Working at Ottawa’s busiest supervised consumption site

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They are the firefighters of the opioid epidemic: The people who wade into the middle of the crisis every day while the rest of us avert our eyes from the scene.

They are staff members of the Trailer, one of the busiest supervised consumption sites in the province.

Located in the basement of the Shepherds of Good Hope, at the corner of King Edward Avenue and Murray Street, the Trailer has 14 injection booths that serve between 220 and 250 people a day. Clients also receive addiction counselling, health care and mental health services.

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One of four supervised consumption sites in Ottawa — soon to be three — The Trailer is the only one that remains open 24 hours a day, seven days a week.

Staff at the Trailer routinely save lives.

Last year, its team of nurses and harm reduction workers, along with members of a special response team, reversed 516 overdoses inside the Trailer, and 1,268 overdoses outside of it — an average of more than four a day. Some clients require five or more injections of Naloxone to reverse the effects of their overdoses.

No one has ever died of an overdose inside the Trailer.

That so many overdoses now occur outside the Trailer reflects the rapidly evolving nature of the opioid epidemic. More drug users now smoke fentanyl and methamphetamine rather than inject them, which means they more often overdose outside the Trailer, where smoking is prohibited.

The dramatic rise in the number of overdoses also reflects other changes. The country’s drug landscape had shifted from plant-based drugs such as heroin and cocaine to synthetic, chemical-based drugs such as fentanyl and meth. The drugs are often contaminated with dangerous substances — everything from xylazine (a veterinary drug used for sedation) to Gravol (an anti-nausea drug) — that can react unpredictably in combination with fentanyl and meth.

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What’s more, there has been a shift towards more polysubstance use: people consuming fentanyl mixed with meth or cocaine — stimulants that can increase the risk of heart attack, stroke and overdoses.

“It’s not getting better, it’s getting worse,” says Tim St. Pierre, a shift leader who began at the Trailer four years ago as a harm reduction worker because he wanted to give back to the community following his own recovery.

Krista Ridley, a nurse, has worked for most of the past five years at the Trailer. She went into harm reduction because her brother suffered from substance use and mental health problems. “I’ve always wanted to be able to help other people through that experience,” she says.

Those like St. Pierre and Ridley are on the frontlines of Ottawa’s opioid epidemic — a public health crisis that claimed 218 lives in this city last year.

Opioid-related deaths in Ottawa have climbed steadily in each of the past five years. During that period, 726 people died from overdoses.

Work in such an unrelenting disaster zone exacts a heavy toll. The Trailer staff bear witness to untold trauma, grief and misery, day after day.

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“Our staff are seeing things that are not normal,” says Anne Marie Hopkins, a former Trailer manager who’s now director of operations at Ottawa Inner City Health, the non-profit agency that runs the Trailer. “It is extreme conditions: They are seeing such high levels of pain, and people in the deepest, darkest places of their addiction. They’re bringing people back from the brink of death over and over and over again.”

Says Fiona Miller, a nurse who began at the Trailer as a harm reduction worker: “It’s really chaotic because you’re watching people actively injecting and using drugs but you’re also trying to deal with secondary issues like infections, or a lack of food and clothing.

“There’s this huge fire,” she says, “but then you’re also trying to put out all these other, smaller fires.”

To further complicate matters, supervised consumption sites like the Trailer are now under an intense — and distortionary — political microscope.

Earlier this week, Ontario’s Progressive Conservative government announced that 10 supervised consumption sites will be closed in the province because of their proximity to schools. In Ottawa, the Somerset West Community Centre consumption site on Eccles Street will be forced to shut down by April 2025.

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“It’s the worst thing that could ever happen to a community, to have one of these safe injection sites open in their neighbourhood,” Premier Doug Ford told reporters.

Meanwhile, federal Conservative leader Pierre Poilievre has vowed to close sites that endanger the public if he’s elected prime minister. “They’re drug dens and they’ve made everything worse,” he told reporters earlier this summer. “Everywhere they’ve been done, they’ve made everything worse.”

