Rob Boyd, Director of the OASIS program at the Sandy Hill Community Health Centre and ex-officio member of the PROUD CAC, spoke on CBC Radio One this morning on why the Sandy Hill Community Centre would be well equipped to receive Supervised Injection Services (SIS) in Ottawa! Ottawans, including the Mayor and the Chief of Police, need to get behind SIS in our City! Tune in and spread the word!
Category Archives: Press Coverage
Medical experts are calling for the creation of a national system to track Canada’s epidemic of opioid-related deaths, as fatalities from popular painkillers continue to mount.
A new study released Monday in the Canadian Medical Association Journal highlights the lack of timely and accurate information on fatal opioid overdoses. Unlike countries such as the United States and Australia, the study says, Canada has no mechanism for collecting and monitoring the number of people who die each year from opioids.
Opioids such as morphine and oxycodone are prescribed as painkillers, but a spike in the illegal use of the drugs, especially fentanyl, is raising alarms with public-health officials across the country.
Against this backdrop, the group of researchers looked for ways to solve what they say is an incomplete picture of the harm done by prescription opioids in Canada.
Tara Gomes, an epidemiologist at Toronto’s St. Michael’s Hospital and one of the researchers on the study, said such information is vital to track and respond to patterns in drug use, which often change quickly.
“As new drugs enter the market, it’s a constantly shifting target, so having up-to-date information on overdose death is a really important surveillance tactic that has been historically quite difficult,” she said in an interview.
In Alberta, the government is under pressure to take immediate steps to respond to a growing problem of fentanyl abuse. Over the first nine months of this year, fentanyl has resulted in 213 deaths in the province, up from 120 in 2014. The powerful opioid is available by prescription, and is also manufactured in clandestine labs and sold on the street.
Donald MacPherson, executive director of the Canadian Drug Policy Coalition at Simon Fraser University, said the number of deaths from fentanyl alone should galvanize policy makers. He called on the federal government to play a leadership role in setting up a national database.
“I would be interested to know if there are other causes of accidental deaths that double annually and are subject to the same level of continuing complacency,” Mr. MacPherson said in an interview.
Dr. John Younes, Manitoba’s acting chief medical examiner, said there should be a national database tracking all classes of drugs that result in fatal intoxications. However, he said, it would take a fair bit of effort to figure out how to create such a database because each province has its own system for conducting death investigations.
The solution proposed by the researchers is to extract numbers from existing Statistics Canada data. Statscan records the cause of death in its vital statistics death database, they note, based on information from a physician, coroner or medical examiner. While the numbers do not exactly match the results that researchers were able to gather through the detailed study of coroners’ records in Ontario, they believe they can provide a reliable indication of trends.
Up until now, Ms. Gomes said, researchers have relied on detailed examinations of coroners’ records – the “gold standard” for this data. She said national numbers are sometimes estimated based on what is happening in Ontario and British Columbia, which publish annual statistics on deaths associated with several classes of opioids.
Neither province, however, has up-to-date statistics available on deaths. In Ontario, the most recent numbers show that opioid-related deaths rose to 652 in 2013 from 344 in 2008.
Dr. Roger Skinner, regional supervising coroner in Ontario’s Office of the Chief Coroner, said it can sometimes take more than a year to complete an investigation, including toxicology testing.
He said he understands that researchers would like more timely information, but he thinks more of the focus should be on drug safety and measures aimed at curbing opioid addiction. To that end, he would like to see the creation of a system to monitor which doctors are prescribing the painkillers.
“By the time folks are dead, the damage is done,” he said in an interview.
Karen Howlett and Elizabeth Church
Follow us them Twitter: Karen Howlett @kahowlett, Elizabeth Church @lizchurchto
Globe and Mail, November 30, 2015
Click here for the story.
A new Canadian study about safe-injection sites for intravenous drug users concludes that they are cost-effective to the health-care system — an argument that is likely to be advanced as Montreal takes steps to open four such facilities in the city.
Researchers at St. Michael’s Hospital in Toronto carried out an analysis that compared the projected costs of maintaining supervised injection sites over a period of 20 years with the potential savings to the health system in averted HIV and hepatitis C infections. The researchers’ estimates were conservative, as they did not include other infections associated with intravenous drug use and the costs involved in treating and hospitalizing patients suffering from overdoses.
