Thread by @tdbrothers

Workshop on how to start a pop-up Overdose Prevention Site at #HR17
@ZoeDodd @gilliankolla @TorontoOPS @StreetHealthOPS

They ran an illegal site for 18 months, with 100+ volunteers saving hundreds & hundreds of lives

Discussion among the crowd about fenantyl coming into local drug supplies as access to prescription pills decreases

This is what we’re now seeing in Halifax

“Don’t wait until fentanyl comes and is killing everyone; start now so you’re ready”

Moss Park OPS tent came out of heartbreak of overdose deaths & frustrations with lack of governmental response

“We went drinking & decided we needed a tent”

251 overdoses reversed in first 11 months

& they learned as they went

Moss Park group didn’t have access to statistics on overdoses, as local public health/EMS/police were not releasing

This is similar to @halifix902, where @nshealth Public Health asked US to tell THEM why OPS should be in North End Halifax when they had data on ODs & new HIV

They set up their injection tent & “chill out” tent - and then people immediately wanted a place to smoke crack safely

The “chill out” tent changed into the crack smoking tent, and they kept learning

.@StreetHealthOPS is a two-booth, low barrier service in an existing agency - successful service in a welcoming space

No need to “overmedicalize” safe substance use - it’s not hard or complicated

Battle with govt over provincial-level policies causing harm

Province sent injectable naloxone (w/ titratable, Safe dose) to pharmacies & intranasal naloxone (with huge, precipitating withdrawal dose) to harm reduction agencies

They had to go injectable naloxone from pharmacy

Drug users & frontline activists had to make their own training & inserts for naloxone kits, as the province kept insisting on chest compressions rather than rescue breathing - even when people are WATCHING other people use & overdose from opioids and clearly need oxygen & breath

Recommend STAINLESS STEEL tables, as plastic tables get destroyed quick

(Heads up @halifix902)

SpO2 monitors & oxgen have been essential, as 2/3 overdose responses only require oxygen rather than naloxone administration

They used less & less naloxone as they went along as they realized they didn’t need it (& didn’t need to make people sick)

They developed new policies - waiting 3-5 minutes between naloxone 0.4mg intramuscular doses for naloxone to work, using oxygen and bag-valve mask only, rather than giving more naloxone

Folks set timers on their phone to keep them from the impulse to jump in with more naloxone

Oxygen & bag valve mask have been way more useful & important than naloxone

By going gentle, with 250+ overdose reversals at the OPS no one has woken up angry or in withdrawal

We often cause harm in ED by slamming naloxone into people

So much wisdom, experience & expertise from people who use drugs

And so many stories where politicians & medical professionals cause harm by not listening and not including this expertise

In Oct 2018, people started immediately turning blue, collapsing, becoming rigid - chest wall rigidity & lock jaw with closed airway

This is when they recognized carfentanyl entered the drug supply

When they recognize these - quick naloxone to start ventilating & call EMS

Responding to ODs has become normal to folks working in OPS - initially were scared but being in these safe, resourced spaces with a response team makes the whole thing calm and possible

One client shared they had reversed 20 ODs while alone

No deaths in any OPS anywhere

Discussion on need for self-directed grief support for peers & harm reduction workers losing so many loved ones

Shout out to @momsstoptheharm for their incredible peer/family-led grief support work, advocacy & organizing ❤️

Importance opening site as a platform for reaching out to the community & building support

Mayor of Toronto came to visit, watched a client inject (into their neck), and spoke with her about her needs and why sites are needed

The experience changed his perspective

By doing tons of volunteer training, the unsanctioned OPS built support AND an entirely new workforce for building sanctioned OPS/SCS

The Moss Park OPS didn’t have any rules for the first few months

Don’t get hung up on policies/procedures (which @GovCanHealth exemption DOES require)

Just ask people what they need to feel safe & let that guide

They didn’t give police advance notice, but started OPS & then showed police a tour of their work and service

“We’re Allie’s here - both aiming to preserve human life”

Police understood the crisis & then spoke in support to press

Lawyers on their team were also helpful!

Proactively working with media (including international) to get the story out & share model for saving lives

They wouldn’t work with self-identified right-wing media, but everybody else

Media could only come when the tent was closed

.@gilliankolla invites professionals, citizens, people without criminal records to put our our bodies on the line when opening an unsanctioned OPS in case of arrests, to lift part of burden from people more vulnerable to harms of imprisonment

.@TorontoOPS has lots of moments of celebration & of grief & direct action - recognizing these deaths are avoidable

Shout outs to @odpreventionott @SocietyWindsor @halifix902 ❤️

OPS/SCS is part of solution - but does not solve problem of toxic/fatal drug supply

We need decriminalization

& we need “safe supply” - MDs/NPs will be part of that (check out @andreasereda & @PHS_PrimaryCare pioneering work)

Shout outs to @VANDUpeople first unsanctioned sites decades ago

& @CAPUD2016 @capud2019 guidance document
“This Tent Saves Lives”

capud.ca/sites/default/…

Oh & all this is actually at #HR19 not #HR17!