Grant: Travel Awards - Institute Community Support

Background: Dramatic increases in opioid overdose mortality have led to rapid proliferation of supervised injection services - currently approved or open in 8 Canadian cities - for people who inject illicit drugs. Over 20 overdose prevention sites (OPS) have also opened, including sanctioned OPS in BC and unsanctioned ones in Ontario, to address overdose-related morbidity and mortality. Objectives: This paper explores data from the first 4 months of operation of an unsanctioned OPS in Moss Park, Toronto, and examines issues involved in providing grassroots emergency health services in the absence of government resources. Methods: Anonymous data on all people accessing injection monitoring from August 19th to November 30th, 2017 were collected and analysed, including age, gender, drugs injected, overdose frequency, and intervention during overdoses. Results: 2933 visits to the injection tent occurred; 66.5% of clients were male, 33.5% female. Self-reported drugs being injected were: fentanyl (33.3%); heroin (20.0%); "down" (unspecified opioid) (15.5%); and hydromorphone (10.4%). Overdose occurred in 3.4% of all recorded injections; 52.2% occurred after fentanyl injection. Overdoses were treated with naloxone in 40% of the cases, and with oxygen, monitoring and/or stimulation in 60% of the cases. No significant gender difference was found in overdose rates. No one accessing the site died. Conclusions: OPS are a low-barrier, low-cost method of intervening during a public health drug poisoning and overdose crisis. In the absence of a timely and effective federal exemption process, municipal and provincial health officials should consider OPS as a simple yet effective intervention to reduce opioid-related mortality.