Six years after the opening of supervised drug use sites in the city, and while a serious overdose crisis continues to claim thousands of victims across the country, the lack of nurses is seriously affecting the effectiveness of these essential harm reduction services.

According to overdose monitoring data from the Montreal public health, there will be an average of 14.3 deaths per month in 2022-2023. This represents an increase of almost three deaths per month compared with the previous year.

Saying they wanted to draw attention to the situation, dozens of care professionals recently took to the streets in a symbolic action, simulating their own deaths in the middle of the street. Their aim was to draw attention to "the risk of death if nothing changes", according to Montreal south central health and social services union (FIQ-SPSS Centre-Sud).

"Services are not 100 per cent available to the population," said Denis Joubert, president of the FIQ-SPSS Centre-Sud.

In his view, the problem is not related to a shortage of staff, but to a lack of will on the part of the regional public health directorate (DRSP) and the CIUSSS du Centre-Sud-de-l'Île-de-Montréal.

The union believes that by applying the current collective agreement, which already provides for certain incentives, it would be easy to gather enough volunteer professionals to work in supervised consumption services (SCS).

"We're not talking about 20 nurses, we're talking about 10," said Joubert. "I'm convinced that with real political will, we'll get there."

At the CIUSSS, director of human resources Martyne Charland said that a recruitment drive is underway and that they are currently looking to fill two part-time SCS positions.

Dr. Carole Morissette, Medical Advisor in STBBI Prevention and Drug Harm Reduction at the DRSP, predicts that a full team will soon be in place.

"We're committed to ensuring that we do everything necessary to reduce deaths and overdoses. We believe that nurses are a complementary offer to community services," she added.

RESIGNED ORGANIZATIONS

In a written statement sent to The Canadian Press, CACTUS Montreal executive director Jean-François Mary said he was raising the same issues as the union of care professionals in his representations to the CIUSSS and the Quebec health ministry.

"(The lack of staff) means that our services are uncovered, which enormously complicates operations, makes schedules unstable and limits access to the service, while we are faced with two overdoses a day on average," at the CACTUS Montréal SCS, he explains.

At Spectre de rue, executive director Annie Aubertin admits that she is a little less affected by the absence of nurses because her organization caters to daytime clients.

She points out, however, that when this happens, she has to compensate by adding staff at the organization's expense, which puts pressure on its already fragile finances.

Aubertin dreams of greater cooperation from the healthcare sector.

"We provide support to individuals, but also to the network. We're part of that big system," she said, noting a certain amount of contempt. "At Dopamine, in the Mercier-Hochelaga-Maisonneuve borough, there is no denying that the number of nurses promised in the original plan has never materialized. As soon as SCS opened, we realized that we would not be able to count on the presence of a nurse seven evenings a week as agreed."

Over time, the occasional absences became permanent.

The organization's general manager, Martin Pagé, said he can count on his fingers the number of times a nurse has turned up at Dopamine since the pandemic began in the spring of 2020.

He estimates that opening four sites simultaneously in the summer of 2017 in Montreal quickly exhausted the small bank of qualified nurses to work there.

In addition to Spectre de rue, CACTUS Montreal and Dopamine, the Anonymous bus crisscrosses the streets of the city to reach users.

"It's a demanding job that requires a lot of supervision," said Pagé. "You can't just parachute into a drug consumption room, whether on a social, community or nursing level."

WASTED OPPORTUNITIES

"In the day-to-day management of a supervised consumption site, you need predictability," said Pagé. "You have to be able to count on your people to welcome marginalized clients in need of services. For the system to work, users have to know that the door will be open when they arrive."

As a result, Dopamine soon modified its operating model to operate without the presence of nurses.

However, Pagé is not closing the door on the return of care professionals because their skills can be of benefit to users.

The marginalized people who frequent SCSs are often reluctant to seek health services for fear of being judged or ostracised.

This is why the presence of medical staff on the organizations' premises can become an opportunity to offer other services. These may include wound care, screening for STIs or any other type of preventive care related to the reality of living on the streets.

This report by The Canadian Press was first published in French on July 5, 2023.