Still, despite their conservative approach, the researchers found that one facility in Toronto would incur $33.1 million in direct operating expenses over 20 years, but save $42.7 million in health-care costs because of an anticipated reduction in HIV and hepatitis C infections. This represented a net savings of $9.6 million.
The researchers predicted that a single site Toronto would spare 164 people from contracting HIV (because they wouldn’t be using dirty needles) and prevent 459 hepatitis C infections.
“I would say that having supervised injection sites in Ottawa and Toronto are a good investment in health dollars because we get considerable health benefits at a reasonable cost,” Ahmed Bayoumi, the study’s senior author, said in an interview.
The study, published on Monday in the journal Addiction, focused exclusively on Toronto and Ottawa. But Bayoumi suggested that setting up safe-injection sites in Montreal might also be beneficial.
“I think it’s a reasonable hypothesis that it would be cost-effective to do this in Montreal, but I really hesitate to say anything definitive without further study,” he added.
In June, Mayor Denis Coderre vowed to establish three safe-injection sites and one mobile unit in the fall despite former prime minister Stephen Harper’s resistance to the plan.
“This is urgent in Montreal,” Coderre said after Montreal applied formally to Health Canada for an exemption that would permit the sites to open in the city.
However, the mayor has since been mum on the subject as he focused on the city’s sewage problems and then the municipal budget.
In 2011, the Supreme Court ruled that Ottawa’s refusal to renew the exemption for Canada’s sole safe-injection site — Insite in Vancouver — was unconstitutional because it deprived people of access to potentially life-saving medical care. Montreal plans to open its sites downtown, in the Plateau and Hochelaga districts and run a mobile unit in the city’s northern and southwest neighbourhoods.
The St. Michael’s study found that running as many as three sites in Toronto and two in Ottawa would be cost-effective.
Although former Conservative Health Minister Rona Ambrose has described the sites as “drug-injection houses,” Prime Minister Justin Trudeau has supported the principle behind the facilities. In June, Trudeau praised Coderre’s plans to open the sites in Montreal as helping to “make people’s lives better, to keep them safe, and I applaud him for moving forward on this.”
Story by Aaron Derfel.
Montreal Gazette, November 30, 2015.
Click here for the article:
Remember the snarky debate about a safe drug-injection site in Ottawa? writes Citizen columnist Kelly Egan.
Well, because it’s 2015, because of sunny ways, because a new, shaggy-haired sheriff’s in town, expect to hear more sound and fury on the issue, and real soon.
It was the one topic that spontaneously drew applause at the 12th annual community forum sponsored by the Alliance to End Homelessness Ottawa yesterday at the RA Centre. While the Conservative government of Stephen Harper hated the idea and wanted to shut Canada’s only such site in Vancouver, the Liberals are more welcoming.
“With the new Liberal government, there is definitely an appetite to look at it,” said Rob Boyd, director of Oasis, a drug treatment program run from the Sandy Hill Community Health Centre.
Boyd has spent some 25 years treating the drug addicted and is one of city’s most respected voices in the field.
There is a plan to establish the site at Oasis, tied in with other services (methadone clinic, needle exchange, HIV care), but the application wasn’t brought forward because of the hostile regulatory climate.
The Conservatives went so far as to pass Bill C-2 in March, which set up a rigorous set of conditions, effectively blocking the creation of any more safe injection sites in Canada.
Boyd said advocates are hoping the bill will be amended or repealed.
The optimism is not misplaced.
During the election campaign, Liberal leader Justin Trudeau supported the opening of just such a site in Montreal.
Boyd said he expects the proposal will get a community airing in 2016. Though both the mayor and police chief oppose the idea in principle, he hopes a proper explanation will help to persuade them of the health benefits and cost savings.
“I would like to have the opportunity to present the model we’re looking at. I’m not sure it’s well understood because we haven’t articulated it very well yet”— Rob Boyd
There is ample evidence that Vancouver’s safe injection site has prevented overdoses, curtailed the spread of infectious diseases, and steered addicts into treatment. And the Supreme Court of Canada supported its existence. But it has always been contentious because some see it as the government enabling drug addiction and turning a blind eye to criminal activity.
The forum was fascinating for its snapshot on the health of the homeless and the city’s drug scene, the two often intermingled.
Every year in Ottawa, about 50 users die of a drug overdose, and paramedics respond to roughly three calls of suspected overdose every day. It is a fluid situation.
