‘Go low and slow’: keeping drug users safe

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This article was published 10/07/2023 (821 days ago), so information in it may no longer be current.

In an RV-turned-makeshift safe consumption site nestled in West Broadway, less than a thimble’s worth of cocaine is tested for poisonous cutting agents Friday evening.

A staff member uses an alcohol swab to wipe down the mobile mass spectrometer, an unassuming $65,000 machine that can determine the components of illicit drugs, installed into Sunshine House’s Mobile Overdose Prevention Site (MOPS). A small clipped straw is used to tip the cocaine from a bag to the machine, in between a flat surface and a laser on a lever, which is lowered onto the sample.

A form then has to be filled out — what drug is the visitor testing, are they intending to use or share the drug, and if they would like the small sample back. Sometimes, the drug is what the buyer thinks it is. Other times, high percentages of dangerous additives such as bro­ma­zo­lam (a highly potent drug with sedative effects) and xylazine (an animal tranquilizer not approved for human use) come up on the laptop screen attached to the machine.

That’s when staff informs the visitor. What they do next is up to them, but these cutting agents are serious enough that the knowledge that their drugs contain them can prevent a fatal overdose.

“We do tell them what’s in the results and if they are aware. We tell them to just be careful if they choose to do it still, which they, 99 per cent of the time, will want to do it still,” the staff member, who asked to remain anonymous, explained as the cocaine was tested.

“We just remind them to be safe about it, be smart. Go low and slow, or be with a friend.”

Less than a minute later, the cocaine’s results pop up on the screen. The only oddity of note is that 57 per cent of the sample isn’t even cocaine, it is benzocaine, an anesthetic typically known as Orajel, a numbing agent meant to impact the experience of the drug but essentially not dangerous.

The staff on board are happy it’s not a more concerning result, but in the four months since the spectrometer was installed, the data it keeps has had a hand in determining how fatal drug-poisoning trends pass through Winnipeg.

The data from the RV’s drug checking machine, along with community consultation and input from organizations on what drugs are hitting Winnipeg’s streets, has become safersites.ca, an easy-to-navigate website run by Sunshine House and the Manitoba Harm Reduction Network that publishes brief drug alerts — public warnings that highly toxic substances, some immune to naloxone, are being included in drugs being sold and used in the city.

Typically, between two and four are published monthly. The most recent was added July 4, a warning that the street drug “down” has been found containing xylazine in Winnipeg.

The alerts have had an impact on some of the city’s most vulnerable. Many coming in to check drugs do so after seeing an alert, and Sunshine House executive director Levi Foy said the simple design and easy-to-digest information comes from workshopping with people from Winnipeg who use drugs.

“People respond to that. And they’re like, ‘Oh, OK, cool, I didn’t know that. That’s good to know. I’ll make sure I take care.’ And then they come back the next day and they’re alive,” Foy said.

“It’s cheap, it’s easy, and if it saves a couple of lives, and if it’s limited ambulance calls, you’ve already saved enough money. You’ve already saved lives, you’ve saved money, and it allows people to make informed decisions.”– Sunshine House executive director Levi Foy

MOPS is the only place in the city people can visit in-person to check their drugs. They can check them without surrendering their drugs, and without the fear of punitive measures from law enforcement, as Sunshine House is the sole organization in Manitoba that has a federal exemption under the Controlled Drug and Substances Act that allows them to run the site.

But Sunshine House can’t come close to meeting the need for safe drug checking and releasing drug alerts in the city, Foy said.

“We don’t have the capacity to be doing specifically the drug checking at the same rate that that needs to be done. At a (government) level, there has to be some way to expedite the ability of other organizations to be able to provide these types of services,” Foy said.

“Because we’re also only operating a very small neighbourhood, so we only have a pretty small catchment area wherever we are.”

In March, when drug checking began at MOPS, there were 2,400 RV visits. That number has increased every month since.

