Taliesin Magboo Cahill, September 22, 2019 on Twitter

Is anyone up for a #tweetorial about what it's like to work as a nurse in a supervised consumption site? Not sure if I've seen one before and I feel like there are some things I could clear up. #harmreduction

FYI - It's not all nurses! Some sites don't have nurses at all! All sites in Canada have harm reduction workers (oft. with SW background) and people with lived exp of drug use employed in their sites. Some have RNs or RPNs as well. [Some sites have paramedics on staff to respond to overdoses and have limited nursing support to address other medical issues, such as infections, wound care, and other.](*) Supervised Consumption sites (SCS) and Overdose Prevention Sites (OPS)(**) are variable in terms of staffing, vibe, usage patterns. Personally, I've know of sites with as few as two booths and as many as 12. Staffed by 1 to 3 or 4 people.

Our main goal is to respond to overdoses (opiate and stimulant) and keep people alive, using stimulation, supplemental O2, and Narcan. We are also trained in responding to other medical emergencies (e.g., anaphylaxis, cardiac arrest, hypoglycemia) and mental health crises.

But we aren't a hospital! We have some medical supplies, but no advanced airways, no cardiac monitor. Common equipment includes MANY pulse oximeters, AED, ambubag and oral airway, BP machine, glucometer, maybe a vein finder. Any emergency requiring more than this - we call 911.

Although we are here to keep people alive, we only spend maybe 10% of our time responding to overdoses. We also do wound care, referrals to all different kinds of treatment/health care, and personally, I spend a lot of time playing DJ and just chatting.

At all sites in Canada, nurses or PWUD will give advice on safer injection techniques and finding veins to use. In a few sites in Canada, peers can help each other inject. The idea is to keep people using IN the site.

The sites vary in how medical they appear, but the idea is to make them welcoming for people who use drugs. Clean, but ideally a little more comfortable than a doctor's office. Welcoming, non-judgemental, fun. Or people won't use them.

Liability - in Canada, these rooms are exempt from laws against possessing and being around drugs. I'm not endangering my license as long as I am responding in an appropriate and safe way to an overdose.

Safety - Most sites don't have security as it exists in the hospital. No chemical or physical restraints. There are often panic buttons as there are in many community health settings. All sites have behaviour standards.

What is great about my job: getting to know/talk to all different kinds of people, the feeling of providing an essential service that saves lives, working in a team, having a standard intervention that I do over and over again so I become really confident in what I'm doing.

What sucks about my job: seeing ppl I know almost dying, hearing some very sad stories, and yes sometimes people are [angry/using foul language] (not very common). Mostly feeling powerless to help people in the long term. Sometimes overdoses are scary.

Addendums: - We don't provide the drugs! (although there are small pilot safe supply programs in Canada) - I get paid! I've done this work as a volunteer before but currently I get a paycheck/benefits/pension. As do the PWUD who work at the sites.

Vibe can lean medical or casual, but most have easily cleaned injection surfaces, lots of mirrors, decent lighting, sharps containers. Some play music. Some have time limits. Some have security. Some have a lot of rules, some have close to none.

Why do people use SCSs? The people who do use them could address this best, but I can try: preventing overdose, clean space, protection from cops, medical care. Access to wraparound services.

What drugs are people using? That varies as well although it's absolutely not all opiates - estimates from sites I've worked in or visited vary from 40 to 60 percent fentanyls or 'heroin'. Other drugs include meth, speed, rx opiates and stimulants, cocaine (crack).

Policing: That depends on the site, but they aren't just allowed inside to check for people without a warrant. Ideally, they aren't parked outside deterring people from coming in either.

Getting people help: Do you talk to your patients about their motivations for using, med assisted treatment, going to rehab/non-profit centers, getting clean? Yes we do, but when they are ready. When someone is dopesick, I know their motivation in the moment. Clients are the ones who will initiate conversations about motivation and recovery when they begin to trust us and feel safe in the space. Trauma/culture informed care is a must.

Sharing drugs: People are not sharing because it's considered trafficking. It's unfortunate because people often buy together and want to split it at the site, but not sharing is one of the conditions of the exemption that let's us operate. [In most sites people are also not allowed to help each other inject, called “doctoring”, which is problematic, as some users inject in hard to reach locations or have difficulty injecting themselves This is more common for women than men, which might be a contributing factor in lower fatal overdoses in women.]

Link to the original tweet https://twitter.com/tmc_RN/status/1119269129293221888

(*) Text in [square brackets] was added by MSTH

(*) An Overdose Prevention Site (OPS) is a “supervised consumption site lite”. Approval is typically time limited (from a few days to 12 month), but can be extended. It is used as a response to an immediate crisis while steps for a full SCS are taken. It is at times in temporary locations, such as trailers/tents and has fewer or no auxiliary services, such as nursing, counselling, social work. Some are funded by government or grants, some through donations, most have paid staff, but some are run by volunteers. When approvals and funding for SCS in Ontario was put on hold by the Ford government volunteer groups managed to keep many of the sites open as an OPS, with federal approval and in some cases federal funding and fundraising. We might see this situation evolve in Alberta, depending on the outcome (expected November/December 2019) of the SCS reviews currently being held in that province.