The first public health emergency of the twenty-first century was declared in March 2003, four months after the first outbreak of Severe Acute Respiratory Syndrome (SARS). There were 438 cases of SARS and 44 related deaths in Canada.
The World Health Organization declared a global pandemic from June 2009–2010, one month after the first outbreak of H1N1 in Canada. There were 33,509 cases of this virus and 428 related deaths in 2009.
Three decades after the opioid crisis was presumed to have started, British Columbia became the first province in Canada to declare a public health emergency in April 2016.
In 2017, there were 3,987 suspected deaths from opioid use in Canada — almost twice the number of motor vehicle fatalities in 2016 and eight times the number of SARS and H1N1 related deaths combined.
These staggering statistics demonstrate the necessity for an immediate, comprehensive, and detailed plan to approach the opioid epidemic. However, with Minister for Health and Long–Term Care Christine Elliot’s decision to halt the introduction of new supervised consumption sites in Ontario and to pause ongoing activities in some existing sites, the lives of many drug users are at stake.
Elliot, who became Minister at the end of June, stated in a press release that Premier Doug Ford needs to examine the evidence and hear from experts before coming fully onboard with supervised injection sites.
However, the evidence regarding Supervised Consumption Sites (SCS) and Temporary Overdose Prevention Sites (TOPS) as harm reduction tools has been well established since the first site opened in 1986 in Switzerland.
SCS and TOPS provide safe spaces and access to sterile drug use equipment for pre-obtained illegal drugs, emergency medical care in response to overdoses, basic health care, and support from health professionals with the aim of reducing communicable diseases and saving lives.
According to Dr. Eileen de Villa, City of Toronto Medical Officer of Health and Adjunct Professor in the Dalla Lana School of Public Health, “Experiences from other jurisdictions other than our own local ones have demonstrated that Supervised Injection Services and Overdose Prevention Sites provide many health benefits, including reversing overdoses and saving lives.”
“We believe that these health services continue to be part of a comprehensive approach to the overdose emergency, along with harm reduction, prevention and treatment services, in response to this very challenging and complex health issue affecting so many people in our community and beyond,” wrote de Villa.
In a 2006 study published in the Canadian Medical Association Journal, researchers found that the use of an SCS in Vancouver was associated with reduced syringe sharing, no significant increase in public drug dealing near the facility, and a reduction in public drug use.
In the three years that this study was carried out, there were no overdose-related deaths at the facility, and 60 per cent of overdoses were successfully managed by the facility without the need for external help. More than 2,400 referrals were made for addictions treatment between March 2004 and April 2005.
Similarly, a study published in the Journal of Public Health in 2007 found that SCS garnered positive changes in injecting practices, including less reuse of syringes, use of sterile water, swabbing injection sites, cooking or filtering drugs, less rushed injections, safe syringe disposal, and less public injecting.
“The people who claim that there is harm would claim that people are going to be more likely to inject drugs if they know that there is a safe place to do that,” said Barry Pakes, Professor of Public Health at U of T.
“In my personal opinion, I don’t think it’s very likely that [SCS and TOPS] increase drug use, but there are some people who would believe that the more society gives permission for this, the more prevalent it might be,” he continued.
“From a public health perspective, we don’t believe that’s the case and we prefer to reduce harm in those people.”
Despite Elliot’s insistence on evaluating the merit of SCS and TOPS, the evidence which suggests that these sites do not work or increase harm is unsubstantiated.
The potential fallout of this decision could be disastrous. Individuals from marginalized groups and those who have the least resources will be most affected by the withdrawal of services.
Cities across Canada can do little by themselves to aid drug users. For instance, Toronto Public Health operates a supervised injection service, but they can’t fund or approve funding for it or overdose prevention sites. Such decisions are made at the provincial level.
A recommendation from the Ontario Ministry of Health and Long-Term Care’s review on how to deal with overdoses is expected to be released in the coming months. Until actionable steps are taken, the fates of individuals and families of opioid users remain grim.
“There is no question that addictions care could be better… but improving care is a very small part of dealing with the opioid epidemic,” wrote Pakes in an email.
