For many medical students like me, Ontario’s closure of Supervised Consumption Sites (SCSs) is personal.
Ontario is in the midst of an opioid crisis, with overdoses claiming more than 2,200 lives in 2024. SCSs were established to play a critical role in harm reduction, offering supervised spaces for people to use substances, ultimately reducing the risk of overdose and disease transmission. Since Toronto’s first SCS opened in 2017, these sites had served as both a refuge for people who use drugs and part of a broader strategy to address the crisis.
Bill 223, however, ordered the closure of all SCSs within 200 metres of a school or daycare, shutting down more than half of Ontario’s 17 sites with no equivalent replacement. The province also passed anti-encampment legislation that further criminalized poverty, targeting individuals using illicit drugs in public with penalties of up to $10,000 or six months in jail. Since the SCS closures, the Toronto Drop-In Network has reported a 179 per cent increase in overdoses at its drop-in centres, and a 288 per cent year-over-year increase in June 2025. This is unacceptable.
During my training, I have met numerous individuals living with substance use disorders, many of whom rely on harm reduction services. Some service users attribute their survival to these sites. SCSs save lives by reducing fatal overdoses, minimizing the transmission of blood-borne infections and connecting people to treatment. They are also supported by evidence, with an article in The Lancet Public Health finding that in Toronto, 1) neighbourhoods with an SCS had significantly decreased overdose mortality rates in contrast to neighbourhoods without them, and 2) that neighbourhoods immediately surrounding SCSs had the greatest reduction in overdose death rates after opening an SCS.
Community concerns about the presence of SCSs are understandable, particularly when hearing alarming statistics comparing crime rates in neighbourhoods with and without such sites. However, some data suggests decreases in crime rates in neighbourhoods after the introduction of a local SCS. In Kitchener, for example, most types of crime in its downtown area with a SCS decreased more substantially between 2019 and 2024 than in the city overall. In Guelph, results varied depending on the type of crime.
In Toronto, drop-in centres have seen a “staggering” increase in overdoses since the closures of multiple SCSs in the city.
Drop-in centres have seen a “staggering” increase in overdoses since the closures of multiple SCSs in the city.
Notable organizations like the Canadian Civil Liberties Association, the Centre for Addiction and Mental Health (CAMH), and numerous faith groups have spoken out against Bill 223. CAMH even considers SCS and needle exchange programs to be “essential health-care services,” the loss of which will increase pressure on already busy emergency departments.
What we need is a comprehensive health and social system strategy to address the drug toxicity crisis. The Ford government’s plans for at least 18 new “homelessness and addiction recovery treatment” (HART) hubs to better connect individuals with addiction programs and supportive housing are promising, but we can still leverage the opportunity to integrate SCS services with them. We can engage with drug users in a mutually respectful relationship to meet them where they are, all while addressing public safety concerns through education and community engagement regarding the sites. There are reasonable ways to move forward that do not involve the elimination of these life-saving services.
While I welcome the new HART hubs, they do not absolve the province from its responsibility to sustainably fund compassionate and effective harm reduction programs in Ontario. As 140+ faith leaders said in their open letter, “both of these approaches are necessary … but without places like Supervised Consumption Sites, people die – and the dead cannot recover.”
And the dead cannot recover.
