On December 2, the Legislative Assembly of Ontario, Canada, passed a law that will shut down 10 supervised drug consumption sites (SCS). It’s an assault on harm reduction in the province that will cost untold lives.
Bill 223 bans SCS within 200 meters of schools, childcare centers and similar facilities. That covers 10 out of the 17 sites currently operating in Ontario. They will be forced to close by March 31, 2025.
As well as intervening to prevent overdose deaths among people using drugs on site, these SCS offer a raft of resources critical to people’s health, like drug checking, sterile syringe provision, naloxone, safe supply and referrals to other services.
The governing Progressive Conservative party had announced the legislation in August; other Ontario politicians either supported or failed to adequately oppose it as it progressed.
The resulting law also bans local governments from applying for exemptions to Canada’s Controlled Drugs and Substances Act in order to decriminalize drug possession.
And it bans municipalities from applying to open new SCS or safe supply programs without the approval of the provincial health minister. That’s not likely.
In August, reporter Jack Hauen asked Health Minister Sylvia Jones if she’d estimated how many people would die as a result of the planned SCS shutdown. “Jack, people are not going to die,” she responded. “They’re going to get access to service. You know, I do not call watching someone injecting an illicit drug to be healthcare in the province of Ontario.”
The report noted that “in 2022/3 alone, the 10 sites that will be closed … successfully prevented fatalities from over 1,500 overdoses.”
December 3, the day after Bill 223 passed, saw the publication of a damning report from Ontario’s auditor general, Shelley Spence: Implementation and Oversight of Ontario’s Opioid Strategy.
The government’s SCS decision, made while the annual report was in development, was taken “without proper planning, impact analysis or public consultations,” it stated, including around “a potential increase in overdoses and emergency department visits” due to the move, when SCS “have been proven to prevent overdose deaths.”
Starkly, the report noted that “in 2022/3 alone, the 10 sites that will be closed upon passing of the legislation had successfully prevented fatalities from the over 1,500 overdoses that happened on site.”
Since March 2020, Ontario’s safe consumption services have hosted 1.12 million visits from 178,000 unique clients. They’ve provided over 530,000 service referrals—including to housing, HIV and hepatitis c treatment, and withdrawal management services. And they have averted 22,000 overdoses.
Ken Miller is the executive director of the Canadian AIDS Society. He lives in Thunder Bay, Ontario, where one of the SCS due to shut down is located.
“I wasn’t surprised,” he told Filter of the developments. “We’ve seen the coordinated effort from Ontario, Saskatchewan and Alberta to restrict or eradicate harm reduction services such as safe consumption sites or needle exchange programs.”
On October 21, Miller organized a “die-in” to protest the closure of the Thunder Bay site. Inspired by earlier advocacy around HIV/AIDS, over 100 people lay down outside city hall, their bodies outlined in chalk, to symbolize the lives that the policy would cost.
Thunder Bay protesters including Ken Miller (with megaphone). Photograph by Ryan Hill.
The provincial government cites public safety and crime concerns in the vicinity of SCS in an attempted justification of its actions. Such claims, common among opponents of harm reduction, are refuted by evidence.
Like other Canadian provinces, Ontario is now doubling down on treatment and recovery at the expense of harm reduction. In closing SCS, the government is touting a $378 million investment in 19 new Homelessness and Addiction Recovery Treatment (HART) Hubs.
“HART Hubs will add up to 375 highly supportive housing units, in addition to addiction recovery and treatment beds, that will help thousands of people each year transition to more stable long-term housing,” it said, in addition to connecting people with medical and social services. “With a focus on treatment and recovery, HART Hubs will not offer ‘safer’ supply, supervised drug consumption or needle exchange programs.”
The exclusion of harm reduction means many people are unlikely to be able to access the services, because they will no longer be alive.
HART Hubs “will in no way be able to fill the gap in services created by these closures.”
Epidemiologist Dr. Tara Gomes is the principal investigator at the Ontario Drug Policy Research Network (ODPN).
“Despite the investment by the government into HART Hubs, which have goals of helping coordinate care and treatment for people across the province, these new Hubs will not provide overdose response, supervised consumption services, access to safer opioid supply programs, or provision of needle exchange services,” Gomes told Filter, “meaning that they will in no way be able to fill the gap in services created by these closures.”
In November, the ODPN published a report, co-authored by Gomes, estimating the potential impact of closing five out of 10 in Toronto, as will happen under Bill 223. One further site, the report noted, “is likely to close after its lease expires.”
“Assuming 4 SCSs remain open and the service radius for an SCS is 500m, we estimated that 636 people (47% of current clients) would lose access if remaining sites were able to accommodate all clients within their service radius,” the authors wrote.
“Those people are going to be at higher risk for overdose, higher risk for death,” ODPN lead author Dr. Ahmed Bayoumi told Toronto’s CityNews. “We also know that many of the clients … are people who are unstably housed or homeless. So those people don’t have another place to go. They don’t have a private residence to go to. So most likely people who don’t have another place to go are going to inject in alleys, in parks.”
An estimated 525 people in Toronto lost their lives to opioid-involved overdose in 2023, even with 10 functioning SCS. Research has shown that Toronto neighborhoods with SCS experienced large reductions in overdose mortality, compared with no statistically significant decreases in other neighborhoods.
