In the two years leading up to the pandemic, Bill Phelps had been to the hospital more times than in his entire life.
He got wired on fentanyl after his pain medication for a years-old head injury was discontinued about two and a half years ago. He lost his job and ended up on the streets.
So when changes that would allow doctors, nurses and pharmacists to prescribe a safe supply of medication to people dealing with substance use disorder were introduced in March to combat the dual public health emergencies, Phelps wanted in.
“I did overdose a few times before the safe supply,” he said, sitting in the back room of Forbes Pharmacy on Gorge Road, one of the first pharmacies in the city to offer the program.
“A lot of my friends also died before safe supply. My friends were people that were able to work, they made a large income and paid taxes – good members of society – they were just stuck with medical injuries without proper medication and support.”
Phelps now lives in one of the hotels purchased by the province to provide housing to people sheltering outside during the pandemic. Medical staff are on site to help residents access health care services, but for those who are left outside, accessing a safe supply isn’t easy.
Cue the Safer Victoria Project. This team of nurses, outreach workers with lived experience, physicians and a systems navigator are working full-time to provide people sheltering in Victoria parks the medications they need.
Jaclyn Letourneau, an outreach worker with SOLID (a partner with Safer), spends most of her time in the community, connecting with her peers, handing out harm reduction supplies and building a bridge of trust.
”I’ve lived in the same situation before,” she said. “I’ve been at a shelter before. I’ve been on the streets. I know what they’re going through and I can relate to them and be like, ‘hey, this person is trustworthy, I’m working with them and you know me from the community.’ ”
Current estimates have more than 300 people still sheltering outside.
While Safer’s main goal is to connect unhoused people with a pharmaceutical alternative, the team does a lot more than that – whether it’s walking a client to the pharmacy to help them get their daily meds, or covering the cost of medication while someone gets their identification and insurance sorted. The project has connected with over 100 people and has got almost half of them onto safe supply.
“One thing people don’t acknowledge is safe supply is a great entry point for people who need connections to care, people who need to get their blood work done or haven’t seen a doctor in a long time,” said Corey Ranger, a nurse with Safer.
‘Nothing about us without us’
Another aspect of Safer is the qualitative and quantitative research component. At the start of the project, Safer ran focus groups and concept mapping exercises with people who are actively using substances – people who have been left unsheltered, and sex trade workers.
“Up until now there’s been a lot of decision-makers behind closed doors, making assumptions about what people need but the old mantra of ‘nothing about us without us’ is true,” said Ranger.
He is also involved in the advocacy side of the project, working at a provincial level to try to expand overdose mitigation guidelines to include the needs of people who smoke their drugs, which is currently not available through safe supply.
According to Ranger, more people are experiencing mental health concerns in the park as the cold begins to creep in. More people are staying in their tent, out of the rain, isolated from their peers and there’s a lot of frustration at being displaced, evicted, and shifted from encampment to encampment.
Every time a person gets displaced, it increases their risk of overdosing because outreach workers and street nurses have a harder time finding them.
A UN Special Report on the right to housing states that no homeless person should be displaced if it’s going to lead to an exacerbation of homelessness – “but that’s exactly what’s been happening over the last six months,” Ranger said.
Housing first solutions
“One thing people don’t realize is that people who are homeless, they don’t get enough sleep,” said Phelps, who’s now been able to actually rest at night since moving into the hotels and getting onto safe supply. “Now I can do the things that got to get done to get on with daily life.”
A former operator of an English school for international students and one-time owner of a construction company, he can see himself getting back to life now with goals of getting involved with local politics to help others get stable housing and the proper supports.
Housing first initiatives have a proven track record, notes Ranger.
“When you can provide somebody their basic needs first and foremost, then the rest of their lives get a little bit easier to manage,” he said. “When you’re sleeping out in a tent and it’s raining and people are overdosing around you, it’s not really a priority to look into those types of things – you’re in survival mode.”
Ranger wants to see more consultation and engagement with people who are living in unsheltered locations. He’d also like to see a centrally located site for safe inhalation where people could get access to safe supply, which he says would be more efficient than having outreach workers going into the community to find people.
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