Since 2017, drug users in Toronto’s east end have relied on the South Riverdale Community Health Centre as a place to inject opioids under the watch of health care professionals. Staff have reversed hundreds of potentially fatal overdoses and connected vulnerable people with other services. But the supervised consumption site has also courted controversy.
Neighbours complained it had become a magnet for drug dealers, intoxicated individuals and discarded needles. Then, last July, Karolina Huebner-Makurat, a 44-year-old mother of two, was killed by a stray bullet while walking nearby. One of three people arrested in connection with the shooting was a health centre employee.
The Ontario government ordered a review of the program – one that became a sort of trial of supervised consumption sites in the province in general. Last week, Ontario said it will shutter 10 of the province’s 23 drug-use sites – those within 200 metres of a school or daycare – and prevent them from relocating or new ones from opening. It also announced $378-million for new treatment centres that won’t allow for supervised use or other vital harm reduction services such as clean needles.
More money for treatment is overdue but slashing harm reduction services is a mistake. As this space has often argued, data clearly show that drug-use sites reduce overdose deaths and offer people access to health services. They also keep at least some people from shooting up in public.
They’re not a substitute for treatment, affordable housing or other initiatives aimed at addressing the woeful blend of addiction, homelessness, mental health problems and powerful synthetic opioids, such as fentanyl. But people need to be alive to seek other services.
Two official reviews of the South Riverdale service recommended expanding and improving its operations, not eliminating it and others like it. Premier Doug Ford rejected that advice.
Yet the controversies around the South Riverdale Centre has foregrounded an issue sometimes overlooked by advocates: harm reduction programs need social licence and community buy-in if they’re going to succeed politically.
Critics of last week’s decision may argue that Mr. Ford latched on to a tragedy – the death of Ms. Huebner-Makurat – to push through a new drug policy that’s based more on ideology than evidence or expert advice. It’s certainly of a piece with resurgent drug-war rhetoric coming from Conservative politicians across the country, including federal party leader Pierre Poilievre, who has labelled supervised consumption sites “drug dens.”
Yet the backlash to the South Riverdale site was building before the shooting. Similar challenges exist around sites in Montreal, Calgary, Vancouver and elsewhere. People living near the South Riverdale Centre have reasonable grievances about public disorder, risks to children and discarded paraphernalia. These issues are tied to broader problems of homelessness and addiction, which would exist with or without drug-use sites. But harm reduction facilities do concentrate problems around specific locations.
The people running harm reduction operations have a responsibility to be better neighbours. And it’s not clear the South Riverdale Centre always lived up to that. Both reviews of the program found too little emphasis on neighbourhood security and poor communication with nearby residents, businesses and police. In one report, when health centre staff were asked about the community, “the answer was often ‘drug users’ or ‘clients,’ thus demonstrating that the primary focus was on the service-user needs, but not on the neighbours as community and how services may impact them.”
Over the past year, the South Riverdale Centre has begun to remedy some of these shortcomings: hiring security personnel, expanding their neighbourhood checks for needles and setting up better channels to communicate with neighbours and police. Shutting down the service was not the answer.
Mr. Ford is not wrong to emphasize the need for public safety. Any sustainable push to address the ills of the fentanyl crisis must have a broad enough conception of community to include, and prioritize, both drug users and their neighbours. But Ontario’s sweeping decision to gut life-saving harm reduction services in the province is a major misstep, one that fails to address the problems it purports to solve.