The Life Process Program is a groundbreaking, non-disease-based model designed to address substance use and substance use disorder. Originally offered directly to individuals seeking support, LPP has now evolved to include a Coach Training Program. This initiative empowers peers to become recovery coaches, equipping them to support individuals in their own communities. By fostering local, peer-led solutions, we’re creating new pathways to reach marginalized populations in ways that truly meet them where they are.

Last week, we had the pleasure of welcoming Zach Rhoads and Daithi Conlon from LPP to Ottawa. During their visit, Case Manager Tabitha Morris led them on a tour of the city, showcasing the diverse programs and services Ottawa offers to support harm reduction and recovery. The visit culminated in a proud moment as Zach presented Certificates of Completion to our first cohort of trainees in the Coach Training Program.

“We are honored to collaborate with Ottawa Inner City Health,” shared Zach Rhoads, LPP Coach. “Their dedication and innovative harm reduction services are truly inspiring. Partnering with peers who empower their communities allows us to add future-focused, solution-driven support to enhance substance use health. It’s exciting to see the impact unfolding.”

Now that the training is complete, our newly certified peer coaches are diving into their roles. They have begun enrolling clients into the program and are facilitating both one-on-one sessions and group meetings informed by LPP principles.

This marks the start of an exciting new chapter—one where peer-led recovery becomes a transformative force in our community. Congratulations again to our graduates; your work is paving the way for a brighter, more inclusive future!

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The post OICH Response to Changes in SIS Legislation first appeared on Ottawa Inner City Health Inc..

The post OICH Response to Changes in SIS Legislation appeared first on Ottawa Inner City Health Inc..

In Ottawa, the people who use drugs who were engaged in the efforts to protect the health of their community and to advocate for the services they and their community desperately needed to survive the toxic drug crisis are mostly dead now. Those that are not, are overwhelmed with survivor’s guilt, demoralized that not only were their efforts not enough to save their friends but that the services they advocated for are being blamed for causing the problems they set out mitigate.

In the public discourse about community safety, the voice of people who use drugs has been absent. This is striking given that people who use drugs a) are part of the community and b) are far more likely to be victimized than any other stakeholder in the conversation and c) necessary for any sustainable solution to public safety issues.

We worked with people who use drugs to develop and implement a survey around the safety needs of people who use drugs. 

https://lnkd.in/eS3qgiDj

Next we held focus groups to ask them what specific things in their current environment are causing them to feel unsafe and how we can address them together.

When we talked to people who use drug about the impact of the toxic drug supply, they told us about the dope sickness, they told us about desperation, the fear and the “every person for themselves” attitude that was created. They did not like what had become of their community. They grieved the way things used to be before the drug supply became so toxic, before the pandemic. And they grieved the leaders they loved and respected who have been lost over the past 7 years.

So we asked them what they wanted to do about it.

What they told us was that they wanted to restore the positive aspects of street culture. That they wanted to be part of the solution to the concerns of neighbours and businesses. They told us that they wanted us to help them to address the things that were impacting their sense of safety.

The Ontario Government’s decision to close supervise consumption sites in Ontario was rationalized by concerns about vulnerable children being exposed to drug use and discarded syringes. People who use drugs, many of whom grew up as vulnerable children who the system failed to protect, couldn’t agree more! In fact, the first thing, they wanted to address was addressing drug use in front of kids, and within a week or two they restored the community norm of people shouting “kids up” whenever they saw a family with kids on the block and everyone putting their drugs away until after the family passed by and the kids were out of sight.

There are policy alternatives to prohibitionist closures of consumption sites that would restore balance to communities and make safer downtowns for all.

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The post The exemption that allows a Lowertown supervised drug consumption site to keep operating first appeared on Ottawa Inner City Health Inc..

The post The exemption that allows a Lowertown supervised drug consumption site to keep operating appeared first on Ottawa Inner City Health Inc..

Like many of you, I read about the deadly assaults that took place out of Kingston’s Integrated Care Hub with horror and dread.

