OTTAWA — Katrina Adams has thought about getting a tattoo for all of her friends who have died in the past two years from opioid overdoses but she doesn't think she has enough room on her body for all the names.
Instead, the 27-year-old has pictures of many of them in her Ottawa apartment, along with images of her two children.
Opioid addiction leads to daily Russian roulette, she said. The supply of drugs on the street is unpredictable, a mix of different chemicals of different potencies. Ottawa police recently tested a sample of stuff being sold as heroin and found it contained no heroin — it was extra-potent fentanyl, mixed with fillers.
Adams knows from experience: she's overdosed seven times, including during her last pregnancy.
"There's no way to tell what you're taking out there from one day to another," Adams said. "I have died; I have come out the other side."
Adams said she has found new hope, however, through a program in Ottawa where she can take intravenous hydromorphone — an opioid known commercially as Dilaudid — up to seven times a day, prescribed to her by a doctor. Participants live in an apartment building in a neighbourhood west of downtown where they can get regular medical care and support.
"I'm not sitting in an alley ... shooting up with puddle water and (with) drugs that I have no idea where they came from," Adams said. "As much as safe injection sites have saved lives because they are there to intervene when the overdose actually happens, these safe injection sites actually have no way of preventing the overdose itself."
Dr. Jeffrey Turnbull, a former chief of staff at the Ottawa Hospital and president of the Canadian Medical Association who has worked closely with the city's homeless population for 20 years, is instrumental in the program. It began about a year ago as Ottawa faced the enormity of the opioid epidemic, with numerous daily overdoses and frequent deaths, and it's aimed at exceptionally high-risk opioid users.
"They were injection-opioid drug users but it was all the poison that was in the heroin that were placing them at an even higher risk — fentanyl, carfentanil, newer metabolites," he said.
"We felt that if we could take away the challenge of getting drugs, the criminality of that, take away the risk of a poisonous drug supply, stabilize the craziness of their lives ... then we could start to work on some of their other, underlying medical and mental health challenges."
The Public Health Agency of Canada released new data this month showing that more than 3,200 Canadians died of apparent opioid-related overdoses between January and September last year alone — a window into the epidemic that rages across the country, particularly in B.C., Alberta and Ontario, despite government interventions.
The federal agency also reported fentanyl and other fentanyl-related substances continue to be a "major driver" of Canada's opioid crisis, with 73 per cent of deaths from apparent accidental opioid overdoses in the nine-month span involving the drug.
The rising death count has prompted numerous health experts, including B.C.'s provincial health officer, to urge the federal look at ways of supplying safer opioid drugs — an avenue being explored by the country's chief medical officer Dr. Theresa Tam and Health Minister Ginette Petitpas Taylor.
The latest federal budget proposes funding of $30.5 million over five years, starting this year, on targeted efforts to address "persistent gaps in harm reduction" and treatment.
"Specifically, funding will support efforts to expand access to a safe supply of prescription opioids," it says.
Conservative health critic Marilyn Gladu said pursuing a safe supply focuses on the wrong things.
"I think they need to be looking at a more holistic solution with prevention and recovery," she said. "I think people have compassion for those that are addicted but we need to get them off drugs."
It is critical to both decriminalize and medically regulate the supply to save lives, said NDP health critic Don Davies.
"The problem, if we name it, is there is a toxic, poisoned, street supply," he said.
Davies notes the death toll from opioids has gone up every single year. "Does that tell you that (the Liberal government's) policy response is working? It's not."
As political discussions unfold on policy, the crisis carries on.
The rationale for the program Adams is in is similar to the one behind a managed alcohol program that has operated in Ottawa for almost 20 years, which Turnbull also helped launch. Participants live in a building run by a shelter organization and get rations of wine once an hour. When they aren't always thinking about finding their next drinks, and can't binge, they can attend to other things.
Studies have found that people with severe alcohol disorders who are in such programs — there are versions in cities across the country — have fewer hospital visits and fewer problems with the law than those who aren't.
It would be a "game changer" to think of making safe opioids available through different channels, depending on users' needs, Turnbull said. He believes Canada needs to have a broader discussion about whether it's on the right track in its anti-overdose efforts.
"I believe that we are going to have to think seriously about drug policy in this country in the face of an epidemic that kills more people than motor-vehicle accidents and suicides," he said. "It is very hard for the police to arrest their way out of this problem and we are really going to have rethink how we deal with drugs and how we think of the criminality of drug use."
Addiction accelerates to a point where using drugs stops being a choice, Adams said.
She said expanding access to safe drugs would help give opioid users like her the chance to also see what they're capable of, like rebuilding relationships, working toward employment and being able to make scheduled appointments.
"These might seem like small things in the grand scheme of things but for us, this is huge," she said. "We are becoming functioning members of society again."
—Follow @kkirkup on Twitter