I remember the most poignant lesson I learned in medical school.
It was a Friday afternoon psychiatry lecture. Knowing our minds were on the weekend, the psychiatrist opened with a story of treating a patient with alcohol use disorder.
The patient was detailing the significant trauma they had endured, and how the alcohol use had escalated dangerously. The patient stopped, probably expecting a long-winded explanation about why alcohol was bad, and why abstinence was the only solution forward. I know I was.
What the psychiatrist told the patient instead shocked me.
“I think it is fortunate that you drink alcohol.”
All of our backs straightened. Did she encourage her patient to drink?
Reading our minds, she continued, repeating what she had told her patient.
“I am not saying that drinking is healthy. But alcohol helped you cope. Without it, you would have coped with your trauma another way. You may have sought a more permanent way.”
We all knew what permanent meant. Patients with a history of significant trauma are at a higher risk of committing suicide.
She continued: “You are alive. Dead people don’t ask for medical help.”
The patient, in stunned silence, finally said: “I think you are right, doc. I never thought of it like that.”
The provincial government’s decision to defund safe injection sites (SIS) brought this memory back to the forefront.
In 2024, the province’s 2024 Community Care and Recovery Act prevented the operation of SIS within 200 metres of schools and child care centres, resulting in the closure of nine sites. The province followed up with a 2026 decision to end funding for SIS, to be replaced with Homelessness and Addiction Recovery Treatment (HART) Hub, with a deadline of 90 days, for SSI users to transition to the HART model. The funding is scheduled to end June 13 and will lead to the closure of seven more sites.
On the surface, the HART Hubs seem like a step in the right direction. A centre where patients can access trauma-informed care, counseling, life skills development, medical and nursing support and help with navigating an increasingly complicated medical system. However, the problem is that a focus on an abstinence based model ignores the central tenet that addiction is a chronic and relapsing condition.
Relapses happen. And a person who relapses is at grave risk from the decline in tolerance for potentially fatal complications such as respiratory depression.
An abstinence model assumes that every person using opioids is immediately ready for abstinence. That they are all motivated, and that those who are not, are not worthy of care. In reality, many may not feel ready for abstinence, instead opting for safe consumption. Abstinence is not an immediate focus, but a goal to be worked toward.
I support safe injection sites as the data overwhelmingly supports their benefit. They lead to an increased number of patients seeking addiction treatment services, reduction of transmission of HIV, hepatitis C and B, reduction in overdose deaths and fewer incidents of drug use in public. But I do not want to dismiss the concerns of my friends and family. There is a growing compassion fatigue as the public is faced with the uncomfortable question of how much more it will tolerate in the name of empathy.
The tension exists because safe injection sites are often misunderstood at the policy level as a solution to addiction itself, and that harm reduction is at odds with abstinence. They are not, and they do not need to be.
SIS are a temporary intervention to keep people alive long enough to access care. The true failure is not that SIS exists. But rather that we did not fund the integration of these temporary measures into a broader system of care, including treatment, housing, social work and mental health services.
This intervention recognizes that quitting drugs altogether is a long-term goal. It is an entry point into the health-care system that patients can trust.
Other countries across the political spectrum have taken this comprehensive approach. Switzerland, often viewed as politically centre right, enacted the four-pillar model that emphasizes harm reduction in conjunction with law enforcement, prevention and treatment that is supported with housing. France was more cautious, slowly studying the results of their consumption sites before deciding to expand further.
By not supporting our sites, we have permitted safe injection sites to become targets of frustration, something easy to cut away in budget conversations. Closing sites when we should be thinking about how to integrate them only displaces the problem from supervised areas to public spaces, and allows for fatal overdoses. This is not just a policy debate. It is a reflection of what we believe should happen to people at their lowest point.
My psychiatry professor did not celebrate her patient’s drinking. She recognized it for what it was: a coping mechanism that kept her patient alive long enough to seek help.
Supervised consumption sites are similar in that sense. They are not the end of the story.
But for many, they are the reason there is still a story to tell.
Interesting angle and insight. Thanks for sharing, Abrar!