How a safer site to use drugs fits into P.E.I.'s addiction strategy

Sometime early next year, P.E.I. intends to open its first supervised site for substance consumption, one part of what will be a three-pronged approach to addiction problems on the Island.

P.E.I. Health Minister Ernie Hudson committed to a safer injection site in March of 2021, and six months ago, the Chief Public Health Office hired its first harm reduction coordinator, Shawn Martin.

Martin is a clinical social worker who has been on the front lines working with people addicted to substances. He also has a background in public policy.

"When I worked in treatment I came to see, obviously, the value of treatment, helping people reduce or stop substance use. I also came across the limits of treatment — for example, if a person isn't ready or able to make a change," said Martin.

Those limitations mean treatment is only one approach to breaking the addiction cycle. Prevention is the first step. In between prevention and treatment comes harm reduction.

"We want to reduce the risks, reduce the harm, so that when a person is ready to take the next step, they'll be — to be quite blunt, they'll still be alive," said Martin.

Location, location, location

Harm reduction sites are available across Canada, so Martin has a lot of expertise he can draw upon when creating a site for P.E.I.

Some things are clear. For one, everyone needs to be on board. Martin leads a steering committee that includes government and non-profit service providers, as well as police. Another is location. It needs to be in a place where users will go, within a 20-minute walk of other services they use.

"What that translates to is a centrally located area, typically in or around a downtown," said Martin.

"If it's out in a rural area or industrial area at a far distance, the reality is people just won't make it there."

But other factors will be particular to each community, and the only way to know them is to talk to the community that you want to use a supervised site. So Martin and the team have been interviewing their target clients.

"We asked them, 'Would you go to an overdose prevention site? If so, what kind of services should be provided? What does this overdose prevention site need to do to meet your needs?'" he said.

"So we've gone directly to the people we will serve."

The service will be anonymous, but some information will be gathered for registration when people arrive.There will be three to four booths for supervised consumption, with trained staff present in case of an emergency.

There will also be a comfortable post-consumption space, where people will be able to get information about services.

"People will come to the service, oftentimes, in a state of withdrawal, which I would never wish on anyone. And so they're feeling very agitated, not feeling good," said Martin.

"Post-consumption is actually when you're more able to reach most people, and then you can have really good engagement conversations and connect people to services."

Tracking illicit drugs

Supervised consumption will not be the only service offered at the centre.

Martin is also planning to offer testing. Clients will be able to provide a small sample of substances they have purchased and have it checked for dangerous adulterants such as fentanyl and benzodiazepines.

In some cases, people will use the substance even if it tests positive, but if they use it on site, trained personnel will know what to expect and how to respond. If they use it off site, they may choose to take a half dose and make sure they have a naloxone kit on hand.

There is another benefit to the testing.

"We'll have anonymized data of what is in the illicit drug supply on P.E.I.," said Martin. "It'll be a little more proactive than the data we have right now. And we'll be able to make that publicly available."

While the physical site is still months away, the province has begun promoting remote services. The National Overdose Response Service is accessible by phone, and users can also download the Brave app.

Brave still gives people an audio connection, but it works through wifi or data. At the start of the call, the user develops a safety plan with the trained operator at the other end, and if the person becomes non-responsive, that safety plan will be activated.

Promotion has only just started, said Martin, so there is no data yet on how many Islanders are using the services.