Since COVID-19 arrived in Nova Scotia a year ago, we have been doing what we can to keep ourselves, our loved ones and others safe. We have masked up, social distanced and ensured our neighbours in isolation have what they need, ranging from grocery drop-offs to dog walks. We have shown Canada and the world we are a province who looks out for one another, especially our most vulnerable.
In March 2020, with funding from the federal government, the province opened three pop-up shelters, two for men and one for women. The pop-up shelters were harm-reduction based, meaning residents who used drugs had unprejudiced access to clean drug paraphernalia while at the shelters.
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This was a change I applauded as a former resident of the women’s shelters I stayed at when I was a teenager; two women I lived with in the shelters passed away from fatal overdose.
Every time a resident approached us for gear, we filled the paper bags, but many of us had immense anxiety when those residents walked out the door and headed off-property to use drugs. This is where the harm-reduction approach fell short.
We were anxious that what they bought off the street would be riddled with toxins, resulting in an overdose we could not bring them back from because they were off-property, without a phone or access to life-saving naloxone.
Within a couple of weeks, anxiety overtook some of us working there, and we began turning a blind eye to use on-site. By doing this, trust was formed between us and the residents, and they came to us if they felt they or other residents were at risk of overdose. This enabled us to do our jobs better, we knew who needed extra wellness checks, and most of all, residents who used felt safe and unjudged.
I mentioned this approach to Jeff Karabanow, co-founder of Out of The Cold, a low-barrier shelter in Halifax, who has been a leader in harm reduction and providing a welcoming space for people who use drugs. As a low-barrier shelter, Out of The Cold ensures people who use drugs will not be removed for being under the influence, nor will people who struggle with mental health issues.
"Harm reduction is a compassionate, dignified and pragmatic way to support those struggling with addiction issues,” says Karabanow. “Covid has amplified challenges around safe supply, supportive spaces for supervised use and needed low-barrier services. Peer advocacy, peer outreach and peer witnessing coupled with safe equipment, safe supply and safer spaces can make a difference. Increasing wellness checks, virtual services and monitoring systems is important. Let's not forget providing grief and loss supports to both clients and staff."
Harm reduction in shelters is crucial to the safety of residents, but without a safe space to use, that resident's safety isn't guaranteed. Especially if that resident is using alone, outside without phone access to call someone they trust or the overdose prevention line. Using alone has increased since the pandemic, for both housed and unhoused folks, and some provinces have seen more death from drug overdoses than COVID-19.
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After a 48 percent increase in fatal overdoses in shelters in Toronto, city council acted and took advantage of federal legislation that allows overdose prevention sites to be opened in shelters and implemented Integrated Prevention Harm Reduction in two of its shelters. Not only does this reduce fatal overdoses, but it also reduces use in public outdoor spaces. This is something the province of Nova Scotia needs to implement now, and make it permanent until everyone is housed and/or has access to safe supply.
In Nova Scotia, many will say we are lucky. Our overdose numbers for 2020 are low compared to Ontario, British Columbia and Alberta. Some may ask, Why should we implement such a thing?
We should because every overdose is a policy failure. With every fatal overdose, parents are burying their children. People who witness these overdoses, both fatal and non-fatal, are becoming traumatized.
Our most recent known fatal overdose occurred in a shelter. This has been traumatizing for the people who live and work there, and both staff and residents have little to no support from a province that claims to have an empathetic approach toward people who use drugs.
We have one overdose prevention site for the entire province, which is accessible to residents of Metro Turning Point and Halifax’s north end. But with pandemic physical distancing, one site is insufficient. People deserve and need a safe place to use, regardless of their housing status.
If you are homeless, a safe place to use is near impossible. Even with a harm reduction model put in place, there is still fear and distrust in the back of someone’s mind. Fear that if they use on-site, they will be kicked out. This deters someone from communicating with staff if they feel they are at risk of overdose.
By providing a safe space for them to use in shelters, trust is built between residents and support staff. Most of all, when residents are not using alone, it enables them to continue living.
People who use drugs are real people, they deserve to live.
COVID-19 measures, although necessary, are killing them at higher rates. This isn’t just due to using alone. Because of the reduced supply due to border measures, the drugs that are making their way in are being cut with lethal toxins; street drugs in Manitoba have tested positive for animal tranquillizers.
As a province, we must come to grips with the reality that people use drugs and are at great risk of dying. Stand together and demand government stops debating what is best for people who use drugs, and instead acts now by providing a safe and regulated supply, implementing decriminalization and opening more overdose prevention sites.
While they talk, we die.
Gayle Collicutt is an advocate in Halifax, whose focus is homelessness, housing and safe supply of drugs. She has lived and worked in shelters, and understands first hand what it means to live with a substance use disorder.