Inside the tug-of-war for safe injection sites in Ontario

Last month, the Ford government announced it would be shutting down numerous safe injection sites across Ontario, sparking outrage from healthcare workers and anxiety for those in the field of harm reduction.  

Ontario’s Minister of Health, Sylvia Jones, announced that any active supervised consumption sites (SCS) within 200 metres of schools must close by March 2025. 

The initial parameters for SCS locations in Ontario (set in 2019) ensured that any facility looking to break ground had to undergo a rigorous application process with federal oversight and specifically mark down their proximity to schools.

This standard for practice has now been overturned by these new parameters set by the Ford administration.

For Nicholas Boyce, policy director for the Canadian Drug Policy Coalition, this U-turn in provincial mandate was likely a reality; however, its sweeping intensity still blindsided many. 

“It caught a lot of us by surprise as to how far they went. At the same time, it’s not that surprising as there has been nothing but radio silence from [the provincial government] when we have attempted to talk to them,” Boyce told INsauga.com. 

Boyce has been an active force in Ontario for years. He was the former head of the Ontario Harm Reduction Network and helped operate the Ontario Ministry of Health’s former Opioid Emergency Task Force, which is now defunct.

“Before [the Ford government] came to power, there was a multi-sectoral task force. When you deal with these issues, I believe it is crucial to hear from people who use drugs, doctors, pharmacists, emergency rooms, emergency responders and addiction counsellors. Because, with different perspectives, you get realistic, tangible and effective solutions,” says Boyce. 

Boyce further indicates that it isn’t a stretch to correlate last month’s decision to the dissolution of the Opioid Emergency Task Force.

“At a recent press conference in Thunder Bay, he said he was listening to the experts, but he’s not. He may be talking to a handful of people but he’s missing a set of different sector perspectives.  He’s just making these decisions arbitrarily, it seems,” says Boyce. 

Information provided by Boyce indicates that as early as 2021, the Ontario Association of Chiefs of Police (OACP) has been calling on the Ford government to re-establish the provincial Opioid Emergency Task Force. 

Boyce states that beyond the lack of experts on the ground, the current number one risk to those who use drugs in Ontario is the toxic drug supply, which, according to him, has been subject to contaminants like fentanyl, benzodiazepines and nitazenes, chemical compounds that increase the risk of death by a staggering margin. 

“The government has done nothing, and now to have arbitrarily made this decision to shut down these sites, which will kill people and clog up emergency departments. I was under the impression that this current government was seriously concerned about ER wait times in the province. Well, now they are going to go through the roof,” says Boyce.

INsauga.com contacted the Ontario Ministry of Health to gain insight into new provincial strategies, such as the new 200-metre standard and any potential correspondence with harm reductionists, medical workers and law enforcement groups like the OACP.

“Communities, parents and families across Ontario have made it clear that the presence of drug consumption sites near schools and daycares is leading to serious safety problems. We agree. Open, taxpayer-funded drug consumption should not be happening on the same block as schools and daycares,” Hannah Jensen, spokesperson for the Ministry of Health, told INsauga.com in an email. 

Additional information by the Minister of Health’s office to INsauga.com indicated that — per information from Public Health Ontario — opioid-related deaths have been on the rise, citing a significant jump from 1,270 in 2017 to 2,858 in 2021. However, unlike the throughline of a toxic drug supply, which many harm reductionists and healthcare workers believe is the main cause of fatalities, representatives with the Ministry of Health indicated that “the data makes clear that opioid-related deaths are on the rise since the inception of these [SCS] sites.”

As a result, operating parallel to the Ministry of Health’s decision to curtail safe injection sites was the announcement of Homelessness and Addiction Recovery Treatment (HART) hubs, which intend to operate as all-in-one treatment centres for those who are unhoused or suffering from long-term addiction.

