PC decision to abandon safe injection sites amid opioid crisis could have deadly implications; Peel’s plan up in the air 

Ontario’s 2023-24 annual work plan from the Ministry of Health, approved by the PC government, states “the ministry continues to work towards providing help to those who use drugs through its support of the Consumption and Treatment Services program, which help save lives by providing supervised drug consumption and wrap-around health services.”

Despite this clear indication from the current government that supervised consumption sites (SCS) offer lifesaving services, the government has decided to close the doors of several sites across the province and block future ones from opening. 

Ten supervised drug consumption sites — five of which are located in Toronto — are slated to close after the Province announced it will be banning such facilities within 200 metres of schools and childcare centres — despite declarations of their proximity submitted along with their application to operate. The PCs also announced they will bring forward legislation in the fall that will prevent any future sites from opening, despite direct evidence that indicates safe injection facilities have reversed thousands of drug-related fatalities since their inception. 

They provide a space for people struggling with addiction to use drugs in a safe and supervised space. These facilities have been ordered to close by no later than March 31, 2025. Outside of Toronto, the other five sites that will be forced to close due to the new restrictions put in place by the Province include one each in Ottawa, Kitchener, Thunder Bay, Hamilton and Guelph.

The announcement raises questions for the Region of Peel’s SCS, which opened in March of this year in Brampton after Peel 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 due to drug abuse. Establishing the interim site was a key part of Peel’s long-term opioid strategy to reduce harm. In 2023 (the most recent data available) 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.  

But Peel’s SCS was approved by council as an interim site and a spokesperson told The Pointer earlier this year that “formal evaluation will be conducted to assess effective implementation and achievement of intended outcomes for people who use substances.” Peel Public Health planned to seek funding from the Province for a permanent CTS. The Region had moved toward the establishment of two new safe injection sites, one was being planned in the Cooksville area of Mississauga and one in Brampton’s city centre, along with a potential mobile site option. With the PCs now moving away from these treatment sites as a response to the opioid crisis, the future of the Region’s current plan is unclear.

The spokesperson told The Pointer following the announcement, “We are concerned, but we are waiting for further details and are committed to working with Regional Council and the province to ensure our community receives the care and support they need.” They added staff are planning to bring an update to council, but “timing will be determined as more detailed information from the province is received.”

Instead of focusing on harm reduction, the Province will be redirecting funding towards implementing 19 new Homelessness and Addiction Recovery Treatment (HART) Hubs, at a price tag of $378 million. These Hubs, the PCs explained, will add up to 375 supportive housing units, in addition to addiction recovery and treatment beds, however, they will not offer safe supply, supervised drug consumption or needle exchange programs. While they will not be allowed to deliver needle exchange programs, the Province said needle return or collection services may be considered during the application process.

Health Minister Sylvia Jones made the announcement Tuesday at the Association of Municipalities of Ontario (AMO) conference in Ottawa. 

The PC government’s latest decision to revamp its approach and close several sites across the province could have dramatic impacts on the lives of those suffering from addiction. 

But Jones denied the likelihood that these changes will cause further, possibly fatal, harm, and instead naively told reporters during the AMO conference on Tuesday, “People are not going to die, they are going to get access to treatment.”

She said the “status quo” — a term the PCs have enjoyed flaunting often — of these supervised consumption sites “is not working,” adding that she often hears concerns about discarded needles, disruptive behaviours, and increases in crime around these sites. The PC plan to shutter these sites will do very little to alleviate these concerns, advocates point out. 

Despite the Province’s optimism that the crisis will not be exacerbated by the closure of SCS, the shift will likely have detrimental impacts on communities that currently operate these sites. 

Minister of Health Sylvia Jones said “people are not going to die” under the government’s new approach, which will initiate the closure of 10 supervised consumption sites.

(Government of Ontario)

“Drug poisoning deaths are preventable deaths,” according to Addictions and Mental Health Ontario. Yet, despite this acknowledgment, more than eight people die per day from an opioid overdose across the province. The organization revealed earlier this year that number has remained constant for the last five years straight, and Ontario is on pace to surpass 3,000 annual drug poisoning deaths. 

Contrary to the claims by the PCs, healthcare and social service organizations have released data that support the use of safe injection facilities.

Advocates in the harm reduction sphere have criticized the move, with Toronto-based community worker Diana Chan McNally calling the PCs decision a “deadly mistake” and RNAO CEO Doris Grinspun saying it is a “death sentence,” while also calling it “obscure and non-transparent.” The Ontario Public Service Employees Union has also called the decision “unconscionable… in the midst of a health care crisis,” adding it “will lead to countless preventable deaths.” The Waterloo Region Integrated Drugs Strategy, which is among the municipalities ordered to close down its site, said it is “deeply dismayed” by the PCs decision, which the Region said “will result in widespread health harms.”