Counsellors have noticed lately, for instance, that opioid users are turning to a powdered form of fentanyl, sometimes with disastrous effects.
Boyd said the fentanyl is mixed with other drugs, like heroin, in such a way that the user doesn’t know the potency of the product. (In August, Vancouver had 16 overdoses in one day from a set of street pills thought to be spiked with fentanyl, which can be 50 times more potent than morphine.)
He estimated there are between 1,500 and 2,000 intravenous drugs users in Ottawa and presented the crowd of about 150 people with a chart that showed overdose deaths in Ontario have soared from 91 in 2000 to 513 in 2013.
There was already a signal that the road to a safe injection site in Ottawa will not be a smooth one.
The city’s medical officer of health, Dr. Isra Levy, attended the forum. His department has taken a neutral position on the issue, “monitoring” the public discussion about safe sites.
“The safe consumption site concept, for me, is a distraction from the larger discussion,” he told the Citizen during a break.
The morning featured a presentation from Dr. Travis Baggett, a physician and researcher who works with the homeless in Boston. One piece of research involved looking at mortality and disease rates among 28,000 patients between 2003 to 2008.
It found that tobacco and alcohol were responsible for a great deal of mortality, much higher, depending on the age group, than drug addiction. In fact, if street people live into their 50s, smoking and booze will likely kill them before drug use does.
And, traditionally, smoking has been viewed as “the least” of their problems — cigarettes even being handed out to street people in the old days as “carrots” to treatment. Yet, as their drug addictions are brought under control, it is the cancers from tobacco and alcohol that may well kill street-involved people.
Many drug programs today, however, include smoking cessation.
Story by Kelly Egan.
Ottawa Citizen, November 25, 2015.
Click here for the article.
September 30th 2015
She was a nurse who got hooked on prescription painkillers after a serious car crash, and when she lost the services of her doctor, turned to the streets to feed her addiction.
“That’s how I found out about Ottawa’s underground,” she said, sharing her story (though not her name) for the first time at Wednesday’s symposium on supervised injection sites (SIS), hosted at the University of Ottawa.
“If there would have been something like (Vancouver’s supervised injection site) Insite at that time, maybe I would have gotten out sooner.”
Instead, seven years of her life spiraled out of control, her nursing career crushed under the weight of the criminal record now shadowing her.
Her story was one of many shared by panelists at the community discussion, launched by the Campaign for Safe Consumption Sites in Ottawa on the fourth anniversary of a landmark Supreme Court ruling that advocates cite as proof of Insite’s “positive impact on the surrounding community and (as) a cost-saving measure.”
Along with speakers from Nurses for SIS and the Drug Users Advocacy League (DUAL), organizers shared findings of a study conducted by Participatory Research in Ottawa Understanding Drugs (PROUD), which surveyed 858 Ottawa drug users.
“People say we aren’t Vancouver, and they’re right, but we do share the need for safe injection sites,” said Rick S. of DUAL, citing the recent increase in use of fentanyl — often with a tragic outcome — as evidence of the need for supervised injection sites.
“People are dropping dead from this stuff,” he said. “And the first thing we need to do is to keep these people alive and safe. And you can’t rope them in, you have to let them come to you.”
There wasn’t much dissent at Wednesday’s event, though organizer and advocate Catherine Hacksel said she invited opponents to have their say as well.
“Don’t be shy to talk to us,” she said. “Once you talk to people about the issue and destygmatize it, folks are much more willing to open their minds.”
And while Hacksel said she’s worked hard to engage all community partners, she still finds herself “at arm’s length” from an important potential partner in the Ottawa police.
“Given that we’re so often working with the same people, it would be great to work together,” she said.
Police Chief Charles Bordeleau and Mayor Jim Watson have both previously voiced their opposition to a supervised injection site in Ottawa.
By: Jean-Francois Dugas
26 juin 2015
Des avocats et des étudiants en droit de l’Université d’Ottawa se sont improvisé un cabinet d’avocats en plein air, hier, au parc Minto du centre-ville d’Ottawa afin d’offrir leurs services gratuitement aux plus démunis de la société cherchant à obtenir une aide dans leur lutte pour contester des contraventions.
