Safe injection Site confidential

A heart felt, first hand look at the day to day life of a front line worker in a safe injection site. Contributed by an anonymous front line worker. — I woke up late this morning. Luckily I live close to the site where I work, so it’s easy for me to arrive on time. The secondary job I’m required to have due to the high cost of living in the city often keeps me awake beyond what my threshold is capable of. My supervisor is aware, and generally merciful knowing what my hourly rate at a government funded position is. As I walk down Yonge street, I’m greeted by the same people I see each day as I supervise their injections. A woman walks up to me, I can tell by her body language and facial expression she hasn’t slept, and is rambling *somewhat* incoherently. This is a familiar banter that her and I have exchanged before. I pause to greet her, giving her a hug. The discomforting glares from onlookers walking past duly noted, and disregarded.


She explains to me that last night, a man she was seeing, pulled a knife on her, refusing to pay for ‘services’ rendered, and left her in the middle of the country, with no money, no phone to call for help, no weapon for self-defence in the event that she’s put directly in harms way, and almost more importantly: in a painful withdrawal from the volatile and unpredictable street drug, Fentanyl. She injects this roughly 5-9 times a day to mitigate opiate withdrawal, (if the finances are available), or PAWS, a lesser known acronym for Post Acute Withdrawal Syndrome.


PAWS is the motivating factor to risk it all. Your life, your freedom, your sexual integrity, your family, and your career. It’s a powerful feeling. Imagine having the worst flu you’ve ever had. You’re body aching, nerves screaming in pain. Sweats, the inability to sleep because your restless and twitching legs. You’re stomach is twisting and you are badly in need of a washroom, but due to the wave of intense anxiety and self-hating depression, you’re apprehensive to ask a Barista at Starbucks, because of the possibility, (and this you know from experience) will look at you, could ultimately write you off as a sub-human ‘junkie’, and deny you access. And now, due to the illicit supply of fentanyl being so heavily adulterated with etizolam, (An injectable benzodiapene found in nearly all fentanyl tests which we receive from CAMH using their mass spectrometer), you have the added bonus of potential psychosis, seizures, and tremors.  


But don’t worry, this can be mitigated for $20, and a visit to the local plug on the corner.

And that is the point where I begin to make my rent. (But not really. I’ll explain)

I’m employed at one of the Consumption Treatment Centers scattered throughout the city. We operate under a medical directive which allows us a legal exemption for people who use drugs to safely inject under our watch, and in the event of an overdose we are to administer compressed oxygen, or naloxone, depending on the severity of the event.


Armed with a unimaginably vast knowledge of public resources, drugs, and the ins-and-outs of the public services sector, our onsite RN’s, PSW’s, and drug users a like, the site offers a myriad of other resources in healthcare built to cater to those with the multitude of socio-economical barriers that PWUD’s often face. 


The team I work with is spectacular. Period. Despite having the lowest wage of any frontline health worker, with painfully high demand for attendance. The minuscule rotation of staff I work with have managed to remain operational throughout the entire duration of the COVID-19 pandemic. Something that potentiated the devastation of the already raging opiate pandemic. Overdose deaths in Toronto alone have more than doubled since we first entered the state of emergency last March.    


We do this despite a total lack of support for the emotional battering each one of us endures on a daily basis. One day it’s death, the other a violent outburst resulting in a traumatized coworker. Full disclosure: I have never been formally taught how to deescalate someone experiencing a stimulant psychosis without the safety of a hospital guard or an array of sedatives at my disposal, but I figured it out how to do it through talking pretty quickly. It’s very sink or swim.


It’s also difficult to teach someone with no clinical background how to discover that a person you’ve interacted with daily basis, someone who you’ve gotten to know well, someone you’ve loved, you’ve shared laughter with, who’s trust you’ve gained, who you’ve looked forward to seeing and have worried about many times, has been prematurely dispatched in an under-equipped pop-up shelter after a shot of fentanyl they didn’t expect would kill them. This has happened countless times. These are people who we consider to be our family. They were our friends, and it’s so rampant it’s become casual. 


