Closing supervised consumption sites is creating a gap in care.
If our goal is to get more people onto the path to rehabilitation and treatment, we need to prioritize building more inclusive and integrated pathways to mental health and addiction care.
The opioid crisis is one of the biggest public health challenges of our time. And the numbers paint a stark picture of the devastation:
In Canada, there have been a reported 47,162 apparent opioid toxicity deaths that occurred between January 2016 and March 2024.
Of these deaths, 1,906 occurred in the first 3 months of 2024. That equates to 21 deaths per day, on average, in this calendar year.
Most accidental apparent opioid toxicity deaths occurred among males (72%) and among individuals aged 30 to 39 years (31%) so far in 2024.
There were 180,961 reported opioid-related poisoning emergency department visits from 2016 to March 2024.
There was a total of 216,560 Emergency Medical Services (EMS) responses to suspected opioid-related overdoses reported between January 2017 and March 2024.
Of all accidental apparent opioid toxicity deaths in the first 3 months of 2024, most (84%) occurred in British Columbia, Alberta, and Ontario.
The numbers also serve to shine a light on the complexity and pervasiveness of substance use. How it knows no boundaries: not age; not employment status; not race; not ability; not bank account.
But here’s where the numbers fall short. Statistics and percentages don’t capture the human experience of substance use. Nor do they capture the judgment, bias, and discrimination applied to every aspect and avenue of substance use support, informing everything from community to policy to treatment availability.
Substance use paths.
People from all walks of life have used regulated opioids and/or unregulated drug supply. For countless reasons.
And some people have developed unhealthy use. Also for countless reasons.
Correspondingly, treatment approaches and services cover a broad spectrum as well. The options available – as is the case for so many health conditions – are affected by factors that include strength of support network and relationships; proximity to support services; and money for and access to private care.
One approach that has proven extremely effective – and one that is available to a large number of people, including those who may have financial, housing, or social instability - is the supervised consumption site model that offers acute harm reduction services and safer supply.
Supervised consumption sites work.
The MH+A Alliance must speak to the best interests of our clients and community. Supervised consumption sites have been a critical component of the care continuum in the province since 2017. In Ontario, across Canada, and around the world, the evidence shows that supervised consumption sites and overdose prevention sites provide life-saving interventions. The Centre on Drug Policy Evaluation elaborates, noting that these sites “play a key role in reversing potentially fatal overdose events, connecting people to basic medical care as well as health and social service programs, and supporting referrals and retention in substance use treatment.”
Here are just some of the ways they help people:
Lives saved. According to Health Canada, safe consumption sites across the country reported 55,693 on-site non-fatal overdoses between January 2017 and January 2024.
Reduced hospital visits. Establishment of supervised consumption services is associated with reductions in opioid-related emergency department visits and ambulance calls.
A judgment-free zone. These are purpose-designed and purpose-managed sites for persons with substance use disorders. These sites remove moral judgment from usage and offer practicalities over platitudes.
Trained and experienced professionals. These sites have trained staff on hand and procedures in place to reduce the incidence of both fatal and non-fatal drug poisonings.
Contain exposure risk: People who access supervised consumption services are 69% less likely to share needles and syringes compared to those who do not use the services. And providing sterile injecting equipment is associated with reductions in injecting risk behaviours and reduced HIV transmission rates.
Reduced public use: Use of supervised consumption services is associated with less public and outdoor injection, less needle reuse and safe disposal of used injecting equipment.
Longer-term health focus: Supervised consumption services increase referrals to and uptake of substance use treatment programs such as detoxification and opioid substitution therapy.
Closing supervised consumption sites is creating a gap in care.
Unfortunately, despite a public declaration from the Ontario government that it takes increases in drug overdoses and opioid related deaths very seriously, their actions are contradicting their words.
On August 20th, the Minister of Health announced that 10 consumption and treatment sites (CTS) located within 200 meters of schools and child care centers would need to be closed by March 31, 2025.
No proposed alternative spaces have been proposed to replace the sites slated to close. And for the remaining CTS sites, there will be much stricter requirements put in place.
Government focus and funding is shifting to a HART model: Homelessness and Addiction Recovery Treatment hubs. These hubs are designed around a housing-first philosophy, and the model is meant to prioritize moving unhoused people into supportive housing units or treatment beds.
Will HART hubs fill the gap left by supervised consumption site closures?
The HART Hubs are designed primarily to help people with complex service needs with immediate and longer-term shelter-led solutions and are aiming to promote long-term recovery.
This is a much-needed and important goal. But it leaves a significant number of people struggling with substance use disorder on the sidelines and at significant risk of drug poisoning or death.
As they are being envisioned currently, the Hubs are not designed to offer the full spectrum of addiction services, including acute harm reduction. Prohibited services would include supervised consumption, safer supply, needle distribution, and needle exchange.
This is why healthcare professionals en masse have come out against these closures and the proposed shifts to a model that will reduce or eliminate harm reduction services. Eliminating supervised consumption won’t make the rising opioid crisis disappear; it just shifts usage. It turns public spaces into unsupervised consumption sites. And results in more visible crises and more visible deaths.