Across Canada, these sites helped reverse approximately 49,000 overdoses and drug-related medical emergencies between 2017 and June 2023, with no reported fatalities on-site, according to the Government of Canada. It was also estimated that at least 361,000 Canadians had sought services provided by SCS during that same period. 

In September 2023, the first sanctioned site for supervised injection in North America celebrated 20 years of providing support to those living with addiction in Vancouver. Officials from Vancouver Coastal Health said the “impact was profound” when the site opened, highlighting that overdose deaths were averted and the number of people connected to support and recovery increased. Data from the health organization revealed that since the site opened in 2004, it has reversed 11,586 overdoses and has had zero drug-related fatalities. 

A report published earlier this year by The Lancet found that Toronto neighbourhoods with supervised consumption sites have seen dramatic decreases in drug fatalities, compared to other neighbourhoods across the city. It found that after safe injection locations were established, there was a 67 percent reduction in overdose deaths in neighbourhoods within 500 metres of the sites, which spanned as far as five kilometres. The report emphasized, “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.”

It added, “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.”  

A 2021 study from the American Journal of Preventative Medicine also concluded that for people who use drugs, these supervised locations can reduce the risk of drug-related fatalities and improve access to care “while not increasing crime or public nuisance to the surrounding community.” The Canadian Medical Association Journal reported in April that the “increased detection of fentanyl in opioid-related deaths in Canada highlights the need for expansion of harm-reduction programs, including improved access to drug-checking services, supervised consumption sites, and treatment for substance use disorders.”  

Data from the Waterloo Region Integration Drug Strategy revealed that since opening the Kitchener site in 2019, there have been 1,031 overdoses reversed, with zero deaths reported on site. A 2023 review of the site found that since opening, 83 percent of respondents reported using supplies less often, with 74 percent using alone less often. Sixty-one percent reported less frequent overdoses and 69 percent said they used drugs in public spaces less often. 

These are just some of the many reports that highlight the positive impacts of the facilities. 

Adding to the mounting concern surrounding the PC decision, in the first month following the closure of a site in Sudbury (after it was denied funding from the Province) Public Health Sudbury and Districts, said it had received reports of an increase in the number of overdoses and “unexpected reactions” from the use of substances in its catchment area. After the site was closed in March, the area has already reported 12 fatal opioid-related deaths in the month of April alone — marking the highest number of deaths reported during a single month in 2024 (data has not yet been made available beyond April). 

A site was also closed in Timmins in June due to a lack of provincial funding. It was the only SCS left in northeastern Ontario where communities tend to see the highest rates of opioid-related fatalities. At the time of the site’s closure, officials said the area could expect to see an increase in overdose calls, which had decreased by 20 percent since the site had become operational. 

During a press conference on Wednesday Premier Doug Ford told reporters and those in attendance that supervised consumption sites are “the worst thing to ever happen,” to those neighbourhoods where they are located, despite clear evidence these facilities have saved thousands of lives. 

(Government of Ontario)

Despite evidence that supports the use of safe injection facilities and the lives they save, during a press conference on Wednesday Premier Doug Ford stood before reporters and said “Giving an addict a place to do their injections, we haven’t seen it get better. This was supposed to be the greatest thing since sliced bread; it's the worst thing to ever happen to a community to have one of these safe injection sites in their neighbourhood.”

Ford’s remarks and the PCs latest decision also goes against the recommendations laid out in its own government-commissioned review 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 last July. The incident led residents to raise safety concerns around the site who blamed it and the City for what they said has been the neighbourhood’s "rapid" deterioration since the consumption site opened in 2017. A lawsuit was later filed with the Ontario Superior Court of Justice against the community centre.

The Province, at the instruction of Minister Jones, subsequently launched a "critical incident review” of all 17 provincial consumption and treatment sites (CTS) and paused the approval of any future sites until the assessments were completed. At the time, a spokesperson from the Minister of Health told The Pointer the review would inform the next steps that would need to be taken by the Minister “including funding, location and application decisions.” 

But the two separate reviews of the South Riverdale Community Health Centre, reaffirmed the need for these sites. The review, completed by Jill Campbell, the former chief nursing executive at Toronto's Centre for Addiction and Mental Health, said SCS “are a necessary public health service, implemented to save lives and prevent accidental overdose death related to substance use,” adding “Recent evidence demonstrates that these health services make a difference in opioid-related death rates based on proximity to the CTS.” The reviews recommended keeping existing locations and expanding them as well as additional policies to improve their operations. This included increasing funding to retain more staff and hiring permanent security to enhance safety around the sites.

