Safe consumption site set to open in Peel but PC delays put municipalities in a chokehold as opioid crisis worsens

“Drug poisoning deaths are preventable deaths,” according to Addictions and Mental Health Ontario. Despite this, more than eight people die per day from an opioid overdose across the province.

A recent press release from the organization revealed that number has remained constant for the last five years straight, and Ontario is on pace to surpass 3,000 annual drug poisoning deaths.

“The best way to protect Ontarians from the increasingly toxic drug supply is to expand Ontario’s network of harm reduction and addictions services, and ensure the community treatment supports are available, where and when they are needed,” the organization states. “Without access to harm reduction and addictions services, Ontarians are more likely to use alone, where they become increasingly susceptible to the often harmful and even fatal effects of an increasingly toxic drug supply.”

Peel has long struggled with health and social harms associated with the overdose crisis. Between 2005 and 2013, the region saw an average of 26 opioid toxicity deaths per year. But then things took a turn. As the street drug supply became increasingly toxic and contaminated with deadly opioids like fentanyl, the number of toxicity deaths began to rise at a disturbing rate.

Between 2018 and 2022, the Region of Peel reported 682 deaths, primarily due to a toxic drug supply. The number of deaths jumped 36 percent between 2019 and 2020 alone, with 156 overdose deaths in 2020, marking Peel’s deadliest year of the opioid crisis to date. Just when these numbers couldn’t seem to get any more grim, in 2021, a total of 189 Peel residents died of an overdose linked to opioids, an increase of 35 from what had previously been the region’s most deadly year for drug use fatalities. 

According to the latest data available from the Region, in 2023, Peel had 121 opioid-related deaths as of October — an increase over the previous year — with April having recorded the highest number at 18 — more than one death every other day during that month.

In an effort to combat the opioid crisis, Peel Region staff advised councillors in May 2022 that “immediate intervention” was needed to start effectively addressing the rising rates of overdoses and reverse the disturbing rate of deaths. In the same year, as a part of its Integrated Opioid Strategy — a blueprint based on several pillars aimed at saving lives and minimizing preventable opioid-related harms — the Region has prioritized establishing a Supervised Consumption Site (SCS) in Peel, a key part of Peel’s long-term strategy to reduce harm.

It signalled a turning point in public health’s ongoing fight against the opioid crisis. 

After reviewing the potential for the site in Downtown Brampton or Cooksville in Mississauga, in July, a report to regional council identified 10 Peel Centre Drive in Brampton as the location of Peel’s first interim SCS. Despite the data from Peel Public Health and delegations that have been made to council, both by loved ones who have lost someone to addiction or individuals with lived experience, some councillors still pushed back against the chosen location. The Pointer previously reported that, in the time Peel was studying numerous locations for the site, the area surrounding 10 Peel Centre Drive saw 25 suspected drug-related deaths, the highest of any area considered.

A spokesperson from Peel Public Health confirmed in an email to The Pointer the Region received the exemption from the Controlled Drugs and Substances Act from Health Canada in February to operate a Supervised Consumption Services (SCS) clinic via an Urgent Public Health Need Site. Originally anticipated to open in the fall, the site will be operational as of March 4. 

The facility will provide a space where people can administer drugs under the supervision of medically trained staff with access to clean equipment and medical help in the event of an overdose. Basic health care, harm reduction teaching, counselling, wrap around supports and referrals will be provided on site. The operation of the harm reduction measures at the site will be handled by Moyo Health and Community Services, with additional clinical services provided by WellFort Community Health Services. Drug testing equipment will also be available onsite in the coming weeks.

“The clinic is a space where people can use their own substance in a safe environment under the supervision of medically trained staff who are knowledgeable, non-judgmental, and trauma informed,” the spokesperson explained. “In addition to providing a lifesaving harm reduction service, the clinic will also help to reduce public drug use and intoxication, reduce the strain on medical services, and connect people with health and social service supports, all of which has been supported by multiple peer-reviewed studies.”

The facility will welcome clients to the low barrier clinic five days a week to start (Monday to Friday), between 12:30 p.m. and 7:30 p.m. It will be staffed by a manager, harm reduction team (supervisors, harm reduction workers and peers) and nursing professionals who are trained in overdose response. CMHA Peel-Dufferin and Peel Addiction Assessment Referral Centre will also be on site on a weekly basis providing services along with referral pathways to childcare, housing and income supports.

The spokesperson reiterated Peel’s SCS is an interim site, and a “formal evaluation will be conducted to assess effective implementation and achievement of intended outcomes for people who use substances.” The Region’s public health unit will be pursuing funding from the Province for a permanent Consumption and Treatment Services Site in Peel — a program staff noted “is extensive and includes broad community consultation.” 

Regional headquarters at 10 Peel Centre Drive in Brampton, has been chosen as the location for a safe consumption site. TOP: The site’s intake area.

