Four years ago, Jaclyn Letourneau was unhoused and living with a methamphetamine addiction. That’s when the Cool Aid Society shelter at Rock Bay Landing first opened an overdose prevention unit on site.

“They got people that were living in the building or staying at the shelter to help out as a peer in the overdose room there,” Letourneau told Capital Daily.

“That was my first taste of harm reduction [work] and ... it gave me a sense of pride, being able to help people there.”

Now, Letourneau is four years clean and works as an outreach worker with Victoria Safer Initiative (or SaferVic), a project launched by AVI Health and Community Services in September 2020. Primarily, SaferVic provides prescription alternatives to the current, increasingly toxic street supply of drugs to people living with addiction.

On Monday, Health Canada announced that this project is one of four safe supply programs in BC to receive part of a $15-million fund—the other three are located in the Lower Mainland.

SaferVic project manager Heather Hobbs said she was “excited and relieved” after learning that the program would receive $4 million to operate over the next three years, as initial funding for the project was set to run out by March 2021.

In an interview with Capital Daily, Hobbs says SaferVic works to provide prescription pharmaceutical alternatives primarily to Victoria’s unsheltered community through outreach work.

“It's really difficult to focus on safer drug use practices, let alone reducing your reliance on substances, when you're trying to maintain your tent in a windstorm,” said Hobbs.

“I'm really excited about the funding announcement today, because I think we have lots of ideas about how we'd like to expand.”

Eventually, after COVID-19 restrictions ease up, Hobbs hopes to help support people in supervised consumption and overdose prevention sites in addition to outreach work with the unsheltered community. 

Peer-to-peer support

In Victoria, the SaferVic initiative follows a comprehensive model and employs a team of physicians, nurses, outreach workers, and systems navigators who currently work with 89 unsheltered people in Victoria to connect them to prescription medication and other supports.

Outreach workers, like Letourneau, build a relationship with participants, get information about what their needs are, and connect them with both a physician who can determine what types of medication can be available to them and with a systems navigator if they need additional supports.

The fact that the project hires outreach workers with lived experience in the unhoused community makes it stand out from others, says Dr. Bernie Pauly a UVic professor and scientist at the Canadian Institute for Substance Use Research. 

Pauly helped develop the initial project proposal for SaferVic, and once it was funded by Health Canada, her role has pivoted to conducting research and evaluation. 

“One of the ways that this program is very low barrier is that a key part of the team are people with lived experience, or often referred to as peers,” Pauly said.

“It's really well established in the research that peer-to-peer support is effective.”

For Letourneau, the impact is obvious: participants she works with in the SaferVic initiative already know her from when she was living with addiction, and the trust is already there. 

“I have those relationships and those bonds already with the folks out there. Like now when they see me they know that I can help them with harm reduction supplies [and] get them on safe supply,” she said.

As a comprehensive model to support people living with addiction, SaferVic offers more than prescriptions for drugs: their service includes delivering safe supply directly to some participants for whom accessing a pharmacy may be a barrier to access. 

The project also helps people navigate bureaucratic systems that are often difficult but necessary in order to get supports like housing or reconnect with their physicians. 

“If you think about folks who are unhoused, they don't necessarily have easy access to phones or the internet; [they] face barriers to making appointments,” said Hobbs.

“When your only belongings in a tent are being compromised by continual displacement, it's very hard to follow through on things like housing applications … so it does require a lot of support, not because people don't have the capacity, but because they're busy trying to just survive.”

In just four months of operation—from September 2020 to January 2021—the response to SaferVic from participants has been overwhelmingly positive.

According to Hobbs, people accessing safe supply through the program have reported reducing their reliance on street fentanyl, reducing overall use of one or more substances. They also reported having fewer cravings and withdrawal symptoms, and less physical impacts of drug use, like abscesses. 

Perhaps the most important impact of all is participants in the project reporting more stable mental health, better sleep patterns, and reconnection with family members.

“The stability piece is really huge and just allows people to not be so reliant on the street economy, or things like survival sex work, in order to meet their basic needs,” said Hobbs. 

At the moment, the SaferVic project is operating at full capacity, and there is a waitlist of people who want the same services.

“They see all their friends that we're already supporting, and they want that,” said Letourneau. “We have to say no to some people because our caseload is too much right now.”

The case for safe supply and harm reduction measures

More than 1,500 people lost their lives to the overdose crisis in BC last year, and while the number of overdose deaths in December have not yet been revealed, 2020 is on course to set a grim new provincial record.

In a statement released in November, BC’s chief coroner Lisa Lapointe underscored the reasons why.

“Challenges during COVID-19—such as access to key harm-reduction services and the toxic drug supply, including the extreme concentration of illicit fentanyl—are resulting in continuing significant and tragic loss of life across the province,” she wrote.

In response to the dual health crises, provincial health officer Dr. Bonnie Henry issued an order in September 2020 allowing nurses to also prescribe pharmaceutical alternatives to toxic street drugs.

