Onsite Manager Liz Moss

When Liz Moss is asked about a success story among her clients at Onsite, she hesitates - not because there are so few but rather because there are so many to choose from.

Moss is the manager of Onsite, which opened on September 24, 2007. Onsite, located upstairs from Insite, Vancouver’s Supervised Injection Site, includes a detox facility and a transitional housing unit. It has been an immediate success story serving a clientele that has not traditionally accessed detox facilities.

Moss tells the story of a current client, a 47-year-old woman who has used drugs for about 20 years and never once in all of that time has gone through detox. During an interview in early December, Moss noted that the women had completed three weeks in the Onsite detox floor and had just remarked that she was ready to move up to the transitional housing floor and start working on the next phase of treatment.

Then she tells the story of the 24-year-old man who completed detox last February. A few months later, his child was diagnosed with brain cancer but the man has stayed off drugs and is coping with his difficult situation.

Moss explained that Onsite’s mandate is to reach the most street-entrenched drug users, who have the deepest needs. They aim to provide a low-threshold service that’s easily accessible.

“Most of the people here are dual-diagnosed so that makes it more stunning that they’re staying.” Liz Moss

About 95 percent of Onsite’s clientele are homeless and suffer the effects of terrible tragedies. She said many suffer from depression and anxiety. There are a lot of clients from lower-income families where mental health issues were not diagnosed or treated, so people wound up self-medicating with illegal drugs. Others were injured in construction accidents, put on morphine and became addicted to opiates. She’s heard stories from women who, as children, were passed around at adult’s parties as a toy; from men and women she’s heard stories of terrible beatings when they were children. “They’re just trying to forget.”

As children, most of Onsite’s clients (the majority are women and/or Aboriginal) had bad role models and were not taught coping skills. “We as a society are not focusing on supporting families,” Moss said.

In terms of success rates, 53 percent of clients have completed detox, which usually takes about one week. Twenty-eight percent complete transitional recovery. “Most of the people here are dual-diagnosed so that makes it more stunning that they’re staying.”

While they stay, either on the detox floor or the transitional housing floor, clients may participate in a broad array of programs. They’re offered acupuncture, spiritual counseling, music programming, yoga, relaxation and mediation, massage therapy, early recovery counseling, games, a book club, relapse prevention work, men’s and women’s groups, and 12-Step and SMART programs. Moss said many clients have legal issues so staff will accompany clients to court. Clients also work with staff to create a six month personal plan.

“It needs to be low-threshold, easy to access, comfortable and it needs to be a community.” Liz Moss

Moss explained that trust is key to Onsite’s success. Onsite’s clients almost exclusively come from Insite’s client base downstairs. As casual staff may have shifts at both facilities, clients have already formed relationships with some staff. That makes the journey from drug use downstairs to the detox facility upstairs a bit less intimidating. Staff will also welcome clients to the detox facility for an hour or two, just to give them a sense of the place so they can go away and think about entering detox.

Some clients do leave and Onsite staff respect that decision. “We see relapse as part of recovery,” Moss said, explaining staff will tell clients, “ ‘Are we going to see you back again? It would be great to see you back.’ ” If they hear that a client has relapsed, they’ll even go out to the streets to find the person and invite them back again. “That’s what makes it work, we have a relationship.”

In early December, Onsite had a wait list of 60 people for its 12 detox beds. That list is constantly reorganized as people in emergency situations tell Insite staff they’re ready to detox.

Moss said that other facilities in the DTES, or elsewhere in the city, could open a similar on-site facility and experience the same levels of success. The key, she said, is the relationships staff at the facility form with clients, leading to a level of trust that allows users to make the decision to then move into the facility’s detox service. “It needs to be low-threshold, easy to access, comfortable and it needs to be a community.”