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Opioid Crisis: Northern cities working toward supervised consumption sites

Northeastern municipalities are at different stages of establishing the facilities

With all eyes focused on COVID-19 statistics, another set of stark numbers need attention.

Drug overdose deaths have grown exponentially across the country.

While safe consumption sites have been touted as part of the solution to alleviate the crisis, some working on the front lines say a sense of urgency to make such services more widely available and easier to establish appears to be lacking.

Time is of the essence. 

For many, time has run out.

Ontario saw 2,426 overdose deaths in 2020 and the situation in Northern Ontario is especially dire.

Algoma Public Health had 53 opioid-related deaths in 2020, up from 17 in 2019.

North Bay region’s death rate in 2020 was 51, compared to 19 the previous year.

The Porcupine Health Unit that covers the Timmins area had 22 deaths in 2019. In 2020 that number jumped to 40.

Sudbury and District reported 105 overdose deaths in 2020, compared with 56 in 2019.

The trend continues in 2021.

The strategy needed to beat back the onslaught requires education and mental health support for youth before they begin the path to addiction. 

It requires detox facilities and counsellors to start the process of recovery.

There is also an immediate need. Survival.

'We need a safe consumption site'

“If they die, they don’t even have the option to get better,” said Connie Raynor-Elliot, who founded a grassroots group called Save Our Young Adults from Prescription Drug Abuse (SOYA) in Sault Ste. Marie 10 years ago.

Raynor-Elliot has seen the destruction of drug abuse first-hand. 

Affectionally known as Mama Bear, Raynor-Elliot made her home available to those struggling with drugs, she’s driven the city streets looking for people at risk, she’s confronted dealers and drummed up public support and attention to what is happening.

SOYA has a downtown location and an active Facebook site with numerous members who lend a hand and share stories

SOYA offers 24/7 support to those facing addiction and Raynor-Elliott estimates they have helped more than 1,400 people and their family members.

“Our city’s getting worse,” said Raynor-Elliott. “I’ve been doing this for over a decade. The synthetic drugs in our city are completely ridiculous. We need a safe consumption site.”

Addicts are going to use no matter what because the illness is so strong, she said.

A safe consumption site would be a lifesaver.

According to Health Canada, properly established, supervised consumption sites and services:

  • reduce the risk of accidental overdose, because people are not rushing or using alone
  • connect people to social services like housing, employment assistance and food banks
  • provide or connect people to healthcare and treatment
  • reduce public drug use and discarded drug equipment
  • reduce the spread of infectious diseases, such as HIV
  • reduce strain on emergency medical services, so they can focus on other emergencies
  • provides space for people to connect with staff and peers, which can help a person moderate their drug use and decide to pursue treatment

Two-thirds of the substances consumed at consumption sites between 2017 and 2019 were opiates, shows data from Canada’s supervised consumption sites and Health Canada. During that same period, there were about two million visits to safe consumption sites in Canada and around 15,000 overdoses and drug-related emergencies at the sites. No fatalities were reported.

It’s an impressive record, but also a source of frustration for people on the front lines navigating their way through government application rules.

'Very long process' to create

Northeastern Ontario’s major cities are at different stages of establishing safe consumption sites. 

It’s a life-and-death race against time slowed down by bureaucracy.

“It’s a very long process which is very frustrating,” said Dr. Julie Samson, who along with Dr. Louisa Marion-Bellemare, is taking a direct and public stand on the ravages of opioid addiction in Timmins. 

They meet regularly with other people in the city to get the ball rolling on a safe consumption site, which can take two to three years to get up and running.

“They make it so difficult,” said Dr. Samson.

Feasibility studies are required along with site plans, a community must prove it needs a site, surveys must be completed with the public and with people who use drugs. The proposal must then be written, which costs money.

“They make every community do the same thing. We all use the same data to prove that it saves lives and we know it does,” said Dr. Samson. “It’s ridiculous that we have to prove the need for one of these.”

Even if the federal government grants the legal exemption required to run a site, funding needs to be in place. 

