Good morning. We’re digging into the debate over supervised drug-consumption sites – more on that below, along with reconciliation in Rwanda and Vancouver Island’s new grizzly bear cubs.
Today’s headlines
- Canada’s biggest railways lock out workers after failed negotiations with union
- TD Bank is setting aside an additional US$2.6-billion to cover expected penalties from U.S. regulators over anti-money laundering controls
- Tim Walz formally accepts the VP nomination at a star-studded DNC as Bill Clinton and Oprah Winfrey back Kamala Harris
A supervised consumption site in Vancouver's Downtown Eastside.Jesse Winter/Reuters
Public health
Doug Ford’s new rules
Roughly every hour in this country, someone dies of a drug overdose – a rate that escalated at the start of the pandemic and has stayed painfully high since. For decades, public health experts have advocated for harm-reduction programs, including places where people can access clean needles and use drugs under supervision. But Ontario Premier Doug Ford doesn’t believe in these sites, calling them a “failed policy” yesterday. “It’s the worst thing that could ever happen to a community,” he said.
For months, provinces have contended with a revived debate over how best to tackle addiction and combat illicit drug supply. This week, Ontario announced sweeping new rules that would shutter more than half of the supervised consumption sites it funds and shift focus to recovery instead. To better understand the implications of this policy, I called Gillian Kolla, an assistant professor in the faculty of medicine at Memorial University, who’s spent the past 15 years researching harm-reduction programs. Here’s what she had to say.
Let me start with the basics: What actually goes on at a supervised consumption site?
These sites are often just rooms in organizations that provide broader health and social services in their communities. They don’t distribute any drugs, but people can bring in drugs that they’ve obtained elsewhere and take them under the supervision of trained professions, who are there to intervene if an overdose occurs. Those professionals also provide support – sterile injection equipment, education on HIV and hepatitis prevention – as well as referrals to health services and treatment programs.
Ontario’s new policy says these sites can no longer operate within 200 metres of schools and child-care centres. What will that mean?
I want to emphasize that it’s natural to be concerned about our children’s safety. But the location of these sites was very well thought out. All the research says you want to make the sites as accessible as possible, and one of the best ways is by putting them in places where people who use drugs are already receiving health and social services. It just so happens that in dense urban communities, that could be down the street from a school. But it’s not a bad thing to have people using drugs inside at a supervised site, where they’re in contact with professionals. If you don’t have a supervised injection site, your whole community becomes an unsupervised injection site.
So it will be awful to lose half the sites in Toronto. But Northern Ontario currently has an overdose rate double that of Southern Ontario, and we need to think about equity here. Timmins and Sudbury were forced to close their supervised consumption sites earlier this year because the province refused to fund them. Now the Thunder Bay site is slated for closure, which means all of Northern Ontario will be without a site.
The Kensington Market Overdose Prevention Site in Toronto will close as a result of Ontario's new rules.Fred Lum
What happens when these sites shut down?
People die. There is very strong evidence that these sites save lives. Since 2020, South Riverdale Community Health Centre’s site has reversed 1,000 overdoses in Toronto. The Works, another site slated to close, has reversed 2,300. So we’re going to see an increase in fatal overdose rates. We’re also going to see increased burdens on ambulances and emergency departments. We’ll see increased rates of infectious diseases, because we’re reducing access to sterile injection equipment, which some of these community health centres have provided since the ‘90s. It’s an incredible rollback of evidence-based public health interventions.
Can we dig into that evidence more? How do we know harm-reduction programs work?
One of the reasons we have so much evidence for harm-reduction programs is because they’re controversial, which means a lot of research gets done on them. There’s over 30 years of public health evidence showing that supervised injection sites don’t lead to increased drug use or crime in the community. They’re incredibly effective at preventing blood-borne infections, and that ends up saving the health system enough money that over a couple of years, you actually pay off your supervised consumption site. And they’re very good at connecting people with services. In my research, people told me that when they were looking for a withdrawal management bed or a residential treatment program, they’d go to these sites because they trusted the workers there to find them a spot.
Ontario said it will shift money from these sites toward treatment and recovery. What effect will that have?
I think it’s a real problem to position these two things in opposition. Of course, we need easy access to evidence-based treatments. So if you think that’s a laudable goal, then fund it, and if demand for supervised consumption sites goes down, we can talk about closing the sites. But when you talk to anybody on the ground in Ontario, it’s more difficult to get people into withdrawal management and find them residential treatment than it was six years ago.
In Alberta, there seems to be some magical thinking that you send people to residential treatment and they come back better. The reality is, residential treatments don’t have better outcomes than when people stay in their homes and receive services within their communities. The one group who tends to do better is folks experiencing homelessness, and that’s probably because we’re giving them a bed and food. But if we’re not addressing the affordable housing crisis, then those people leave recovery centres just as homeless as when they entered it.
What does a comprehensive response to the drug crisis look like?
If we don’t address the fundamental issue that the drug market is incredibly volatile and toxic, it will be difficult to make headway. Treatment approaches are an important part of that. So is easy access to evidence-based, harm-reduction programs, and to medication-based interventions like methadone or buprenorphine, which are both long-acting opioids, so people’s withdrawal is controlled and they’re no longer craving drugs from the street markets. Because they’ve been hit so hard by the overdose crisis, B.C. probably has the best access to residential treatment, evidence-based treatment and harm-reduction programs. But there’s not a single province or territory that has scaled up these interventions to meet the need.
This interview has been edited for length and clarity.
The Shot
‘When I decided to forgive him, a new life started for me.’
Mukaremera Laurence and Nkundiye Thacien, the man who killed her husband 30 years ago, work together in his garden in Mbyo, Rwanda.Paloma Laudet/The Globe and Mail
In 2003, two decades after the Tutsi genocide, Rwanda’s government set up eight “peace villages” where survivors and former perpetrators would live – and rebuild – side by side. Read more about the long road to reconciliation and forgiveness here.
The Wrap
What else we’re following
At home: More than 100 Jewish organizations, synagogues and hospitals across Canada received identical bomb threats yesterday, with police evacuating several buildings.
Abroad: Secretary of State Antony Blinken returned to the U.S. without a ceasefire deal, as Israeli air strikes killed more than 50 people in Gaza.
Spotted: Two grizzly bear cubs (and their mom) were seen for the first time on Vancouver Island – that’s promising news for trees, which grizzlies help fertilize, and seeds, which they help spread.
Plotted: Sometimes, it pays to put off your travel bookings – Paris hotel rooms were $350 cheaper two weeks before the Olympics than 11 months ahead. (Swifties heading to Toronto this fall, take note.)