Poilievre suggested his government would defund them and redirect public money to treatment services.

The beleaguered staff at the Trailer is deeply concerned about the increasingly hostile political climate, and what the future holds for supervised injection sites — and the people who use them.

“There’s so much criticism currently of harm reduction and the work we do,” says Miller. “But we’re not seeing this increase in drug use and chaos in the community because of harm reduction. We’re seeing it because of a lack of other services.

“I would love people to understand that harm reduction is working, but there needs to be more added to it. We can support people to a point, but we need other services beyond that: supportive housing, mental health care.”

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Hopkins says politicians and the public need to understand that closing supervised consumption sites will not mean drug users simply disappear. It means more will be injecting on the street; more will require ambulance and hospital services; more will die.

“We understand why people are upset about the chaos in the (ByWard) Market, but they also have to understand that the folks we’re serving are people’s children,” she says. “They’re people’s brothers, sisters, mothers — and they’ve been through a lot.”

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The Trailer opened its doors in November 2017 as the city’s opioid crisis gathered force.

Forty people in Ottawa died from drug overdoses in 2016. At the time, heroin, cocaine and OxyContin were the drugs of choice.

But overdose deaths rose sharply in 2017 as a dangerous new, synthetic opioid appeared with increasing frequency on Ottawa streets: Fentanyl was being mixed into other drugs with unpredictable and sometimes fatal results.

The rapidly escalating public health crisis eroded political opposition that for years had frustrated those who wanted to open a supervised injection site. Advocates had started lobbying for such a site in 2014, but then-Mayor Jim Watson and Police Chief Charles Bordeleau both publicly opposed the idea.

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Watson said he preferred that government money be spent on drug rehab programs, while Bordeleau worried such a site would create a public marketplace for drug trafficking.

The Sandy Hill Community Health Centre pushed to open an injection site as part of an existing harm reduction program, but with drug deaths rising, activist group Overdose Prevention Ottawa launched an illegal, “pop-up” site in Lowertown’s Raphael Brunet Park in August 2017.

One month later, Ottawa Public Health opened the city’s first legal supervised injection site on Clarence Street.

By the time the Trailer opened in November — in a 40-foot trailer in the parking lot of the Shepherds of Good Hope — the opioid crisis was already morphing into something much more deadly.

Fentanyl was fast displacing other drugs on the street. It metabolized more quickly in the body, which meant drug users were typically injecting 10 to 15 times a day — more than double the rate of those who used cocaine or OxyContin.

The Trailer’s eight injection booths could not keep pace with the soaring demand. Projected to accommodate 60 to 80 visitors a day, the Trailer instead averaged more than 120. Lineups often formed during peak periods in the late afternoon and evenings.

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One year later, a 60-foot construction trailer was brought in to replace the original one, and outfitted with 12 injection booths. It became known as Trailer 1.5.

Then, in July 2019, Doug Ford’s Progressive Conservative government announced it would spend $2 million to give the Trailer a permanent home in the basement of the Shepherds of Good Hope.

Within months of Trailer 2.0 opening, however, COVID-19 arrived — and changed the opioid epidemic all over again.

The pandemic made everything worse. Its forced isolation eroded the mental health of clients and drove many recovered addicts back into drug use. They re-entered a drug world made exceptionally perilous by fentanyl and its unpredictable analogues.

Ottawa’s street drug supply was also disrupted by the pandemic’s travel restrictions, which meant the city was flooded by drugs concocted in basement chemical labs. Overdoses appeared in clusters, driven by the toxicity of the new supply.

The Trailer remained open 24 hours a day, seven days a week throughout the pandemic. A satellite supervised injection site was opened at the Guigues Service Centre to assist those drug users who were in quarantine.

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Staff at the Trailer found they sometimes had to inject clients nine or ten times with Naloxone to bring them back from overdoses. Some suffered brain damage from hypoxia.

