Fears of exposure to illicit drugs in public places based on politics, not facts

Recent news stories from B.C. have featured concerns from nurses about symptoms reported after exposure to second-hand smoke from non-prescribed substances, such as fentanyl and crystal methamphetamine, a consequence of the toxic drug supply that has killed 42,494 people in Canada since 2016, more than 11,000 of them in British Columbia.

There is no question that there is a crisis – deaths from toxic drugs increased nationally by 8 per cent between 2022 and 2023. In B.C., Alberta and Ontario, inhalation of drugs is the most common cause of toxic drug supply deaths – 72 per cent of these deaths in B.C. were the result of inhalation. But the number of overdose prevention sites that allow inhalation do not reflect the vast increase in need for such service. There are only 26 sites in Canada that offer support for people to inhale their drugs safely, with most located in B.C.

Safe consumption sites allow for people to use pre-obtained drugs under the supervision of trained staff who provide harm reduction education and emergency response if needed. Lack of access to supervised inhalation means users have no choice but to use in public spaces for safety or in private residences where they are at risk of unwitnessed overdose and subsequent death.

Health-care providers deserve to have a safe workplace, and this includes accurate information about their environmental risks. Health care is rooted in evidence, and the vast majority of practice changes are thoughtful and rigorous processes that have a strong evidence base. Despite this, reactive policies have been highly political rather than rooted in evidence.

A number of studies, plus anecdotal experience from nurses who work in supervised consumption spaces, demonstrate negligible risk from exposure to second-hand fentanyl or crystal methamphetamine smoke. Workplace and residential research from New Zealand and the U.S. shows no long-term health impacts from brief airborne or surface exposure to fentanyl or crystal methamphetamine. There are some short-term effects reported but these have been mild, such as throat irritation or watery eyes. It is important to note that methamphetamine does not accumulate in the body and is not considered to have high intrinsic toxicity; otherwise it would not be used as a therapeutic medication for ADHD. Thus, long-term adverse health effects from exposure are highly unlikely.

Available workplace safety recommendations acknowledge that short-term exposure to inhaled drugs may be expected in a workplace setting. Though personal protective equipment recommendations may include a mask and gloves, the recommendations are not made because of a certainty of risk, but rather because the absence of risk cannot be confirmed. Considering the available evidence, the perception of the risk and the reaction to second-hand smoke in health-care settings has been disproportionate.

As authors of this article, we have a collective 28 years of experience working in supervised consumption sites and outreach in homes of people who smoke illicit substances, equating to hundreds of hours of second-hand exposure. None of us have experienced adverse health implications. In Vancouver’s downtown eastside, hundreds of health authority staff, housing providers and non-profit workers enter in and out of spaces each day where smoke from illicit substances is present, yet anecdotal reports of illness from exposure are nearly non-existent in the community.

Is second-hand exposure to drug smoke truly as unsafe as the media portrays it, or does stigma have a larger role to play?

This does not negate the experiences of those who report symptoms or the rights of health-care workers to be safe at work. It can be distressing for people to witness drug use for a number of reasons. This distress can cause symptoms but it is not the result of exposure to drug smoke. The distinction between safety and comfort is important: Is second-hand exposure to drug smoke truly as unsafe as the media portrays it, or does stigma and discomfort around drug use have a larger role to play? Health-care providers deserve accurate information so they can advocate for their safety and the safety of their patients.

But instead of funding evidence-based public health interventions like Overdose Prevention Sites for Inhaled Substances, there have been reactionary policies that ban people from using drugs in public spaces and health-care settings. Recently, B.C. walked back its pilot project decriminalizing drugs for personal use in public places; Toronto had its request for a similar pilot project disallowed. Policies like these drive people to use alone, in private spaces because they experience discrimination from the health-care sector when seeking support.

A tragic example of the harm perpetuated by removing safe places for people to use drugs is Lethbridge, Alta. Lethbridge used to have a safe consumption site that supported people who used drugs, including via inhalation, and was the busiest safe consumption site in Canada. Since the site’s closure in August 2020, the rate of toxic drug deaths has risen more than 230 per cent; Lethbridge is now the municipality with the highest death rate in Alberta.

The perpetuation of these policies not only misinforms but also harms both nurses and people who use drugs. It stigmatizes people by incorrectly portraying them as sources of danger. The implications of this messaging are twofold: people who use drugs feel unwelcome and unsafe accessing health-care services, and it can lead to hesitancy among health-care professionals when responding in emergencies. Even a short delay can be lethal for patients.

From a workplace perspective, it is unfair to let health-care providers believe they are working in an unsafe environment. Health-care providers deserve an accurate assessment, not one driven by false information and fear. The distress from working in an environment that has falsely been deemed “unsafe” is a contributor to burnout, which has significant implications in the current nursing crisis.

The political narrative has polarized nurses and patients, prioritizing the safety of one group over another when evidence shows that both are possible.

As nurses, we call for evidence-based health and social policies that prioritize the safety of health-care workers and patients alike and address the root causes of substance use disorders. We call for the establishment of safe inhalation sites in every single community; for resources to be put into public education aiming to decrease stigma around substance use; for a legal and regulated supply of substances; and for evidence-based health and safety protocols.

Let’s get back to practices rooted in evidence and compassion, rather than stigma and discomfort.