A strange bond is formed when you reverse someone’s overdose. For me anyways, I’m sure some coworkers would agree. When they become attached to a pulse oximeter and you can see that the oxygen saturation in their blood has dropped dangerously low, enough so that at the rate its depleting, without your intervention they would die. That is the point when it happens. You cradle their heads, count their breaths, ensure their belongings are kept safe. You make sure that they don’t injure themselves with a fall, but before anything you get their lungs filled with oxygen through any means necessary. The ironic part is that the person who’s overdosing, doesn’t actually know what you’ve done for them. They can’t remember. But I do. 


These are the things that are overlooked with our positions. People we work for don’t see the little parts of this job that affect us in such a visceral way. I’m a part-time employee, although I work full-time hours. I have no entitlement to benefits. No one to speak with other then my friends at work, which I’m beyond thankful for. I don’t have dental coverage, or an allotment or even a subsidy for psychiatry, or professional emotional support. My wage is a mere dollar more than when I began this position back in 2019. A ‘generous’ raise I was notified about when I renewed my contract earlier this year. I don’t have paid sick days, or the ability to take a leave when my emotional well-being is so spent that I feel like imploding. These are the realities of this job. I could quit, sure, but what else would I do when I know that this reality would still be here?


It’s a cycle I don’t understand. This job hinders my ability to function normally. It’s not like I can bring it up to any of my friends outside of this line of work. It certainly isn’t casual conversation. I remember the precise moment when I realized that I have nothing in common with the average 9-5. A man, whom I’ve never met, used in the washroom. Something we strongly encourage not to do, for obvious reasons. A mental stopwatch goes off in my head, he was dopesick, I’m not new. The brain dies after 5 minutes of oxygen depletion, I check on him in 3. He’s slumped over on the toilet, pants down, used He’s slumped over on the toilet, pants down, used rig on the floor. I run to get my tank of O2 with a non-rebreather mask to strap over his face. At this point I don’t need a oximeter, I know what’s happening by the color of his face by now. As I’m charting his recovery, arm stretched holding the device to his mouth and nose, carefully avoiding the precarious setting we were in. My best friend texts me,

“Hey, what’re you up to?”

“Nothin, just at work” I reply. 


I begin to laugh. I start howling as I realize how absurd the situation I was in was. A man I’m currently supplying oxygen, while he’s in the midst of using the washroom, and I’m just there… Doing ‘nothing’. It sits with me to this day. Him and I, only one of us is in tears. Thankfully, no one around us noticed the outburst. Even if they did, they probably wouldn’t care.


There’s so many changes our country needs to make to end this. The OPS, isn’t doing much to mitigate the crisis. I’m aware of this now. At first I believed it was making a difference, and sure, it does. However it’s not a means to an end. We need total reform. Badly. Decriminalization of drugs, and a non-biased education for young people to learn about them. If we could break down the traditional stigma of the ‘junkie’ (a word I despise more than anything), and understand that behind the facade of a homeless person who uses drugs, who begs for your money, is an actual human life, deserving of love, deserving of affection and someone who was once a person who dreamt to be something bigger, we could be a better society. Seriously, next time someone asks you for change, just look them in the eye if you don’t have any. A small gesture is enough to remind someone suffering a bad disposition that they’re still human. 


Although the city is only right now taking possible steps towards decriminalizing personal amounts found on users, there are so many models that highlight the benefits of full decriminalization. Portugal,  for one. Switzerland used Heroin assisted therapy from 1992-2015 in a groundbreaking decision when faced with the 90s heroin pandemic they were faced with. This eliminated criminal activity due to the sale of illicit polluted narcotics overnight. We offer quantitive drug testing through a program funded by health Canada which utilizes the mass spectrometer at CAMH. I oversee much of what goes into the drugs people are using on the street. It’s shocking. Benzodiazapenes, easily the most dangerous things to mix with an already powerful CNS depressant like fentanyl or it’s analogues runs rampant in the supply. Etizolam being the heaviest hitter. This is a direct result of prohibition, and it’s killing more people than ever before. 


But I’m not in politics. I don’t work in policy. I just am one of the many people within the community, helping to clean the mess the war on drugs has caused. It’s a helpless, meagre feeling. 


I really hate to end this article here. It’s a predictably melodramatic point to drop off on, but I really hope these things change soon.   

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