Toxi-City (Part 2): Deadly drugs in Edmonton — Combating overdoses in city streets and pedways

This is part two of a three-part series from reporter Anna Junker exploring the toxic drugs crisis in Edmonton.

Today, we follow a group of dedicated volunteers, and EMS responders who are taking to Edmonton’s streets, alleyways, parks, and transit pedways to assist those suffering with addiction. Part Three, April 2: We sit down with Alberta’s associate minister of mental health and addiction to discuss what the province is doing to combat the crisis.

Read Part One: Toxi-City: Deadly drugs in Edmonton — Overdoses are happening across all neighbourhoods and families are bearing the brunt of the crisis

Listen to the 10/3 podcast: Edmonton’s overdose crisis and Alberta’s deadly record

It took three doses of Naloxone to revive the woman.

On a Friday afternoon in February, Alyssa Miller, Raye Cameron, and Brittney Powell work to revive a woman experiencing an overdose near 96 Street and 105A Avenue.

Powell came across the woman, who appeared unconscious, lying on icy ground next to a sidewalk. A man sitting next to her, orange and blue tarps somewhat erected around them, asked Powell for Naloxone.

Calling Miller and Cameron over, they quickly get to work. With the first dose of Naloxone administered, Cameron rubs the woman’s sternum in an effort to get a response from her.

Two minutes later, a second dose is administered, this time through the nose using spray. Cameron calls out to Powell, who is on the phone with emergency services, “Britt! Two doses!”

“Come on sweetheart, let’s go. Deep breath for me love,” Cameron says to the victim, as he again rubs her sternum.

As they work on reviving the woman, they monitor her oxygen levels and heart rate.

Cameron gives her rescue breaths.

Another two minutes pass, as Miller checks her watch. The woman is then given a third dose — another injection — into her leg.

As the trio work feverishly to revive her, onlookers peer from across the road, while drivers, including an Edmonton police vehicle, pass by.

About 10 minutes into the ordeal, Edmonton Fire Rescue Services (EFRS) arrive on scene, two firefighters donning plastic aprons over their uniforms. Miller provides them with information about the woman’s vitals and they help her, now conscious, sit up.

Minutes later, emergency medical services (EMS) arrive. Both fire and EMS crews help the woman stand and assist her in walking over to the waiting ambulance.

After fire and EMS take control, Miller, Cameron and Powell collect their discarded Naloxone kits and peel off their gloves, placing them and other garbage into a bag. They’re quickly ready to continue their route.

Taking to the streets, pedways

The trio are part of Boots on Ground, an organization that formed last summer after Edmonton saw a sharp spike in overdoses. While EMS is inundated with “opioid-related events” Boots on Ground is one of many volunteer organizations that have sprung up to do their part to address the growing drug poisoning crisis.

“We saw an extreme need last summer and thought that we could really make a difference by using our combined skills, our knowledge, and our lived experiences in a way that was mobile and really meet people where they’re at, not just in terms of substance use or houselessness, but also in terms of literally where they are at environmentally,” Miller, a co-founder of Boots on Ground, said.

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“So we come to them rather than presuming that somebody knows how to navigate or knows where to go to access supports.”

Donning backpacks and duffel bags, Miller, Cameron, and Powell met in a parking lot behind Boyle Street Community Services that Friday. The bags are stuffed full of Naloxone kits, both injectable and nasal, water bottles, and harm reduction supplies such as clean needles, pipes and tin foil. They also have chocolate bars and other sweet treats to hand out. The sugar helps with dope sickness and coming out of an overdose.

While the group primarily works north of the river, their routes change daily, using data to determine where they are needed most on any given day.

“One of the things that we’re using right now is a dashboard that allows us to look at where drug poisonings are happening throughout the city and a bit of heat-mapping and probability scaling,” Miller said.

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“We can really use that, in addition to other intel, and knowledge from community members and other organizations to figure out where we would be most effective, where we can reach the most amount of people that maybe aren’t close to services that support them. And that way we can be flexible and responsive, and pivot as needed.”

‘There’s no words for it’

Not only do they work the streets of Edmonton, but also the pedways which can get crowded especially during harsh winter weather, often because people have nowhere else to go.

Boots on Ground’s other co-founder Angie Staines meets with Powell and Cameron about 7 p.m. on a Tuesday in February at the Edmonton Public Library parkade in Downtown. This evening, the group plans to head to the pedways.

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Once again donning backpacks and duffel bags, the group walks through the labyrinth of connecting transit tunnels, approaching small groups sitting down along the walls. They also make sure to check behind the escalators leading to and from the LRT platforms. The group hands out snacks, water, and harm reduction supplies, striking up conversations with each person.

Sometimes, Staines said, they’ll provide information on services individuals may need. Often they chat and build relationships, listening to stories and “letting them be people and be respected.”

“It’s been very eye-opening, seeing the huge gaps and people falling into these gaps, because services either aren’t available or due to the ongoing pandemic, things close,” Staines said. “To see the lack of services available and the need, and the hoops that need to be jumped through is absolutely heartbreaking. And of course, to see the amount of overdoses and deaths, it just keeps piling on and piling on. There’s no words for it.”