Not all health professionals have yet come on board with safe supply, however. Dr. Jeremy Devine, a psychiatry resident at McMaster University, wrote an article in Policy Options in 2019 questioning what was already a clear move toward adoption of safe supply and other harm reduction policies. “Proponents have failed to address significant safety and ethical concerns,” he wrote. 

“Under the harm reduction paradigm, individuals are considered ‘treated’ if they remain alive and are not actively committing crimes or using health care resources. This approach compromises the potential of the drug user, who is now viewed as a liability to be managed rather than an individual with potential gifts to offer.”

Several major studies have seen positive effects for drug users and the communities around them. One study conducted by the BCCDC found that out of 2,780 people who received prescription alternatives to street drugs—mostly opioids—between March 27 and Aug. 31, 2020, less than 0.4% lost their lives. However, it is unknown whether they died of overdose or other causes. 

During the same period, more than 800 people died of overdoses in BC, which suggests that prescription drugs are “unlikely to be contributing to the rise of overdose deaths observed in the province in 2020,” reads the study.

On the contrary, providing a safe supply of prescription drugs and decriminalizing possession have been heralded by advocates as some of the best ways to reduce the number of overdose deaths in BC and beyond.

A June 2020 paper in the Journal of Drug Policy points at safe supply as a lifesaving tool for curbing soaring deaths. “The current toxic drug supply is responsible for the vast majority of North America's overdose fatalities,” the authors write.  

“[T]he prevalence of fentanyl in local drug supplies varies considerably and is constantly changing, making drugs purchased on the street unreliable and the strength of batches and individual doses unpredictable.

“Immediate scale-up of low-barrier opioid distribution programs are urgently needed,” the paper concludes, calling for safe supply programs like the ones funded this week.

So, the announcement from Health Canada this week promising funding for several safe supply initiatives in BC was received with hope and optimism.

Karen Ward, a drug policy advisor to the City of Vancouver, said she felt a lot of relief when she heard the news of funding that would scale evidence-based programs that already work well.

“I’m optimistic that this is going to change everything,” Ward said in an interview with Capital Daily.

“I'm hopeful that physicians will look at the success of these projects [and] realize ... this is about basic health care. So, I'm hopeful that this is actually gonna be a great spur to other doctors around the province.” 

Challenges and hopes 

For all the positivity surrounding the SaferVic project and the funding that will keep it running, there are still a number of hurdles to overcome before measures to combat the overdose crisis can be fully implemented.

One of the biggest obstacles to achieving a consistent safe supply for all drug users, according to Hobbs, is that there are currently not enough physicians or nurses willing to prescribe alternatives to street drugs, especially in light of ongoing recriminations over the over-prescription of opioids like Oxycontin.

“For years, physicians were blamed for the overdose crisis for over-prescribing, which is problematic because what we know is actually happening is that people are dying of tainted fentanyl, not from prescription medications,” said Hobbs.

“Part of it is that the regulatory colleges have not come out in support as strongly as they've needed to. So prescribers are reluctant and nervous to engage in prescribing.”

Another significant challenge is that the drugs approved for prescription in BC right now are not strong enough for some users to switch their reliance from street to safe supply.

“For people with high fentanyl tolerances, things like hydromorphone or dilaudid, which is commonly being prescribed under the risk mitigation guidance—it's a weaker opioid. And so it's not touching people's tolerances for fentanyl,” Hobbs added.

Hope for a solution is on the horizon, however. Hobbs says BC has been looking into expanding pharmaceutical options “for quite some time,” and SaferVic has already been preparing to offer these options to their clients. The hope is that the project can soon expand to prescribe pharmaceutical-grade heroin (or diacetylmorphine) and powdered fentanyl.

Finally, one point every expert and advocate we interviewed agrees on is that safe supply does not replace a need for decriminalizing possession of drugs.

“It's important to recognize the role that [decriminalization] would play in reducing stigma and changing attitudes,” Pauly said.

Hobbs agrees, adding that prioritizing the expansion of safe supply should not happen at the cost of slowing down work that needs to be done to decriminalize drug possession. 

Even Devine, the McMaster psychiatrist who is skeptical of safe supply, supports the decriminalization approach first taken by Portugal. 

At the moment, Vancouver is the first Canadian city to approach Health Canada with a motion to decriminalize possession of small amounts of illicit drugs. 

But even after decriminalization, there would still be room for programs providing other harm reduction measures like safe supply. 

“We know from other countries that have decriminalized that they also scaled up health and social programs, and so SaferVic would be an example of a program that could fit into that kind of comprehensive approach,” Pauly said.

For Hobbs at SaferVic, the current model “feels like a bit of a drop in the bucket,” but the work she and her team does gives her hope.

“Just talking with our front-line workers who are out there, their energy is up, and they're positive,” said Hobbs. 

“That alone, to me, is an indicator that some of what we're doing is helping people and providing hope to people in the community too.”