A leading health and research organization has applied to the City of Vancouver to open six inhalation booths at its existing Health Canada-approved drug consumption site in the Downtown Eastside so that people who smoke drugs have a place to do it under supervision.
The BC Centre for Excellence in HIV/AIDS wants to operate the booths inside its Hope to Health facility at 611 Powell St., where it opened an injection site in 2020 and more recently offered medication-assisted treatment therapy to patients.
“We have not been nimble enough to move with the epidemic as the epidemic evolves,” said Dr. Julio Montaner, executive director of the centre, in an interview Thursday.
“It doesn’t mean that we have to stop doing what we're doing. But we need a greater dynamism in terms of addressing these issues as they emerge, and if I could get this started tomorrow, I would be very happy.”
For the inhalation booths to begin operating, city council has to approve a resolution to not enforce the city’s bylaw that prevents people from smoking indoors. In this case, the resolution would only apply to indoor spaces at the city’s three Health Canada-approved drug consumption sites.
Insite at 139 East Hastings St. and the Dr. Peter Centre at 1110 Comox St. are the other Health Canada-approved drug consumption sites in Vancouver, according to the Government of Canada’s website.
A city staff report that goes before council May 31 doesn’t indicate the operators of those two sites have applied for indoor inhalation rooms.
In its report, staff has requested the ban on enforcement last two years. That would allow time for the centre to run a two-year trial and monitor the results of having people smoke drugs in a supervised facility.
The goal of adding indoor inhalation rooms is to reduce the harms associated to smoking drugs and prevent deaths, said Montaner, a trained respiratory medicine doctor who estimated the cost to design and build the rooms at $1.5 million.
As Glacier Media reported in February 2022, BC Coroners Service data showed the highest percentage of overdose deaths in the province from 2017 to 2020 was the result of smoking rather than injecting drugs.
In 2020, for example, 56 per cent of deaths were attributed to smoking and 19 per cent to injection drug use. Intranasal consumption, or snorting, accounted for 18 per cent of deaths while oral ingestion was connected to five per cent.
Evidence of multiple modes of consumption were found in 16 per cent of cases.
The percentages, however, could be higher or lower in one or more of the categories because the coroners service was unable to conclusively say in 20 per cent of the cases which method of use led to a person’s death.
Montaner provided statistics for 2021 that showed similar results to 2020 in that more people in B.C. died from smoking drugs.
'An option worth pursuing'
Coun. Pete Fry pointed out that concerning trend in discussing his support for the trial.
“Recognizing that there is a demonstrable need here, and [the centre] would be observing practices that protect people's health as best as possible and protect workers’ health and it’s well ventilated, then it's certainly an option worth pursuing,” Fry said.
The existing Health Canada-approved drug consumption sites in Vancouver are not to be confused with the nine B.C. government-approved overdose prevention sites operating in the city, two of which have outdoor inhalation spaces.
“Outdoor supervised inhalation sites are the preferred option from a broad public health perspective and should be the first choice for supervised inhalation services,” the city staff report said. “However, the number of appropriate, available outdoor locations is limited.”
'I walked someone to detox yesterday'
Sarah Blyth-Gerszak, executive director of the Overdose Prevention Society, operates one of the nine overdose prevention sites with an outdoor inhalation space. It’s located near Main Street and East Hastings Street.
Blyth-Gerszak said she supports having indoor inhalation rooms, noting such a facility can attract people off the street to connect with staff, who can help guide clients to services such as treatment and housing.
“I walked someone to detox yesterday,” she said Thursday. “It’s good to have a place for people to go so that they can talk to people and see what other options are available, whether they need anti-depressants, or methadone or something else.”
Added Blyth-Gerszak: “If doctors are asking for it, and they're seeing that people are in need of it, and they want to help people, then that's great. I think it's a good idea. Piloting it is good just to show that it's successful and it works and then hopefully we can get more.”
If successful in its application, the centre would be the first organization in the city to legally operate indoor inhalation spaces, which harm reduction advocates have lobbied for since Larry Campbell pushed the concept when he was mayor from 2002 to 2005.
Drug consumption sites have increased in Vancouver and across the province since Insite on East Hastings Street opened in September 2003 — one of the first legal sites in North America, along with the smaller Dr. Peter Centre in the West End.
In fact, Insite was originally designed with an indoor inhalation room.
As of December 2021, there were 39 overdose prevention and supervised consumption services in B.C., including 13 sites offering inhalation space, according to the Ministry of Mental Health and Addictions.
No stand-alone inhalation sites in B.C.
But there are no large, indoor stand-alone inhalation sites in the province.
In 2019, Russell Maynard, a board member of the Overdose Prevention Society, secured a $30,000 grant via the provincial government to develop a prototype for a stand-alone inhalation room.
The study team for the research paper included Dr. Marcus Lem, the former senior medical advisor for opioid addiction and overdose prevention policy at the BC Centre for Disease Control.
Architect Sean McEwen, who designed Insite and Onsite, and Hannah Leyland, an intern architect in Vancouver whose graduating architecture thesis examined the design of drug consumption spaces, also worked with Maynard.
The team settled on a modular design similar to the modular housing that currently exists across Vancouver for people at risk of homelessness. In the end, a prototype was never built.
The BC Centre for Disease Control told Glacier Media in March 2022 that “the work did not continue once the project was complete” and that “feedback from stakeholders indicates that cost is a factor in designing indoor inhalation overdose prevention services.”
'A new model of care'
Montaner’s hope is that expansion of Hope To Health with inhalation rooms will add another service in a one-stop shop type of facility, where people who use drugs have access to a full range of care and resources.
If the centre wins approval from council to lift indoor smoking, the next step will be detailed technical work on the design of the booths, said Montaner, whose organization continues to consult with WorkSafeBC and Vancouver Coastal Health on the project.
“What we're trying to do in this clinic is create a new model of care that is comprehensive, supported locally and low threshold,” he said. “It’s a recipe that we're trying to perfect so that when this is done, my dream is that a unit such as this will be easier to reproduce.”
