It's dinner time at Shelter House in Thunder Bay, Ont., and Sherry-Lyn Kuzior stops by while walking her four dogs to ask for a brown bag of clean needles and other drug supplies — kits the homeless shelter hands out every day.
But Kuzior won't use them herself. With the help of her doctor, she conquered her addiction to opioids years ago.
As part of her recovery, she stopped seeing many of the people she used to do drugs with. But as the opioid crisis ravages the city, she's worried about old friends.
"Everybody that I've kind of turned my back on are people I still care about."
After recovering from years of addiction, Sherry-Lyn Kuzior is enjoying a happier life. But she worries about people close to her using drugs, and tries to protect them by giving them clean supplies and a safe place to inject. (Nicole Ireland/CBC)
So Kuzior makes "some exceptions" for family members and close friends, keeping in contact and doing her best to protect them by giving them a safe space in her home and access to the clean supplies she's just picked up. She also has naloxone — the drug that reverses overdoses — on hand.
"These are people close to me that were shooting up in the back alley. I don't want that," she said. "I'm not fine with what you're doing. But it's safer under my light and in my bathroom … than you doing it in a dirty back alley."
Although Ontario as a whole has not been as hard hit by overdose fatalities — largely driven by the rise of fentanyl and carfentanil in the drug supply — as British Columbia or Alberta, Thunder Bay, Ont., is a disturbing exception. According to the Ontario's chief coroner, the city and its surrounding area had twice the rate of deaths by overdose in 2017 (18 per 100,000 people) as the provincial average (8.9 per 100,000).
Public health officials and police say there are several factors that could make Thunder Bay especially vulnerable, including limited access to health and social services, high rates of emotional trauma among the large Indigenous population that lead to addiction and high rates of poverty. The city is also targeted by gangs from Toronto and Ottawa, because its remote location means they can sell drugs at a higher price on the street.
Opioid problem keeps getting worse
The situation shows no sign of improving. Between January and August of this year, paramedics responded to more than 173 overdoses — and that's just people who called an ambulance. It's also almost double the total number of calls in 2017, with four more months to go this year.
"In the 20 years that I've been a nurse in Thunder Bay I've never seen a problem this bad," said Tannice Fletcher-Stackhouse, a nurse practitioner at NorWest Community Health Centres. She's part of the team working at a "rapid response addiction medicine" clinic that opened a few months ago at NorWest's south-end Thunder Bay location — an area where there is rampant drug activity.
The clinic allows people using drugs access to services ranging from suboxone or methadone treatment (medications which suppress the horrific withdrawal symptoms that happen when people stop taking opioids) to psychological therapy. They can come in without an appointment.
Shelter House in Thunder Bay provides clean needles and other drug supplies to clients and people who walk up to this window, in an effort to keep users safe from infection. But health officials say people also need a supervised place to use drugs given the high risk of overdosing on opioids such as fentanyl. (Nicole Ireland/CBC )
Directly below that clinic is an area with steel tables and chairs, equipped with clean needles and other supplies. It was supposed to open in August as Thunder Bay's first overdose prevention site, where users could bring their drugs and use them under the watchful eye of trained nurses and support staff. If someone overdoses, they can immediately revive them with naloxone.
It would be an official — and appropriately staffed — version of what Sherry-Lyn Kuzior is trying to do for her friends in her home.
But the facility sits empty, because Ontario Premier Doug Ford's newly elected Conservative government halted the opening of all new overdose prevention sites in the province while it consults experts about its concerns that letting people use drugs will discourage them from seeking treatment.
That upsets Kuzior, because she knows first-hand the dangers people face when they use in the streets — and how an overdose prevention site could protect them.
A safer environment
"This way there's registered nurses … there's no chance of fighting, there's no chance of stealing, there's no chance of hotdosing and there's no chance of overdosing," she said. "But then people look at it like, 'oh, well we're giving in to them.' It's not that we're giving in to them. We're just trying to help them."
With an addiction treatment clinic right above the overdose prevention site, it's an ideal model for encouraging people to ultimately seek help, Fletcher-Stackhouse said.
Nurse practitioner Tannice Fletcher-Stackhouse says an overdose prevention site in Thunder Bay would not only save lives, but give users a gateway to get addiction treatment. (Nicole Ireland/CBC)
"When you're dealing with people with substance dependencies, every interaction is a chance to help somebody. So even though the patient may not be ready for treatment, having the conversation with them, developing a relationship, a trusting relationship, and providing them with education [is important]," she said.
"Patients just don't have the education about, one, how unsafe the drugs are, two, how to use them safely, and how to get help," she said. "By having the [overdose prevention] site in our basement … people would just walk up the stairs and say, 'You know what? I'm ready to quit. I want some help.'"
One young woman tearfully described how she desperately wants help, but feels trapped by addiction. She's also terrified of the prevalence of fentanyl, which many users call "down." People can buy a hit of fentanyl for about $ 20, she said.
"It's just horrible. Like, everybody's on it. Everybody," she said. "It's just so scary. Because, like, my best friends are on it and they keep saying, 'oh, I'm going to go to detox,' but they never do."
CBC News has agreed to protect her identity because she is afraid of retribution for speaking publicly about drug use.
Struggling with depression
She was addicted to OxyContin for years after using it recreationally at age 17, she said. When she eventually met her husband, he helped her get treatment through a methadone program and she got clean.
But she spiralled back into drug use after he died, she said.
"It's really tough now because, like, the depression and stuff. So I find myself going back to … drugs," she said, starting to cry. "I wish it was just a bad dream and I'd wake up."
The overdose prevention site would save lives, she said.
"Instead of going to do [drugs] where nobody can help them, they'd be able to go and do it [at the site] and if they overdose, somebody'll be there. You know, instead of being alone and nobody finding them for three days."
An overdose prevention site is set up and ready to go below a rapid access addiction medicine clinic at NorWest Community Health Centre, located in an area of Thunder Bay where there is a high volume of drug use on the streets, in alleys and by the river. (Nicole Ireland/CBC)
Fletcher-Stackhouse said that's exactly what's happening now — and it won't stop if the province doesn't approve the overdose prevention site.
Losing patients to overdose
"People are going to die. It's plain and simple," she said. "I'm going to continue to lose patients from overdose that are never going to have the chance to access supports and services because they're going to die in a back alley, or in a river, or in a crackhouse somewhere."
The Ontario government is "committed to fighting the ongoing opioid crisis," said Hayley Chazan, press secretary for Health Minister Christine Elliott, in an email to CBC News.
"Minister Elliott is undertaking an evidence-based review, listening to experts, community leaders, community members and individuals who have lived through addiction to ensure that any continuation of drug injection sites introduces people into rehabilitation and ensures those struggling with addiction get the help they need," Chazan said.
"We expect this review to conclude in short order and will be making a recommendation on how to proceed."
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