“I see my brother’s face in every patient I meet:” Member fights for supervised consumption sites

In this deeply personal story, ONA member and street nurse Hannah Stahl explains how supervised consumption sites save lives and what we can all do to fight for them.

I have done this work, operating out of supervised consumption sites in downtown Toronto for more than five years because in 2017, my older brother, Dalton, died of an overdose. He died alone and behind the locked door of a restaurant bathroom stall. He was 28 years old. At the time, I was in nursing school, learning about systems of care while watching my brother fall through the cracks of those same systems. There was no supervised consumption site in our hometown then. There still isn’t.

I do this work because I see my brother’s face in every patient I meet. It’s a privilege to offer gentle, low-barrier health care to people enduring some of the hardest moments of their lives. These sites are not “drug dens,” as Premier Ford calls them. They’re sanctuaries of safety and compassion. They’re places where people can find dignity, connection and survival in a world that relentlessly stigmatizes and alienates people who use drugs.

But now, the Ford government has closed my site and is deliberately moving to close supervised consumption sites across the province. There is an injunction before the courts on human rights grounds, but this has not stopped them. They remain intent on shutting doors that save lives, despite overwhelming medical evidence in support of harm reduction.

Supervised consumption sites do far more than reverse overdoses. They provide wound care, preventive and primary health care, case management, safer drug use education and social support. My site hosted arts and crafts groups, community meals and even karaoke parties. We celebrated birthdays for those who society has forgotten. We co-parented potted plants and carried out community clean-ups. My supervised consumption site was like a second home for me during COVID-19 lockdowns. Many of my patients stated that it was their only home.

The evidence is clear: supervised consumption sites reduce overdose deaths, decrease public drug use, alleviate hospitalizations, lower rates of HIV and hepatitis C and more. They also reduce strain on emergency services. Data repeatedly shows no link between these sites and increased crime. In fact, Toronto Police Service data suggests the opposite: neighborhoods with sites saw 57 per cent fewer shootings and 40 per cent fewer robberies compared to those without.

Overdose is a leading cause of accidental death in Ontario. Risk spikes after release from jail, discharge from treatment programs and hospital admissions: times when people are most vulnerable and least supported. Supervised consumption sites are the open doors that prevent deaths in these critical periods. Closing sites means locking people out of care and into isolation. The open doors of supervised consumption sites are often the only low-barrier, accessible gateways that our most marginalized neighbours have into the health-care system.

Treatment alone is not a solution and mandatory treatment is neither humane nor evidence-based. Harm reduction and treatment are not opposing forces: they can be complementary. Treatment without public investment and an expanded social safety net won’t work. Treatment won’t work if people are forced into it. Harm reduction keeps people alive long enough to access treatment, which can only be successful when they’re ready. Recovery can’t happen if people are dead. Dalton never got the chance to access a treatment program because he died before he could. Alone and behind a locked door.

As nurses, we are bound by our code of ethics to advocate for health equity, evidence-based practice, and the dignity of every person. The closure of supervised consumption sites is a direct attack on all three. This is not just about people who use drugs, it’s about the integrity of our profession and the health of our communities. Educate yourself and your colleagues about harm reduction and its evidence base. Speak up in your workplaces, professional associations and communities.

Write to your MPP and demand that these closures stop. Support organizations fighting for harm reduction in Ontario.

We need to keep doors open to health-care services. It’s when we lock doors that our friends, neighbours and patients die. I know because my brother died behind a locked door too. I will keep fighting every day so that your loved ones don’t.