Outreach agencies in London, Ont., focusing on providing services for those who use substances and those living rough say collaboration, resourcefulness and ingenuity have been phenomenal, but more needs to be done for vulnerable populations.
A provincial report released this month found that, “generally, the increased rate of opioid-related deaths during the pandemic has occurred throughout the province.” However, the Middlesex-London Health Unit was among the outliers with reported opioid-related deaths holding steady.
“In the first 15 weeks of the COVID-19 pandemic in Ontario, 695 people died of a confirmed or suspected opioid-related death, representing a 38 per cent increase compared to the 15 weeks immediately preceding the pandemic,” the report states.
“During the pandemic, fentanyl and stimulants (particularly cocaine) were more commonly direct contributors to these deaths.”
While provincial data suggests deaths have been steady in the London region, local outreach organizations say the situation is serious with anecdotal reports of a steep increase in overdoses.
Adapting service at Carepoint
In London, the Regional HIV/AIDS Connection (RHAC) operates the Carepoint Consumption and Treatment Service, formerly known as the Temporary Overdose Prevention Site, which was the first of its kind in Ontario. Carepoint offers supervised consumption of any substance, so long as it’s not inhaled.
RHAC provides numerous other services, including wrap-around services at Carepoint through partnerships with Addiction Services Thames Valley (ADSTV), the London InterCommunity Health Centre (LIHC), London Cares, the Southwest Ontario Aboriginal Health Access Centre, the Middlesex-London Health Unit and the Canadian Mental Health Association.
Director of harm reduction Sonja Burke says RHAC had to quickly make a lot of changes to adapt to the pandemic, though many of the necessary cleaning and sanitizing protocols were already in place. For physical distancing, RHAC reduced the number of injection booths to three from four. She says service visits have decreased by roughly 25 per cent since the onset of the pandemic, which she’s guessing may be related to the decrease in booths.
RHAC also had to introduce a mask policy, which required a particularly nuanced approach due to the history of the centre.
“Our organization comes from a grassroots support network that was created to support people living with and dying from HIV and AIDS. When that was happening, there was such stigma and judgment and bias around people living with the illness and people were wearing masks and sterilizing — it really created the perception that people were dirty or unsafe to be around,” she explained.
“We will never forget that experience and how that affected people’s human rights in the way that people were treated in receiving care and health care. And so when the introduction of masks came in to play, one of the things that we did is we really spent a lot of time working with people accessing services and educating them on how the mask is actually a strategy to support and ensure their safety when they’re accessing the services.”
Burke says RHAC staff would be more likely to transmit the novel coronavirus to service participants, rather than the other way around.
“Many of the individuals accessing have compromised immune systems, are living in situations that are precarious and so really re-framing the narrative around, ‘This is a way that we can ensure your safety and ensure that we are not putting you at risk of contracting COVID.'”
Because Carepoint was deemed an essential service, it was included in hospital distribution of personal protective equipment (PPE).
“So we did have enough PPE for us to continue services, but we didn’t have enough to distribute masks to our participants,” Burke says.
Providing participants with masks
That’s where numerous organizations stepped in to donate masks, including Canada Sews London. Canada Sews began in March as a community of volunteers across the country sewing and distributing masks and other items to front-line workers and, once that need was met, to other organizations and groups in need.
Katie Timson is the regional co-ordinator for London-Middlesex and Lambton-Huron-Perth regions in the Canada Sews network.
“Sonja Burke first reached out to our organization in April looking for masks to provide for their clients for the HIV/AIDS Connection. At that time, their request, along with dozens of other requests from the organizations, were just starting to be accepted,” Timson says.
“All of our material and time, of course, is entirely one hundred per cent donated.”
Canada Sews London has provided RHAC with 2,350 masks in total, but over 50,000 items have been donated in total throughout the region. The local team includes over 300 volunteers “that have donated their time, materials, or skills at least once to our efforts. Over half of those volunteers are regular contributors,” Timson says.
“Our perspective is that by serving our community, we’re serving ourselves by staying stronger and healthier together.”
Burke says that not only are masks important for the safety of participants within the walls of RHAC during the pandemic, but they are also necessary for participants to be able to go to a bank or a mall, or access other services in the community.
“We recognize, though, that many individuals do not have the opportunity to be able to wash the masks as recommended by the guidelines. So what happens is every time a person comes in, they’re able to get a new mask. If their mask needs to be disposed or they’ve lost the mask, we just provide a new one for every time that they do come in.”
Collaborating to meet participants’ new needs
An additional hurdle for vulnerable populations in London resulting from the pandemic was access to public washrooms. Burke says RHAC has been providing disposable cloths “that acts as a hand-washing tool.”
Another local organization has not only offered access to showers, but also provides 24/7 outreach.
