By Scott Martin, Declan Keogh, and Kenyon Wallace (Toronto Star Reporter)
As opioid overdoses continue to ravage Ontario, Toronto neighbourhoods with supervised consumption sites have seen dramatic decreases in drug fatalities, a new study shows.
The study, published this month in The Lancet, found a 67 per cent reduction in overdose deaths in neighbourhoods within 500 metres of supervised consumption sites after they opened. That reduction in mortality rippled as far as five kilometres from the sites.
It is one of the first papers to study overdose deaths in communities surrounding consumption sites, controversial spaces where people can use drugs under supervision. The results come amid a provincial pause on consumption site approvals, and provide new evidence supporting controlled drug use as an effective tool in the battle against a public health crisis that has affected tens of thousands of Canadians.
“These sites are doing what they’re supposed to be doing, which is preventing deaths,” said Indhu Rammohan, a research assistant at Li Ka Shing Knowledge Institute’s Centre on Drug Policy Evaluation and the study’s lead author. “And potentially also doing that in a way that we haven’t really thought of before, which is at the community level or population level.”
Annual opioid overdose deaths in Toronto have skyrocketed in recent years, increasing more than 250 per cent between 2015 and 2022. Across Canada, more than 40,000 people have died from overdoses since 2016 — one of the leading causes of death in the country.
The study’s authors used records from the Office of the Chief Coroner of Ontario to measure fatal overdose rates between May 1, 2017, and December 2019, before and after the implementation of nine consumption sites in Ontario. The researchers analyzed 787 fatal overdoses and found the mortality rate decreased to 2.7 deaths per 100,000 from 8.1 in neighbourhoods that implemented the sites.
There are 10 supervised consumption sites across Toronto where people can bring their own drugs to use under the supervision of health professionals. The sites teach safer consumption practices and provide access to clean needles and other drug-use materials — as well as Naloxone, the life-saving drug that can reverse the effects of an opioid overdose.
The sites have been controversial, with some residents and businesses questioning their impact on neighbourhoods. The first sites opened in Toronto in 2017, but concern over their services ramped up last July after Karolina Huebner-Makurat was killed by a stray bullet fired outside South Riverdale Community Health Centre (SRCHC).
Indhu Rammohan, a research assistant at the Centre on Drug Policy Evaluation at the Li Ka Shing Knowledge Institute and the lead author of the study. Photo credit: supplied
This week, the Star’s Betsy Powell reported that a proposed class-action lawsuit was filed in Ontario Superior Court alleging the SRCHC was failing to follow city and provincial rules in its operation of the site and is responsible for Leslieville’s “rapid” deterioration since the site’s inception in 2017. The suit, which is seeking unspecified damages, alleges the centre has failed to enforce a zero-tolerance drug-trafficking policy.
The new research suggests the consumption sites increase the protection to drug users over time, said Daniel Werb, director of the Centre on Drug Policy Evaluation and a co-author of the Lancet study.
“The effect was so immense that you saw two-thirds reduction in mortality and that it was so spread out geographically, you know, which was pretty amazing,” he said.
“What we know about them, whether you like it or not, is that they produce a sense of community among clients and the broader network of people who visit them and are served by them … From a public health perspective, that’s a good thing.”
Sarah Larney, an associate professor at the Université de Montréal and an expert in harm reduction, said the study is particularly timely given that it was conducted when fentanyl and other highly potent synthetic opioids had overtaken heroin as the drug of choice for many users.
“Because fentanyl is so much stronger than other opioids, then that tolerance and withdrawal cycle is also very strong,” said Larney, who was not associated with the Lancet study. “It’s very difficult to manage that without actually continuing to take opioids.”
The Investigative Journalism Bureau and the Toronto Star have previously reported on the increasingly toxic illicit drug supply and the emergence of ultra-potent synthetic opioids in Toronto and beyond.
Kimberly Mitchell, who has used supervised consumption sites and now advocates for drug users, credits the sites as a factor in her recovery. She says that having a safe place to use drugs helped lift the burden of physical addiction and allowed users to focus on their mental health.
“They’re non-judgmental, right?” Mitchell said. “So you go there, and just talk to them. I’ve seen so many lives saved. I was the worst of the worst, and now I can function.”
In October, the province announced it was pausing approval of any new supervised consumption sites and treatment facilities, citing “public safety” concerns — including the death of Huebner-Makurat — while it conducts a “critical incident review.”
A spokesperson for the Ministry of Health said the province has invested $525 million in 2019 on addictions and treatment services — including short-term accommodations for those brought to hospital in crisis and increased access to medications for people looking to kick their opioid addictions.
The spokesperson added that the 2023-24 budget includes a five per cent increase “in base funding for all community based mental health and addiction organizations.”
France Gélinas, MPP for Nickel Belt and NDP health critic, called the results of the Lancet study “powerful,” and said she hopes it will inform policy and the review that is currently underway.
“This is the strongest body of evidence that we get to work with … So does that give me hope? Yes, absolutely.”
Gélinas approaches the overdose crisis with the fatigue and perspective that comes from deep personal loss.
The son of a close family friend is currently in the hospital following an overdose. And two and a half months ago, she buried her nephew, who died from an overdose, she said.
“When will this end? … This is too hard,” she said in a recent interview. “Why is it that we see young people needing our help and we turn our backs on them?”
Sam Mortimer, a public health nurse at Public Health Sudbury and Districts, said the new study has implications for communities in northern Ontario, where funding for these sites is strained.
Sudbury’s supervised consumption site, The Spot, has stopped receiving funds from the city and currently operates on donations while it awaits a funding decision from the province. Mortimer said that if sites such as this lose funding, it would be “devastating” for Sudbury and other northern Ontario communities.
“Then we’re looking at preventable deaths, substance-use related harms and strained emergency and health care, like social services.”
According to Public Health Sudbury and Districts, 29 non-fatal overdose events occurred at The Spot, and 645 referrals were made to off-site health-care services since it opened in late September 2022.
In the fall of 2020, Rammohan, then studying for her master’s in science in health policy, made a weekly trip to the chief coroner’s office in Toronto from her parents’ home near Grimsby, where she would sift through hundreds of files containing the intimate details of Ontarians who died of an overdose. The reports included the circumstances surrounding a person’s death, including hospital admission records, police reports and interviews with family, friends or whoever had found them.
Rammohan became a witness to the tragic — and often untimely — deaths of Ontarians swept up in an ever-expanding overdose crisis.
Those hours at the coroner’s office became the foundation of her research into supervised consumption sites. But it came with a mental toll, she said.
“It was heavy. It was … the nature of people’s lives ending and descriptions of how they were found,” she recalls. “In many cases people were alone in their last minutes and they were found later.
“That was difficult. … You can only read so many of those stories.”
The Investigative Journalism Bureau is a non-profit newsroom based at the Dalla Lana School of Public Health.
This article is also available on the Toronto Star website.