Supervised consumption sites: A health-care issue

And that is that SCSs not only lessen the strain on our already maxed out health-care system, they also save lives.

Despite that, the Ford government announced in August 2024 it would close 10 provincially-funded SCSs by the end of March 2025 because of their proximity to schools and daycares, and ban new sites from opening, which was put into legislation last November. Instead, they said they will shift from a harm reduction to an “abstinence-based approach” by launching 19 new homelessness and addiction recovery treatment (HART) hubs and 375 supportive housing units.

The legislation also requires municipalities to obtain the health minister’s approval to apply for an exemption from the federal government to launch a new SCS (previously, municipalities could apply directly to the federal government for approval). But Health Minister Sylvia Jones stated at a media conference, “I want to be very clear, there will be no further safe injection sites in Ontario under our government.”

“It’s very apparent the Ford government hasn’t got a clue about the significant role these sites and the staff who work there, including many ONA members, play in our health-care system,” says ONA Provincial President Erin Ariss. “And so we are doing everything in our power to educate and dispel the blatant misinformation they have been spreading to Ontarians to try and convince them that their misguided plan to shutter SCSs makes sense.”

What SCSs are – and aren’t

Harm reduction nurse Hannah Stahl, who works at a Toronto community health centre that offers supervised consumption services, believes this education is key.

“I encounter people every day who don’t understand what SCSs are,” she says. “They are small spaces exempted by the federal government to allow people to come in with their own drugs and use them safely [drugs aren’t provided onsite]. They were built as a response to the toxic drug crisis in which we find ourselves where people are buying on the street and have no idea what the potency is or what other drugs could be in the product. And it’s creating a really deadly environment for people who are just trying to survive. 

“My site saves [the lives of] about two to three people every day. When someone overdoses on the street and it’s not witnessed, it can be a long time before EMS gets to them, possibly resulting in hypoxia and brain injury. SCSs were created with the philosophy that the overdose response shouldn’t be a burden on lay people in the community who are finding people on the streets. It should be in the hands of trained professionals. And it’s really unethical that the Ford government is putting this on the backs of communities again.”

She adds that on a policy level, SCSs are “a radical approach to care that reframes how we approach people who use substances, away from both a coercive approach that drives people into treatment and a law enforcement/carceral/criminality approach. Unlike treatment centres that are unaffordable and largely private – I know people who have been on wait lists for two years for public treatment centres – SCSs are a public fixture of our health-care system.” 

In Canada, SCSs, which operate around the world, were specifically born out of the HIV and overdose epidemics that took hold of Vancouver in the mid-1990s. Spearheaded by grassroots activists and public figures, the first official Canadian site, Insite, opened in that city in 2003, and was touted as a scientific pilot. Twenty-two years later, it still operates. The first sites in Ontario opened in 2017, and as of September 2024, before the Ford closures, there were 39 SCSs operating in Canada. 

“The first SCS actually opened in Switzerland in 1986, so we’re talking about a health-care intervention that has almost 40 years of evidence behind it,” says Dr. Gillian Kolla, Assistant Professor at Memorial University’s Faculty of Medicine and member of the Coordinating Committee for the Moss Park SCS in Toronto, who spoke at an ONA education session open to all members. 

“Apart from reducing overdose-related deaths within communities, it turns out they’re also very good at reducing the transmission of bloodborne infections like HIV, hepatitis B and hepatitis C. They also function as a crucial access point for vulnerable people to access other health and social services. One of the trained health-care professionals onsite in most Ontario SCSs is a nurse who can provide a wide variety of health-care services.” 

In fact, Stahl, who chose this line of nursing after her brother tragically passed away from an accidental overdose in a town that didn’t have an SCS and “never will because of Ford’s policies,” explains that her role goes far beyond overdose response and education on prevention and harm reduction. 

“I provide primary care, I do cancer screenings, wound care, FIT tests, PAP tests, inoculations – basically anything that people would access from a family doctor, just on a drop-in basis. I provide counselling and connections to other health and social services in the community with very low barriers. If people are ready for it, also referrals to housing, as my clients are largely unhoused. Really a million different things. SCSs are one of the only entryways to the health-care system [for their clients]; they are the only place many feel they can trust health-care professionals. My clients exist at many different intersections of vulnerability.”

SCSs also see overrepresentation of racialized communities, including Indigenous people, particularly in Northern Ontario where the opioid mortality rate is three times higher than the south. Yet, the sole remaining SCS in the north, where 80 per cent of First Nations communities are located, was shuttered in Thunder Bay at the end of March. Because the Ford government also refused to fund SCSs in Timmins and Sudbury, where sites were already established and running after years of community investment and labour, they were forced to close, meaning there are now no SCSs between Ottawa and Winnipeg. 

At an emergency webinar last December by the Shelter and Housing Justice Network, Mskwaasin Agnew, a Cree-Dene practitioner with Toronto Indigenous Harm Reduction, made it clear: “We are going to see an increase in Indigenous people and other racialized people paying the price of this bill. This is going to have ripple effects in our community. When we look at our toxic drug supply, and we know that our people are out there on the streets, the most vulnerable they could possibly be, it is only in SCSs that they receive the safety and supports they need.”

