FOCUS: An injection of life

SURREY — If drug addiction is a ticking time bomb in Surrey, then the rundown streets surrounding Whalley Athletic Park are surely its Ground Zero.

It is here that dozens of addicts shuffle past chain-linked fences with furtive glances, always seeking that next fix. Some find it in crack shacks and drug dens, but the people who go there are far from safe.

With the potency of narcotics overflowing the Lower Mainland’s drug trade, far too many users wake up in an emergency room after being resuscitated from overdose. Some never wake up at all.

According to the B.C. Coroners Service, 13 people died from over an overdose of fentanyl – a powerful opiate – in the Fraser Health region in the first four months of 2014.

Those numbers might have been even higher if not for Doug Nickerson, who is something of a guardian angel on the streets of Surrey. A homeless addict himself, “Dougie” has administered live-saving medication to at least six people in a state of overdose since January, using an anti-opiate medication called Naloxone.

He has come to recognize the telltale signs of overdose, which can be tricky, considering how still and peaceful addicts look when it happens.

“Their eyes are shut, they’re on their back and their breathing is very shallow,” says Dougie. “Everybody has what they call the death rattle. They’re still breathing and there’s always a pulse.”

But just two weeks ago, Dougie was called to help a young man who had stopped breathing completely. He quickly pulled out his Naloxone kit, filled the syringe and pushed the needle into the man’s arm.

His eyes fluttered open as the paramedics arrived, Dougie still monitoring his vital signs.

“He had a heart rate of 120,” he recalls. “For a man laying on his back, a young guy in his late-20s, that’s a pretty high heart rate for a guy that was blue less than a minute ago.”

Harm reduction outreach worker Crystal Ladriere (left)

and Dr. Caroline Ferris work at Keys Housing and Health

Solutions in Whalley, an area of Surrey that has long been

known for drug-related issues. (Photo: ADRIAN MACNAIR)

Surrey is the last stop on the SkyTrain and a destination for many drug addicts looking for a change of pace from the notorious Downtown Eastside. Dougie has a simple theory as to how people wind up here.

“Well, to get away from the people they owe money to in downtown Vancouver,” he says, without any hint of humour.

Dr. Caroline Ferris, who has worked on the front lines of drug addiction for five years at Keys Health and Housing Solutions on 135A Street, says there are more people than ever seeking methadone therapy and detox services.

“This area has always been skid row,” she says. “Ever since the ’50s, ever since the Pattullo Bridge was built. The hotels, the sleazy bars, so this was always where the bikers and the hoes hung out and this is where the services were.”

Alcohol was the drug of choice back then, but today it’s more common to see abuse of prescription drugs, crack cocaine and crystal meth. The landscape has changed but people never do.

Ferris says roughly seven per cent of any human population will be prone to substance abuse, which is why doctors increasingly view harm reduction as an essential component of health and well-being.

“We figure that if we’re nice to people when they’re using and they don’t harm themselves, one day when they’re ready to move along in treatment then they’ll be open to it,” she says.

These days there is a surfeit of prescription drug abuse, which Ferris blames on a host of reasons. There can be a diversion of prescriptions written by a well-meaning physician, warehouse theft of pharmaceuticals, illegal sale of prescription narcotics by pharmacies and even counterfeit prescriptions.

“There’s a variety of ways these drugs get out onto the street but it’s certainly an open-air market out there,” says Ferris.

There’s also what she calls the “accidental addict.” Ferris explains that some people can start with a prescription for Percocet as a pain killer for a broken limb. But when the prescription runs out, some people aren’t ready to let go.

“They were cut off all of a sudden, went through withdrawal, found some on the street, discovered heroin was cheaper, and there you go.”

Prior to 2012, Naloxone was only available in B.C. to paramedics or doctors in hospital. But the medication has been around for 40 years and is on the World Health Organization’s list of essential medicines.

Since B.C. began the Take Home Naloxone pilot program in August 2012, more than 125 drug overdoses have been prevented, according to the BC Centre for Disease Control.

