Programming Connection

Overdose Prevention Site at St. Paul’s Hospital 

St. Paul's Hospital

2019

How Does the Program Work?

The OPS currently operates out of a room in the basement of a building on the St. Paul’s Hospital campus. People can visit the site between 11:00 am and 11:00 pm, 7 days a week. Peer workers, support workers and a manager staff the site. A renovation of the OPS space was completed in early 2019 through funds supplied by Providence Health Care. Inpatients can find the site using signage within the hospital and through hospital staff. The OPS has been publicized outside of St. Paul’s Hospital largely through word of mouth.

Approximately one-quarter of the OPS participants are hospital inpatients. A variety of services are provided. OPS staff are trained in first aid and advanced overdose management techniques (e.g., administration of naloxone, administration of oxygen, rescue breathing). Staff monitor overdoses and call emergency services, if required. The OPS site offers the following services:

  • overdose management and intervention
  • take-home naloxone kits and training — the site is a registered Take Home Naloxone satellite site and all staff (i.e., peers and housing support workers) are trained to dispense kits
  • access to safer drug supplies including clean injection supplies (e.g., needles, alcohol swabs) and clean inhalation supplies (e.g., stems, screens, bowl pipes), as well as safe needle disposal
  • peer support (e.g., filling out housing applications and advocating for clients in the hospital emergency department)
  • referrals to health and community services, including referrals to opioid agonist therapy and other treatment (staff are familiar with available resources and referral processes)
  • accompaniment or referral to services offered at St. Paul’s Hospital (e.g., the Rapid Access Addiction Clinic, emergency department)
  • drug testing via fentanyl testing strips during hours of operation and biweekly scheduled drug testing by the Vancouver Coastal Health Spectrometry Team using a mass spectrometer

The OPS currently offers safer drug use facilities for up to four users at a time, and it is hoped that it will be possible to increase the number of booths from four to six in the near future. The space also includes a desk for staff and an area for users to sit after consumption (i.e., a “chill out” space). There is ongoing work to make the space more inviting for clients.

In a typical visit, a service user will enter the site and obtain the supplies (e.g., needles, alcohol swabs, filters, sterile water, cookers) that they need before proceeding to one of the four booths. Booths include a chair, table and sharps disposal bin. The post-consumption “chill out” space is monitored by staff and provides an opportunity for staff to interact with service users and make referrals to services, if required. There is no time limit on how long service users can stay at the site and the site can be used with a companion.

Some service users visit the site only to obtain supplies and leave. While the site provides safer inhalation supplies, it does not have facilities for safer inhalation on site. If service users want to smoke their drugs, they can obtain supplies and are encouraged to inform staff where they are going. They are then encouraged to check in with staff afterwards.

Peers work six-hour shifts per day, with one or two peers per shift, and support workers have four- or eight-hour shifts, with one support worker per shift. A site manager works 36 hours per week. During operating hours there is at least a one peer and one support worker staff on site. No clinical staff are on site, although OPS staff can call hospital nurses to debrief or ask questions.

Since the OPS is not directly linked to hospital services, discussions with BC Ambulance had to take place to ensure that they were aware of the site and could respond in the case of an emergency.

The start-up cost of the OPS when it was located in the walled tent was approximately $5,000, including the booths, tent, furniture, electrical cords and floor mats. The ongoing monthly total cost for the current (indoor) site is $19,876, most of which is staffing costs.