I feel horror about the terrible, violent loss of life and the impact that these deaths will have on the community of people living in the encampment, on the loved ones of those who have passed in such a horrible way, on those who responded to the emergency who are people who hold a deep passion and empathy for the people they serve.

And I feel dread about the potential policy response to this terrible incident.
The hull has been breached, the ship is going down and people have fallen overboard.   Our leaky lifeboats are at risk of being swamped by the desperate needs of those in the water. Those that can swim are doing what they can, those that cling to bits of wreckage are making as much space as possible for others. While it is hard for bystanders to hear the screams for help, those screams will not stop because the people in the water are survivors, clinging to whatever hope they can for rescue.

So, what should be our response? We have deployed a few leaky lifeboats like supervised consumption services and prescribed alternatives to the toxic drug supply, and we support those who manage to find refuge in the flotsam and jetsam of tents and encampments and other public spaces, building community under the direst of circumstances.  They do this because they understand that their chances of survival are better if they stick together.

I am filled with dread because there is an ill-informed public debate about how to “save” people from this disaster. Some offer the unhelpful observation that it would be better if everyone could swim (i.e. go into “treatment”), others suggest our time would be better spend designing better lifeboats or new shipping routes, some suggest that we solve the problem of our existing leaky boats by scuttling them–closing consumption sites, disbanding encampments, prohibiting prescribed alternatives with their wraparound supports.

In sea rescues, crews are taught to put all their efforts into pulling as many people out of the water as possible—and then the sea will take the rest. We know these are not perfect solutions but these are resources we have been given, despite calls for more.  We must deploy them to save as many people as possible.

We cannot rescue everyone but we can, and should, be rescuing as many people as possible because time is running out for far too many.

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We knew that the arrival of the toxic drug supply in Ontario would lead to an exponential rise in the number of drug toxicity deaths due to the failure of governments to dedicate the resources to match the scope and scale of the crisis.

What we hadn’t anticipated was how the toxic drug supply was going to impact the community of people who drugs.

Different opioids have different levels of toxicity, but also of duration.  Hydromorphone’s duration is 1-2 hours while fentanyl’s is 30-60 minutes, meaning that you need to dose as much as 4 times more frequently.

Use fentanyl and experience relief from suffering–begin experiencing withdrawal (dopesickness)– acquire money to buy drugs–source their next dose–find a safer place to use, then repeat the process.     

This leaves little time for anything else, even when the person is motivated to make changes in their life.  They are dope sick all time, which many report as “feeling like they are dying”.

With higher potency opioids—people started smoking stimulants (crack cocaine, crystal methamphetamine) in association with injecting their fentanyl. 

More recently, people who had previously injected fentanyl, began to smoke fentanyl, possibly due to poor venous access from years of high frequency injecting and possibly due to the mistaken belief that smoking fentanyl was less risky than injecting fentanyl from an overdose perspective. 

Since 2020, approximately half of opioid toxicity deaths had evidence of inhalation.  No sites in Ontario have been approved to bring the smokers inside, away from the public spaces and we now respond to more drug toxicity events in the immediate vicinity of our site than we do inside.  Neighbours are right to complain, but it is critical to understand that we have been asking to allow people to smoke in our sites and it has been denied.

Under the prescription opioid crisis street level illicit drug trade was primarily conducted within the community of people who use drugs in Ottawa. Diverted oxycontin was sold by one person who uses drugs to another as a means of making money to maintain their own use. Community norms were well established, and violence was limited. 

When the toxic drug crisis overtook the unregulated, non-prescribed drug supply, drug trafficking shifted to organized crime which led to more violence and an escalation in the intensity of violence.  Drug debts became more common and that invariably leads to more violence.

For organized crime, unregulated drugs created an ideal business model.  They are easy to acquire, with low risk of detection from border services or police, and profit margins are extremely high and public policy that limited access to prescribed alternatives, creates a steady market, even when thousands die each year in Ontario.

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The post Update on the Toxic Drug Supply appeared first on Ottawa Inner City Health Inc..

