How Toronto’s mayoral hopefuls would tackle the city’s drug crisis

Thestar.com
April 25, 2023

In a recent mayoral campaign video, former police chief Mark Saunders stands outside city hall holding a naloxone kit -- a medication used to reverse opioid overdoses -- and says families are keeping them by their front doors just in case someone overdoses after getting accidentally spiked by a discarded needle.

The problem? It is extremely unlikely if not impossible to overdose in this way, said Jessica Hales, a nurse-practitioner who has worked in east downtown Toronto for 13 years, and has spent the last three working on a safer opioid supply program.

“I’ve never heard of that happening. It’s just such a sensationalized thing that I think leads to a lot of discrimination toward people who use drugs,” she said. The typical worry from a needle stick accident would be an infection.

“It is just so discouraging to hear this lack of evidence-based information being shared publicly,” said Hales, adding that it reminds her of the misinformation about HIV transmission in the 1980s and ’90s.

Toronto is in the midst of a drug crisis -- and the debate over what to do about it is shaping up to be a fault line in the mayor campaign.

Toronto drug crisis worsens
Overdose fatalities spiked during the pandemic and have shown no sign of decreasing. It is estimated 499 people died in 2022, a toll that could have been twice as high without supervised consumption sites, according to Toronto Public Health.

Meanwhile, the Centre for Addiction and Mental Health (CAMH) has documented a significant spike in crystal meth-related visits in the past five years, prompting them to call on mayoral candidates to invest $500,000 in a walk-in addiction medicine hub with a methamphetamine and stimulant focus.

The approach of the next mayor will be a matter of “life and death,” said front-line outreach worker Lorraine Lam.

That’s why Hales and others were alarmed to see Saunders share misinformation last week as he sparred with fellow candidate Olivia Chow over supervised consumption sites -- with Chow responding to Saunders’s tweet that “naloxone saves lives” and that free kits and training are available at pharmacies.

Saunders’s claims in a news release and recent interviews that just touching some drugs could “severely injure someone, especially a child” is a commonly shared and debunked myth.

Fentanyl is not absorbed through the skin and casual exposure through touch is not a risk, though experts warn to be cautious touching your mouth or face afterwards.

“It’s pure fiction,” said Gillian Kolla of Saunders’s comments. Kolla is a public health expert who helped organize the Moss Park overdose prevention site and who is now based at the University of Victoria’s Canadian Institute for Substance Research.

“I find it troubling that Saunders is putting information he knows to be false out there as part of a political campaign,” said Kolla, who has responded to hundreds of overdoses. “It feels like he is trying to use misinformation to create controversy and attention for his political campaign, and from a public health perspective, it is totally irresponsible.”

Toronto Public Health asks Ottawa for decriminalization exemption
Saunders was Toronto police chief in 2018 and reversed policy, outfitting front-line officers with naloxone nasal sprays in response to the drug poisoning crisis. That same year, Toronto Public Health first called for drug decriminalization for personal use and a safe, regulated drug supply.

In 2022 it formally asked the federal government to approve an exemption that would allow possessing personal amounts of drugs to be decriminalized since 2021, a plan endorsed by Toronto police Chief Myron Demkiw and leading hospitals, including CAMH.

Saunders is the only high-profile candidate to oppose the city’s decriminalization push. Mitzie Hunter, Olivia Chow, Brad Bradford, Ana Bailão, Chloe Brown and Josh Matlow have all told the Star they would support the plan.

“Right now, we can’t even control what we have. It’s like giving up,” Saunders said in a recent interview after a news conference in which he spoke about the need for law enforcement resources to accompany harm-reduction measures.

If the concern is discarded needles and public drug use, these could be addressed practically, according to experts. These include measures such as more supervised consumption sites with longer hours, access to ventilated spaces for inhaling drugs, more sharps disposal bins around the city and -- as Saunders has proposed -- more responsive city cleaning services.

Toronto’s drug strategy includes expanding hours at consumption sites
The city’s current drug strategy -- which will be fully released in the fall -- includes expanding the hours and services at supervised consumption sites through hospital partnerships, and a proposal for a 24/7 crisis centre.

Lam points out that thousands of needles have been kept off the streets because of supervised consumption sites. Needles are provided as a harm-reduction tool to prevent spreading infection and diseases like HIV through sharing.

“Why are there needles on the ground? It’s not because people are using drugs, it’s because there is nowhere safe for people to go,” said Lam.

Decriminalization would also help, added Hales, because then people would not have to throw away their drug paraphernalia because they were afraid of getting arrested.

It would also make it easier for people to access life-saving supports and services (such as calling 911 to seek treatment) without worrying about being arrested, and all the harms that come from that.

There are also public safety benefits to supervised consumption sites and safe drug supply programs like the one Hales works for that provides Dilaudid tablets as an alternative to heroin.

If people don’t have to buy drugs, they will not need to resort to petty crime or risky survival sex work, said Hales, and instead can spend money on food, shelter and other needs.

Mark Saunders would shift city’s focus from harm reduction measures
Saunders has said he knows supervised consumption sites save lives. However, he would shift the city’s focus from harm-reduction measures -- he does not want to “normalize” drug use -- and towards “treatment and recovery options,” which Toronto Public Health has said is really the responsibility of the province and federal governments.

Treatment captures a vast array of options depending on what the person wants, said Dr. Leslie Buckley, head of the addictions division at CAMH. It can mean a program aimed at stopping drug use entirely, but it can also mean seeing a psychiatrist to address concurrent mental health issues impacting substance use, addictions counselling or using medications like methadone.

But the reality is that waiting lists are long -- unless you have several thousand dollars for private care -- and the mental health and addictions sector is underfunded.

Residential treatment programs often have restrictions on whom they will accept. Medical detox beds often necessary to safely care for someone in withdrawal are scarce. Even accessing prescribed drugs such as methadone, used to treat opioid use disorder, can come with challenges, including requiring people to come to a clinic or pharmacy daily.

Crisis in shelter and housing compounds the problems with drug treatment
All of this is compounded by a shelter and housing crisis -- another reason for public drug use and discarded needles.

Stable housing is essential, said Buckley.

“It is so hard for people to be able to access and it is so critical to someone’s well-being,” she said, adding that CAMH is asking for mayoral candidates to commit to building 13,000 new supportive housing units this year.

Garth Mullins, a B.C.-based advocate for drug users who was part of that province’s consultations on decriminalization, said a focus on rehabilitation or abstinence ignores the reality of the current illegal drug supply that is both highly toxic and hard to stop using -- and the housing crisis.

Over many years, he tried 12-step programs to stop his heroin use. That would work for a little bit, but he’d always start using again. Eventually, he got on methadone and gradually stopped using other drugs.

“It took me 10 or 15 years of screwing around, and if I started doing that today, I’d be dead before I got there,” said Mullins, who is part of the Vancouver Area Network of Drug Users. This is why he advocates for a safe and regulated drug supply and a more dignified approach to services.

Safe consumption sites, a regulated drug supply and decriminalization are essential parts of a public health response to this crisis, Hales said.

“We desperately need more evidence-based treatment programs … but if we focus on treatment and abstinence-based approaches only we are going to leave lots of people behind,” she said.

“Harm-reduction measures are a way to support people who use drugs so they can stay healthy and alive. I’ve personally seen the huge difference it makes in people’s lives.”