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Inside Ottawa's ambitious experiment to reduce drug overdoses


Record numbers of people in the U.S. are dying from drug overdoses, more than 100,000 deaths a year. And now, public health experts here are watching a controversial experiment underway in Canada. It aims to keep drug users alive, not by curing their addiction but by helping them get high more safely. NPR addiction correspondent Brian Mann reports.

BRIAN MANN, BYLINE: Ann Marie Hopkins takes me down a street in Ottawa, Canada's capital, where dozens of people lie on the sidewalk.

ANN MARIE HOPKINS: We do have quite a lot of overdoses out here. Hi, honey, how are you?

MANN: Hopkins runs a program here for people with addiction. But these days, that means scrambling all the time just to keep patients alive.

HOPKINS: We've got port-a-potties that you have to check for bodies.

MANN: Addiction has changed. It used to be a chronic illness, something most people struggled with before eventually recovering. Now, street drugs in the U.S. and here in Canada are far more deadly, laced with powerful synthetic opioids like fentanyl and other toxic chemicals. So Hopkins says her philosophy of addiction care also had to change. She sums it up in a single sentence.

HOPKINS: There is no recovery if you're dead.

MANN: So here in Ottawa and other cities across Canada, addiction workers are partnering with doctors, nurses and pharmacists to create addiction programs to help people even when they're not yet willing to give up the drugs that get them high.

Pardon me.


MANN: Hey there.

Hopkins takes me inside her clinic where half a dozen people are sitting in little booths. They look sort of like the study desks you'd see in a library. They're shooting up, injecting heroin and methamphetamines purchased from street dealers. Hopkins says these people can get in trouble fast, so her team watches every user on a closed-circuit TV screen.

HOPKINS: He's taking a look right now. He's watching somebody inject. If he were to see, like, say, for example, this gentleman not doing well, he would yell out to the staff on the floor, hey, go check eight and make sure they're OK.

MANN: It's troubling to watch. Overdoses happen here all the time, just like they do out on the street. But in this clinic and similar clinics across Canada, nurses stand by ready to help. During my visit, a woman slumps forward in her chair.

HOPKINS: The individual in that booth is under, like, a very mild overdose. We're just going to pop her on just a little bit of oxygen, probably a very low level, just to make sure that she doesn't dip down further.

MANN: Some forms of harm reduction have been around for years in the U.S. and Canada. More communities are distributing naloxone. It's a drug that reverses opioid overdoses. They're handing out clean needles to help people with addiction avoid diseases like HIV and hepatitis. The harm reduction experiment here in Ottawa is more radical, more controversial. In most of the U.S., this kind of care would be illegal. But the people who come here to use drugs say it's a lifeline.

SHELLY: The staff here are very special people to come and be here with us, for us.

MANN: Shelly, who doesn't want to share her last name, just finished injecting opioids in one of the booths. She says using drugs outside on the streets is frightening. She tells me about a recent overdose that happened in a place with no medical care, no safety net.

SHELLY: I was thrown in a bathroom with cold water, and when I came to, my friends were smoking crack. And I could have probably died in that bathtub. I see it every day. I see overdoses. And I have - many, many friends have lost their lives.

MANN: I want to pause here and acknowledge this may sound a little crazy. If people experience this much danger using drugs, why don't they just stop? Why not get the kind of addiction treatment aimed at full recovery? But studies show tens of millions of people in the U.S. and Canada who use illegal drugs either can't quit or aren't yet willing to try. So the question is how can the health care system help people who are still using these high-risk drugs?

MAX: Hi, I'm Max.

MANN: I meet Max at another Ottawa clinic a half-hour drive away. He's sitting with a fantasy novel, waiting for a session with one of his caseworkers.

MAX: I used to be a complete mess before I got on this program.

MANN: He's 26 years old and tells me he's used methamphetamines since he was 12.

MAX: I used to be a very heavy meth user. I used to inject a gram of meth in a shot every day, three times a day.

MANN: So Max now comes to the pharmacy in this clinic every week for another form of experimental harm reduction not available in the U.S. It's called safer supply. With a doctor's prescription, he gets enough Ritalin that he can inject it to get the high he craves without buying high-risk meth on the street. He joined the program after an overdose nearly killed him.

MAX: I spent three months in the ICU. And that's when I got on safe supply, is when I came out of the ICU. And it - basically, I'm pretty sure it saved my life.

MANN: So that's the big win. Max is still alive. He says he's also using smaller doses of drugs, trying to taper his addiction. And while he's here, he gets other kinds of medical care, and he's working with a social worker to find permanent housing.

Now, here's why addiction experts in the U.S. are paying attention to what's happening in Canada. The U.S. is seeing an even bigger surge of drug overdoses. And public health officials are embracing this idea that helping people with addiction survive has to be a first step. Dr. Brian Hurley is with ASAM, the top organization in the U.S. pushing for better addiction care.

BRIAN HURLEY: There is a tremendous number of Americans at risk for overdose that are not going to go into treatment, or at least they're not going to go into treatment right now. And if we say, well, wait until they're ready, they might be dead.

MANN: ASAM hasn't taken a position on doctors prescribing drugs to people who use the medications to get high. Hurley says they need more data first, more research. But ASAM supports the idea of supervised drug use clinics, like the ones in Canada, opening across the U.S.

HURLEY: I think that we should see more communities start and test safer consumption sites, see what works and what doesn't and make modifications in order to bring these to scale.

MANN: It's common for Americans to romanticize health care in Canada, so a note of caution is important here. People working in Ottawa's harm reduction network don't claim their programs offer anything like a quick, easy solution. Yes, services and health care for people using drugs have gotten better, but street drugs also keep getting more powerful, more toxic. Ann Marie Hopkins says even with their best efforts, a lot of people are still dying.

HOPKINS: It's completely exhausting for the team. We have a very high rate of burnout. Yeah, it's definitely very emotionally taxing on the staff.

MANN: But Hopkins is convinced that with more clinics like hers and better public health care for people still actively using drugs, a lot more lives could be saved, both in Canada and in the U.S.

SUMMERS: And NPR's Brian Mann is here with me now. And, Brian, a lot of these approaches that you've been reporting on, well, they're quite controversial. Could we see them perhaps tried here in the United States?

MANN: You know, Juana, a couple of years ago, I would have said no. You know, there are still big ethical debates even within the addiction and health care communities over some of these approaches. But these drug deaths just keep rising astronomically. The medical journal The Lancet has predicted that another 1.2 million Americans will die from overdoses by the end of this decade. So we're seeing more public health responses that once seemed impossible, they're now on the table.

SUMMERS: And at one of the clinics you visited, there were people who were injecting street drugs under medical supervision. Is there anything like that now here in the U.S.?

MANN: Yeah. We've seen two supervised injection clinics open in New York City last year. People in other states are considering similar pilot programs. A big question now is what position the Justice Department will take on this kind of harm reduction. Right now, what's happening in Canada would be illegal under U.S. law, but the DOJ is doing a policy review right now. If they allow safe injection sites to open, that would be a game changer.

SUMMERS: NPR's Brian Mann, thank you.

MANN: Thank you. Transcript provided by NPR, Copyright NPR.

Brian Mann
Brian Mann is NPR's first national addiction correspondent. He also covers breaking news in the U.S. and around the world.

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