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'If you deny that the need is there, then you'll never build the services and you'll never see it.'
'If you deny that the need is there, then you'll never build the services and you'll never see it.'
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'If you deny that the need is there, then you'll never build the services and you'll never see it.'
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The phrase, “Build it and they will come” is usually reserved for business and baseball fields. But Olivander Day, a harm reduction worker in Langford uses it differently.
Day coordinates the Westshore AVI Health Centre, a harm-reduction clinic for drug users on the Westshore where the goal is to promote health, dignity, and well-being. The full name, AIDS Vancouver Island, dates back to its roots in the midst of the AIDS crisis—but its role has evolved to help mitigate the distinctly contemporary crisis in opioids. Patients get a doctor, access to a social worker, a nurse, harm reduction supplies, and peer support.
The need is immense and has grown starkly worse during the pandemic. Many programs that had been supporting users through the toxic drug crisis were closed, temporarily or for good, in response to the pandemic. On the Westshore, the need for services—like safe supply, drug testing, supervised consumption, medical care, or counselling—tends to be hidden compared to downtown Victoria.
“We know the need is huge, but we don't know exactly how much is needed,” Day said. “There's not great data on what the need is in the western communities in general, because homelessness and poverty looks very different out here than it looks downtown. But there's thousands of people who are not getting care who need it, that's for sure.”
Since the Westshore AVI Health Centre opened more than a year after the opioid emergency was declared, the area’s population has continued growing at record levels, and the drug supply has become more deadly. From January to October, 2021, 120 people died of a drug overdose on the South Island health service delivery area. Province-wide, October was the single deadliest month on record, with 201 confirmed deaths from drug poisoning.
Calls to 9-1-1 for overdose emergencies in 2021 were also at an all time high across BC, and the Westshore was no exception. Langford residents made 155 calls, Sooke made 62, and View Royal called 48 times, and 46 calls from Colwood. Altogether, it’s 35% more than 2020. Provincially there were about 8,500 more calls than in 2020. Paramedics attended 97 overdose calls every day in 2021, on average.
One thing that would help, and that AVI patients from Langford to Sooke are asking for, is an overdose prevention clinic. It’s just a matter of funding, Day said.
Right now the Westshore AVI Health Centre—which started with one patient in late 2017—is at full capacity with 500 patients between four part-time doctors. Day believes the clinic could easily fill a patient list of double that number.
It is the only dedicated harm reduction clinic on the Westshore and operates four days a week on a patchwork budget pulled from three-month contracts and one-time grants, and MSP billing for the doctors. They aren’t taking names for a waitlist right now, because they can’t estimate how long the wait will be. So new patients are referred to the Rapid Access Addiction Clinic in Fernwood.
“If you build it, they will come. That's just the reality,” Day said. “If you create a safe place for people to access services, then you will start to see the need. If you deny that the need is there, then you'll never build the services and you'll never see it.”
The AVI health centre mainly works with people they call “expert drug users”: people who have been using for years and are dependent on the substance. Even for them, now that stronger and stronger opioids are in everything, the risk of overdosing is unpredictable and very high. That’s something Day thinks a lot of people who aren’t drug users misunderstand. It’s not that people are using more, it’s that fentanyl, carfentanyl, and other lethally powerful drugs contaminate multiple categories of drugs.
“It's a constant trauma to have no control over the fact that you or someone you love, or someone you know, could pass away like that”—he snaps his fingers—“any day. And it happens every single day,” Day said.
“It's terrifying, and people are exhausted, and they do everything they can to try to protect themselves and each other, but you have no control over what you're getting. We can try to equip people with knowledge of safer use practices, but the reality is, people need to get high. And there's not the services available to keep them from dying when they do.”
Island Health has a referral centre on the Westshore, for mental health and substance use issues, but like everywhere else the wait lists are long—as long as five to six months to see a counsellor. It’s somewhat easier to get into group therapy sessions, which are being held over Zoom.
But more than ever clinic staff are relying on extended health benefits to pay for therapy. A referral centre employee says it’s the first thing they ask a new patient now. Benefits are rarely enough to cover the full cost of counselling, but it can help bridge the wait time.
That works for folks who have jobs with benefits, but almost all of Day’s patients at the AVI health centre are struggling with poverty and homelessness, and often have a hard time getting or maintaining employment.
On the third floor at 713 Johnson St. at AVI's head office in Victoria, they had an independent overdose prevention site. There were five stainless steel tables where people could do their drugs, and someone monitored them for 15 or 20 minutes to make sure they didn't overdose.
But in March 2020, social distancing rules and COVID precautions took precedent. The space wasn’t large enough to physically distance, so the overdose prevention room, which had been running for 10 years, was closed. AVI hasn’t been able to get another space to operate.
There are two overdose prevention sites in Victoria—The Harbour, at 941 Pandora Ave., and Cool Aid Society, at 535 Ellice St.—as well as some in hotels reserved for people at risk of homelessness, but they only serve hotel residents.
Day believes the deadliest year for opioids is a direct consequence of the closure of programs like that
“I don't think it was inevitable [for deaths to increase]. There just needed to be more planning, foresight, and care as to how shuttering essential services would impact the folks who rely on them the most to survive. But, you know, people who use drugs are often an afterthought, if they're a thought at all. There are so many stories of folks who have passed away because the site they normally would have gone to for support, or to inject, was shut down.”
Island Health’s Westshore referral centre staff were co-facilitating a group session for opioid users in partnership with Pacific Centre Family Services Association, a non-profit health society, but that was also paused for COVID. Pacific Centre is opening a new community health clinic this spring in Colwood, which will have some services for drug users, but that won’t be its main focus.
“Not to deny the reality of COVID at all, but the folks in our community are several times more likely to pass away from an opioid overdose than they are from COVID,” Day said.
Even without COVID, short-term funding or one-off grants regularly threaten services in this field. Day said it feels like they’re begging for scraps to provide life-saving services.
“If somebody’s contract ends and we can't get more funding, their job ends and that service no longer exists. And it’s the community members who struggle or pass away.”
Every Friday the Westshore AVI Health Centre hosts a peer support group that’s open to everyone, geared towards drug users. The clinic, at 11-2787 Jacklin Rd., has harm reduction supplies including for safe sex, free Naloxone kits, toiletries, and snacks, and offers Naloxone training.
Email westshore@avi.org if you want to learn more, or if you need help. BC’s crisis line: 1-800-784-2433, is open for 24/7 support. Call 911 if someone around you is overdosing, and administer Naloxone if it’s available.