“It was scary,” says Fiona Miller, “because clients could be down for a very long time.”

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When it’s fully staffed — it often isn’t — the Trailer has six people on duty: three harm reduction workers, two nurses and a manager.

Harm reduction workers such as Marissa Renaud greet clients, hand out clean needles, connect clients to other services — food, housing, legal advice — and try to make them feel comfortable. The Trailer is one of the few places in the city where drug users are welcomed, and the staff want them to feel comfortable enough to hang out after consuming their drugs.

There’s a small lounge where clients can have a coffee, a snack and watch TV.

Renaud has been working in the Trailer for 10 months. She tries to “read” clients to understand if they want to talk or be left alone. A former drug user — Renaud is five years clean — she has lost many friends to the opioid epidemic.

“I want to show our clients I’m here for them, and help them gain trust in what we do,” says Renaud.

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Inside the Trailer’s office, one nurse monitors a bank of TVs with video feeds from the injection booths, and another feed from just outside the Trailer. The nurse watches for signs that a client has overdosed, such as someone slumping into a “ragdoll” position, being unable to support their limbs.

Usually, those signs will appear within the first five minutes of an injection so nurses pay close attention during that critical window. (Those newly released from prison are also treated with extra caution because their reduced drug tolerance puts them at high risk for an overdose.)

If the nurse in the office notices something unusual, she will notify the nurse on the floor of the Trailer to check on a given client. The floor nurse will assess a client’s alertness, skin colour and breathing pattern.

When the overdose is outside, the nurse calls “Code Abby” — the code was named for a shelter client who often overdosed — and a dedicated team responds to the medical crisis.

The Trailer staff have learned to take a graduated approach to overdoses. Some clients simply need to be physically stimulated — repositioned, rubbed with ice, or reminded to breathe — to return their breathing to normal.

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Others require Naloxone to reverse the effects of opioids, which can interfere with brain receptors that govern the drive to breathe. The Trailer staff administer low doses in an attempt to minimize a client’s “dopesickness” since Naloxone binds to opioid receptors, and rapidly reverses the drug’s effects. (Dopesick clients will often consume more drugs to relieve their symptoms.)

Staff reassess the situation after each dose of Naloxone to understand if another injection is necessary.

The nurse on the floor of the Trailer actively monitors clients, treats their open wounds, and “flags” those who may be having difficulty injecting. Nurses can’t inject clients, but they can help them find a good vein and insert a needle.

“We’re trying to help them understand how to inject in a safer way and make sure they use clean methods,” says Ridley.

The Trailer also offers a drug-checking service that uses a spectrometer to identify exactly what’s in the substance a client is about to inject. It’s part of an initiative, known as Safer Supply Ottawa, that provides prescription opioids and stimulants to select participants.

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The Trailer receives funding from the Ontario Ministry of Health and Ottawa Public Health, and operates with a special exemption to federal drug laws.

Anne Marie Hopkins calls the site’s staff the most dedicated, flexible, adaptive team in health care, but the salaries offered to its nurses are not comparable to what they could make in public hospitals.

Not surprisingly, there’s a high staff turnover rate.

“This is not a place that some people can work for a long time because of the amount of things you’re exposed to,” Hopkins says.

Staff at the Trailer struggle to find ways to deal with the unique stressors posed by their work environment. Most rely on debriefing sessions with their colleagues since few others can fully appreciate their workplace.

Yet for those who continue to perform the difficult, demanding work of the Trailer, there are rewards.

“I think it’s important,” Tim St. Pierre says. “I think, like a lot of people who stay around the Trailer, I feel like I’m part of something bigger than myself. Some of the most satisfying times I have are when I see a client who just feels normal for 10 minutes.”

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Says Fiona Miller: “I believe really strongly that people deserve dignity and safety,” she said. “So being able to repeatedly offer these things, which aren’t offered elsewhere, is what makes me want to continue doing it.”

Krista Ridley says she keeps doing her job because of the clients. “They deserve someone to look after them.”

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