Cooksville businesses largely silent on proposed supervised consumption site to alleviate overdose crisis
Stigmas surrounding the use of street drugs often create negative stereotypes in urban areas where consumption is more common. In Mississauga, neighbourhoods such as Cooksville have witnessed the frightening impact of the ongoing overdose crisis.
Unfortunately, one of the best known solutions is often misunderstood due to the same stigmas.
Business owners in Cooksville have witnessed the impacts of Peel’s overdose crisis firsthand, and while some support the proposal from the Region for a supervised drug consumption site, many are unaware their Mississauga neighbourhood is one of two proposed locations to house one of these critical harm reduction facilities.
Despite their success, many local residents and businesses in places around the world have associated such facilities with the presence of negative elements in their community.
The city has long contended with health-related and social harms associated with the overdose crisis. The last two years have been the deadliest on record for overdose deaths in Peel. Last year saw 189 residents lose their life to a suspected opioid overdose and 30 people died in the first three months of 2022 alone, according to preliminary numbers from Peel Public Health. During the same time, there were 38 hospitalizations and 172 emergency department visits.
In May, regional staff advised councillors “immediate intervention” was required in order to reverse the disturbing rate of deaths—a trend exacerbated by the COVID-19 pandemic, which forced the drug-using population to consume alone with an increasingly poisonous supply of street drugs.
To respond to the crisis, regional officials are implementing several harm reduction programs and policies. The Region of Peel is now moving forward with the consultations and site selection plan for a SCS following council approval in July. The facility, which would create a space for the drug-using population to use in a clean environment supervised by medical professionals, is a key piece of the Region’s Opioid Strategy approved by council in 2019.
A previous needs assessment identified downtown Brampton and Cooksville in Mississauga as priority locations due to the prevalence of paramedic responses to overdose calls and drug use in the two areas. Staff are also considering the potential for a mobile site to service less densely populated areas in the region based on need and capacity.
Hershita Arora, manager of the Cooksville Dominos, says she understands how these sites can be beneficial to someone struggling with addiction, and recognizes the benefits that could be realized for the community.
Hershita Arora has worked at the Cooksville Dominos location for nearly four years and has witnessed firsthand the severity of the overdose crisis in the city.
(Paige Peacock/The Pointer)
“I am facing this issue,” she told The Pointer. “Almost once a week I have to call the cops into the store because something happens.”
Arora says she has been approached in the store by individuals under the influence and has faced harassment, not just directed towards her, but also her employees and customers, to the point of needing to hire a security guard to ensure staff and customer safety.
Arora has had to replace the menu screen several times after customers have come in and thrown items, including shoes, at it.
“For me, my customers are everything and if you're putting my customers in a bad space, they're not going to walk in again,” she said. “It's going to be a bad space for them and a bad space for us.”
While she has worked in other locations around the city, Arora said she’s only ever faced issues at the Cooksville location.
She said the site proposal is an affirmation that action is finally being taken to address the ongoing overdose crisis in the region. Her experiences have made it clear that such a facility is necessary in Cooksville as the impacts of public drug use have become increasingly common in the area.
“I cannot say no to anybody if they want to order a pizza,” she explained. “I have to welcome them the same way I’m welcoming others.
“So it was like a barrier for us that we had to take care of our employees’ safety and I have to take care of my employees, but at the same time, I have to take care of the situation.”
According to Health Canada, SCS are set up in areas where there are high rates of public drug use to provide important health, social and treatment services, such as access to clean drug use equipment and a place to safely dispose of items, including needles, after use.
A Peel Supervised Consumption Site Needs Assessment and Feasibility Study was completed in the fall of 2019 and looked at the perspectives of people who use substances, community members and key stakeholders in order to determine how impactful a supervised consumption site would be in Peel.
The study highlighted a dire need for supervised consumption services in Peel. Of the drug-using population surveyed, 87 percent said they would use a supervised consumption service if available and that community consultation should occur to increase acceptance of these services.
According to the Region of Peel, the results of this 2019 assessment are informing the consultation work that is currently ongoing.
“Since council's direction in July, Peel Public Health has engaged in a thorough site-selection process, including land use considerations and neighbourhood-specific needs,” A Region of Peel spokesperson told The Pointer.
The operations of the harm reduction services at any future site will be handled by Moyo Health and Community Services, with additional clinical aid provided by WellFort Community Health Services. The site is anticipated to open in the first quarter of 2023, pending approval from Health Canada—the Region will need to obtain an exemption under the Controlled Drugs and Substances Act to operate the facility—and funding from the provincial government.
The current plan will see the Region phase in these critical services following the initial launch.
“The intent is to start with a low-barrier, smaller-scale service to address immediate needs and learn from an initial interim site to inform ongoing and additional models of supervised consumption services,” a spokesperson from Peel Public Health stated in an email.
Peel has recorded an increase in opioid-related harms practically every year over the past two decades as measured by emergency room visits, hospitalizations and deaths, with a more rapid increase in the last five years.