Let us learn from Alberta, where deaths in public spaces increased after the government eliminated access to harm reduction treatments. According to data from the province's substance-use surveillance system, deaths in public spaces account for 43 percent of all opioid poisoning deaths from July to September 2023, up from the 23 percent reported in the same period the year prior.
How the MH+A Alliance proposes addressing these gaps in Halton Region.
The MH+A Alliance recognizes that HART hubs can address the often complex and intertwined issues of substance use, mental health, instability and social identity that are common among unhoused populations.
This is an issue that already lives here. The Region of Halton closely monitors its unhoused population, maintaining a “By Name” list of people who are experiencing housing instability.
Currently, more than 30 people are being added to the list each month. The need for specialized supportive housing and ancillary supports for individuals with complex mental health and addictions issues is only going to grow.
The driving purpose of the MH+A Alliance is to save the lives of our loved ones by building a pathway for individuals with mental health and addiction issues to start the road to recovery. As such, our HART Hub must offer a continuum of care, addressing various states of homelessness and associated primary care and mental health and addiction challenges.
A promising start in our community is Halton’s existing Mobile Health Team: a team designed to enhance access to primary care for vulnerable and marginalized populations.
The Mobile Health Team is able to meet people where they are: encampments, shelters, community centres, etc. This team’s breadth of focus includes preventative care; primary care; addictions medicine and peer supports designed to improve outcomes for our most vulnerable residents.
The MH&A model is designed to augment the HART hub model, offering expanded and complementary services that include short-term residential facilities, transitional beds, monitored treatment beds, and holistic supportive housing that integrates housing, healthcare, and social services. This expansion of services helps to further establish a low-barrier, client-centred framework in Halton Region.
Looking ahead.
Representing community health partners spanning the continuum of mental health and addiction care in Halton, the MH+A Alliance recommends we follow the evidence by remaining focused on addressing the drug toxicity crisis as a health issue without perpetuating the stigma that is often detrimental to individuals seeking help. We support the government’s objective to select locations that do not compromise other community concerns, but relocation does not require a policy of closure and eliminated access.
Supervised consumption sites save lives and serve as a critically important pathway for individuals with addiction issues to start the road to recovery. It is as much part of an effective continuum of care as addiction counselling, housing and other wraparound supports.
If our goal is to get more people onto the path to rehabilitation and treatment, we need to prioritize building more inclusive and integrated pathways to mental health and addiction care to ensure healthier communities for everyone.
About the Mental Health + Addictions Alliance.
The Mental Health + Addictions Alliance brings together community health organizations that build innovative solutions to transform care. The Alliance establishes partnerships with political, health, social and local leaders to create policies to support individuals living with mental health and addictions. We leverage the best possible data information systems and key metrics to support collaboration, decision-making, and best practices for building integrated mental health and addiction care pathways.
References
Milloy MJ, Wood E. Emerging role of supervised injecting facilities in human immunodeficiency virus prevention. Addiction. 2009;104:620-621.
Kerr T, Tyndall M, Li K, et al. Safer injection facility use and syringe sharing in injection drug users. Lancet. 2005;366:316-318.
Wood E, Tyndall MW, Stoltz J, et al. Factors associated with syringe sharing among users of a medically supervised safer injecting facility. American Journal of Infectious Diseases. 2005;1(1):50-54.
Bravo MJ, Royuela L, De la Fuente L, et al. Use of supervised injection facilities and injection risk behaviours among young drug injectors. Addiction. 2009 Apr;104(4):614-619.
Kennedy MC, Karamouzian M, Kerr T. Public health and public order outcomes associated with supervised drug consumption facilities: a systematic review. Current HIV/AIDS Report. 2017 Oct;14(5):161-183.
Potier C, Laprévote V, Dubois-Arber F, et al. Supervised injection services: What has been demonstrated? A systematic literature review. Drug and Alcohol Dependence. 2014;145:48-68.
Strike C, Watson TM, Gohil H, et al. The Best Practice Recommendations for Canadian Harm Reduction Programs that Provide Service to People Who Use Drugs and are at Risk for HIV, HCV, and Other Harms: Part 2. Toronto, ON: Working Group on Best Practice for Harm Reduction Programs in Canada. 2015.
Gibson DR, Flynn NM, Perales D. Effectiveness of syringe exchange programs in reducing HIV risk behaviour and HIV seroconversion among injecting drug users. AIDS. 2001;15:1329-1341.
Aspinall EJ, Nambiar D, Goldberg DJ, et al. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: A systematic review and meta-analysis. International Journal of Epidemiology. 2014;43(1):235–248.
Freeman K, Jones C, Weatherburn D, Rutter S, Spooner C, Donnelly N. The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime. Drug Alcohol Rev. 2005 Mar 1;24(2):173–84.
Chalfin, A., del Pozo, B., & Mitre-Becerril, D. (2023). Overdose Prevention Centers, Crime, and Disorder in New York City. JAMA Network Open, E2342228.
Government of Canada. Canada.ca. Opioid – and Stimulant – Related Harms in Canada. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/. Last Updated 2024-09-13.
Centre on Drug Policy Evaluation. The Centre on Drug Policy Evaluation’s Statement on the Closure of Supervised Consumption Sites. https://cdpe.org/the-centre-on-drug-policy-evaluations-statement-on-the-closure-of-supervised-consumption-sites/. Posted September 4, 2024.