London Cares, which initially began as a collaboration between RHAC, the Unity Project and Addiction Services of Thames Valley, grew so large that in 2018 it became a separate independent not-for-profit and charity.
London Cares offers housing programs, syringe recovery and a street outreach program.
Earlier this year, London Cares also began offering Resting Spaces, with 15 beds as well as access to showers and food and help with system navigation.
“And we take a very low-barrier approach to all of our services. So it doesn’t matter to us if you use substances, if you have some mental health — underneath it all, what is really going on is there’s deep trauma. And so we understand that. We take a trauma-informed approach to all our services,” executive director Anne Armstrong says.
“We’ve been pretty successful. I think if I remember correctly from my numbers, it’s 545 people have accessed our resting spaces from those who are on the street since the end of January when we opened this year.”
Armstrong says the city also stepped in to provide a number of porta-potty stations across the downtown core. The YMCA’s Centre Branch at 382 Waterloo St., in partnership with the city, also offered access to showers and snacks beginning in late May. Within its first 10 days, it had over 50 visitors.
Outreach staff report increase in overdoses
While much has been done to try to address the added challenges of the pandemic, workers have noticed a sharp increase in overdoses.
“Our experience is there has been more deaths this year, although that’s anecdotal,” Armstrong says, “and also a lot more overdoses.
“So our team carries naloxone with them all the time. And we have responded to a number of overdoses and have been able to bring folks back through treating with naloxone and then we are able to get them to the health care they need.”
Armstrong says members of the outreach team rarely responded to overdoses before, but now it seems to be a weekly occurrence at least.
“It was rare before (the pandemic) — it happened on occasion — but it was rare, whereas it feels like there isn’t a week goes by these days that we’re not responding to at least one, usually multiple overdoses in a week.”
Burke says the stabilization of the opioid-related death rate in the community is in large part due to the widespread distribution of the overdose-reversing medication naloxone.
“However, there is so much more to the story,” she says, noting that the pandemic has resulted in challenges for people to access substances, increasing the tainted supply of substances within the community.
“Which, again, highlights the need for us to have safe supply where people are able to engage in a medical model of support, where they’re accessing substances while they are getting well.”
The Public Health Ontario report also mentioned “an increasingly toxic unregulated (‘street’) drug supply,” as well as “barriers to access to harm reduction services and treatment, and physical distancing requirements leading to more people using drugs alone” as potential factors contributing to the increased provincial death rate.
The report also found that fentanyl “was more commonly a direct contributor to opioid-related deaths” than it was before the pandemic, contributing to 87.2 per cent of deaths up from 79.2 per cent.
Preparing for winter
With colder weather approaching, both RHAC and London Cares say work is in progress to address changing needs.
Burke says many organizations in the city are doing “the best they can with what they have.” Still, more support is needed.
“The likelihood of deaths will increase because of weather-related concerns. Last year, we did see a number of individuals presenting with frostbite and some people experienced amputations due to the frostbite,” she said.
Donation drives are held throughout the year, with RHAC shifting focus to fit the season. For example, in the summer they will collect sunscreen and water, while for winter they’ll work on getting donations of socks, mittens and hats. RHAC also helps facilitate “warm transfers.”
“So if we’re referring to someone to London Cares, we’re referring them staff person to staff person,” she explained.
“We will help that person get the transportation from point A to point B in that moment… We do it whenever it is possible.”
Additionally, Burke says RHAC has outreach teams that will target areas within the city where people may be living rough.
“So we’ll be doing regular check-ins to see where people are at, what supplies do they have, what are they willing to connect with, what do they need?”
Armstrong says London Cares is in the early stage of planning with “a number of different agencies to see what we can do to provide more support and get people inside for the winter.”
While it won’t be available this winter, a community hub is in the works as part of a partnership with the Hospitality Centre through the Sisters of St. Joseph as well as London InterCommunity Health Centre and RHAC.
“Where folks who are marginalized and need a place to get in and get warm, need support, can come in and access services all in one place,” Armstrong says. “We are hoping to have income supports, an ID clinic, food, for sure, help with that system navigation to begin that conversation around housing.
“We were very fortunate to recently receive a very large London Community Foundation grant. It is our hope to have that up and running within the next year.”
Armstrong also stressed that while some people experiencing homelessness use substances, not all do.
“And we know that lots of people who are housed and some who you might not think, maybe it could be someone middle class, they use substances. So I just I would want to kind of break that myth about ‘all folks on the street use substances.’ That’s not the case.”
She says, anecdotally, for those who are experiencing homelessness, “there’s always trauma underneath that.”
“If you’re on the street for very long, you’re going to experience more trauma and challenges to your safety. And so that’s why we’re a big believer in everyone deserves a house and deserves a home. And once you get into a home, then you can start to work on some of those other issues that are or have been challenging you for a long time.”