Ontario regions hit hardest by the opioid crisis may not get supervised drug-use sites

Theglobeandmail.com
January 10, 2019
Carly Weeks

The Ontario government is promising to approve 21 supervised drug-use sites in places hard hit by the opioid crisis, but some of the communities with the province’s highest rates of opioid-related deaths and hospital admissions won’t be on the list.

Health Minister Christine Elliott announced in October the government would create a new system, called consumption and treatment services, and that anyone wishing to operate a site, including those that had received prior approval, would have to apply through the new program. The province says the sites will be approved starting this month and that all will be running by April.

The government is limiting the number of supervised drug-use sites to 21, which corresponds with the number of sites that already had approval to operate before the Ford government came to power last year. Ms. Elliott’s office said the sites will go to areas in need, based on criteria such as opioid-related deaths and hospital visits.

But only four of the communities with the 10 highest opioid-related death rates in Ontario last year have approved consumption sites. Only three of the communities with the 10 highest hospital-admission rates currently have supervised drug-use sites open.

Several of these communities are seeking approval under the new system, but say the provincial deadline and cap are creating doubts about their prospects.

The reasons vary by region: In some areas, public-health workers say extensive application requirements mean they may not meet the April deadline. In other communities, public-health and harm-reduction officials say they aren’t convinced that a supervised drug-use site is the right fit. Others point to simple math – there are not enough spots to meet the demand.

And some communities that had been in preliminary discussions about whether to apply for a supervised drug-use site say they are unsure whether to move forward after the provincial policy changes.

Joyce Lock, medical officer of health with Southwestern Public Health, which covers a region that includes St. Thomas and had the highest rate of opioid-related hospital admissions in Ontario last year, said any talks about supervised drug use have been put on hold until officials see how the new policies take shape.

Algoma, a region that includes Sault Ste. Marie and had the second highest opioid-related death and hospital-admission rate last year, isn’t pursuing a supervised consumption site either. The region is spread out and having one supervised drug-use site doesn’t address the needs of the population, said Allison McFarlane, a public-health nurse and co-chair of the Sault Ste. Marie and Area Drug Strategy.

“In the future, maybe," she said. “But just right now, it’s not something that we can actively look into.”

The decision to limit the number of sites to 21 is shortsighted, said Thomas Kerr, senior scientific adviser and senior scientist at the British Columbia Centre on Substance Use who has conducted extensive research on supervised drug-use sites.

“I think that that’s a very unconventional approach to establishing public-health policy and practice,” Dr. Kerr said. “If the service is needed, then it should be implemented.”

Hayley Chazan, a spokeswoman for Ms. Elliott, said in an e-mail the new program is being put in place after an extensive evidence-based review and will focus on connecting users with access to primary care, treatment and other resources.

“Our program and its parameters are entirely consistent with expert input and feedback,” she wrote.

Barrie and the surrounding region had the eighth highest opioid-related death rate in Ontario last year, and despite work by public-health officials to open a supervised drug-use site, the new provincial cap means it may not happen.

Lisa Simon, associate medical officer of health with the Simcoe Muskoka Health Unit, which covers Barrie, said she and colleagues in other communities are concerned about the limit of 21 sites because it means some applicants will ultimately get rejected. She said they are hoping to submit their application by April, but it’s a struggle to complete all of the necessary legwork, such as conducting community consultation and getting an endorsement from local government.

“We do fear that [deadline] won’t be feasible to us,” Dr. Simon said. “It’s not something we can rush.”

Hamilton, which had the seventh highest opioid-related death rate last year, has one supervised consumption site. It isn’t enough to meet the need, but the cap means that is unlikely to change under the provincial model, said Robin Lennox, a family physician who helps run the city’s supervised drug-use site. The best hope now, she said, is for organizers to apply directly to the federal government to have a site and try to get the necessary funding themselves. The federal government announced in December cities and groups that want supervised drug-use sites can apply directly to Health Canada.

In Sudbury, which had Ontario’s third-highest opioid-related death rate last year, health officials recognize there’s little chance they will get a provincially approved site because of the cap and the government’s decision to approve all sites by April. Ariella Zbar, associate medical officer of health and director of clinical services with Public Health Sudbury and Districts, said officials aren’t ready to submit an application yet because they still determining whether a supervised drug-use site would help the community and whether it would be supported.

“We are really early stages right now,” she said. “We don’t expect to be coming up with recommendations until spring 2020.”

Rob Boyd, program director at Oasis, a supervised consumption site in Ottawa, said his centre has applied to be one of the 21 sites so it can continue operating. He also expressed concern over the provincial cap, saying it could encourage the creation of large sites, which may not be the most effective set-up.

“If the idea is to spread this around so people have access to it, then you need multiple small sites rather than a few large sites,” Mr. Boyd said.