This means looking to local governments and private sources because in 2018 the Doug Ford government replaced the provincially funded Supervised Consumption Services and Overdose Prevention Site models with Consumption and Treatment Services and announced that it would cap the number of sites at 21. 

The cumbersome process promotes the stigma faced by people with addictions, said Samson.

“This is a medical issue,” she said.

If this were a diabetic clinic or an oncology unit, public acceptance would not be an issue, said Samson.

“It’s absurd to me,” she said.

Sudbury is further along in its process.

In June, Sudbury council voted to support the establishment of a temporary site. A series of trailers will be used to create the 2,500-square-foot space at a cost of $1.1 million a year. In the meantime, locations that could be suitable for hosting a permanent supervised consumption site will be assessed.

A big obstacle to overcome is the stigma associated with drug addiction and fear of consumption sites.

The fears are addressed with facts and logic.

Having somewhere for people who use drugs to go is a great thing for the community, said Heidi Eisenhauer, manager of programs and services at Sudbury’s Reseau ACCESS Network.

The permanent site will be in a location where drug use already exists. 

“You’re not going to have police and ambulances constantly coming through,” said Eisenhauer.

There are cost benefits that come with using harm reduction rather than incarceration and for alleviating pressure on hospitals.

“Economically it makes sense to be proactive rather than reactive,” she said.

However, the bottom line is about more than money. Safe consumption sites save lives and show compassion, say supporters.

“I think the stigma of drug use can create a lot of barriers for people and when you actually have a place for people to go where they feel warm and welcome you are going to have that opportunity to really touch their lives,” said Eisenhauer.

Program impact goes beyond its walls

Ottawa’s Oasis program has been operating a safe consumption site since 2018. The process of establishing the facility began in 2015 under rules set up by the Harper government. It was a complex ordeal.

The Trudeau government scaled back the number of conditions considerably, but the federal exemption is just the first step. 

Groups in Ontario that want to run a site with provincial funding must meet additional requirements under the province's Consumption and Treatment Services program.

Oasis program director Rob Boyd said in 2020 his site, which isn’t Ottawa’s only facility, had 18,500 visits for consumption. That’s about a 75-per-cent occupancy rate in a year when the world was dealing with COVID.

Oasis has five booths for supervised consumption.

“We pretty much always have somebody in the room consuming and we often have people waiting to get into the room,” said Boyd. 

Boyd said there is no way a consumption site could cover all the drug use in a community, but the impact and effect go beyond its walls.

A study done by the Insite consumption facility in Vancouver saw effects in terms of a decrease in needle sharing and other positive health outcomes. That’s based on an estimation that only five per cent of overall community injections were at the site.

Insite is North America’s first safe consumption site. 

In 2017 it recorded 175,464 visits by 7,301 unique users; 2,151 overdoses occurred with no fatalities due to intervention by staff.

When Oasis first started in Ottawa it was a strange concept for users who were not familiar with safe consumption sites, said Boyd.

Oasis has been around for 25 years providing various social services. 

People who use drugs were used to going into Oasis, but it took some time for them to trust that they could actually use their drugs at the centre in front of staff they already know.

“It’s a very odd switch for them to go from this thing that carries a lot of shame to this thing that is now becoming medicalized,” said Boyd.

They don’t have to worry about hiding, taking drugs alone in stairwells or public washrooms.

“That takes a shift in their thinking,” he said.

In its first few weeks, the number of visitors was minimal. It increased month by month as trust was established.

How it works

A user basically goes into the site and equipment such as clean needles are distributed. If they have never been there before, they are registered and the rules are explained. Some basic information is taken down such as their history of drug use and any medical conditions and then an anonymous code is created that they use.

Supervised consumption sites are anonymous. 

Even if the workers know the user, a name is never attached to their use of the service.

Users have up to half an hour in a booth. When they leave, they have the option to stay in a post-injection space. It’s encouraged because it gives them a chance to interact with the staff more. 

The need for consumption sites is becoming more acute because of the potency of the drugs currently on the street, said Boyd.

Boyd said there has been a 75 per cent increase in overdose deaths in Ontario.

“People are injecting drugs that are potentially lethal to them,” said Boyd. 