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It hits home for Staines, whose son Brandon has been using substances for 10 years. His drug of choice is fentanyl. She says he has repeatedly tried to get help, including when he reached out back in January.

For three weeks, Staines spent time trying to get Brandon help.

“The waitlists were huge. And the stigma encountered a lot of the time was soul-crushing.”

Staines said she’s told there are beds available but in reality there are none, and then detox will be closed weeks at a time due to COVID-19 outbreaks. She acknowledges that everyone is trying to do their best.

But while trying to get help, Brandon relapsed.

“Brandon has me, a lot of these community members have nobody and I do not know how anybody could navigate the system alone,” she said.

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Business community bands together

One Alberta organization of small businesses is turning its collective attention to how employers can help curb the crisis.

Euan Thomson is the co-founder of Each and Every, a business collective aimed at promoting harm reduction and reducing stigma around drug use. Thomson is also the owner of Raft Brew Labs and works with small breweries in Calgary using science to maintain quality control. Using the prohibition as an analogy, he says a brewery is nothing more than a consumption site that offers a safe supply.

“If you’re in the beer industry, you need to understand that 100 years ago we had the same crisis in alcohol that we’re seeing with fentanyl right now,” Thomson said, adding society is failing to connect the dots between the way alcohol is consumed and the way people who use drugs are treated.

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“It’s an unregulated supply because of prohibition, and so you’ve got organized crime effectively being subsidized by the government through criminalization of the product that they’re distributing.

“It’s an unfortunate stigma that is killing people.”

Since launching in 2021, the collective has grown to include not just businesses in Alberta, but across the country. From breweries to coffee shops to marketing agencies, Thomson says they all came together with a united feeling like they needed to do something to address the crisis because governments won’t.

We’re just part of this cycle that we’re not really helping the problem, which is the addiction.

Elaine Hutchings, paramedic

Members agree to carry Naloxone kits, which can reverse an overdose, on-site, as well as stickers that are prominently displayed, indicating they are an Each and Every member and have the kits available.

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“We just recognize this opportunity that we can totally change the conversation and push back against this narrative that businesses are against harm reduction because it’s not true,” Thomson said.

Darren McGeown, owner of Arcadia Brewing, is one of more than a dozen members of Each and Every in Edmonton.

He became aware of the growing crisis through his close relationship with Boyle Street Community Services and through media coverage. He reached out to Each and Every asking how to get involved and became one of the first businesses in the city to have Naloxone kits on hand and to distribute.

“I think the stigma was these overdoses are all in the downtown cores of cities and the sad reality is that that’s not the case, they are in neighbourhoods throughout the city,” he said.

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He has also used the brewery space, at 10712-120 St. NW, to hold events where people can learn more about the drug poisoning crisis and get trained on how to use Naloxone.

McGeown said businesses should be pillars and leaders in the community.

“If customers are supporting us, as a business in the community, we should be doing something to strengthen our community and I feel like doing what we can right now with the overdose crisis is very important,” he said.

McGeown points out the contrast in government response to the COVID-19 pandemic compared to the “overdose pandemic” and that there doesn’t seem to be the same urgency in the latter. He says one logical answer to addressing the crisis is having more supervised consumption sites, noting, like Thomson, that his bar is a supervised consumption site.

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“That’s why I assume why bars were created, to get people off the streets and into somewhere.”

McGeown has not yet had to respond to an overdose near his business, but he’s prepared with Naloxone kits, and stickers on a window to the right of the entrance to Arcadia indicating the kits are on-site.

“It’s sad to know that it’s still happening constantly every day in other areas when we don’t want it to be happening anywhere,” he said.

“We feel fortunate it’s not happening in our neighbourhood, but it doesn’t mean that it couldn’t just happen one day. And it’s good to know that we’re prepared in case it does.”

Legal battle over ID requirements

Moms Stop the Harm is a nationwide network of families who advocate for change to drug policies and provide support to grieving families, such as Healing Hearts, a peer-supported Facebook group for those who have lost a loved one to the drug poisoning crisis.

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Currently, Moms Stop the Harm is engaging in a legal battle with the province over the Alberta government’s decision to require safe consumption sites to ask clients for their personal health numbers.

The province says those who don’t have a health number will not be refused the services, however, Moms Stop the Harm and co-plaintiff the Lethbridge Overdose Prevention Society, argue that asking for any identification will deter clients from using safe consumption sites and therefore, possibly lead to more deaths.

The groups turned to the court to grant an injunction on the ID requirements, in an attempt to delay the implementation of the rule, while their lawsuit against the province makes its way through the courts.

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The injunction case was initially dismissed, but lawyer Avnish Nanda brought it to the Appeal Court of Alberta, which unanimously sided with the government. The Supreme Court of Canada is expected to make a decision this month on whether it will hear the case.

Petra Schulz, co-founder of Moms Stop the Harm said people do not want substance use, which is deemed a criminal activity, linked to their health record.

“It’s a highly stigmatizing thing to have on your health record and people will avoid the health service if that is the case, and here we have a life-saving health service,” she said. “We want to encourage people to use consumption sites, not have them avoid them because they are afraid of having their personal data collected.”

