A local organization that works with homeless youth in Ottawa is sounding the alarm over an increase in drug-induced health effects among young people as the homelessness and toxic drug crises persist.
Operation Come Home is an Ottawa organization that works with youth between the ages of 16 and 25 and helps to connect them with counselling and social services. For the staff there, it’s no surprise that prolonged drug use has adverse side effects. But as the drug supply becomes more complex, and with one of Ottawa’s safe consumption sites set to close down, executive director John Heckbert says his team is seeing increasingly “pervasive” health impact among the young people they serve.
The opioids circulating on Ottawa streets, including fentanyl, have been one of the main culprits in overdoses. But as the drugs become more toxic and laced with other substances, the drugs get more addictive, resulting in more overdoses, and it can be more difficult to reverse, said Heckbert.
Issues like gender and sexual identity, economic status and family situations put youth more at-risk. Youth can become homeless after leaving foster care or the welfare system, but also can choose to leave their homes.
“Sometimes the family has their own challenges around mental health or substance use and it’s a question of safety or care and well-being for the young person who was either forced to leave or decides to leave,” explained Heckbert. “In some cases, families experience exacerbated conflicts right now because inflation and cost of living increases put a lot of stress on families, and so if there’s existing conflicts that are happening in the home, those things get a lot worse and they start to have these more intensive arguments.
“Unfortunately, right now, we are also seeing a lot of youth who are either identifying as transgender or as a member of the queer community, being Two-Spirit, LGBTQ plus, and more and more of those youth are getting kicked out,” he continued. “There’s a greater intolerance among certain areas, and I think it’s an identity question for teenagers.”
The increased toxicity of the drugs is also being exacerbated with the presence of xylazine, a non-opioid that is traditionally used as a sedative and anesthetic for animals. Xylazine use among people who use drugs has been reported since the early 2000s, but was first identified in the unregulated drug supply in Canada in 2012, the Canadian Centre on Substance Use and Addition (CCSA) found.
A report from 2022 found that traces of xylazine found in Canada’s unregulated drug supply were leading to an increased risk of overdose. The centre found the drug has been used as an additive, mixed with other illicit drugs to enhance the potency and “bulk up” the drug quantity in order to increase profits.
Xylazine can lower heart rate, blood pressure and breathing and significantly increase the risk of overdose and death. In some cases, users are unaware that it has been added to their drug supply, raising the risk.
The CCSA also found that for overdoses involving combinations of xylazine and opioids, naloxone can reverse the opioid effects but has no effect on xylazine.
“This can impact the success of the overdose response,” the report said. “There is no pharmaceutical antidote specifically for xylazine.”
Fentanyl test strips also cannot detect xylazine.
Among the 90,701 samples of seized drugs analyzed by Health Canada Drug Analysis Service
between May 2022 and April 2023, 13,957 (15.4 per cent) were positive for fentanyl and 1,331 (1.5 per cent) were positive for xylazine.
Compared to all provinces and territories, Health Canada identified the highest presence of xylazine in Ontario.
The drug’s presence among the unregulated drug supply in Ottawa is raising the stakes, Heckbert said, making an already dangerous situation even more deadly.
“There are very, very dangerous opioids and synthetic drugs out there right now. They’re much cheaper to produce, I think, than they ever have been, they’re very cheap at street level, and they’re intensely addictive and dangerous,” he said. “Usually, about one in eight [young people] we see self-identify as people that have really significant challenges with their substance use.
“They come to us because they wanted to reduce or end their substance use, or they wanted to change some of their behaviors around it, or feel more safe about it. We’ve learned part of the reason why people are seeing more substance use downtown, just generally, is that the youth themselves are saying they have to use in public spaces because if they have an overdose, they want somebody to see them so that they don’t just lay there and die.”
Data from Ottawa Public Health shows that opioid overdose occurrences are focused in the downtown core of the city, particularly in Centretown and Lowertown.
Like many community organizations, Operation Come Home is grappling with a major health crisis unfolding across the country and trying to keep up as the risks change.
“The concern right now is that overdoses, and repeated overdoses particularly, will cause lasting brain damage for people that experience them,” he explained. “And the overdoses from opioids are significant because they’ll shut off oxygen to the brain.
“If somebody passes away on the street and then is later revived with Naloxone, you know that depending on how long they’re under and how much is required to revive them, [the damage] can be significant, too.”
People who are revived from repeated accidental overdoses are showing long-term health impacts, including brain injury, Brain Injury Canada has reported. The prolonged lack of oxygen to the brain has “catastrophic” and permanent effects.
These effects, while relatively “new”, are “not unusual anymore,” he continued. Youth are displaying atypical changes in behaviour, he said.
One individual, a 17-year-old young man, became street-involved after conflicts at his home, including violence with his stepfather, Heckbert recalled. The youth, who Heckbert referred to by the alias James, was in and out of the child welfare system and had been staying at a church. He was also combative and reactive with staff, Heckbert said.
“He was very, very angry, which as a young man is fairly normal because he’s got a lot that he can be frustrated about. Life has not gone very well for him, and he’s not had an easy go,” said Heckbert. “But in the last six months, he’s not an angry man anymore.
“He’s hardly responsive at all, very withdrawn, not talking. When he’s asking for things, he’s quite meek,” Heckbert explained. “You know, this isn’t typical of our experience at all. We don’t usually see a progression where the more the clients become street-involved, they withdraw and become so passive.”
The changes in behaviour can make it more difficult for staff to counsel youth and connect them with resources.
In an Ottawa Public Health (OPH) survey from 2021, 10 per cent of students in grades 7-12 reported using opioids.
OPH has been working together with various levels of government and community organizations to address the “increasingly toxic and unpredictable unregulated drug supply”, OPH told Ottawa Compass — including how it is impacting youth.
“A key part of OPH’s work is prevention of harm by supporting and fostering resilient communities that support children and youth,” a representative said. “OPH’s training to reduce stigma and provide harm reduction strategies that engage people who use drugs are activities that can result in more people linked to care and treatment.”
In January, Operation Come Home received $1.3 million from Health Canada to extend its counselling and substance use programs.
At a press conference in Ottawa on Monday, Yasir Naqvi, Ottawa Centre MP and Parliamentary Secretary to the Minister of Health announced the funding, which will be allocated to a peer-led program and allow OCH to hire additional counselling and support staff.
The program is led by peers with personal experience with homelessness or substance use and will deliver information, resources and harm reduction support, first-aid and overdose response training, and ongoing access to social supports and counselling.
The staff will also work closely with hospital and treatment centre programs, Naqvi added, to deliver wraparound services.
For Heckbert and his team, the governmental funding will be a “game changer” for downtown Ottawa.
“Over the last year, we’ve had to respond to more overdoses here than we ever have in our cumulative history, up until last year,” said Heckbert. “Just last week, a young woman around the corner from us passed away in the alleyway, but we were able to revive her after two of our staff had to administer CPR and several doses of naloxone.”
“It’s just a lot.”
And while he said overdoses might not immediately decrease, the harm reduction and preventative care that his team will be able to provide through the new funding will save lives. By working with caseworkers, youth can be connected to the resources they need to find housing, educational help or addiction treatment.
“Our goal is to try and reach as much of the street-involved population as possible so that we can get them under our caseload,” said Heckbert. “We can start talking to them immediately about how to keep themselves safe, and we’re going to give them all first aid training and the Naloxone training, so that we build a network of people in Ottawa that are out there on the street that know how to use these measures, to help save lives.
