A satellite emergency room established in Vancouver's Downtown Eastside to help relieve pressure from emergency departments amid the overdose crisis will stop accepting patients next week as it begins phasing out operations.
Instead, low-risk overdose patients who would have been taken to the Mobile Medical Unit (MMU) will be taken to a nearby community clinic – a first in B.C. after Health Minister Terry Lake signed an order on Thursday allowing paramedics to transport such patients to alternative health-care facilities rather than hospitals.
The mobile unit, a trailer that can expand to 1,100-square-feet in an empty lot in the Downtown Eastside, opened in December as health officials struggled with a worsening overdose crisis that killed more than 900 people across the province last year, 215 of them in Vancouver.
City officials estimate about 100 people have died of overdoses in Vancouver so far this year.
The MMU was intended to relieve pressure from the emergency departments at St. Paul's and Vancouver General hospitals and free up paramedics more quickly for other 911 calls. Currently, overdose patients in serious condition are transported to hospital while stable patients are taken to the MMU, where physicians and nurses monitor them and offer them addiction treatment options.
While most visits in the first few weeks of operations were for overdoses, three months' of data now show they account for only about 22 per cent of visits. From Dec. 13, 2016, to March 26, the MMU logged 2,561 visits; of those, 566 were for overdoses.
"Almost 2,000 [visits] were people walking up for addiction treatment or harm-reduction supplies or other things," said Patricia Daly, chief medical health officer and vice-president of public health for Vancouver Coastal Health.
From March 12 to 18, the MMU averaged 26 visits a day. Only 11 that week were for overdoses.
Moving forward, paramedics will take low-risk overdose patients to a facility such as the DTES Connections clinic, which opened on March 1. The clinic offers same-day starts on opioid-substitution therapies methadone and Suboxone, which few clinics offer but are crucial in capturing drug users in the moment they are ready for treatment.
This strategy was outlined in a BC Emergency Health Services action plan that noted that many patients assessed as non-urgent can receive the care they require and have better health experiences without going to a hospital emergency department.
Dr. Daly emphasized that the MMU's closing is not a retreat in the fight against the overdose crisis but rather a transitioning of services into permanent, purpose-built locations such as DTES Connections.
"We don't want people to think that they're abandoned in the Downtown Eastside," she said. "We're prepared to reactivate the MMU if we need to. We also don't want to give the impression that the crisis is over, because that is not the case."
About 90 per cent of illicit-drug overdoses happen indoors. Dr. Daly said this speaks to the need to focus efforts on single-room occupancies and other supportive housing units with initiatives such as training staff to administer naloxone and establishing shared using rooms or overdose-prevention sites within facilities so people do not use alone.
As well, Vancouver Coastal Health is pushing hard for an expansion of opioid-substitution therapy to get people off of street drugs, the majority of which are laced with fentanyl and its analogues.
Mayor Gregor Robertson has called for the federal government to urgently fund the expansion of various treatment options.
"The [MMU] has saved hundreds of lives with invaluable emergency care and treatment-on-demand over the last several months, but it will soon be shutting its doors," Mr. Robertson said in a statement.
"We desperately need the B.C. government to spend the recently received $10-million from the federal government to combat the fentanyl crisis to broaden access to clean prescription drugs, substitution therapy and treatment-on-demand."
Outreach staff will remain on site at the MMU during the transition period to redirect visitors. The MMU will close at the end of May.