SisterSpaceJUNE2017UPDATEREPORTThesecondreportaspartofathree-monthdevelopmentalevaluation

Preparedby:MadisonThulienMPHPracticumStudent,UniversityofBritishColumbia

TasnimNathooMSc,MSW,PracticumSupervisor

INTRODUCTIONSisterSpace,theworld’sfirstwomen-only,community-accessibleoverdosepreventionsite,openedonMay16th,2017inVancouver’sDowntownEastside(DTES).TheprogramisrunbyAtiraWomen’sResourceSociety,inpartnershipwithVancouverCoastalHealth(VCH),theCityofVancouver,B.C.Housing,B.C.Women’sHospital,andtheProvincialHealthServicesAuthority. Todescribeearlyprogramactivities,outcomes,andlessonslearned,athree-monthdevelopmentalevaluationisbeingconducted.Asthesecondreportoftheevaluation,thisupdateprovidesanupdateonprogramactivities,adescriptionoftrendsintheuseofSisterSpaceservices,andadiscussionofhowSisterSpacefitsintothegreaterpublichealthresponsetotheoverdosecrisis.

UPDATEONPROGRAMACTIVITIES• Housingoutreach:AnoutreachworkerfromAtirahasbegunregularlyvisitingSisterSpacetoanswerwomen’s

questionsaboutaccessinghousingaswellasgovernmentservicesforpeoplewithdisabilities.Thepeersupportworkersandtheprogrammanagerhavealsohelpedseveralwomenfindhousingandfilloutapplicationforms.

• Respondingtooverdoses:TwooverdosesoccurredinJuneonSundayJune4thandSaturdayJune10th.Bothoverdosesoccurredataround7:00am,andthewomenreportedusing“down”1.Paramedicswerecalledandonewomanwenttothehospital,whiletheotherdeclined.Neithersituationrequirednaloxonetobeadministeredastheirbreathingremainednormal.

• Safety:Therehavebeenacoupleviolentand/orthreateningincidentswithmenwhohavepartnersthataccessservicesinSisterSpace.Ononeoccasion,amanbroketheglassfrontdoorbutdidnotcomeinside.Thepeersupportworkerscalledpolice,andthemanwasarrested.AcamerahasbeeninstalledtogetabetterviewofpeopleapproachingSisterSpacefromthestreet.

• Outreach:Theprogrammanagerandpeersupportworkershavebeenvisitingotheroverdosepreventionsites(OPS),women-onlyservices,andsingleroomoccupancyhotelsintheneighborhoodtoincreaseawarenessofSisterSpace.TheyhaveputparticularfocusonWISHDrop-inCentreSociety,whichprovidesservicestowomeninvolvedinstreet-basedsexworkandislocatedaroundthecornerfromSisterSpace.WISHstaffrequestedthisoutreachbecausetheyhaveobservedthatmanywomenusesubstanceswhileatWISH.Thisputswomenatriskofoverdose,becauseWISHisnotableobservesubstanceuseandrespondtooverdoseslikeSisterSpacedoes.Byincreasingwomen’sawarenessofSisterSpace,staffofbothprogramshopetoencouragemorewomentoaccessSisterSpace.

• Weeklymeetingswithpeersupportworkers:Theprogrammanagerhasdecidedtoholdmeetingsweekly,insteadofeveryotherweekaswasoriginallythecase.Thesemeetingsareanopportunityforthepeersupportworkerstodiscussquestions,challenges,andsuggestionsasagroup,andgetinsightandguidancebothfromtheprogrammanageraswellasfromtheirfellowpeersupportworkers.

• Theopenhouse:AnopenhousewasheldonJune15th.WomenandmenfromvariousprogramsintheDTESstoppedby,asdidwomenfromthecommunityandseveralpeersupportworkers.Foodwasserved,andtheWildflowerWomanofTurtleIslanddrumminggroupperformedsongsanddidasmudging.