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Speaking one late January morning outside the downtown Alberta Health Services (AHS) building, 9925 109 St., Tracy Griffin, an incident response paramedic, said she had already attended to an overdose that morning.

It’s not an uncommon occurrence.

“One minute I can go into the shelter and help someone there for maybe an overdose,” she said. “And then the next minute I’m going up onto the top floor of a penthouse for the same thing. It crosses every boundary, every race, every age, gender, the whole works.”

A good portion of Griffin’s day is going from one overdose call to the next, often within the same vicinity.

“We will get to a park or somewhere and they’ll be one person that’s overdosed,” she said. “And then when you’re dealing with that one, when you turn around and realize that there’s someone else there that’s got the same symptoms because most likely they’ve used the same batch.

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“We may end up with anywhere from one to five patients from just one batch of drugs.”

Sometimes, when opioid-related events spike, AHS will send out a public alert. The province’s Substance Use Surveillance Dashboard tracks weekly EMS calls to opioid-related events.

Most recently, in December, AHS issued an alert after there were 140 opioid-related EMS responses between Nov. 29 and Dec. 5. While in November, EMS responded to between 57 and 112 calls a week.

‘I’m seeing five to 10 overdoses a day’

A big problem is not knowing what is in the drug supply, the concentration of it, or how consistent it is.

Paramedics have been noticing opiates are being mixed with various pharmacy drugs, such as benzodiazepines and diabetic medications. This means that not only is an overdose occurring, but in the case of drugs mixed with diabetic meds, the patient’s blood sugar is so low it renders them unconscious.

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And often, once they regain consciousness, patients will decline further treatment or transport to a hospital.

“You’re an adult, if you don’t want to come with me to the hospital, that’s unfortunate, but I can’t kidnap you, right?” said Griffin.

Griffin said it can get overwhelming at times, going from 20-year-olds to the elderly who have overdosed.

“I’m seeing five to 10 overdoses a day sometimes, and it’s sadness, it’s never a good thing,” she said. “This is terrible. This is one of the worst days of their lives.”

Within EMS is a different branch of community paramedics who are also providing urgent care services directly to patients, known as Mobile Integrated Healthcare (MIH), under the medical direction of physicians and nurse practitioners. There are six types of teams: Community Response, City Center, Crisis Response and EMS, and the Assess Treat and Refer Program. AHS operates teams throughout Alberta, including in Grande Prairie, Peace River, Camrose, Red Deer, Lethbridge, Medicine Hat and Calgary.

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Community and advanced care paramedics Elaine Hutchings and Marie Berube operate out of a van and provide care such as suturing, IV therapy, and medication administration to patients in the community who have barriers accessing them.

“We do a lot of diagnostics in the community too, so we’ll do blood draws and collecting specimens for diagnostics for physicians,” Hutchings said.

As part of the city centre team, Hutchings and Berube support Edmonton’s vulnerable population. They said they see many patients who are homeless and are dealing with addiction and mental health needs. And they work closely with the Boyle McCauley Health Centre to get referrals from physicians and nurse practitioners, as well as supporting inner-city agencies and shelters.

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Last summer, they noticed they were attending a lot of overdoses in between scheduled patient visits.

“Say if I was travelling from the George Spady over to 96 Street to respond to another one of my scheduled events, (it was) not uncommon to come across two or three overdoses in between scheduled events,” Hutchings said.

“In that case, we have to jump back into emergency mode and do first response while waiting for the EMS crew to arrive.”

This past summer, overdoses were at levels never seen before. It’s become disheartening.

“We’re just part of this cycle that we’re not really helping the problem, which is the addiction,” Hutchings said.

Reducing cravings with Suboxone

A few years ago, Hutchings said, community paramedics were able to administer opioid agonist therapy such as Suboxone, which helps to reduce cravings and ultimately ease people off opioid use.

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“Unfortunately, in the last couple of years, we have not been allowed to do this because of regulations with Alberta Health,” she said. “This is something that we’ve been fighting for in the last couple of years to get that permission to administer Suboxone in the community again.”

The use of Suboxone by community paramedics has been under review since October 2020. In a statement, AHS said Suboxone is classified as a restricted medication under the federal Controlled Drugs and Substances Act and requires an exemption to allow paramedics to administer it.

“AHS has applied to Health Canada for an exemption, and is working with them directly and has recently provided additional information as requested by Health Canada,” spokesman Kerry Williamson said. “Alberta Health provided a letter of support for AHS’ application to Health Canada.”

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While it’s been under review, Hutchings said they have been missing out on a huge opportunity to get treatment to patients who are open to opioid agonist therapy.

“We had the medication on hand, and we were able to call a physician and get orders to get them started and get it organized through a community pharmacy that they could get set up to get this medication every day, and also access addictions and mental health services as well,” she said.

Hutchings said there are not enough detox facilities for the volume of patients, and allowing paramedics to once again provide Suboxone would be an easy way to ease the pressure.

“We’ve lost so many opportunities to help patients,” she said.

ajunker@postmedia.com

@JunkerAnna

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