Images of the drug toxicity crisis in Canada are harrowing. In 2023, an average of 22 people died every day from opioid toxicity. It’s a crisis that has captured the attention of Canadians, and almost everyone agrees something needs to be done.
The Ontario government announced last month they would commit $378 million dollars over four years to fund 19 Homeless and Addiction Recovery Treatment (HART) Hubs across the province. The hubs will offer supportive housing, employment help and addiction care. The announcement also detailed the plan to close 10 supervised consumptions sites because they are located within 200 metres of a school or child-care centre.
Experts in the field have welcomed more funding for treatment centres. However, the closure of supervised consumptions sites, coupled with the news that HART Hubs will not offer safer supply or needle exchange programs, is dangerous.
Evidence shows supervised consumption services both save lives and benefit communities.
A research study in The Lancet found that overdose death rates decreased significantly in neighbourhoods with supervised consumption sites. This reduces the strain on emergency medical services. Data also shows that neighbourhoods with sites actually saw crime drop. Also important to note is the fact that sites provide or connect people to healthcare services such as addiction treatment and testing for blood-borne infections.
Safer supply is another life-saving approach to the drug toxicity crisis. In this approach, primary care providers distribute doses of opioid medications that are safer than the increasingly toxic supply laced with substances like fentanyl or xylazine found elsewhere. A January 2024 BMJ study on the program found that people with opioid addiction were 61 per cent less likely to die if they were prescribed a safer supply.
Needle exchange programs – yet another approach to harm reduction – reduce the transmission of blood-borne infections including HIV and hepatitis C and keep needles, particularly used needles, off the streets and out of parks.
The closure of supervised consumption sites in Toronto goes directly against the evidence about the many benefits of these sites. The changes made are likely to lead to poorer health outcomes for people who use substances, worsening already major health inequities between those who use and those who do not. No evidence has been provided to indicate our communities as a whole will be safer or healthier.
Funding for treatment centres is a positive step forward but not everyone who overdoses has a substance use disorder and, as Ontario’s Minister of Health correctly noted, not everyone in need of addiction healthcare is ready for treatment. Readiness for treatment is critical to it being successful.
The reasons behind drug use are complex. Most people with a substance use disorder will use drugs whether they are safe or not. More funding for treatment programs should only be part of the solution. Even while people are receiving treatment, research shows it is common for them to continue to use.
For Ontario’s response to the drug crises to be equitable, the government must continue to provide necessary healthcare. They must ensure supervised consumption is available to reduce overdose deaths, safer supply is part of the strategy to eliminate deaths due to drug toxicity, and needle exchange programs are open to protect the public and those who use drugs. They should invest in supportive housing until the supportive housing deficit is eliminated and everyone who needs a unit receives one. They should also address other social determinants of health fueling substance use.
These approaches are evidence based, they are healthcare, and they are needed.