Canada’s grassroots drugs deaths response

What can Scotland learn from British Columbia’s approach to overdose deaths?

Thursday 23rd May 2019

Part of the answer to mounting drugs-related deaths in Scotland lies in grassroots charities, community groups and experts with lived experience taking a lead role, a Canadian substance use researcher says.

Professor Bernie Pauly of the Canadian Institute for Substance Use Research was in Scotland last week to speak at a Dundee harm reduction event organised by the Scottish Drugs Forum.

 In Vancouver, the setting up of unsanctioned ‘pop up’ overdose prevention sites to save lives in the face of a rising tide of overdose deaths led to the provincial government backing these sites across the province, Professor Pauly, who is also a nurse at the University of Victoria School of Nursing, tells healthandcare.scot.

Her comments come amid an ongoing standoff over a safe consumption room in Glasgow. The Home Office refuses to allow such a facility, which campaigners, local politicians and the Scottish Government say has been proven to “save lives”.

British Columbia is home to just over five million people, compared to just under five and a half million for Scotland.

Like Scotland, it has also struggled with drugs. In 2015, overdoses became the highest cause of unnatural deaths, outstripping suicides and traffic accidents.

Fatalities have remained stubbornly high, with more than 1,500 people losing their lives in 2018 and, for the first time in recent history, life expectancy is falling.

In Scotland, 934 drug-related deaths were recorded in 2017.

Professor Pauly explains how, in light of long processes for federal approval of drug consumption rooms, activists and campaigners moved to provide an “essential health service” themselves.

“There were people, particularly in Vancouver, who started by setting up unsanctioned sites – often called pop-ups, because they were in tents. One of the ones in Vancouver was basically a tent in an alleyway where people could be observed and Naloxone administered immediately in the event of an overdose.

“People knew there were evidence based-interventions that would save lives – so why weren’t we doing that?”

Following the declaration of a public health emergency in 2016, the provincial government sanctioned overdose prevention sites – a move opposition politicians in Scotland have been calling for.

Overdose prevention sites are small-scale, “welcoming and friendly” spaces typically staffed by harm reduction workers, including staff with lived experience of drug use.

As well expanding access to overdose prevention, they created “a space that was safe, where people felt like they wouldn’t be judged, with opportunities to develop trust and facilitate opportunities to access other services.”

In Canada, larger drug consumption spaces – of the kind proposed for Glasgow – have a broader range of staff, including nurses and counsellors.

But while British Columbia is held up as an exemplar when it comes to harm reduction policy, Professor Pauly says a comprehensive response is critical.

Alongside overdose prevention sites, there was rapid scale up of the provincial Take Home Naloxone Program and Opioid Substitution Therapy – but, she argues, more is needed.

While no deaths occurred at supervised consumption or overdose prevention sites, British Columbia still saw 104 suspected overdose deaths in March.

Ultimately, these spaces are still “emergency measures,” Professor Pauly says. The ‘real prevention’ is ensuring a safe supply.

One idea being proposed in Canada’s western-most province is ‘compassion clubs’, in which members would be able to access a safe source of heroin.

It’s hoped this would undermine the illegal market, reduce poisonings and overdose deaths caused by impurities.

Asked what lessons Scotland could draw from the Canadian experience, Professor Pauly says:

“One is engaging people with experience right from the start, because so many innovations are driven by them. The establishment of the safe consumption sites…were really led by people with expertise and lived experience.”

Ultimately, she returns to the issue of supply, which is “something that should be addressed from the start.” 

“You can scale up things like overdose prevention,” Professor Pauly says, “but you really have to address the fact there is an unsafe supply and really focus on changing policy to ensure a safe supply – that’s the real prevention.”