From 2017 to 2021, the Region of Peel reported 654 opioid-related deaths, a 133 percent increase in deaths in 2021 compared to 2017. Fentanyl contributed to nine out of 10 deaths in 2020 and 2021. In 2021, a total of 189 Peel residents died of an overdose linked to opioids, an increase of 35 from 2020—the region’s previous most deadly year for drug use fatalities.
According to regional data, opioid-related deaths have increased 249 percent since 2014. The number of deaths increased sharply in 2014 (45 deaths) and again in 2017 (81 deaths). Following the decrease in opioid-related deaths between July 2019 and February 2020, deaths increased again starting in March 2020 once the COVID-19 pandemic set in.
The number of emergency department (ED) visits have starkly increased since 2016 causing an unnecessary burden on the already overwhelmed healthcare system; a safe consumption site would reduce the pressure on local hospitals.
(Peel Public Health)
Before 2014, the percentage of opioid-related deaths in Peel where fentanyl was detected was low with an average of 13 percent. Coinciding with the increase in total opioid-related deaths in 2014, the percentage of opioid-related deaths where fentanyl was detected also increased sharply to 35 percent between 2014 and 2016.
Of the most recent opioid-related deaths in Peel (January – December 2021) fentanyl was detected in 88 percent of deaths. Peel Public Health notes more than one type of opioid can be detected per death.
On November 16, Toronto Public Health issued a drug alert after 15 people who consumed unregulated substances died. The public health unit reported in the last month there were three different occurrences where there were at least five fatal calls within a four-day period. Toronto's Drug Checking Service found higher concentrations of fentanyl than usual in substances – particularly in substances collected in the downtown core.
This rise in the presence of fentanyl related opioid overdoses is a perfect example of the life-saving potential of a safe consumption site. With a compromised street drug supply, the user may not always know what is in the drugs they are consuming, and fentanyl, an incredibly powerful opioid, is deadly in even small amounts. At a supervised consumption site, if a user does overdose, medical professionals are there to revive them and save their life. Also, tools are available that can allow the user to test their drugs ahead of time to determine if any unknown substances are lingering in their drugs.
Overdoses are only one indicator of the toll the opioid crisis is taking on the Region of Peel. Regional data found that for every fatal overdose, there are approximately 20-30 non-fatal ones—while not causing death, they can lead to dangerous, long-term impacts like hypoxic brain injury; peripheral neuropathy, a condition caused by damaged nerves that can lead to numerous side-effects in the body; and renal failure.
This ongoing crisis indicates clearly that more must be done.
Dennis Arenburg, who works at a business in Cooksville said he supports the proposal for a SCS.
“I think it’s definitely a benefit for people who have drug issues… and I think if it helps them with healthcare and being safer it’s definitely a plus because they’re going to do it regardless,” he told The Pointer. “I’d rather them do it on a level where they are safe just in case they get something that’s tainted or they simply just take too much.”
As someone who has had a bad personal experience consuming cannabis while on prescribed medication for a mental health diagnosis, Arenburg said he wishes there had been a place available for him to go to at the time.
“I switched my medication and was unaware that I wasn’t allowed to take [cannabis] while on that medication and I ended up in the hospital,” he explained. “It was a bad experience for my 16-year-old son to see me in that state so I kind of wish there was somewhere I could’ve went where he didn’t have to witness that.”
“I think it’s a really good thing,” Arenburg added. “I definitely think it would be an improvement for the community and for people who need it.”
As The Pointer canvassed the streets of Cooksville, approaching approximately 20 different business owners, many were unaware of the proposal to bring the site to Cooksville, or had no desire to speak about it.
In an email, Trevor McPherson, president and CEO of the Mississauga Board of Trade, said the board would not be weighing in on the matter, but that they “do acknowledge that the ongoing opioid crisis is of serious concern for both the overall community and for businesses specifically.”
A survey of the community completed as part of the Region’s feasibility study reported a lack of awareness of the magnitude of drug and substance use leading to morbidity and mortality in Peel.
Respondents also reported not fully understanding what is offered at these sites. There were specific knowledge gaps identified around services provided at and expectations of SCS.
“A common opinion expressed was that illegal drug use is a crime and criminal behaviour should not be supported,” the report states. “Respondents believed taxpayers should not be held responsible for harms associated with drug use and suggested that people who use drugs should be held responsible for their decisions and the consequences that come with drug and substance use.
“Respondents worried that SCS would enable drug use and not address the root causes of addiction.”
The survey also found many community members didn’t want it. Approximately 61 percent of respondents had concerns with a SCS in Peel, including worries about such a site leading to more drug use and trafficking in the area, alongside decreased property values, and personal safety concerns.
Approximately 44 percent of respondents thought a SCS would be helpful in Peel, 42 percent did not think SCS would be helpful, five percent had a neutral opinion, and nine percent were unsure.
