The idea of providing safe injection sites for people with active substance use has been a central discussion in Canadian public health policy and social politics. The intent of healthcare organziations actually providing the drug has proved even more challenging. However, the evidence is clear, both in other jurisdictions where these services are part of public healthcare, and in Vancouver.
Supervised injection facilities and clinical opioid therapy services are saving lives and providing much needed healthcare services to a vulnerable, and often neglected, population.
In 2003, InSite opened its doors to habitual drug users in Vancouver’s Downtown Eastside. Since opening, the clinic has had over two million visits and currently has approximately 12,000 registered clients. A recent 10-year overview of InSite shows that the clinic has been successful at reducing harm associated with illicit drug use and increased safety on the streets. The InSite website indicates that there’s never been a fatality at the clinic and that overdoses in the surrounding area have decreased by 35%.
Another safe injection facility in the Downtown Eastside is Providence Crosstown Clinic or “Crosstown.”
Unlike InSite, where clients bring their own pre-obtained drugs with them to the facility, Crosstown is unique in that it has an on-site pharmacy that provides prescription injectable opiates, based on each client’s needs.
All of Crosstown’s 150 clients were part of the SALOME research trial, a study that tested alternative treatments for people with chronic heroin addiction who were not benefitting from other known treatments. Participants of the study who benefitted from prescription heroin were allowed to continue receiving their treatment at Crosstown.
To learn more about Crosstown and the work they do I visited the clinic and met with Scott Harrison, Director of Urban Health for Providence Health Care, and Julie Foreman, Crosstown Clinic Manager.
The Downtown Eastside is a neighborhood where isolation, poverty and mental illness flourish. Drug use in the area is rampant and Crosstown provides a safe alternative to dangerous street drugs, but a lot of what they do is about teaching basic life skills and helping clients cope with their emotions. The atmosphere at the clinic is supportive and therapeutic with a variety of health and social services available to clients on-site.
“We ask questions like…did you make it to your dentist appointment yesterday, did you see your social worker…those sorts of things. Our clients know we’re somebody they can trust, so we’re a very important part of their support network.”
Scott and Julie say they’ve never had an issue with violence at the clinic and that it’s their choice to not have uniformed security on-site. Instead, all staff receives training in violence prevention and conflict resolution, so they know how to de-escalate situations if they arise. “We have a direct line to the police if we need them, but we rarely do because we’ve learned how to handle problems on our own.”
Urban Health’s BC PSLS Handler Feedback Form thanks Reporters for “making patient safety a priority!”
In addition, client safety is integral to the team’s overall philosphy at Crosstown. Unexpected events such as accidental overdoses, unusual side effects to opioid dosages and behavioural issues are reported in BC PSLS. Scott and Julie identify trends in their BC PSLS data and collaborate with Crosstown staff to promote quality improvement at the clinic.
“PSLS has really changed the safety culture,” says Scott. “Our staff takes reporting very seriously because they know it leads to a change in practice – not a smack on the hand – and will ultimately improve safety for all our clients.”
Crosstown is special and an important part of our healthcare system. Julie says all their clients are special for unique reasons.
“Some are really capturing this moment and using our services to improve their lives. They move out of the Downtown Eastside and do well. Others we lose track of but they say ‘hi’ to me when I see them on the street. Even when a client slips-up and comes back we’re still here for them, and for me that means we’ve been successful at what we’re trying to do here.”
Julie Foreman is the Clinic Manager at Providence Crosstown Clinic. She mentors nursing staff to ensure they have the necessary knowledge and skills to work at the Clinic. Julie also supports the on-site Pharmacy so each client’s unique needs are adequately met. You can reach her at jforeman@providencehealth.bc.ca
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