• MediaInterview:AninterviewwithNews1130waspublishedonJune27.TheinterviewdescribeshowSisterSpacehasbeendeveloping,withafocusonthesafetyissuesthathaveemerged.Theonlinearticlecanbeaccessedat:http://www.news1130.com/2017/06/26/violence-men-women-supervised-injection-site-get-busier/

1“Down”isastreettermforanopiate.Somewomenuseittorefertoheroinspecifically,whileotherwomenuseitforanunknownopiate.

SISTERSPACEBYTHENUMBERSHowmanywomencametoSisterSpaceinJune?Figure1showsthedistributionofvisitsperdayinJune.Therewereatotalof332visitstoSisterSpace,witharound11visitsperdayonaverage.Thisisa45%increasefromtheaveragenumberofvisitsperdayinMay.Eveningsweregenerallybusierthanmornings,butnotbyaswideamarginaswasthecaseinMay.WelfareanddisabilityassistancechequesweredistributedJune21st.Therewere17visitstoSisterSpaceonthisday,whichis55%higherthanthemonthlyaverage,andtheaveragenumberofvisitsonthedayssurroundingJune21stwas25%higherthanthemonthlyaverage.However,thereweresimilarpeaksinvisitsthroughoutthemonth,soitisunclearwhetherthisincreaseinvisitscanbeattributedtochequedistribution.

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Figure1:NumberofvisitstoSisterSpaceinJune

Morningvisits

Eveningvisits

CommentsandfeedbackAcommentboxwasaddedinJunesothatwomenareabletoleavefeedbackandsuggestions.TheresearcherhasalsostartedconductingshortsurveyswiththewomenwhoaccessSisterSpaceservices.Hereissomeofwhattheyhadtosay:

“Thestaffarefriendlyandhelpful.Ifinditnicehere.”

“I’mveryimpressedandgratefulforstoppingbyhere.”

“It’sacalmingenvironment.”

“Asatransgenderedwomansafetyisalwaysmy#1concerninanyspacehenceIfeelrespectedandacceptedhere-THANKYOU.”

“Ilovethepeacefulnessandoptionofbeingabletocomehereandit’salovingenvironmentanditssafe,thestaffareamazingandlikehavingtonsofmoms.”

Whathoursdowomencome?Figure2showsthedistributionofvisitstoSisterSpacebytime.Thereisadipinthenumberofvisitsforthelasthourofboththemorningandeveningshiftsbecausepeersupportworkersstopseatingnewwomenaroundahalfhourbeforeclosing.ThisensuresthateveryonehasenoughtimetousebeforeSisterSpacecloses.Womencomefairlyconsistentlythroughoutthemorninghours.SomewomenwhodosexworkhavetoldthepeersupportworkersthattheyvaluehowearlySisterSpaceisopenbecausetheyliketousesubstancesbeforegoingondateswithmenwhoareontheirwaytowork.SisterSpaceistheonlyOPSthatisregularlyopenbefore7:00am.Intheevening,thereisapeakinvisitsfrom21:00-22:59.ItisunclearwhetherthatpeakwouldcontinueintothenightifSisterSpacewereopenlonger.WhatsubstancesdowomenuseinSisterSpace?InJune,newdatacollectionformsweredevelopedthatcollectinformationaboutwhatsubstance(s)womenareusingduringtheirvisittoSisterSpace.Thisinformationwascollectedfor283ofthe332visitstoSisterSpaceinJune(85%),andispresentedinFigure3.“Down”wasthemostfrequentlyreportedsubstanceusedinSisterSpace(48%).“Down”isatermthatcanbeusedwhenthesubstanceissomeunknownopiate.However,itcanalsobeusedasastreetnameforheroin.Itisunclearhowmanywomenwhoreportedusing“down”meantitasasynonymforheroin,andhowmanymeantitasatermforanunknownopiate.Similarly,“side”canbeusedtorefertoanunknownstimulant,orasasynonymforcrystalmeth.Roughly15%ofinjectionsinSisterSpacewereacombinationofsubstances.Allofthesecombinationswereamixtureofastimulantandanopiate.Themostfrequentlyreportedmixturewas“downandside”(75%).Twowomenreportedusingfentanyl.However,manymorewomenlikelyusedfentanylunknowingly,sincealargeproportionofillicitsubstancesinVancouverarelacedwithsomeamountofthehighlytoxicopiate(1).AllsubstancesusedinSisterSpacewereinjected,althoughafewwomenhavecomeintoSisterSpaceaftersmokingsubstancessothattheycanbemonitoredbythepeersupportworkersforanadversereaction.

