New study suggests possible increase in overdoses after some Toronto safe consumption sites close

When the province closes some supervised consumption sites in Toronto in March of next year, a new study suggests it will result in an increase in public drug usage, overdoses and overdose deaths due to a severe reduction in safe spaces to use drugs in the presence of trained health professionals.

In August, the Ontario government announced the closure of 10 supervised consumption sites (SCS) and consumption and treatment sites (CTS) in the province because they were close to childcare centres and schools. Five of those are in Toronto.

Advocates have been raising concerns and rallying against the decision since it was announced, pointing out that potentially life saving services are being taken away from those who need them and it will have dire consequences.

The study conducted by St. Michael’s Hospital’s MAP Centre for Urban Health Solutions and the Ontario Drug Policy Research Network analyzed usage data from SCSs and CTSs to quantify that impact.

It found that on average, 1,366 people used Toronto’s SCS and CTS services monthly between April 2022 and March 2023.

Of those people, 561 used the sites that are set to close. The study estimated that only 35 of those people were located within 500 metres of another open site and would have access to it, assuming that site could accommodate them. The others who are located beyond this radius would effectively lose access to an SCS.

“We did our analysis assuming people would travel 500 meters or a kilometer or two kilometers, and of course if they travel more, there’s less of an impact. But we know from other studies that generally people don’t want to travel more than a few blocks,” says lead author Dr. Ahmed Bayoumi.

“Preliminary data initially for the sites originally back in 2017 showed that people will walk about 10 to 15 minutes to access a site, but longer than that, they’ll just find somewhere else to go,” adds Dayn Kent, Consumption and Treatment services manager at Regent Park Community Health Centre.

Bayoumi says those who will lose access represent “tens of thousands of injections over the course of the year.”

“Those people are going to be at higher risk for overdose, higher risk for death. We also know that many of the clients of supervised consumption sites are people who are unstably housed or homeless. So those people don’t have another place to go. They don’t have a private residence to go to. So most likely people who don’t have another place to go are going to inject in alleys, in parks,” he says.

“You’re using a substance that you don’t want to get caught using, so you hide, but when you’re hiding, people can’t find you if you overdose. So it multiplies the risk factor for the community. People are going to choose other options, incredibly less safe options and incredibly less supportive options which is going to have downstream effects on the healthcare system,” says Kent.

“If you look at the number of EMS calls for overdoses in 2023 in Toronto alone it was 4,500 and a few and in that same year, over 3000 were managed by CTS. So we’re seeing now potentially 7,500 to 8,000 overdoses a year being managed solely by the EMS that’s going to delay ambulance response times. That’s going to add a tremendous amount of capacity need for the emergency departments which is going to mean longer wait times … people need to understand the reality of these closures … this [study] will provide irrefutable evidence to the broader public to understand the implications of the CTS closures.”

Kent adds that CTSs are the doorway to other support and rehabilitation services and the first point of contact for treatment and detox.

“Which means that people are coming to use [drugs] at the CTS and it’s like, ‘come for the CTS but stay for the services.’ CTS is the trust building touch point and without the CTS services, people won’t have a reason to come see us. And then therefore the downstream kind of cascading effect of that is that they miss out on the opportunity to be connected and referred to all of those other services that will help address the more complex needs that they have aside from just the substance use,” he says.

Bayoumi says the study also points to the need for better planning as well as increased support for the sites that do stay open to increase their capacity.

“That might mean more staffing. It might mean more money, it might mean longer hours. But we need to do something to actually address the gaps that are going to be introduced into the system by this policy,” he says.

“This decision was introduced without really any way to accommodate the clients who are going to lose access.”

The province says they will be opening 19 new Homelessness and Recovery Treatment (HART) Hubs to provide people with related supports. The SCSs and CTSs that are closing have the option to convert into these hubs.

“We recognize Ontarians deserve more than a health care system that is focused on providing people struggling with addiction with tools to use illegal drugs and our government is taking the next step to create a system of care that prioritizes community safety, treatment and recovery by investing $387 million to create HART Hubs,” said Hannah Jensen, spokesperson for Health Minister Sylvia Jones.

“Similar to existing hub models in Ontario that have successfully provided people with care, Hubs will reflect regional priorities by connecting people with complex needs to comprehensive treatment and preventative services, including mental health services, addiction support, primary care, and supportive housing.”

Bayoumi says HART Hubs are likely not going to be an effective substitute for SCS and CTS services because the people who use them aren’t all looking for or ready for recovery supports.

“The government has announced that HART Hubs aren’t allowed to do supervised consumption of drugs. We know that they’re not allowed to distribute needles and syringes to individuals. So many of the services that people are relying on at supervised consumption sites are not going to be allowed to be delivered in HART hubs … we’re still going to have a huge gap in the system,” he says.

The province has said that provincially funded CTSs and SCSs that convert to HART Hubs could be eligible for four times more funding than they currently receive.

Bayoumi says more funding for the care of people who use drugs is a positive move, but “restrictions on that funding don’t make sense.”

“We need funding for people across the entire spectrum of drug use — people who are still using, people who are thinking about stopping and people who have stopped. We need funding for people who are homeless and people who are not homeless. And the way the HART Hub funding is being rolled out, it’s only for one part of that population and it’s really leaving another huge part of that population without any services,” he says.

The five SCS/CTS locations that must close their doors by March 31, 2025 are:

• Parkdale Queen West Community Health Centre
• Kensington Market Overdose Prevention Site 
• Regent Park Community Health Centre
• The Works -Toronto Public Health
• South Riverdale Community Health Centre

The province says HART Hubs are slated to open on or before these sites close.