There is a worrying trend of elected officials trying to place the blame for decades of failed social policy on those who have experienced the most harm because of them.  

Social service and health agencies desperately working to mitigate the impact of the toxic drug supply and and the housing crisis on communities are being vilified as not caring about the impact on neighbours and businesses, when that is simply not true. We have not been given the resources.  

We asked for more primary care resources and were denied.

We asked for more mental and substance use health resources and were denied.

We asked for more case management, more drop in spaces, better access to public washrooms, showers and were denied.

We asked to bring the people who smoke drugs inside, out of the public view and into care and were denied.

We asked for resources to employ people who use drugs and to redevelop leadership in this community that we have lost to the toxic drug supply and were denied.

We have been set up for failure.

The Homeless Addictions Recovery Treatment (HART) hubs are not a bad idea. We know this because people who use drugs have been asking us for better access to treatment, more housing options and opportunities to work for decades. 

However, because recovery is not linear and because relapse can be fatal—our recovery efforts must be built on the solid clinical evidence base of harm reduction.

The HART Hub should be built on top of the CTS infrastructure, not replace it. 

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The post About HART Hubs appeared first on Ottawa Inner City Health Inc..

On August 9^th, 2015, we got our first warning that something different was happening to the drug supply in Canada.16 overdoses in one day in Vancouver was enough to sound alarm bells across the country.  

Government policies to address the prescription drug crisis led to massive deprescribing of pharmaceutical opioids and resulted in thousands of Canadians who were dependent on these medications to the streets to source drugs to ease their pain and the drug they found there was fentanyl.

This day marked the end of the prescription opioid crisis and the beginning of something much, much worse—the toxic drug crisis.

https://www.cbc.ca/news/canada/british-columbia/fentanyl-blamed-for-spike-in-heroin-overdoses-1.3185431

Around this time in Ontario, we were watching as the first wave of the toxic drug crisis was making its way from west to east and Ontario was not ready.  

The tools we needed but didn’t have in place were take home naloxone, 

low barrier access to opioid agonist treatment, and supervised consumption services. 

These services were just getting up and running when the toxic drug crisis hit Ontario. And we were immediately overwhelmed by demand.

Fentanyl is a short acting opioid, meaning that people needed to dose more frequently to maintain the effect and that they were in withdrawal more frequently. While all opioids carry risk of overdose, fentanyl was by far the highest risk and so people wanted more of their injections supervised. Our sites were not big enough to meet the demand and so people did the next safest thing they could do which was to inject just outside of our doors, knowing that we were there to respond if they overdosed. Going two blocks away was potentially lethal.

We saw a rapid shift in our communities away from injecting unregulated drugs to smoking them and we were not prepared for that. When we were planning the sites, people were primarily smoking crack cocaine in Ottawa and there was no contamination of the cocaine supply in the pharmaceutical opioid crisis. And so, people began to smoke their drugs around our sites for the same reason as above.

It was not just consumption sites that were impacted.  

Naloxone wasn’t as effective in reversing opioid overdose and multiple doses were required to revive people.

Opioid agonist treatment, the gold standard in treating opioid use disorder was also less effective in the face of a toxic drug supply.   

• Measuring treatment attrition at various stages of engagement in Opioid Agonist Treatment in Ontario Canada using a cascade of care framework

What was shocking news in August 2015 is now the common experience in big and small cities in Canada that have been hit with the toxic drug crisis. While there are those that would blame consumption sites or harm reduction in general for decades of social policy failure, we turned to people who use drugs to ask them what we needed to do. This is what they told us:  

Address the safety needs of people who use drugs to reduce trauma to the individual and, subsequently to the neighborhood. This includes access to pharmaceutical alternatives to the toxic drug supply. Access to drug checking should be scaled up.

Address the stigma they experience accessing health care and social services that is triggering their trauma and sense of disconnection.

Build safer spaces indoors and outdoors for people who use drugs. This includes smoking spaces but also community and recreational spaces. They should not all be concentrated in one area of the city.