BOTTOM: The consumption area provided to individuals to use in a safe space.

(Peel Public Health)

These medical services have recently fallen under scrutiny after 44-year-old Karolina Huebner-Makuratwas was killed by a stray bullet near a Toronto consumption site at the South Riverdale Community Health Centre in July following a physical altercation between three men, leading residents to raise safety concerns around the site. A lawsuit has since been filed with the Ontario Superior Court of Justice against the community centre, blaming it and the City for what claimants say has been the neighbourhood’s "rapid" deterioration since the consumption site opened in 2017. 

The incident prompted the Ministry of Health, at the instruction of Health Minister Sylvia Jones, to launch a "critical incident review” of all 17 provincial consumption and treatment sites (CTS), including a third-party review led by Unity Health of the Riverdale site, while effectively pausing the approval of any future sites until the assessments are completed. 

“These reviews include consulting with Public Health, community engagement and reviewing complaints against the CTS sites,” Hannah Jensen, spokesperson for the Minister of Health, stated in an email to The Pointer, adding they “remain ongoing and will inform the next steps taken by the Ministry of Health including funding, location and application decisions. All applications remain on pause." 

The decision to halt site approval came nearly a year after Toronto Public Health issued a drug alert in November 2022 in response to the deaths of 15 people who consumed unregulated substances. The public health unit reported during that 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 follows trends witnessed between 2015 and 2021, when annual deaths from opioid overdose in Toronto increased by more than 300 percent, from 137 to 574 — an increase largely attributed to the saturation of the unregulated drug supply with synthetic fentanyl and other poisonous substances. 

But as the South Riverdale Community Health Centre comes under review, Toronto Public Health recently reported a weekly average of 14 overdoses successfully reversed at its SCS facilities. 

Meanwhile, Belleville has been battling an alarming spike in opioid overdoses in the city. 

In the first week of February, 23 Belleville residents overdosed within the span of 48 hours due to the increasingly toxic drug supply. On February 6, emergency responders reported 14 people overdosed in the city’s core within a two-hour period between 2 and 4 p.m. in what police described as an “overdose emergency.” None of the overdoses were deemed fatal. By Thursday morning, less than 48 hours later, the City said there had been 23 overdoses since 2 p.m. Tuesday. 

The City’s mayor subsequently declared an addiction, mental health and homelessness emergency. 

Stigmas surrounding the use of street drugs often create negative stereotypes in urban areas where consumption is more common. These supervised sites are one of the more effective solutions, but are often misunderstood due to the same stigmas. 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.

This narrative and stigmatization is not unique to Peel.

A survey of the community completed as part of the Region’s 2019 feasibility study, which highlighted a dire/severe need for supervised consumption services in Peel, reported a lack of awareness of the magnitude of drug and substance use leading to morbidity and mortality in Peel. There was also a knowledge gap in residents’ understanding around the services provided at SCS. The survey found a majority didn’t want it with approximately 61 percent of respondents expressing concerns with a SCS in Peel, including worries about the site leading to more drug use and trafficking in the area, alongside decreased property values, and personal safety concerns.

“A common opinion expressed was that illegal drug use is a crime and criminal behaviour should not be supported,” the 2019 report stated. “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.”

According to the latest data available on the Region’s website, in 2023, Peel reported 121 opioid-related deaths as of October.

(Public Health Ontario) 

Contrary to the stigma associated with these medical facilities and the public belief that these harm reduction strategies such as opioid-agonist treatments, sterile injecting equipment, safe injection centres, and psychosocial interventions promote drug use, a recent study of the City of Toronto from the Centre on Drug Policy Evaluation found there was a “67 percent reduction in overdose deaths in neighbourhoods within 500 metres of supervised consumption sites” after they opened, and the reduction in deaths extended as far as five kilometres from the sites. 

“SCS have been shown to reduce harms associated with drug injecting, including overdose mortality, syringe sharing, and public injecting; some evidence also suggests that SCS increase initiation of opioid agonist treatment and engagement with primary care,” the report revealed.  

“Beyond their immediate function of overseeing and responding to overdoses onsite, SCS provide services that can reduce the risk of overdose among clientele and other people who use drugs: they distribute naloxone (an opioid antagonist that blocks the action of opioids on the brain and thereby reverses overdose events), provide referral or low-barrier access to substance use treatment, and disseminate safer injection education.”

The study found that “neighbourhoods surrounding SCS had the greatest reduction in overdose mortality after implementation.”

The Peel Public Health spokesperson said a similar study for Peel’s SCS will be conducted to assess effective implementation and achievement of intended outcomes for people who use substances. There have been consultations with Peel Regional Police and Moyo, the site’s operator, on the development of policies and procedures of the facility. An in-reach worker will be available on-site to assist with de-escalation and crisis management. The security team is also prepared to respond to any incidents should they occur. 

