Man survived COVID-19 outbreak at Hamilton shelter, but not opioid crisis

Scott Rupert survived a pandemic, then fell victim to an epidemic.

The 49-year-old lived through a coronavirus outbreak at the Salvation Army in downtown Hamilton but died of an opioid overdose in his room there in late March.

He was kind. He was sweet. He was a gentle guy," Jeff Vansickle, a friend who's still staying at the Booth Centre, recalled this week. He just had his pains, right?"

Vansickle says Rupert was one of many at the York Boulevard shelter who took part in a temporary arrangement that saw men take addiction medicine under the supervision of medical professionals and volunteers during the outbreak.

That was working for him. He didn't have to ask someone like me to stick their nose in his business."

But as the outbreak, which was declared Feb. 10, waned in late March before cresting at 63 cases, the initiative drew to a close, too.

Rupert died a week later.

He just got cleared, so he was back in his room," Vansickle said.

The emergency response, a partnership with the Hamilton Social Medicine Response Team and others, was open to all at the men's shelter.

But it aimed to prevent those from leaving isolation to acquire drugs on the street and potentially spreading the virus in the process.

I think it really did benefit in keeping them in place, at least for that isolation period," said Eminet Dagnachew, a regional director with the Salvation Army.

Men visited the basement clinic 129 times to take addiction medicine, including hydromorphone, an opioid painkiller, over the four-week initiative.

Keeping Six, a harm-reduction group, St. Joseph's and Hamilton Health Sciences' in-patient addiction-medicine services, public health and paramedics also supported the effort.

Dr. Claire Bodkin credits the Salvation Army for allowing the initiative to happen.

I think it's huge leadership that they've shown. No other shelter in the city has done this."

The continuation of such a program would help people with addictions who are experiencing homelessness, says Bodkin, a member of the social medicine response team.

I think the fact that someone died after the site closed shows that, whether or not there's an outbreak, there's a need for safer drug-use spaces in our shelters."

Dr. Jill Wiwcharuk, a street outreach physician also with the team, agrees.

It is one of the tools in the tool kit that's going to work for some people that are struggling with addiction."

After the Booth Centre effort ended, doctors suggested the service be transferred to Bennetto Community Centre, which had been converted into a COVID-19 isolation space in the North End for people experiencing homelessness.

But the proposal didn't fly with the city. A city spokesperson wasn't able to provide a response by deadline Thursday.

The Salvation Army, however, would consider exploring the potential for a longer-term, safe-space service based on the emergency response's data, Dagnachew said. It would have to be more structured."

Vansickle, meanwhile, is adamant his friend would be alive today had the project continued. Absolutely."

Before he wound up at the shelter, Rupert had lived with some people who also used drugs, but it didn't last and he ended up on the street.

He cared about himself enough still, you know what I mean? He still had enough grip on things ... He never wanted to be addicted. Nobody ever does once they are."

But the day before he died, someone had given Rupert heroin, Vansickle recalled. The 55-year-old had to work the next day, so he left his friend to get some sleep that night.

The next morning, when he went to check on Rupert, he was seated but slumped over in his room.

Personally, I'm furious over it. I'm just absolutely enraged."

The Salvation Army declined to speak about overdoses at the Booth Centre for this article, but Vansickle and others say they have not been uncommon there.

Shelters in Hamilton don't allow drug use on their premises, but they're still consumed inside despite the rules. The discovery of stashes and needles can mean the end of a person's stay.

Under such circumstances, people are particularly vulnerable to overdoses because they tend to use furtively - quickly or out of sight - fearing they will be kicked out, Bodkin noted.

But during the temporary project, there wasn't a single overdose in the supervised space, she emphasized.

There were some overdoses elsewhere in the facility, but there were no overdoses on the site because people could take their time and also had access to safer supply."

The COVID-19 pandemic has coincided with an increasingly unpredictable supply of opioids, including fentanyl and heroin, that has left drug users with greater uncertainty of what might be mixed in with the product they purchase.

A study released last week found Hamilton and other parts of Ontario experienced a spike in overdose deaths during the pandemic in 2020 amid an opioid crisis that had already raged for years.

Between March and December 2020, there were 2,050 opioid-related deaths (suspected and confirmed), compared to 1,162 during the same period in 2019.

The joint analysis by the Ontario Drug Policy Research Network, Office of the Chief Coroner for Ontario and Public Health Ontario noted 110 deaths in Hamilton during the pandemic in 2020. In 2019, the tally was 77 over the same span of months.

The study suggested several factors were likely behind the spike in deaths, including altered access to health care and community programs that support people who use drugs, more isolation due to efforts to control the pandemic and the volatile market of street drugs.

At 87 per cent, fentanyl remained the most prominent direct contributor of deaths, but the involvement of nonprescribed benzodiazepines, which are sedatives, saw a tenfold increase in opioid-related fatalities during the pandemic.

Locally, public health, doctors and drug users have expressed concern over opioids mixed with benzos," a concoction that can make it more difficult to revive someone from an overdose with naloxone.

The Ontario study found the number of deaths among people who were homeless during the pandemic more than doubled to 323, representing 16 per cent of all of the province's fatalities.

The volatile market and high number of deaths involving various substances bolster the case for more harm-reduction services, including access to naloxone, addiction medicine programs, a safer supply of regulated drugs and safer spaces to use drugs, the authors concluded.

The synergistic effects of the COVID-19 pandemic and Ontario's overdose epidemic have led to a continued escalation in the rate of opioid-related deaths across the province, demonstrating that rapid action is needed to support people who use drugs as this pandemic continues to evolve."

Jeff Vansickle concurs, saying it's just common sense" to provide services where people are living.

I would say half the people that I know are dying of this crap these days."

Vansickle isn't sure how, but he dodged coronavirus during the Salvation Army outbreak, where he has stayed while waiting for work with a home renovation crew to pick up again.

He has also managed to steer clear of the opioid epidemic.

I'm 21 years clean, by the way," Vansickle says, then adds with a chuckle, I just don't want to die. Nothing to do with willpower, trust me."

Teviah Moro is a Hamilton-based reporter at The Spectator. Reach him via email: tmoro@thespec.com