« Les personnes qui ont reçu des constats d’infraction pour mendicité ou des amendes municipales pour avoir enfreint des règlements municipaux ne peuvent évidemment pas payer pour leur infraction. L’aide d’aujourd’hui, une première publiquement, est une façon de combattre le système », a expliqué Chris Dalton, un porte-parole de l’événement qui oeuvre au sein du groupe d’intervention d’Ottawa nommé PROUD.
Les mendiants plus obstinés, comme les squeegees ont particulièrement été ciblés par la Loi sur la sécurité dans les rues, en vigueur depuis 1999 en Ontario. Plusieurs groupes de pression et même des politiciens militent toujours pour son abolition, rappelle M. Dalton.
« Cette loi apporte une criminalisation plus accrue des personnes vivant déjà dans la pauvreté. J’ai dû déchirer plusieurs contraventions que je ne pouvais payer », a commenté à cet effet Brian Lyons, qui a connu sa part de déboires quand il habitait dans les rues d’Ottawa par le passé.
PROUD, qui vise à mieux comprendre la santé et le risque d’infections du VIH parmi les usagers de drogues, a d’ailleurs découvert que bon nombre de personnes opprimées avaient été ciblées par les forces de l’ordre dans le cadre d’une étude auprès de quelque 850 consommateurs.
« Les gens qui ont une dépendance ont besoin de plus de soutien, pas d’être punis davantage », a signalé M. Dalton, avouant que la guerre contre les drogues exige des changements systémiques.
L’initiative de mobilisation « Debout contre les contraventions » fait partie de la campagne mondiale « Soutenez. Ne punissez pas » qui se déroulera aujourd’hui dans plusieurs pays.
By Andrew Duffy
May 8th 2015
A new study suggests a significant number of Ottawa’s most serious drug addicts would use a safe injection site if one ever opened in this city.
The study, prepared for a group that wants to bring at least two safe injection sites to Ottawa, found that 75.4 per cent of surveyed addicts said they would be prepared to use a facility where they could inject drugs with clean needles under medical supervision.
That level of participation would reduce overdose deaths and offer huge health benefits to drug users, who suffer high rates of HIV and Hepatitis-C, while also improving the safety of downtown streets made hazardous by discarded needles, advocates said Thursday at a community meeting held to discuss the study.
“I think it shows that, contrary to popular belief, drug users are actually interested in their health,” said Rob Boyd, director of a program at Sandy Hill Community Health Centre that offers harm reduction and health services to drug users and sex workers.
“I think it shows they’re interested in ways of using drugs that are less harmful and that they don’t want to be using drugs publicly,” he said. “We all want a solution to drug use on the curb.”
The study is based on interviews with 858 crack cocaine and injection drug users, about two-thirds of whom live in the downtown core. Developed in consultation with people who use drugs, the study aims to better understand the city’s population of addicts and the impact of HIV on them.
Participants completed a one-time questionnaire that touched on a broad range of topics, including drug history, harm reduction, health status, access to treatment, sexual activities, police interactions and housing.
Such studies are notoriously difficult to conduct because drug users often don’t like to enrol. The Ottawa study represents one of the largest studies of its kind in Canada.
Most (74.4 per cent) of the participants were men and a significant proportion (18.2 per cent) identified as Aboriginal. The median age was 43.
Among the 272 participants who said they had injected drugs in the past year, 14.2 per cent were HIV positive and 18.5 per cent said they had engaged in sex work. A sizable majority (74.6 per cent) also reported having a mental health diagnosis.
About half of the men and 59 per cent of women said they would use a safe injection site daily.
Boyd said the Sandy Hill Community Health Centre intends to apply to the federal government for an exemption from drug laws that would allow it to open a safe injection site. But he conceded that application will likely be made more difficult if the Conservative government’s Bill C-2, the Respect for Communities Act, becomes law.
“I think we just have to make an application for an exemption no matter what happens,” he said. “There’s a clear willingness to use this type of service and I think there’s an obligation on us to make an attempt.”
Bill C-2, the government’s response to a 2011 Supreme Court decision that preserved Vancouver’s Insite drug clinic, is now before the Senate. Advocates say the new law undermines the court ruling by setting out”excessive and unreasonable” requirements for applicants that want to open a new safe injection site. Such applications must solicit written opinions about the proposed site from the mayor, the police chief, the chief medical officer and the relevant provincial minister.
