Ottawa may not have advanced as far as some neighboring municipalities—like Toronto or Montreal—when it comes to formal proposals for drug decriminalization. But Canada’s capital has nonetheless been discussing the approach, with Ottawa Public Health officially adding potential decriminalization to its 2019-2022 strategic plan for mental and substance-use health. This is the result of a long-enduring dialogue amongst harm reductionists in the city—spurred by the rising prevalence of substances previously uncommon there, and by drug-related deaths, with numbers drastically increasing during the pandemic.
This conversation has provided a shred of hope to Ottawa’s harm reduction community, But with limited supervised consumption capacity and a constantly evolving drug supply, the clock is rapidly ticking on the how and the when.
“Even [since] we opened three years ago, the drug supply changed and the demand for services increased,” Rob Boyd, director of the Oasis Program at the Sandy Hill Community Health Centre in Ottawa, told Filter. “This really outpaced the level of services that we have available in the city.”
“We have seen a shift from crack cocaine to crystal methamphetamine—we have predominantly been a crack cocaine city for decades.”
Boyd has long been following trends of drug consumption in Ottawa, as he oversees the operation of one of its four sanctioned supervised consumption sites (SCS). The unforeseen shifts in drug use that he has witnessed make harm reduction provision more difficult and add urgency to the decriminalization question.
“We’ve had benzodiazepines appear in the drug market,” he explained. “Sites are generally not set up to monitor people who are sleeping off a benzo overdose. Additionally, we have also seen a shift from crack cocaine to crystal methamphetamine—which is new to Ottawa, we have predominantly been a crack cocaine city for decades, even prior to the opioid problem.”
Amid these trends, Ottawa’s SCS have been scrambling to seek ways to reduce harms for people who use drugs in the city. But compared to a raft of options around opioids—including naloxone, referrals to opioid agonist therapy and hydromorphone offered under a safe supply program—they have relatively few resources around meth, say, save for providing safer-use supplies like pipes and foil.
Complicating matters, much drug use involves combinations of substances, rather than people using just one or the other. “When we were consulting and thinking about our service and checking in with sites about what we can do, in the back of our minds it was all about injection, opioids and overdosing,” Boyd said. “We were certainly anticipating a lot of stimulant use, but what we didn’t anticipate was people combining their injecting of a ‘down’ with the smoking of a stimulant.”
Boyd cited instances where large portions of SCS participants have moved directly from an injection tent to a stimulant consumption tent in an effort to balance out the effects of both substances. This phenomenon is boosted by the adulteration of opioid supplies, as in many other parts of North America, with fentanyl and its analogues, he added. The effects of a more potent opioid supply on Ottawans have resulted in a corresponding higher demand for stimulants.
It’s in this context that conversations around harm reduction solutions and general decriminalization have accelerated. Ottawa Public Health’s recent strategy illustrates this, and it was formed after the city communicated with several harm reduction organizations. The Community Addictions Peer Support Association (CAPSA) is one of those organizations.
“In the beginning, we reached out to Ottawa Public Health,” Gord Garner, CAPSA’s president of strategic partnerships, told Filter. “We believe that we have loving wisdom that can help educate, make a change and increase people’s health around substance use. One of the ways to end stigma is taking that knowledge in a measured way and bringing it to health service providers and organizations.”
Garner has a personal stake in the fight for education and solutions, as his own past experience with substance use led him to take on a prominent advocacy role.
“We’ve been very fortunate to be a part of this,” he said. “There have been a couple of action plan meetings that have rolled out, and we’ve had a chance to train our public health nurses on stigma and person-first language. These are pretty critical things because we’re coming in as people with lived experience and educating health service providers.”
“It’s when the oppressors change their minds.”
CAPSA operates with a heavy emphasis on ending the stigmatization of people who use drugs—and the link with decriminalization is clear when persecution and criminalization both result from stigma and increase it, making everyone less safe.
If any governing body wants to address the problem, Garner emphasized, it needs to be all-in. “This is the approach we’re taking with substance use health and discrimination, it’s when the oppressors change their minds, and how to do that is you find people in the oppressing community—who are non-malicious but ignorant of some issues—and change their minds.”
A primary example of this is a recent unofficial shift from the Ottawa Police Service, where according to harm reductionists, officers are opting to avoid arrests for simple drug possession within the municipality.
“They’ve spoken to the fact that they’re not actually charging people with simple possession, they have no interest in doing that at this point,” Boyd said. “They’re not interested particularly in the types of folks who would use harm reduction services [nor do they] want to proceed with simple drug charges, that doesn’t solve the problem of crime or poverty.”
With a number of initiatives working towards decriminalization in all but name, the question still remains: What about decriminalization proper?
Wendy Muckle is the CEO of Ottawa Inner City Health, a harm reduction program that operates in the city’s downtown core and provides services such as a safe supply program. She has been observing the moving pieces of government institutions and harm reductionists in Ottawa.
“I feel like the conversation around decriminalization needs to be separated from what the drug supply is,” she told Filter. “The decriminalization/regulation conversation needs to happen, irrespective of anything that’s happening within the drug supply.”
Muckle is fairly certain that the writing is on the wall.
Muckle additionally pointed to the COVID-19 pandemic’s role in disrupting supply, saying it has added to the shift to methamphetamine use. She has noticed the substance being used both as a substitute for opioids and as a self-administered tool used in the opioid detox process, she said.
As for what the municipal government of Ottawa can do in the face of this crisis, Muckle believes the city’s ability is not as far-reaching as some organizations may hope. “I think at the municipal level there are lots of discussions to be had but they have very limited powers.”
Where all this is likely heading is to Ottawa following other municipalities in eastern Canada, by applying for an exclusion from the federal Controlled Drugs and Substances Act.
Muckle is fairly certain that the writing is on the wall. “[The strategy motion] passed unanimously at the Board of Health in Ottawa, with the recommendation to write to the federal government,” she said. “I think most of the city councillors who are part of the Board of Health participated in the Getting to Tomorrow dialogue, and a lot of them were profoundly impacted by what they heard.”
Decriminalization in Canada’s national capital would have symbolic as well as practical significance. But like many other harm reductionists, Muckle believes that decriminalization without regulation and increased provision of resources would be a very limited positive step.
“I think like anything else, the devil is in the details, so decriminalization on its own is pretty meaningless. It’s what’s behind it that actually helps people’s lives, that’s where that attention needs to go.”