Engage people who use drugs in the solution to public disorder and safety as they also live in these communities and are often the most victimized. We have learned that they have the best ideas on how to address these concerns in a sustainable way.  

https://ottawacitizen.com/news/local-news/block-leaders-drug-users-homeless-byward-market

Give people who use drugs more access to low barrier treatment and make injectable opioid agonist treatment services as a first line treatment for people who inject drugs.

More access to mental care and treatment for complex trauma for those who need it.

Provide a range of safe, affordable housing. Provide opportunities for employment. 

It is urgent that governments at all levels across the country make the investments necessary to address the scale of this humanitarian crisis that is devastating people, impacting communities and threatening economic prosperity.

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The post A Word on the Toxic Drug Crisis appeared first on Ottawa Inner City Health Inc..

Connectedness 

Welcome to our blog page where we will be sharing our perspectives with the hope of generating a broader understanding of the amazing people we serve and the joys and the challenges of the work we do. Each month we will be featuring perspectives from each of our different staff groups. 

Substance use is a universal human experience. All over the world and throughout time people have taken psychoactive substances for pleasure or for ritual. We like the way that drugs make us feel, we like the way that they make us not feel, and most importantly, we like the way they help us to connect. From the cocktail party and going for a coffee to groups sharing a crack pipe or hanging out near a supervised consumption site, we are all after our hardwired need to interact with other human beings.

Most substance use is relatively non-risky (there is always some risk, but we are also hardwired to be risk takers!) and most people’s relationship with their substances is balanced with their natural connection to others through family groups, workmates, sports teams and gaming, social clubs etc. 

A person’s relationship with drugs is typically reflective of their relationship to others, their culture, themselves and the environments in which they live.  

Problems arise when instead of facilitating this connectedness, the substances become the connection as they hit those same pleasure and reward pathways in the brain that come from our relationships and the pleasures associated with joint activities.

While most substance use is non-problematic, a small percentage of people (about 10%) whose relationship with substances begins to interfere with their other relationships. Of those, the vast majority will recognize this on their own and simply rebalance their relationships on their own.

An even smaller number of people (about 20% of the 10%!) seek professional help to rebalance their connections with the goal of either changing their relationship with the drug that is causing the imbalance (managed use) or ending the relationship completely (abstinence).  

Like any problematic relationship, it is difficult to change one’s relationship with drugs because there are many positive aspects along with the negative. It is difficult to change, especially if you lack multiple areas of connectedness rather than just one.  A bank executive going through a divorce may find themselves drinking more to manage their anxiety or taking opioids to numb the pain, but because they have strong work relationships, obligations to their children or social commitments, less likelihood of developing a substance use disorder and a greater chance of achieving their recovery goals than someone who is lacking connectedness in multiple areas of their lives.

The people we serve through our programs at Ottawa Inner City Health have experienced multiple severe disruptions that have disconnected them from these critical relationships, creating intolerable psychological stress.

Childhood trauma, the cultural genocide of Indigenous people, regular experiences of structural oppression and racism, poverty, stigmatization and homelessness all increase the risks of individuals developing problematic relationships with whatever substances are available to them.

“Getting people off drugs” will not do anything unless we address the barriers they face to restoring relationships in all areas of their lives.  

At OICH, we are treating the trauma, not the substance use.  We do that through making or remaking connections.  It starts with their connection with themselves and respecting and validating that they are the experts in what they need right now to function in their world and support their autonomy to make decisions.  

Relationships formed with a peer worker, a nurse, doing a smudge or attending a country feast, a decision to have something treated, start a new medication, a chance to earn a bit of cash and help one’s community, getting involved in advocacy, kicking a soccer ball, moving from a shelter to a supportive housing unit—all of these things are aimed at either restoring or building first-time connectedness for people who have been severely disadvantaged through no fault of their own.

Finally, our goal is not abstinence, and our goal is irrelevant. We walk alongside people in their journey, no matter where it takes them. We don’t measure success by how far they go; we measure it by how far they have come and the obstacles they have overcome along the way.

In partnership,
Rob 

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