Information from the provincial government indicates that these locations will provide standard necessities such as food, showers and other transitional housing services. Additional amenities in these locations will also focus on addiction support and naloxone administration as needed. However, unlike the standards set by supervised consumption locations, HART hubs will only be offering detox care, meaning that there will be no supervised injection of any variety.

According to the province, this detox-focused incentive aims to break what the Ford administration deems as a cycle of harm, as consumption treatment services (CTS) — a secondary term for safe injection locations — allegedly trap drug users in a cyclical pattern. The official Ontario government website, which details the HART initiative, states that “these services allow for a client to start to receive treatment, addressing presenting needs and providing a platform for positive long-term treatment outcomes.”

In response to this incentive, Boyce remains on board with the prospect of an all-in-one care centre. However, it’s the cost of its implementation and the attitudes surrounding it that concern him most.

“It’s not a bad idea; no one is saying it is a bad idea, but [it is] at the expense of harm reduction. I mean, you want to prohibit handing out needles now? We have done a really good job containing HIV in Ontario, and there is still work to be done, so I can’t understand why,” says Boyce.

The Ministry of Health was not able to provide any correspondence with the Ontario Association of Chiefs of Police (OACP). However, a public statement was supplied by the Police Association of Ontario (PAO) on behalf of the ministry, which stated:

“Our members play a vital role in safeguarding the public safety of our communities. Today’s announcement of new HART Hubs marks a significant advancement in enhancing community safety while delivering essential treatment and recovery services. Protecting our children and supporting those in need are our top priorities. This balanced approach will make our neighbourhoods safer and stronger.”

Apart from the focus on community safety, the Ministry of Health also provided INsauga.com with crime statistics from areas within proximity to supervised consumption facilities, specifically in Toronto, which are as follows:

• 113.07 per cent higher reports of assault.
• 76.46 per cent of higher reports of breaking and entering.
• 40 per cent higher reports of shootings
• 96.95 per cent higher reports of robbery
• 44.81 per cent higher reports of homicide

It is important to note that, unlike the data on opioid deaths, the provincial government did not indicate how this data was collected or which internal agency was in charge of its oversight.

In light of these new policies, and their mounting support, the 10 safe injection sites anticipated to close in Ontario are in Toronto, Ottawa, Kitchener, Thunder Bay, Hamilton and Guelph. 

“There were multiple applications to expand and build new sites, specifically, in Timmins, Windsor and Sudbury, who all had applications sitting on Doug Ford’s or Sylvia Jones’s desks for months, if not years,” says Boyce. 

These applications have been torn up in correlation with the new policy, as only the existing supervised consumption sites outside of the new threshold are allowed to stay open, alongside additional policies that prohibit the construction of any new SCS locations.

Boyce told INsauga.com that there have already been prevalent examples of what the future will likely look like for municipalities across the province, as several Ontario cities have declared states of emergency parallel to the opioid crisis this past year. 

“We just have to look at what happened to places like Belleville; earlier this year, they declared a state of emergency, as emergency services were completely overwhelmed, and they had to essentially shut down the whole town just to respond to these overdoses,” says Boyce. 

However, Boyce isn’t putting the blame — or responsibility — strictly on the moving parts of Ontario’s socioeconomic/political engine, as he further indicates that as stability has become nearly unattainable for the average Ontario resident, the need for a boogeyman has become more and more crucial.

“We’re all struggling to pay our bills and pay our rent. The cost of living is going up and we’re concerned about the future of our kids, so it’s very easy to go ‘Oh it’s people who use drugs, who are on the street and are contributing to the overall problem surrounding homelessness,’ instead of taking a step back and looking at the overall complexity of the issue,” says Boyce.

As for the future of the remaining supervised consumption sites in Ontario, Boyce believes that the reality of the current situation is only a slice of the intended outcome, as he states “I think they would have, ideally, wanted to shut them all down, but to shut down all 20 in the province right away would have looked bad. So using this 200-metre rule to slowly close down 10 will eventually lead to them finding a way to close down the rest of them.”