In Ottawa, both the mayor and police chief have expressed opposition to a safe-injection site.
Ottawa resident Dave Pineau, 54, contracted HIV 30 years ago while sharing needles with a group of friends in Vancouver’s Downtown East Side. At the time, he said, users could buy a new needle for $10 or a used one for $5. “I know that sounds horrible, but that’s just the way it was,” he said.
Pineau said a safe injection site would allow users to employ safe equipment and protect themselves against fatal overdoses. “If they OD by themselves, there’s no one there to help them through it: to perform CPR or whatever,” said Pineau, who suffered a near fatal overdose in 2003. “I did a really strong hit and I overdosed. I fought through it. But I was just lucky.”
He said a safe injection site is desperately needed: “Drug users are people, too, and this is what health care looks like for them.”
By Dani-elle Dube
May 7th 2015
Supervised Injection Sites, or SIS, has been a contentious issue in Ottawa for almost a decade decade.
Some see them located in Ottawa neighbourhoods as a cause for concern, others see it as a solution to the city’s drug problem.
On Thursday, members of the Participatory Research in Ottawa: Understanding Drugs (or PROUD) released results of their city-wide survey relating to SIS. The study surveyed 858 drug users between March 2013 and January 2014.
The Sun spoke with Chris Dalton, knowledge translation co-ordinator of the study, to discuss the results and what they mean to the study group, drug users and communities.
Q: What do the results of the study show and tell you?
A: The data shows that people in Ottawa who are affected by addiction are the people who want and need these sites in order to feel safe and be healthy by not sharing dirty needles and spreading diseases like HIV or Hepatitis C.
Q: Why does Ottawa need a SIS?
A: Addiction is like any other disease out there. These people have a health problem and they need treatment that is humane, compassionate and proven to work.
Q: The study revealed that 58% of Ottawa drug users felt unsafe in the location they were currently injecting and that 84% would feel safe using an SIS. But what will be done to ensure that the community feels safe?
A: Studies done in Vancouver reported that there was no evidence of increased crime in the area where an SIS was located. Right now what’s going on in our neighbourhoods where there is homelessness and drug use, you’re going to have (an increase in crime) in the public. People are using in public bathrooms, backyards and alleys right now so it’s actually less safe. Education is key and we hope to provide communities with that so misconceptions are avoided and they feel safe.
Q: Almost 40% surveyed said they had used a needle that had been used by someone else before. How will SIS sites make sure that users don’t continue to share needles on the street when they’re not using the services?
A: If we had a 24-hour site open, then the service will always be available with new gear and would help solve a large part of that problem. We see this as an alarming statistic that shows how much we need this service because we don’t believe people will reuse syringes if they’re in a safe and healthy facility with plenty of needles available. People want to be healthy. People don’t want to contract HIV or Hep C, overdose or die. So if we can help them to prevent those things from happening then we’re saving lives.
Q: About 48% of men and 59% of women surveyed said they would use an SIS daily. Is this the solution Ottawa and drug users need as opposed to making more resources available that will help them get clean?
A: Treatment is great for people who want to do it. But if you force people into treatment, often people aren’t successful in the long term. We need to provide a space for people so that, until they’re ready for treatment and decide that’s what they want to do, they can still be safe where they’re using while making healthy choices by using clean gear. But the only choices users have is to stop using and get treatment or to use in the street with dirty needles and get kicked out of the shelters. We need a middle ground that can help and provide services to people who need it.
MORE RESULTS FROM THE STUDY
72% of male participants and 83% of female participants think there should be an SIS in Ottawa
Among the participants who would use an SIS
– 91% of participants had been homeless at one point in their life
– 10% self-reported testing HIV positive
– 70% think there should be an SIS in the Byward Market/Lowertown areas
A follow up study was done in the summer of 2014. It surveyed 136 participants who had injected drugs within the last 30 days.
– 66% injected in public
– 58% felt unsafe due to the location where they were currently injecting
By Joe Lofaro
December 17th 2014
A former sex worker turned advocate is calling for a Vanier drop-in centre for people working the sex trade, who she says are noticing a heightened police presence since new legislation took effect Dec. 6.
A new centre would operate from 8 p.m. to 8 a.m. and would serve as a safe space for sex workers who need to escape violence, seek counselling for mental health issues, or help with addictions.
