Supervised inhalation sites take surprising forms in B.C. amid challenges setting them up

A glass enclosure that looks like a bus stop. A repurposed ice-fishing tent in a car park.

While they might look trivial in the face of a mounting toxic drug crisis, these consumption sites designed for smoking substances are saving lives, overdose prevention workers say — and are doing so despite the financial and bureaucratic challenges setting them up.

Almost 5,000 people have died from toxic drugs in British Columbia in the past two years alone, according to the provincial coroners' service. 

At least half of them were smoking the substances that killed them — and that proportion is growing, says Jordan Stewart, executive director of the Pounds Project.

The overdose prevention service in Prince George, B.C., currently offers supervised injection services, and Stewart says it now has support for an outdoor space that includes a small shed dedicated to smoking. When established, it will be the first official supervised inhalation site in the city in two years. 

Stewart says there are many reasons people prefer inhaling drugs. There is less risk of infection compared to injecting, it's easier to conceal and use and quicker to prepare. 

"Unfortunately, the overdose risk remains exactly the same," she said. 

But health officials, as well as advocates, say it's taking too long for supervised inhalation sites to be set up in response to that reality and that they remain few and far between in many parts of the province. 

Dr. Jong Kim, chief medical health officer for Northern Health, says that's due in part to the initial strategy in dealing with the crisis when a public health emergency was declared in 2016.

"At the beginning, one of the main focuses was ensuring naloxone was more broadly available ... not necessarily safe consumption, but harm reduction," Kim said.  

Yet, as far back as 2017, smoking was the mode of consuming substances that most often led to death, according to the B.C. Coroners Service.  

In a written response, the Ministry of Mental Health and Addictions says it knows there's "more to do, and won't stop working until all British Columbians can access the supports they need and deserve."

In the meantime, some service providers are getting creative. 

Smoking room

Behind the Cowichan Valley Wellness and Recovery Centre, a boxy brown building at the edge of downtown Duncan, B.C., is a structure that could be mistaken for an out-of-place bus stop.

In reality, it's a purpose-built smoking room designed for supervised consumption. 

While not fully indoors, the room has four walls and a powerful ventilation system.

Jessica Huston, Island Health operations manager for substance use services, says it sucks the smoke from the space through pipes that extend well above the roof of the multiple-storey building, keeping users, workers, and their neighbours safe from any incidental contact. 

Huston says the centre sees 350 to 450 people a week in the space. Staff monitor people through the glass and administer Naloxone if they are in medical distress. They estimate they reverse an average of three to five overdoses a week. 

The recovery centre is operated by Island Health and receives funding for some services through Health Canada. 

But Huston says it's a struggle to expand its services and pay additional staff with its current budget, which is made up of a patchwork of funding sources from the health authority and grants from various organizations. The services are only available for limited hours as a result. 

Out of the cold

In Fort St. John in the north of the province, an insulated tent marketed to ice fishers pops up in various parking lots as a makeshift supervised consumption site. 

It's part of Northern Health's mobile overdose prevention service (OPS).

Rakel Kling, medical health officer for Northern Health, calls it an "alternative option" to an indoor site — and, she admits, an imperfect one. 

"With so much snow and cold, it's really hard to ensure appropriate services in an outdoor space … it can put people at risk of cold injuries," said Kling.

Daytime temperatures in the Peace Region frequently plummet to –30 C in the winter months, and frostbite can occur within minutes. 

A Northern Health-operated van that provided additional support was destroyed by fire last fall and has yet to be replaced.

But the authority says it has continued to provide services, and Kling says Northern Health is now working on establishing a full indoor site in Fort St. John, having chosen a central location that's close to other services. 

However, it's not the first time the health authority has been in this position. A previous plan for an indoor inhalation OPS went nowhere after the landlord pulled the permitting application without warning, delaying the opening by years.

First site in Prince George since 2021

There's hope that the Pounds Project site will offer a similar service again in Prince George after the city shut down an outdoor area behind a building shared by multiple agencies providing harm reduction and overdose prevention in 2021, citing fire safety concerns. 

There hasn't been a sanctioned supervised inhalation service in the city since.

Stewart says the RCMP, fire department, city bylaw services and the property's landlord are all on board with the plan for the new space and shed. Construction is set to begin this summer. 

"This time around, we really did our best to be super thorough in planning and brought as many involved parties to the table as we could to make sure we got off on the right foot," Stewart said. 

In the absence of a designated space, she said, people often congregate on the sidewalks outside the Pounds Project and knock on the window when they need staff to respond to an overdose.

Stewart said the cost of setting up an indoor service is prohibitively expensive for non-profits like the Pounds Project, but the smoking shed is a step forward.

"Having a designated space where [there are] benches and picnic tables and flowers and staff to say hi to… is preferable to having to sit on a sidewalk," she said.