Jamie MacBeth demonstrated how to remove the top of a Naloxone vial.

Jamie MacBeth demonstrated how to remove the top of a Naloxone vial.

Pending cuts could cripple fentanyl fight

In the midst of the fentanyl crisis, a local organization that provides overdose training is bracing for the loss of its funding.

In the midst of the fentanyl crisis, a local organization that provides overdose training and harm reduction is bracing for the loss of a major chunk of its funding.

ANKORS (AIDS Network Kootenay Outreach and Support Society) was founded in 1992 at the height of the HIV/AIDS crisis and provides services around HIV and Hepatitis C, harm reduction and prevention education. Originally established in Castlegar, the organization now has offices in Cranbrook and Nelson, and between the two may soon lose five employees and a significant part of its funding.

ANKORS has two major funding sources: Interior Health and the Public Health Agency of Canada (PHAC). Interior Health funds ANKORS’ support worker, outreach worker and its community care team, while PHAC funds ANKORS’ Hepatitis C education and support program, its HIV prevention and support program and its Rise Up Community Engagement program, “which addresses barriers to health care and services for people who are living with HIV and/or Hep C and who are at significant risk and who use drugs.”

PHAC has been funding ANKORS for over 20 years, but in September 2016, when PHAC announced the successful applicants to its new HIV and Hepatitis C Community Action Fund (CAF), ANKORS was not among the successful applicants.

“We’ve been funded for over 20 years by the Public Health Agency of Canada and in this last call out for funding, there were over 40 organizations in Canada that had previously been funded that were turned down, including ANKORS,” explained Cheryl Dowden, executive director of ANKORS.

A total of 124 organizations were successful in applying to CAF, but 42 organizations that were previously provided funding were unsuccessful, while 41 new organizations received funding. Not one of the three applicants from the Interior Health Region received funding.

ANKORS and other unsuccessful applicants have been provided with one year of transition funding, which will end March 31, 2018, which PHAC says “is being provided to help organizations seek other sources of funding, transfer their services to other local providers, or close out their currently funded projects.”

But if ANKORS is unable to either find a new source of funding or convince PHAC to reinstate funding, it will lose funding for its HIV and Hepatitis C programming.

“We’re really looking to our community for support for those programs and looking for alternative funding, because we’re basically run off our feet offering those programs and it’s taken us many years to develop the Hepatitis C program — it’s hugely significant — and also the prevention and education program,” says Dowden.

“We know that there’s a community need for this. We get requests for workshops and training in Kaslo and Lardeau and New Denver and Nakusp and all over the region. A loss of that funding is going to have a significant impact and we really feel that we gained a lot of ground in terms of addressing HIV and Hepatitis C, but it’s not a time to take our foot off the gas pedal, so to speak.”

Dowden hopes that community members will assist ANKORS by pressuring the federal government to restore ANKORS’ funding.

“We’ve had great support from our MPs in this area and we asked for letters of support to be sent to our MPs, to the federal Minister of Health, and to the president of the Public Health Agency of Canada,” she says. “Some of those letters were hand-delivered to the president of the Public Health Agency of Canada and she read them, and I think some of those efforts really resulted in the transition funding, but we need to stay that course.”

The funding loss comes at a time when ANKORS’ staff say they are busier than ever, due to the fentanyl crisis sweeping the country.

Jamie MacBeth is one of the three ANKORS employees working out of Nelson who will lose her position unless funding can be found. Since the fentanyl crisis began, MacBeth has been offering community Naloxone training and has seen a growing demand for the service.

“Since last March I’ve been doing a lot of Naloxone training — like a lot, I’ve probably trained 500 people in the last year,” she says.

Attending one of her training sessions, it becomes clear that MacBeth’s experience with Naloxone kits goes beyond injecting water into an orange for training. She has helped people during overdoses, she has injected Naloxone into their thighs and delivered rescue breathing while waiting for the paramedics.