Just the facts

Appallingly, Premier Ford is spinning a narrative to justify closing these sites that is largely based on fear, saying he’s gotten "endless phone calls about needles in parks, schools and daycares” and that “giving an addict a place to do their injections, we haven’t seen it get better; it’s the worst thing that could happen to a community to have one of these sites.”  

Trouble is, it doesn’t hold up to the actual evidence. 

“There is strong evidence that SCSs reduce the amount of injecting that happens in public, and leads to increased referrals to medical care as well as to drug treatment,” says Kolla. “ A 2017 Canadian review found both lower rates of public injecting and discarded equipment in areas that had put in place SCSs, along with no increase in crime or public order complaints. In fact, recent supervised consumption use was in a Toronto study and associated with about a 50 per cent decrease in the amount of public injecting that was happening.”

The report, Supervised Consumption Services in Ontario: Facts and Recommendations, released last November, also found no evidence that monthly incidences of homicide, assault, robbery and break and enters increased in areas near SCSs. In fact, they trended downwards.

“It’s important to highlight these statistics because crime is one of the main reasons the Ford government has used to try and justify closing SCSs,” states Kolla, noting that journalists have been asking where their statistics and data come from and “no one has, to my knowledge, received it.” 

There is, however, a lot of evidence highlighting the benefits of SCSs. 

Health Infobase Canada data from March 2020 to January 2024 shows there were about 2.5-million visits to SCSs and among those, close to 40,000 overdoses reversed onsite, of which about 36 per cent (or 8,000) occurred in SCSs that have now been closed by the Ford government. SCSs in Ontario have responded to nearly 22,000 overdoses without a single death and provided more than 500,000 referrals to health and social supports.

A study published in Lancet Public Health in February 2024, Overdose mortality incidence and supervised consumption services in Toronto, Canada: an ecological student and spatial analysis, compared city neighborhoods that put in place SCSs with ones that didn’t and found the overdose mortality rate in neighborhoods with SCSs decreased significantly – and during a time when overdose deaths were actually increasing rapidly across the province. 

The Ford government decision is also illogical considering that SCSs save our health-care system money. In fact, for every dollar spent on SCSs, more than five dollars in future health-care costs are saved.

“There is a tremendous burden within the health-care system that these sites are addressing,” notes Kolla. “They also act as a way to prevent blood borne infections like HIV and hepatitis C that end up being very costly to treat further down the road.”

“We’ve had federal exemption for sites in Ontario for about eight years and in that short amount of time, we’ve got really strong data,” concurs Stahl. “We know they greatly reduce 911 calls in the surrounding communities for overdoses and other issues and the burdens on our emergency response teams. Every overdose call in Toronto takes paramedic teams an average of two hours from start to finish. So, you can imagine how the closure of these sites, with the many overdoses that we respond to every day, is going to impact EMS response times going forward.”

Help us push back

After the announcement, ONA signed a joint letter with our union allies to Premier Ford and Health Minister Jones to call on them “to do the sensible thing: support and expand lifesaving health services, rather than close them.

“The government’s announced HART Hubs are not an adequate or analogous replacement for SCSs, with conditional funding that bans evidence-based health services,” it reads. “We need to value evidence and facts over ideology and opinion when making public policy. Public health guidelines, including the Chief Medical Health Officer’s annual report and the provincial government’s own expert–appointed review call for the expansion of SCSs.”

ONA members have stepped up too. You have participated in rallies with like minded community groups, and following our education session on SCSs, 39 of you volunteered to be part of lobby teams to meet with MPPs demanding they stop the closure of these sites. Twelve teams were created and received training from staff before conducting those meetings. You reiterated that SCSs save lives and left behind a fact-filled handout. 

We were heard.

In late March, Justice John Callaghan of the Ontario Superior Court of Justice granted an injunction to keep open the 10 SCSs slated for closure while he considers a Charter challenge of the new law. They can remain open until 30 days after he decides the case, he says.

“The constitutional issues in this application are complex,” he wrote. “My decision will require some time. Thus, I have reserved my decision on the Charter and other constitutional issues, and the judgment will be released in the coming months.”

His decision is part of a legal process initiated by The Neighbourhood Group, which runs the Kensington Market Overdose Prevention Site in downtown Toronto. They argued in court that the new law violates both the Charter of Rights and Freedoms and the Constitution, including the right to life, liberty and security of the person. 

While we were pleased with this 30-day reprieve, the Ford government immediately signalled that it would still proceed with closing nine of the 10 sites and transition to an abstinence-based treatment model on April 1. That means we must continue to fight.

“ONA will not back down, and I urge that if you hear a member, colleague or anyone who agrees with Ford’s BS on SCSs, please explain why his direction is misguided and harmful,” concludes Ariss. “We need everyone in on this fight. As ONA members, you absolutely have the power to reverse Ford’s decision. But you also have something else: A lack of fear and unwillingness to take no for an answer. We must and will prevail. Too many vulnerable lives are at stake.”