“It’s cheap, it’s easy, and if it saves a couple of lives, and if it’s limited ambulance calls, you’ve already saved enough money,” Foy said. “You’ve already saved lives, you’ve saved money, and it allows people to make informed decisions. So what is actually the real risk here around drug checking?”

While Sunshine House is the only in-person drug checking site where people can keep the drugs and get instant results, the Winnipeg Regional Health Authority (WRHA) has been publishing drug poisoning alerts since 2017. The way they operate uses different channels — published through Street Connections, the warnings use data collected from Health Canada’s drug analysis data, which usually comes from drugs confiscated by police and sent in for testing. Some data comes from a Vancouver-based organization that checks drugs sent by mail and publishes results online.

The WRHA works with Sunshine House and other community organizations to help decide when to put out alerts, and the fact that Winnipeg now has a space where drugs can be checked instantly has been helpful, said Shelley Marshall, a population and public health clinical nurse specialist with Manitoba Health and the WRHA.

“Sometimes (the data the WRHA uses), it’s not super timely information, particularly drug analysis services, sometimes the product was seized from the market a month or two months ago, and we suspect that it’s long gone,” she said. “So we’re giving historic information, whereas access to more timely drug checking results would be helpful.”

Their alerts are less frequent than Sunshine House’s, and how they decide whether to put out an alert is based on different information. But like Sunshine House, Marshall said she knows the alerts are under-estimating how widely spread poisoned drugs are.

“I can see drug checking being something that expands, definitely, throughout the province. It has a utility for everyone… Drug checking is not a highly-contested terrain, in harm reduction.”– Shelley Marshall, public health clinical nurse specialist

“We don’t have every drug product being tested, we couldn’t,” she said. “There’s absolutely harmful substances that probably whip through the market very quickly.”

She sees the conversation around installing similar drug-checking machinery to MOPS’ in other Winnipeg organizations becoming a prominent one in the future.

“I can see drug checking being something that expands, definitely, throughout the province. It has a utility for everyone… Drug checking is not a highly-contested terrain, in harm reduction. There are some other kinds of services that seem to have more debate around them, but drug checking seems to resonate with the logic of most people.”

Both Sunshine House and the WRHA’s most recent alert warns of xylazine in Winnipeg drugs. Several months of increasingly challenging overdose calls and the provincial medical examiner recently confirming in postmortem tests that fatal overdoses included the tranquillizer has made that all too clear, Winnipeg Fire Paramedic Service public education coordinator Cory Guest explained.

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“The anemia that it causes is really, really making people sick. It’s increasing patient’s blood sugars as well, and the sedative effects of a sort of run-of-the mill fentanyl-type overdose seems to be much worse with this stuff,” he said. “The central nervous system-depressing capabilities of xylazine is definitely increasing the severity of our patients.”

Paramedics already work closely with community organizations to navigate Winnipeg’s drug crisis — “They’re doing phenomenal work with limited resources, and we really appreciate the fact that they are often the first responders to these folks,” Guest emphasizes — but he’s not sure if the WFPS will ever take on the task of drug testing the people they serve.

“There’s various sorts of lab tests that we could be doing, be it cardiac enzyme testing for people that are having heart attacks or chest pain. There’s a whole bunch of stuff that we could do, not just drug testing, do I think that’s a real benefit to that? Yeah, probably … Are we looking to do that? I’m really not sure. But like anything, there’s a huge cost to that,” he said.

“And I hate saying that, because we’re talking about humans and lives. But I think there would be a benefit to that.”

malak.abas@freepress.mb.ca

Malak Abas
Reporter

Malak Abas is a city reporter at the Free Press. Born and raised in Winnipeg’s North End, she led the campus paper at the University of Manitoba before joining the Free Press in 2020. Read more about Malak.

Every piece of reporting Malak produces is reviewed by an editing team before it is posted online or published in print — part of the Free Press‘s tradition, since 1872, of producing reliable independent journalism. Read more about Free Press’s history and mandate, and learn how our newsroom operates.