“This loss of supervised consumption sites will have devastating impacts on all of the communities that they currently serve,” Gomes said. “Research … shows that not only do these sites help prevent harms by reversing potentially fatal overdoses, but they also help connect people to treatment, housing and health care, reduce transmission of infectious diseases like HIV and hepatitis C, and reduce discarded needles and other drug-related materials within neighborhoods.”
The HART Hubs will not do most of those things, though they will seek to connect people with services. How much of a replacement will they be?
Dr. Dan Werb is the executive director of the Centre on Drug Policy Evaluation, at St. Michael’s Hospital, and a faculty member at the University of Toronto’s Institute of Health Policy, Management and Evaluation.
The government is “shutting down the best referral system this province had, which is supervised consumption sites, and replacing it with a model that is frankly untested.”
“It appears to be kind of an inpatient-like supportive housing intervention that has its goal linking people who use drugs with a range of services they may need,” he told Filter of the hubs plan. “Now, the irony here is that if you are looking to link people who are at risk of overdose with the services that they need, you only have to go to the Health Canada database. There is a national dashboard that tracks the number of visits at supervised consumption sites across the country and the number of referrals made.”
“The notion that the government is changing tactics here to try and focus on referrals is actually going to be shutting down the best referral system that this province had, which is supervised consumption sites, and replacing it with a model that is frankly untested,” he said.
Werb noted that the Ontario government “did not provide any clinical evidence” on the effectiveness of HART Hubs. “I fully don’t understand what the model is.”
“There are going to be other services that are affected by these closures, and I will highlight in particular drug checking,” Werb said, calling these services “a real straightforward and effective way to help people ensure they are not going to be consuming drugs that have unpredictable contents or adulterants.”
“Drug checking is generally co-located with supervised consumption sites,” he explained, “so if you close those sites people are going to have their access to drug checking compromised, which not only has a knock-on effect [on] an individual’s capacity to avoid bad batches but also compromises an emerging provincial drug market monitoring system that is based around the results of tests. If we don’t know what people are using, we can’t do drug market monitoring, responding through public health alerts to warn other people about the types of drugs circulating in the community, and that is really problematic.”
SCS “are not and have not been associated with increases in crime, and certainly not violent crime. Despite this, the rationale was one of public safety.”
For months, people who use drugs in Ontario, health care providers and academics have been fiercely advocating against the looming SCS closures, both by highlighting their lifesaving benefits and by pushing back on the government’s supposed justifications.
Werb’s Centre on Drug Policy Evaluation released a report on Ontario SCS in November which, among other things, analyzed crime data in light of the government’s claim of increased violent and other crimes around the sites.
Using 13 years of Toronto homicide data from the Office of the Chief Coroner of Ontario, the researchers found that after SCS opened, areas within 500 meters experienced a minimal but statistically significant decrease in homicides, while areas further than 3 kilometers away experienced a minimal but statistically significant increase.
Their analysis of nine years of Toronto Police Services data meanwhile showed that neighborhoods with SCS experienced significant decreases in assault and robbery rates after implementation, while other downtown neighborhoods showed no such decline. There were no significant changes in thefts over $5,000 after the opening of SCS, but both neighborhoods with and without the services experienced initial increases in break-and-enter rates, followed by significant downward trends.
In other words, the government’s claim that these sites increase crime is demonstrably false.
“They are not and have not been associated with increases in crime, and certainly not violent crime,” Werb said. “Despite this, the rationale that was put forward was one of public safety.”
“In one month alone after the site was closed, more people died from overdose than in the previous year.”
But the government has ignored all kinds of compelling evidence—most of all, how its plans are a recipe for mass deaths. Real-world examples underline that.
“There was a site that closed in March of this year in Sudbury, in Ontario’s northern region, which has been disproportionately hard hit by overdose,” Werb recounted. “Last year in Sudbury, which is a city of about 160,000 people, 100 people died from an overdose. By October of this year, after the site was closed, 115 have people had died of an overdose. So three quarters of the way through the year, more people have died from an overdose than in the entire previous year.”
Photograph by Ryan Hill
The bottom line is that the Ontario government is “morally” against the notion that people like or need to use drugs, and willing for people to die in its pursuit of that ideology.
In Toronto the sites being forced to close are: Parkdale Queen West Community Health Centre’s Bathurst, Regent Park Community Health Centre, South Riverdale Community Health Centre’s Queen, Toronto Public Health’s The Works, and the Neighbourhood Group’s Kensington Market Overdose Prevention Site.
Other Ontario sites being forced to close are: Guelph Community Health Centre, Hamilton Urban Core Community Health Centre, Thunder Bay’s NorWest Community Health Centre, Region of Waterloo Public Health and Emergency Services, and Ottawa’s Somerset West Community Health Centre.
“I would urge policymakers to immediately reconsider their decision to implement these changes, and work together with safe consumption sites to find ways to support their continued operation,” Gomes said. “We’re losing dozens of people every week in Ontario from drug overdoses, and we simply can’t afford to move backwards, removing access to evidence-based services.”
Nothing suggests that the Progressive Conservative government, led by Ontario Premier Doug Ford, will start listening.
“I think of the people involved in this movement. I think of the people who are no longer here in body because they have been taken too soon from this preventable issue,” Miller reflected. “I think about what needs to be said. I think we need to call it out. Is the new face of genocide inaction? Inaction towards communities who are not receiving proper support?”
Top photograph of Thunder Bay die-in by Ryan Hill
Correction, December 11: The original version of this article misstated Sudbury’s fatal overdose figures before and after its SCS closure. The article has been edited with a corrected quote.
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