She says that Naloxone training is something she does off the side of her desk. Her actual position is education and prevention regional coordinator, and she is only paid for three and a half days a week.

“The position is defined as offering … preventative workshops on HIV and STIs and Hepatitis C and harm reduction, but in our rural area, to actually address those issues with adults and youth, it’s a much bigger… It’s not just teaching the HIV prevention equation. [It’s] talking about culture, talking about use, talking about consent, talking about party scenes.”

MacBeth also runs the Party Safe program, which teaches people about harm reduction and responding to overdoses. But what MacBeth teaches as part of the program has changed since the beginning of the fentanyl crisis.

“In the past, we would have done tips for safer partying in a harm reduction way, but the fentanyl crisis has changed a lot of that, because what we would have offered as harm reduction tips for safer partying doesn’t really matter anymore,” she explains.

For example, in the past MacBeth would have talked to people about test-driving substances — trying a small amount to see what happens — but fentanyl doesn’t have a uniform concentration, so test-driving doesn’t work.

“So now I kind of have pulled the Naloxone training into the Party Safe structure,” says MacBeth.

ANKORS has also been playing a role in battling the crisis at the provincial level.

Alex Sherstobitoff is the Rise Up Community Engagement Project coordinator and another ANKORS’ employee whose position will be eliminated when the PHAC funding runs out.

He says ANKORS is one of the few rural B.C. organizations providing input to provincial bodies overseeing harm reduction, such as the B.C. Center on Substance Use, the B.C. Centre for Disease Control, and gives some input to the Canadian Research Initiative in Substance Misuse. ANKORS has also had input on opioid management guidelines and has given input to various committees on the opioid crisis.

“Without this input, particularly the West Kootenay-Boundary is going to lose out because we’re already lacking in resources. Urban folks they have a lot of resources there, but if we lose that piece, we’re going to feel it,” he said.

Asked what the effect of the PHAC funding loss will be on ANKORS’ ability to play a role in the fentanyl crisis, Sherstobitoff said, “I think that our resources will be so limited that we may be only doing mobile needle distribution and then as far as working in partnerships and collaborations with the various agencies throughout our communities is going to be limited, because we just don’t have the resources. Our mobile services are already barely just hanging in there.”

Loss of the PHAC funding will also mean the loss of Hepatitis C services, and that’s far from all Chloe Sage is responsible for.

Sage is the Hepatitis C coordinator for ANKORS and runs the festival harm reduction and drug checking programs. Her job is also on the chopping block.

Sage not only works with people living with Hep C, but does education and prevention work.

“In the prevention and education it’s really broad because we work with people who use drugs a lot, because a lot of folks get Hep C from using intravenous drugs,” Sage explains.

The fentanyl crisis has also led to a demand for needles, which comes with an increased risk of transmitting HIV or Hep C.

“One of the things that we’ve been noticing in this opioid crisis is that our needles are flying off the shelves, because new needle users are happening, because fentanyl is so addictive that people are moving to needles quite quickly, because you can get addicted to it so quickly.” Sage explains. “A lot of the times when you’re addicted to something, you’re always chasing that first high, so if snorting is not getting you that any more you may move to needles to get the rush that you need.”

Sage predicts a spike in Hep C cases if her position is eliminated.

“When there is a new population of needle users, you need to find them and connect with them, and if we don’t have community organizations that can put that time in, who’s going to do that?” Sage asks.

She also administers a drug-checking program in partnership with Interior Health and is on several national drug-checking committees. That includes testing substances at the Shambala Music Festival. She also administers fentanyl urine tests throughout the West Kootenay in partnership with Interior Health. If her position is eliminated those programs will also end.

Sage emphasizes that while there has been funding provided to health care authorities to help with the fentanyl crisis, it’s community organizations that have made connections with those most affected.

“I think it’s a tragedy to ignore the role of community organizations in this crisis, because it’s community organizations that have the relationship and the relationship with people is the most important thing, because if we don’t have relationship, we cannot help people.”