At one time, oxycontin was the drug of concern. 

Boyd said several initiatives that restricted access to pharmaceutical drugs happened at exactly the same time as the illicit drug market was growing with what’s called bootleg fentanyl.

“Now what we’re getting is these really complex mixtures. It creates such volatility that nobody can get a steady dose,” said Boyd. 

Boyd said his centre detected drugs that are not even meant for human consumption including large game tranquilizers.

Those involved in North Bay's community drug strategy are going a step further than safe consumption. They are looking to make the city Northern Ontario's first "safe supply" site. This would provide access to legal prescription versions of drugs that are often purchased illegally.

Toronto, Ottawa and London are the only three cities with one of these facilities.

"... margin of error right now is so small for people"

What’s clear to Boyd is that action is needed in the increasingly deadly drug landscape.

“Interventions like supervised consumption sites become even more critical because the margin of error right now is so small for people,” he said.

“It takes a real concerted effort to get a supervised consumption site up and running. It’s an obvious thing that needs to happen. It should be much easier to open up than it actually is.”

One of Oasis’s former workers now leads the campaign for a safe consumption site in Sault Ste. Marie.

Desiree Beck is executive director of Willow Addiction Support Services, a newly established non-profit that is looking to establish a Sault site.

“This is something I have wanted to do for some time now with our community being impacted overwhelmingly by the ongoing overdose crisis,” said Beck.

Beck seeks to provide other services along with the consumption site.

Public consultations have recently wrapped up. Local police and city politicians are on board with the idea.

“Harm reduction and safe consumption sites are methods to stop the spread of this illness,” said a recent Sault Ste. Marie Police Services statement. 

“To those who are not afflicted with the illness of drug dependency, the idea seems foreign and extreme. It is important for you to know, accredited and approved safe consumption sites are not sources of narcotics. Trained health care professionals are on-site to provide clean supplies, prevent overdose deaths from occurring and to connect addicts with the supports they need to beat their addiction. This is a public health crisis and public health experts are advocating for this approach in our communities.”

Beck heard the concerns businesses and some members of the public have about a safe consumption site. 

However, she maintains that such a facility would help take drug use off the streets and allow a community to regain its footing.

“The biggest and most important thing it is going to do is keep people alive,” she said.

Currently, Beck is working on finding a location and completing all the basic components of the application.

“It’s a significant amount of work,” she said. “We not only have to show we have the data to back up our argument, but that we have a plan in place that is very concise, very meticulous, lays out how the site will be utilized and how we are going to support people through their substance use disorder.”

Opposition to consumption sites can be tied to the overall stigma which surrounds drug users.

Beck says it’s important for people to avoid judging people who use drugs without understanding anything about their lives.

“We do have to recognize there is a significant number of socio-economic factors that keep people trapped within the confines of their addictions,” she said.

“What is your living situation, what are your personal relationships like, what is your mental health like, how do you sleep at night, where do you sleep at night, when was the last time you had a solid meal. A lot of people who struggle with addictions are never asked about those things.”

Addressing the need for human connection is another positive aspect of safe consumption sites. 

Being alone in one’s addiction is dangerous for the body and it also drains the soul.

“One thing I can say with 100 percent confidence is that having spent most of my career as an outreach worker who works with people who use drugs is that the connections, I made with those people is the reason they came back to see me.”

To connect with resources, ConnexOntario provides free, confidential and personalized responses 24/7 to people regarding mental health, addiction and problem gambling services in the province. It can be reached at 1-866-531-2600. Good2Talk offers confidential support for post-secondary students in Ontario and Nova Scotia. It can be reached by calling-1-866-925-5454 or text GOOD2TALKON (686868). Kids Help Phone is available 24/7 at 1-800-668-6868.

- This story was supported by a reporting bursary from Journalists for Human Rights and the Solutions Journalism Network and made possible by funding from the McConnell Foundation.

Frank Rupnik

About the Author: Frank Rupnik

Frank Rupnik is Editor of SooToday. Frank is a veteran writer and editor who has worked at daily newspapers across Ontario for more than 30 years
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