politics in 2015, Hajdu worked in harm reduction in Thunder Bay, and was the executive director of a shelter in the city.

"I don't think we can talk about the decriminalization or legalization of all drugs without also having a corresponding system that has adequate, if not, excellent supports for people in the aftermath of whatever comes next," she said, referring to supports like shelter beds or job skills training.

Listen to Health Minister Patty Hajdu's full interview on The Current.

Answer the call for help

Lawson and her team strive to offer those supports at NorWest's Rapid Access Addiction Medicine (RAAM) clinic. Clients are encouraged to to see physicians, nurses and counsellors whp are available upstairs.

"We don't want that individual to be turned away, or have to come back tomorrow, because they might not come back tomorrow," Lawson said.

"There's been probably many times that they've asked for help and haven't received it, so I think that's a really important piece." 

Since its opening in 2018, the clinic has had roughly 700 clients, with 80 per cent coming back for repeat visits. The average patient visits the clinic nine times.

Amanda Rusnick has been sober for a year, and credits the RAAM Clinic in Thunder Bay with helping her to turn her life around. (Sinisa Jolic/CBC)

Amanda Rusnick has been sober for a year, and credits the clinic with helping her to turn her life around.

"They actually help you to get clean, and once you're there, they help you to stay there."

Rusnick became addicted to prescription painkillers after a violent assault in Edmonton in 2004. She turned to illicit street drugs when she moved from Alberta to Ontario (medical prescriptions are not transferable from province to province, and no doctor was willing to write a new prescription.)

Her opioid dependency lasted nearly two decades, during which she resorted to crime and served time in jail. She told Galloway she kept crushed opioids nearby as she slept, as she couldn't get out of bed without them.

But when a NorWest nurse practitioner asked her if she would like to visit the RAAM Clinic, everything changed.

"I have a counsellor there who I can contact 24 hours-a-day," Rusnick said.

"If I didn't have that, I don't know how many times I probably would have slipped."

The waiting room at the NorWest supervised injection site. (Sinisa Jolic/CBC)

Rusnick thinks people could benefit from other centres offering the same services as RAAM, but Lawson warned that in the opioid crisis, success can be relative.

"It's not necessarily stopping, and moving into housing, and having a family, or all those things," she said. 

"It's the fact that they actually went upstairs, and they met with a physician to talk about different options. That's success."

Written by Padraig Moran. Produced by Lara O'Brien, Joana Draghici and Documentary Editor Joan Webber.