As health-care providers for people who use drugs (PWUD) in Ontario, we know that the decision to close 10 out of 17 safe consumption sites (SCSs) goes against current research and knowledge of best clinical practice. The government justified closures by introducing new Homelessness and Addiction Recovery Treatment (HART) Hubs. While there is still much not known about these hubs, we advise that they need not come at the expense of tested, effective, and established SCSs.
By closing urban sites, the provincial government is putting our patients and communities in danger. Ontario is in an overdose crisis and health-care providers need more than one tool in our clinical toolbox. Much like how we support people using alcohol along all stages of recovery, we must also address those who use substances with care that is comprehensive, flexible and accessible.
We know substance use is individual and complex; people need to be mentally prepared to engage in recovery programs. Mandatory treatment or treatment alone does not work. PWUD who are not ready to stop using drugs are like someone drinking alcohol daily who is not ready to quit. Our government is increasing alcohol consumption by expanding the areas that can sell alcohol, such as convenience stores, while health-care providers continue to see – close to double the number of PWUD – suffering from alcohol use. People can openly drink at bars, clubs and patios because it is legal to do so, but does that mean it is safe?
Death from overdose is the third leading cause of accidental death in Ontario. When PWUD are biologically stuck in a cycle of use, like your friend who might be drinking but not ready to stop, SCSs provide safety, dignity and a bridge to next steps. SCSs allow people to self-administer pre-obtained drugs under the safety and support of trained personnel. They are purposefully set up in areas where there are high rates of public drug use. From January 2017 to May 2024, SCSs in Canada reversed nearly 60,000 overdoses.
In addition, SCS staff help to catch individuals who have fallen through the cracks, offering housing, medical, mental health and addictions treatment referrals. Sites have made well over 525,000 referrals since 2017. Many also serve as low-barrier drop-in clinics, where individuals can access emergency, preventative and primary care, including wound care and health education.
The Ontario government states that HART hubs will be “upstream investments in prevention.” According to research, harm reduction is already one of the best tools we have to help prevent PWUD from getting sick. Harm reduction, is a “set of activities that are intended to minimize the negative physical and social impact incurred by behaviours related to drug use.”
Unfortunately, HART hubs will not offer needle exchange programs or supervised drug consumption. Many PWUD get the drug into their bodies using needles that when not clean, used multiple times and shared with others puts users at high risk of contracting many health issues. The prevalence of hepatitis C and HIV among PWUD prior to needle exchanges have greatly decreased at SCSs due to clean needles, early testing and access to quick treatment. Additionally, they reduce costs. Australia noted that every dollar invested in safe needles produced $4 in health-care cost savings.
Thus, for those of us working at SCSs as well as The Centre of Addiction and Mental Health, Canada’s largest mental health hospital, it was tough to hear Ontario’s health minister say “the status quo of drug consumption sites is not working.” The evidence is strong that the government must implement SCSs and HARTs as complements to one another.
To view them as mutually exclusive and dissolve a lifesaving, evidence-based resource in the midst of an overdose death crisis will lead to harm.
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