Supervised injection sites face new roadblocks in Toronto with provincial guidelines

Thestar.com
November 7, 2018
Jennifer Pagliaro

Life-saving overdose prevention sites risk being shut down amid an ongoing opioid crisis after Premier Doug Ford’s government introduced new rules that front line workers say create unnecessary barriers.

The Ford government launched a review of safe consumption and overdose prevention sites this summer --putting the brakes on the opening of three overdose prevention sites in Ontario --and worrying advocates that the programs and services would be defunded and barred altogether.

Under new guidelines the province will assess the proximity of the drug consumption sites to parks and schools, which could be a problem for The Works site, which is near Ryerson University.

Health Minister Christine Elliott announced on Oct. 22 that the sites could continue operating under new guidelines.

But those rules create needless red tape and restrictions, say concerned workers and a Toronto city councillor, with peoples’ lives at stake. And with a lack of clarity on the new deadlines to apply and requirements, the provincial government is refusing to answer key questions.

“I feel like crying. I feel like we started a service in Moss Park 15 months ago to show what you do in an emergency and what you do to save lives,” said Sarah Ovens with the Toronto Overdose Prevention Society, an advocacy group that has repeatedly called on governments to be more flexible and nimble in responding to a growing health crisis.

She said after working with former premier Kathleen Wynne’s government on a process that allowed legal sites to open quickly, the Ford government has “thrown the process out the window.”

“We have new deaths of friends and family members and volunteers and people who use the site all the time. It just feels like we need to be moving forward not backwards.”

There are two types of sites in operation in Toronto today.

Anyone wanting to open what’s called a supervised consumption service has to go through a lengthy and onerous federal exemption process designed under the previous Conservative government. That process has since been somewhat streamlined by the current Liberal government but can still take months for applications to be approved.

In Toronto, there are four such sites located within existing community health centres, which have multiple booths and allow people to bring their own drugs and inject under the supervision of a nurse who monitors for signs of infection or overdose.

But in the midst of the ongoing emergency spurred by the increased prevalence of lethal drugs like fentanyl on the streets, the province, under Wynne, worked with local organizations to create a faster process for a second type of site, the overdose prevention locations. The province is responsible for approving those sites, where workers, often volunteers, are trained to administer oxygen and naloxone, which can reverse an overdose. Those sites are given approvals to operate for up to six months at a time.

But the new rules, detailed in a guide created by the province, mean all sites must now meet federal requirements and additional provincial standards to be approved.

Those new standards dictate that sites can’t be within 600 metres of similar services, which will be problematic in the downtown east area where multiple sites exist today, and that the provincial Health Ministry will assess the sites’ proximity to parks and schools, including universities and colleges.

That could impact the status, for example, of the city-run site, The Works, near Yonge-Dundas Square which is less than 200 metres from Ryerson University.

It also includes a requirement that all sites have a “designated health professional” present at all times, a costly requirement that would be difficult for some of the sites to meet.

The sites are also required to meet certain ministry-designed space specifications and to have foot-wash stations. The provincial guideline document does not explain why the foot-wash station is now a requirement, but it lumps it in with the need for a hand hygiene sink.

The requirements will be especially difficult to meet for the city’s four existing overdose prevention sites.

In an email, Elliott’s press secretary Hayley Chazan did not answer the Star’s specific questions about how the new application deadlines are unclear and whether additional funding would be available.

“Our government takes the ongoing opioid crisis very seriously,” she wrote. She said the new rules are “entirely consistent with expert input and feedback” and that existing sites can continue to operate while they apply.

Councillor Joe Cressy, chair of the city’s drug strategy implementation panel and the strongest council voice in support of harm reduction, said it is significant that the Ford government has acknowledged the benefit of these services and is willing to pay for them.

“That being said, the regulations as has been released are overly restrictive,” he said. “In the midst of the most significant health crisis in a century, we should not be restricting our ability to save lives, we should be scaling up our ability to provide life-saving health care.”

He said he’s optimistic the regulations will be adjusted, calling restrictions like the 600-metre rule “arbitrary.”

At last count, 308 people died from an opioid overdose in Toronto last year --nearly five times the number of homicides recorded in the same year and nearly seven times the number of fatal collisions involving cyclists and pedestrians reported by Toronto police.

That tally included Justin Lidstone, not yet 23 years old, who was found slumped in the stairwell of a downtown building and whose family and friends described as a generous and much-loved brother and son.

Pierre Gregoire, 28, was remembered for his wide grin and love of sports. He died of an overdose in a KFC washroom on Queen St. after being told there was no room for him to lie down to sleep at a nearby drop-in.

Since harm reduction sites have been open, many lives have been saved. The Moss Park overdose prevention site, which began as an unsanctioned tent and later trailer in the park run by volunteers in response to the slow-moving federal approvals process, oversaw close to 8,750 visits to their injection site and stopped or reversed close to 240 overdoses during the first 10 months of operations.