Perhaps the leading reason for allowing it into the hands of drug users is that it has no pharmacological effects in the absence of opioids.

In 2013, there were 308 deaths in the province due to illicit drug overdoses, the majority involving opioids. Today, more than 1,215 Naloxone kits have been distributed throughout B.C., and the program has trained more than 2,200 people to use the medication.

Erin Gibson, the regional harm reduction coordinator for Fraser Health, says that drug users can learn to administer the medication at places like Keys Health and Housing Solutions.

“Their loved ones or caregivers are encouraged to come and do the training with them as a way to sort of recognize and to feel confident in their response to a crisis,” she says.

That’s important, because 85 per cent of drug-related deaths were likely witnessed by at least one person at some point during the overdose.

“It’s not just Naloxone, it’s also engaging people and education and training, how to recognize and respond to opioid overdose,” says Gibson.

B.C. has participated in harm reduction programs since the late 1980s, the most notable being the safe injection site in the Downtown Eastside. Gibson says research has shown that people who do the training can lead to positive change, even rehabilitation down the road.

“Whether you’re using drugs or not, you have value and we care about you,” she says. “People who participate in the program that use drugs and then go on to save a life... the ability to save a life is a really powerful thing.”

Dougie knows something about saving lives. He says it’s all about getting the medication to the victim before brain damage can set in. Sometimes paramedics are delayed by crucial minutes, meaning he’s something of a first responder.

Word has gotten around in the community. If somebody is in a state of suspected overdose, street addicts call out the names Dougie and “Narcan” – the brand name of Naloxone.

“They all know me out on the street because I’m out there every day, every night and they catch on.”

Dougie says he’s homeless by choice – although he was living in his van until it was stolen. That was five winters ago. Now he says he likes “camping out.”

“Since I took on the harm reduction, making myself available is the main reason for sleeping on the sidewalk.”

He’s also open about his crystal meth addiction and makes light of the suggestion he’s a recovering drug addict.

“Yeah, I recover every day,” he says, chuckling.

But Dougie is worried about the potency of some of the drugs that are spreading through the streets of Surrey’s skid row. Street level drugs these days aren’t “cut” so much as they are “buffed” to make them more potent.

Ferris says drug dealers will “buff” with fentanyl, a strong, fast-acting opiate that makes the heroin more addictive, but more dangerous as well.

“What’s happening now is you just don’t know what the hell you’re getting,” says Ferris. “We get crystal meth that’s cut with ecstasy, we get crack cocaine in the crystal meth, we get fentanyl in the opiates, we get fake Oxycontins that are really fentanyl. Nobody really knows what they’re getting.”

Crystal Ladriere also works at Keys Health and Housing Solutions as an outreach worker. A recovering addict herself, she got into harm reduction to help addicts through difficult periods in their lives. But she says she knows from experience there is a way past addiction.

“It’s about meeting them where they’re at and making sure they’re aware of resources and providing them with harm reduction until they may be ready to quit,” she says.

Keeping people alive long enough to reach that state of readiness is the core value of harm reduction.

What is Naloxone?

• Naloxone is a pure opioid antagonist (anti-opioid) developed by global pharmaceutical company Sankyo in the 1960s

• It is on the World Health Organization’s List of Essential Medicines, a list of the most important medication needed in a basic health system.

• Naloxone counteracts the life-threatening depression of the central nervous system, respiratory system, and hypotension secondary to opiate overdose

• Since the Take Home Naloxone program was launched in B.C. in 2012, there have been 1,215 kits distributed to 51 sites in the province.

• The program has reversed 125 opioid overdoses over the past two years, according to the BC Centre for Disease Control

• In the event of an opioid overdose, Naloxone restores normal breathing within two to five minutes

• Naloxone is currently used in harm reduction programs in the U.K., Italy, Germany, Australia, and 17 U.S. states.

• Canada has the highest consumption of opioid prescription drug use in the world.