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Figure2:NumberofvisitstoSisterSpacebyhmeinJune

Heroin,41"Down",136

CrystalMeth,16 "Side",51

Combinahon,49

Morphine,2

Cocaine,2

Fentanyl,2

DMT,1

Other,7

Figure3:SubstancesusedinJune

SISTERSPACEINCONTEXT:THEOVERDOSECRISISANDTHEPUBLICHEALTHRESPONSESisterSpaceopenedonMay16,2017inresponsetoBC’songoingoverdosecrisis.SincetheoverdosecrisiswasdeclaredbypublichealthofficialsinApril2016,overdoserateshaveremainedhigh(2).ThemostrecentstatisticscomefromMay2017,when129peoplediedfromanoverdoseacrossBC,downslightlyfrom136peoplethemonthbefore.Thisismorethan4peopleperdayonaverage(3).FromJanuary1toMay31thisyear,3,626peoplepresentedtoVCHemergencydepartmentsforanillicitorunknowndrugoverdose,themajorityofwhomwerefromVancouverCityCentreandtheDTES(4).OPSareoneofthemainstrategiestoaddresstheoverdosecrisis.Theirprimarypurposeistoprovideaspacewherepeoplecanusesubstancesinthepresenceofotherswhoaretrainedinoverdoseintervention.AsofMarch2017,therewere20OPSinBC,andnoneofthemhaveeverhadanoverdosedeath(5).TherearefiveOPSinVancouver,ofwhichSisterSpaceisthenewest(4).SisterSpaceisalsotheonlywomen-onlysiteinCanada.Researchersandpublichealthofficialshavebeenmonitoringhowoverdoseratesareaffectedbythedistributionofwelfareanddisabilitycheques.ChequesaredistributedonthelastWednesdayofthemonth,knownas“WelfareWednesday”.A2016studybytheBCCentreforDiseaseControlfoundthatoverdosedeathswere40%higherinthedaysfollowingthedistributionofcheques(6).InApril,emergencycallsforanoverdoseinVancouverwere29%higherduringchequeweekthantheyhadbeentheweekbefore(7).Inlightoftheseresults,researchershavesuggestedthatprovincesadjustthewaytheydistributethesecheques(6).InJune2017,chequedistributionhadnocleareffectonthenumberofwomenaccessingSisterSpaceservices.

Whatisthedifferencebetweensafeinjectionsites(SIS),overdosepreventionsites(OPS),andconsumptionrooms(CR)?Allthreearespacesthatallowpeopletousesubstanceswiththegoalofreducingtheriskofoverdosedeath.

• SISarepermanentservicesthathavebeenapprovedbyHealthCanadaandareexemptedfromSection56oftheControlledDrugsandSubstancesAct,whichiswhyitisnotillegaltopossessillicitsubstancesinthesite(8).Insite,whichopenedin2003,istheonlySISintheDTES.Recently,anewSISwasapprovedfortheneighbourhood,andtwowereapprovedinSurrey(4).