Studies of other SCS around the world, of which there are about 120, including close to 40 across five provinces in Canada and 24 in Ontario alone, suggest these concerns are misguided and built on harmful stigmas. Academic analysis has found no evidence to suggest that these sites attract more drug users to the area—in Cooksville’s case the users are already there; no evidence has been found that links an increase in crime to the presence of a SCS in the neighbourhood; and the perception that these services simply “support” addiction, completely disregards the premise of harm reduction. A drowning person in the ocean does not need to be told they should not have gone swimming, they need a life jacket. A supervised consumption site is that life jacket for the drug using population. Keep them safe, and alive, until they reach the point in their addiction journey that they are able to make the decision to get the help they need.
Council’s approval in July to move forward with consultations for the future site was not without pushback from some councillors, with statements from Mississauga Councillor Dipika Damerla and Brampton Councillor Paul Vicente suggesting it will not be easy to approve sites in areas where they are desperately needed.
Damerla has been particularly critical of the site’s proposed location in Mississauga, noting her ward, which includes Cooksville, would be an inappropriate location for such a site, and it would be “very difficult” for her to support it.
“I just want to put it on record that it would be very difficult for me to support a safe injection site that would negatively impact small business,” Damerla said in July. “We really have to be careful in balancing people’s livelihoods and people’s lives. They’re both very important.”
This is not the first time Damerla has pushed back against the proposed site. In December 2019, when the Region’s opioid strategy was delivered to council, she raised the same concerns. She was the only councillor to vote against the endorsement of the strategy.
Councillor Damerla did not respond to repeated requests for comment for this story.
However, contrary to the stigma associated with these medical facilities, numerous studies have demonstrated the health and social benefits of safe consumption services.
These sites have the potential to reduce the risk of accidental overdose, connect people to social services, provide and connect people to healthcare and treatment, reduce public drug use and discarded equipment like needles, reduce the spread of infectious diseases, and reduce strain on emergency services.
Naloxone is a staple in the harm reduction community and is used to quickly reverse the effects of an opioid overdose – where the person is often unconscious – greatly reducing the risk of death. These kits, which come with two single-use nasal sprays, are available for free at participating pharmacies across the province.
(Alexis Wright/The Pointer)
The Region’s report noted the SCS would create multiple benefits not only for the vulnerable drug users, but also the very community members and business owners who expressed concerns with the potential location for these sites. It would give users a place to use safely, and in the presence of a trained health professional who could intervene in the event of an overdose—for over half of the opioid-related deaths in 2021 there was nobody present at the time of the incident.
It would also eliminate the need for users to take drugs in public, something business owners have said is currently a concern. According to the feasibility study, 85 percent of drug users surveyed said they used drugs in public at least once in the last six months, and 47 percent said they used drugs in public usually or always.
At the facility, a person brings their drugs to consume in a clinical environment. Trained staff are available to help if there is an accidental overdose—something that has become increasingly common as toxic additives like fentanyl and carfentanil are finding their way into street drugs unbeknownst to the users.
The sites also include drug checking to detect if the product contains harmful substances; emergency medical care; basic health services; testing for infectious diseases; access to health care providers; referrals for drug treatment, rehabilitation and other health services; and access or referrals to social services.
Forty-four percent of general survey respondents thought SCS would be helpful for Peel, the feasibility study noted. The most commonly reported benefits of SCS were reduced risk of injury and/or death from overdose (52%), connecting users and their families to health and social services (49%), reducing the risk of HIV/hepatitis C transmission (48%), less public drug use (45%) and less used needles in public (43%).
The proposed SCS is expected to increase safety for people who use drugs, decrease crime in neighbourhoods, improve efficiency in the health system through partnerships and system navigation, and decrease costs of substance use, emergency room visits and hospitalizations. According to data from Canadian Substance Use Cost and Harms, opioid abuse cost the Canadian economy $6 billion in 2017, due to its impacts on the healthcare and criminal justice systems—both systems are funded using tax dollars—as well as a result of lost productivity.
The Peel study found respondents felt SCS would be a step toward treating drug and substance use as a health issue rather than a criminal issue.
“There was acknowledgment that drug use is a complex social problem and that it is important to remove criminal consequences to drug use to increase support and treatment for addiction,” the report noted. “Respondents felt the issue of drug and substance use required the support of the community with a need for a coordinated plan to address the associated harms.”
Once the site becomes operational, regional staff will continue to work with the establishment of a more permanent location. A permanent SCS would require sustained funding from the provincial government. Staff estimate the current plan will cost approximately $3.3 million for the first year, including $731,000 in one-time set-up fees, and $2.5 million for the second year. The majority of the costs are for staffing the site.
In the meantime, next steps will include continuing to work towards securing a site location, conducting neighbourhood-specific community engagement as part of the site location selection process, applying for the Urgent Public Health Need Site exemption from Health Canada and advocating for sustained provincial funding of SCS.
A key part of the Region’s efforts moving forward, outlined ahead of council’s approval, is detailed public consultations ahead of any site selection.
Email: [email protected]
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