An epidemic within a pandemic: How Thunder Bay Ont., health care professionals are managing the opioid crisis

While the world grapples with the COVID-19 pandemic, health care professionals in Thunder Bay, Ont., are still dealing with a different, deadly public health issue - the opioid crisis.

The pandemic has created new challenges for staff at the city's NorWest Community Health Centre (NCHC)  where vulnerable people, who face higher health and safety risks, can access addiction and mental health services.

"We have two concurrent public health crises with COVID-19 and the opioid epidemic, two intersecting crises and they're affecting our city's and our country's most vulnerable people," said Brad King, Path 525 supervisor of consumption and treatment services with NCHC.

At the beginning of 2020, Path 525 was the busiest it had ever been since opening in 2018. As the months went on, the overdose prevention service saw an increase in demand through March, but then experienced a drop in clients when the pandemic hit.

"We're definitely concerned when there's a decrease because we're afraid that people are going to be using alone or unsafely. So we were concerned that people were self-isolating, as they should be, but they were then going to be using drugs in an unsafe manner," said King.

King said Path 525 and Norwest Community Health Centre is open for safe consumption services, and staff members have been handing out harm reduction supplies and services at the door of their facility.

The Thunder Bay COVID-19 Community Relief Fund and the Canadian Association of Community Health Centres have provided NCHC with funding which has allowed staff to develop emergency boxes. The outreach being provided focuses on going to where the clients are, which includes the delivery of harm reduction supplies and sanitation kits to individuals in the community.

"Those initiatives that the community health centre has been able to do with support from the United Way has been really important, but the ability of our staff to adapt and to work in a different way with clients in the community rather than in the centres has been really important too," said Juanita Lawson, CEO of NorWest Community Health Centres.

The facility has also adapted its service model to ensure it can provide health service support while still meeting COVID-19 public health guidelines. People accessing services, including Path 525, are screened for COVID-19 symptoms at the door, and the number of injection booths have been altered to allow for "safe distancing".

Street drugs increasingly unsafe amid pandemic 

But access to the city's only safe injection site and other harm reduction supplies are not the only issues faced by the Thunder Bay community.

"The drug supply, which is unpredictable at the best of times, is getting worse during this pandemic," said King.

Several overdose deaths have been recently reported in the city, paralleling a spike in overdoses recorded across the country since COVID-19 pandemic was declared.

"It's been very it's difficult to keep ahead of it in terms of knowing what's out there with regards to substances...that also is a risk when people think they might be injecting a substance they're familiar with and used to, and when it's changed, when it's cut or supplemented with other substances of course it's an increased risk," said Lawson.

According to the Thunder Bay District Health Unit (TBDHU), the number of 911 calls for suspected opioid overdoses received by Superior North EMS has been steadily increasing since January of this year, which includes calls where the responding paramedic suspected an opioid overdose.

From January to February the health unit reported 53 overdose related EMS calls, while the time between March and April saw 62 calls. In 2019, the months of November to December saw a total of 34 overdose related calls. 

"One of the things that is happening...is that while people might not be using the site [Path 525] there is there is still a significant response to overdoses through the emergency medical services and through the administration of naloxone," said Lawson.

The TBDHU also reported there 63 cases of nalaoxone being administered in overdose situations, prior to the arrival of paramedic between January and April. Paramedics administered naloxone 36 times within the same time frame.

The call for safe supply 

As toxicity of street drugs continues to worsen, calls for a safe supply of drugs continues to get louder, said King.

"If anything COVID has made the call for safe supply stronger and more people are listening to it because the situation is becoming more dire," he said.

Lawson said a safer supply of drugs, which would typically only be accessible through an illicit market, will take time, but that there is a lot of work happening at provincial and national levels surrounding the issue.

"I think there's more of an appetite to look at that in terms of change and reform," she said in reference to harm reduction and drug policy. "However having said that it will take time and a lot of advocacy and work at a policy level with our provincial and federal administrators and government to take a look at the needs of individuals."

Lawson pointed to examples in London Ont., and Ottawa where administering safer supply has been met with a positive community response, but she said that response will need to grow across other communities too.

"It [safe supply conversation] has to remain strong because...not only do we have the COVID crisis but we still have a crisis with regards to overdoses and deaths in our community," she said.