• OPSaretemporaryservicesmeanttosupportotherservicesduringtheoverdosecrisis(8).Theirstructureandfunctionvarydependingonlocalneedsandresources,andtheyoftenhavealessmedicalizedenvironmentthanSIS,whichmayincreasetheiraccessibilityformanygroupsaffectedbytheoverdosecrisis(9).SinceDecember2016,sixOPShaveopenedinVancouver,andfiveofthemarestilloperating(4).SisterSpaceisthenewestofthesesites.

• ACRisadesignatedspaceforsubstanceuse,ofteninashelter,hotel,orotherresidentialbuilding.Theseroomsarenotoperatedinpartnershipwitharegionalhealthauthority,andthereforedonothaveasmanyresourcesasanOPSorSIS(8).

NEXTSTEPSFORTHEEVALUATION

• TheresultsofafocusgroupthatwasconductedwiththepeersupportworkersinJunewillbeanalysed• SurveyswillcontinuetobeconductedwithwomenaccessingSisterSpaceservicestolearnmoreabouttheir

perceptionsoftheprogram• Theresearcherwillcontinuetoobserveprogramdevelopmentandactivities• AfinalreportwillbewrittenandreleasedattheendofAugust2017

REFERENCES1.AkinsT.(May15,2017).DrugcheckingatInsiteshowspotentialforpreventingfentanyl-relatedoverdoses.VancouverCoastalHealth.Availablefrom:http://www.vch.ca/about-us/news/news-releases/drug-checking-at-insite-shows-potential-for-preventing-fentanyl-related-overdoses2.KlassenD.,&BuxtonJ.(2016).OverdoserecognitionandresponseintheBCtakehomenaloxoneprogram:ReviewofdatatoJuly2016.BCCentreforDiseaseControl.Availablefromhttp://towardtheheart.com/assets/naloxone/thn-report-aug-final_197.pdf3.News1130.June30,2017.NumberofdeadlyoverdosesinBCdroppedinMay.Availablefrom:http://www.news1130.com/2017/06/30/number-deadly-overdoses-bc-dropped-may/ 4.VancouverCoastalHealth.(May2017).Overdosestatistics-May2017.Availablefrom:http://www.vch.ca/about-us/news/overdose-statistics-may-2017 5.BCCentreforDiseaseControl.(March2017).TheBCpublichealthopioidoverdoseemergency:March2017update.Availablefrom:http://www.bccdc.ca/resource-gallery/Documents/Educational%20Materials/Epid/Other/Public%20Surveillance%20Report_2017_03_17.pdf6.OtterstatterM.C.,AmlaniA.,GuanT.H.,RichardsonL.,&BuxtonJ.A.(2016).Illicitdrugoverdosedeathsresultingfromincomeassistancepayments:Analysisofthe‘checkeffect’usingdailymortalitydata.TheInternationalJournalofDrugPolicy.33:83-87. 7.KimV.(May2,2017).Overdoseshitall-timehighinBritishColumbiaonWelfareWednesday.TheFix.Availablefrom:https://www.thefix.com/overdoses-hit-all-time-high-british-columbia-welfare-wednesday 8.KendallP.R.W.,&StevensonL.(2017).Guidanceforsupportivehousingproviders,homelessshelterprovidersandregionalhealthauthoritiesonoverdosepreventionandresponse.BCMinistryofHealth.Retrievedfromhttp://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/guidelines-and-resources-for-supportive-housing-providers-letter-feb2017.pdf 9.SmyeV.,BrowneA.J.,VarcoeC.,&JosewskiV.(2011).Harmreduction,methadonemaintenancetreatmentandtherootcausesofhealthandsocialinequities:AnintersectionallensintheCanadiancontext.HarmReductionJournal.20:8-17.

Tolearnmore…

TolearnmoreaboutSisterSpace,pleasevisittheAtirawebsiteathttp://www.atira.bc.ca/sisterspace-overdose-prevention-site

Forfurtherinformationabouttheevaluation,pleasecontactMadisonThulienatmadison.thulien71@gmail.com