Jennifer Bigelow says she left the sex trade after a violent attack by a client last year. At a luncheon in Ottawa on Wednesday, the International Day to End Violence Against Sex Workers, she recounted the traumatic incident.
She said in the New Year she is going to enroll in a social worker program and hopes to become a counsellor and work in a drop-in on Montreal Road — a place she says is a “high traffic” area for sex workers.
“At 4 o’clock in the morning when it’s raining and you have perverts driving around harassing you as well as two police cruisers, you need a place to go to. Or you’ve had a sh–ty date. You need a place to be,” she said. “You need people who understand you. And not from 9 to 5.”
Even though she is no longer working on the street, she still says “we” when talking about sex workers. “My heart is still on the streets with those girls. I lived it for so many years.
The new federal legislation, Bill C-36, targets johns and pimps by making the purchase of sex illegal. The government also lauds the bill for making it easier for vulnerable women to exit prostitution.
But, Bigelow disagrees with the suggestion from the Conservative government that sex workers should be viewed as victims and argues the new laws will force them more underground in unsafe conditions.
“Us women are not victims. We chose to do this. We chose to put on our high heels, paint our faces, fill our purse with condoms and go out,” said Bigelow. “The profession isn’t going to go away. The girls are always going to be out there.”
Advocacy groups say Ottawa sex workers need more social services, not legislation.
By Paula McCooey,
December 17th 2014.
A new survey by a pair of advocacy groups looking at how the drug and sex trades are intertwined in Ottawa highlights just how many sex workers are homeless and says many live in fear of being mistreated by clients or police.
The survey was conducted by PROUD — or Participatory Research in Ottawa, Understanding Drugs, along with DUAL, Drug Users Advocacy League.
The groups surveyed 858 people at community health centres across the city from March 2013 to January 2014. Among those questioned, 108 said they had engaged in sex work over the past year.
Of those 108, there were 68.5 per cent who said they were not living in their own house or apartment. That same percentage said they had spent at least one night in a shelter over the past year.
The survey also found that 77 per cent of the sex workers reported being stopped or searched by police without arrest; and that 50.6 per cent said they had experienced verbal abuse by the police.
The study’s release Wednesday coincided with the International Day to End Violence Against Sex Workers.
About 50 community members met at the PROUD and DUAL centre on Murray Street to speak about the results and emphasize the need to protect the rights of sex workers and fight against the criminalization and stigma of sex work.
“POWERS’s position is that sex work is not inherently dangerous but rather it’s the social and legal context in which it takes place that makes it dangerous,” says Emily Symons, chair of the group Prostitutes of Ottawa-Gatineau Work Educate and Resist.
Of particular interest to these groups is the new law Bill C-36 governing sex work that was brought into effect on Dec. 6. The so-called Protection of Communities and Exploited Persons Act largely criminalizes the buying of sex.
They say the new law will continue to stifle workers’ ability to communicate freely with clients and therefore put sex workers at risk of violence.
“It’s now illegal in Canada to advertise sexual services and what this means is sex workers are no longer able to communicate opening and honestly with their clients about services they are willing to perform and services they are not willing to perform,” said Symons. “And it also means that sex workers are not able to negotiate safer sex practices with their clients.”
Jennifer Bigelow, 46, a former sex worker turned advocate said she is concerned the new laws will damage inroads they’ve made with police over the past decade to help keep sex workers safe. Now she feels workers will have to “go more into seclusion.”
“So now do you not only have to fear the violence of the johns, you have to fear the harassment and probably the violence and brutality of the police,” says Bigelow, adding she’s noticed a larger police presence on streets that are high traffic areas for sex workers since the bill was put into place.
Rather than criminalize sex work, Bigelow would like to see it legalized and controlled with more social support so workers don’t have to fear for their lives
“My passion is to open up a centre in Vanier where 90 per cent of the prostitution happens,” she says. “Where they can drop in, always have condoms and always have drug harm reduction tools and be provided with a counsellor because you never know when you are going to have that bad day.”
By the Numbers
44.8 per cent of female participants had received money, drugs or gifts for sex
31.3 per cent of male participants had given money, drugs or gifts for sex
Of the 108 participants who had engaged in sex work in the past 12 months:
68.5 per cent were not living in their own house or apartment
52.7 per cent had spent at least one night on the street or outdoors in a park
31.5 per cent had experienced violence from a client in the previous 12 months