According to data from the Government of Canada, between 2017 and March 2023, 47,000 overdoses were handled inside safe consumption sites across the country, with not a single fatality recorded on-site. The government data show that while the types of substances consumed by those using SCS varied by location, opioids were the most common class of drugs consumed at the sites between 2017 and June 2023, reporting that on average, nearly 70 percent of the substances consumed at the sites were opioids, with fentanyl and hydromorphone/dilaudid being the most frequently consumed types. 

These sites are needed now more than ever as opioids and other substances are becoming increasingly tainted with sedatives and tranquilizers that render traditional opioid overdose reversal methods like Naloxone less effective. Fentanyl is the opioid involved in the vast majority of drug overdose deaths in Ontario and is often combined with benzodiazepines. Naloxone can reverse an opioid overdose, but does nothing for benzodiazepines and xylazine — a more recent addition to the already lethal substance. 

Before 2014, the percentage of opioid toxicity deaths in Peel where fentanyl was detected was low, with the region reporting an average of 13 percent. Coinciding with the increase in total opioid toxicity deaths in 2014, the percentage of opioid toxicity deaths where fentanyl was detected also increased sharply to 35 percent between 2014 and 2016. Deaths attributed to opioid toxicity also increased by 68 percent from 2018 to 2021 with fentanyl contributing to nine out of 10 deaths in 2021 and 2022. Of the most recent opioid toxicity deaths in Peel (July 2022 to June 2023) fentanyl was detected in 93 percent of the fatalities. The Region notes more than one type of opioid can be detected per death. 

According to a report from Public Health Ontario, there were 8,767 accidental substance toxicity deaths from 2018 to 2021 in Ontario that involved alcohol, stimulants, benzodiazepines, and/or opioids. It reveals substance toxicity deaths nearly doubled from 1,586 in 2018 to 2,886 in 2021 in Ontario. Of the 8,767 individuals who died, 85.2 percent of deaths involved opioids. 

“The number of substance toxicity deaths is alarmingly high in Ontario — five times higher than deaths due to motor vehicle collisions in the province — and has grown at an unprecedented rate during the pandemic,” the report states. “Over the past 4 years, substance toxicity deaths have nearly doubled in Ontario, with 8 such deaths occurring on average every day in 2021. The arrival of the COVID-19 pandemic not only led to rising substance-related deaths generally, but to rising polysubstance involvement in deaths, with over 80% of alcohol, stimulant, benzodiazepine deaths also involving opioids.”

“These findings also stress the continued relevance and need for the adoption and expansion of harm reduction programs, including supervised consumption services across Ontario.”

Naloxone can be a life-saving tool in the event of an overdose, which are becoming increasingly common in the presence of unregulated substances.

(Joel Wittnebel/The Pointer files) 

Even in the absence of supervised sites, drug use is still taking place in public spaces in all corners of the region. 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. Health Canada says SCS are set up in areas where there are high rates of public drug use to provide important health, social and treatment services, including access to clean drug-use equipment and a place to safely dispose of items, such as needles, after use. 

These drug consumption rooms provide additional security and stability by offering a safe, supervised space to use substances. They have the potential to reduce the risk of accidental overdose and connect people to social services, healthcare and treatment. Most sites offer sterile equipment, immediate overdose response, and other benefits including overdose training, take-home naloxone — reducing public drug use and discarded equipment like needles — and psychosocial support and referrals to other health and social services.

Peel Region’s report noted a supervised site would create multiple benefits not only for the vulnerable drug users, but also for the surrounding community, bringing those who use the substance off the streets. 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 — something that has become increasingly common as toxic additives like fentanyl and carfentanil are finding their way into street drugs.

With limited supervised consumption sites province-wide, these services remain out of reach for many Ontarians. In the case of Belleville, the closest supervised consumption sites are in Kingston or Peterborough, more than a one-hour drive away. While the Ministry of Health has declared it's allocating up to $31.3 million in annual funding for up to 21 SCS across the province, there are only 17 sites in Ontario that fall under the provincial government’s purview. 

In response to the lack of accountability at the provincial level, Addictions and Mental Health Ontario (AMHO) is calling on the Province to expand access to evidence-based programs and services. This includes improving (access) to supervised consumption services, among other programs and supports. 

“Without the right supports in place, Ontario will remain unable to handle the toxic drug supply crisis,” Alisha Tharani, CEO of AMHO, said in the February 26 release. “Investing in the entire continuum of mental health and addictions services is the best way to keep Ontarians safe.” 

“Despite federal approval to expand supervised consumption services in Barrie, Windsor, Timmins, and Hamilton, recent decisions by the province have capped the number of supervised consumption sites. Without a reversal of that decision, and a further expansion of harm reduction and addictions services, Ontario will remain unable to protect the health and safety of its residents.”

Email: [email protected] 

Twitter: @mcpaigepeacock 

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