The timing of Tuesday’s announcement may have raised a few eyebrows among those in attendance at the annual AMO conference. As Jones touted the news of the impending closures, a recently released policy paper from AMO requested a more collaborative approach to dealing with the opioid crisis. Recognizing that several sites have been closed due to insufficient funding from the Province, the Association stressed the locations should be “approved and funded based on demonstrated local need and community engagement.”

Safe injection operations provide people who use drugs with a private, supervised space where they can access sterile drug use equipment and use pre-obtained drugs under the supervision of trained staff, as opposed to obtaining unregulated, potentially laced drugs and using them in public spaces where their risk of overdosing is significantly higher. Despite the success of these sites rooted in several reports and evidence-based data, residents and businesses continue to associate such facilities with the presence of negative elements and stereotypes in their community. 

The PCs shift in response will not stop people from using, but instead, force them back to the streets. 

Addictions and Mental Health Ontario has warned that “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.” The organization added the best way to protect people from coming face to face with 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.”

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

(Alexis Wright/The Pointer Files) 

Between 2015 and 2021, annual deaths from opioid overdose in Toronto increased by more than 300 percent, from 137 to 574. The increase has largely been attributed to the saturation of the unregulated drug supply with deadly additives like fentanyl. Preliminary data released in May from Toronto Public Health revealed that 523 opioid toxicity deaths were reported in Toronto in 2023, representing a 74 percent increase from 301 deaths in 2019. The public health unit warns unregulated drug supply is increasingly toxic and contaminated with unexpected and dangerous substances, but assured overdose deaths can be preventable through the use of SCS. 

As the issue worsens, the Registered Nurses Association of Ontario (RNAO) recommended in October that the provincial government support and fund overdose prevention and SCS “in every community in need across the province.” The Association pointed out that in 2018, the PCs “arbitrarily” capped the number of sites permitted in the province at 21 “without regard for community need, and despite the fact that SCS interventions have been shown to save lives.” RNAO highlighted that the sites “have the potential to reduce the number of fatal and non-fatal substance overdoses and the spread of infectious diseases,” as well as connect people in need with wrap-around health and social services. 

“They help save lives and can stop the increase in overdose deaths. The number of sites in our province must reflect actual community need,” the Association asserted. The recommendation asked the Province to lift the cap “immediately” on the number of locations allowed to operate.

A spokesperson for Minister Jones told The Pointer in an email the sites that have been ordered to close “could be eligible on average, for up to four times more funding under the HART Hubs model than they receive from the Province as a consumption site.” The spokesperson did not respond to a list of detailed questions that asked for more information on where the Hubs will be located or whether closing supervised sites will lead to an increase in discarded drug paraphernalia in public spaces.

Meanwhile, the number of people coming into contact with the unregulated drug supply in the municipalities that now have to shut down their sites (Guelph, Hamilton, Thunder Bay, Kitchener) will continue. Wellington-Dufferin-Guelph Public Health, reported just this week that the City of Guelph and Wellington County experienced the highest number of substance-related fatalities on record in 2023, with at least 62 deaths. Hamilton Paramedic Services responded to more incidents related to suspected opioid overdoses in 2023 compared to the year before, with 964 incidents (approximately 80 per month). In the first quarter of 2024, Thunder Bay’s public health unit reported 164 suspected opioid overdose calls. 

During the announcement, the Province referenced several data points to justify its decision, citing that in Toronto, reports of assault in 2023 were 113 percent higher and robbery was 97 percent higher in neighbourhoods near SCS compared to the rest of the city. Jones said during her remarks at AMO that homicide was up 450 percent near Hamilton’s urban core where the site is located and that reports of violent crime were 195 percent higher compared to the rest of the city. A press release from the Province also said the crime rate near an unnamed Ottawa site was 250 percent higher than the rest of the city. Jones also said on Tuesday crime was up 146 near the city’s Somerset site (it is unclear whether she was referring to the same site but with a contrasting data point.) 

It also remains unclear what metrics or radius the Province used to calculate the data. The Ministry of Health spokesperson said the data in Hamilton was received from Hamilton Police Services, which they said reported 3,595 occurrences of violent crime per 100,000 people in the City’s entire Ward 2 (the location of the supervised consumption site) in 2023.

The Region of Peel was unable to provide data on how many potential opioid-related fatalities it has reduced to date, but told The Pointer that since the SCS was opened in March, it has supported over 245 visits, with 90 service users. A spokesperson added that with several Toronto sites closing, “It’s still too early to determine how these changes will impact the number of clients who may visit the site in the future.”

Email: [email protected] 

Twitter: @mcpaigepeacock

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