Supervised Consumption Sites (SCS) and Overdose Prevention Sites (OPS) are critical, evidence-based interventions that save lives. In Ontario, an estimated 6 to 7 people die every day due to the toxic, unregulated drug supply.
Despite this, the provincial government has increasingly restricted access to these essential services through funding cuts and stricter regulations. In response, communities are taking action. Grassroots organizations, volunteers, and harm reduction advocates are stepping in to operate OPS independently and meet urgent local needs.
This document provides an overview of key legal considerations for individuals and groups involved in supporting or running an OPS in Ontario.
Dear Minister Jones and Associate Minister Tibollo,
RE: Supervised Consumption Services site closures due to lack of funding from Ministry of Health
This is a follow up to our letter dated March 4 2024 regarding the need to implement emergency funding for supervised consumption services, to which we have received no response. Ontario’s drug poisoning death rate – now approximately one Ontario resident dying every 2 ½ hours – is dire.
We reiterate our urgent request that the Ministry of Health provide immediate funding for supervised consumption services (SCS) in Ontario, and to act collaboratively and with transparency to deliver life-saving services for existing and future applications for SCS under the provincial Consumption and Treatment Services (CTS) model. We urge the Ontario government to respect the needs of local municipalities, end the deadly and discriminatory delays, and provide relief for emergency responders in establishing evidence-based health and social supports via SCS.
While treatment and recovery options must be made available to all who wish to access these services, it is paramount that a spectrum of harm reduction services and other health and social supports are immediately scaled up. We remind the government that hundreds of people have died who were not diagnosed with a substance use disorder and would not have been eligible for addiction treatment services. The Ontario government’s ongoing delays further entrenches stigma and discrimination while contributing to needless and preventable deaths, injuries, grief and trauma.
Tragically, since our previous letter, supervised consumption services sites in Timmins and Sudbury, where applications have been awaiting a response from the province for 16 months (Timmins) and 33 months (Sudbury), have been forced to shut their doors in June 2024 and March 2024 respectively, along with the Windsor site (application submitted 21 months ago) which was forced to shut down in December 2023, leaving an increasing number of local communities without the necessary services to prevent overdose-related death. In Barrie, applicants have been forced to rescind their application submitted two and a half years ago due to the unsustainability of maintaining rental payments for a location without having any confirmation of funding nor timelines from your government. It is unacceptable that the provincial government is acting as the central roadblock in establishing urgently needed life-saving services, despite local support and significant local investment into these services that will all go to waste.
The 2023 annual report of the Chief Medical Officer of Health recommended that Ontario increase access to harm reduction services, like supervised consumption services, as part of a fulsome response. The Association of Municipalities of Ontario, the Association of Local Public Health Agencies, and Addictions and Mental Health Ontario are among the many, many organizations urging immediate action establishing new SCS sites. Data shows that there were an estimated 3,812 drug-related deaths in 2023, and an additional 1,842 suspected-drug toxicity deaths in the first six months of 2024. In Timmins, Windsor and Sudbury, the opioid toxicity mortality rate is nearly three times the provincial average. There is a dearth of supervised consumption services in northern Ontario contributing to service inequities between the north and south.
This crisis has worsened under the current provincial government, with deaths totaling more than 21,000 Ontario residents since 2018. Given the inordinate delays and lack of transparency in providing timely funding for simple, life-saving services, we are concerned about this government’s unwillingness to adequately implement a successful holistic and comprehensive provincial drug strategy.
We reiterate our calls to:
Immediately provide direct emergency funding to supervised consumption services (SCS) sites that have submitted their Consumption and Treatment Services (CTS) applications to the province and have closed due to lack of provincial funding.
Urgently provide, improve, and sustain uninterrupted provincial funding for SCS, including inhalation, and ensure equity in regional service availability, particularly in northern communities.
Phase out the Consumption and Treatment Services (CTS) approach to funding SCS, which requires additional and overly stringent conditions over and above Health Canada’s requirements.
In the interim, immediately remove the cap on the number of funded SCS sites and the prohibition on inhalation services under the provincial CTS model.
In the interim, introduce transparency and an expedited 30-day timeline for responding to applications under the provincial CTS model.
Introduce a low-barrier process by which community organizations can seek provincial funding for SCS.
Integrate SCS into Ontario’s core funded healthcare system with ongoing, integrated funding and resources.
Meet with us by September 13.
Signed by,
DJ Larkin, Executive Director, Canadian Drug Policy Coalition
Dear Minister Jones and Associate Minister Tibollo,
RE: Supervised Consumption Services site closures due to lack of funding from Ministry of Health
We write to you with grave concern regarding the Ontario government’s inaction in ensuring the provision of urgently needed supervised consumption services (SCS) amidst a worsening public health emergency caused by the toxic unregulated drug supply. We are calling on you to immediately provide direct emergency funding on or before March 29 to SCS sites that have submitted their applications to the province and are under imminent threat of closure or have closed due to lack of funding, eliminate the Consumption and Treatment Services (CTS) approach to funding SCS and urgently provide, improve, and sustain uninterrupted provincial funding for SCS that includes inhalation services.
Unregulated drugs of unknown contents and potency are driving increased deaths, hospitalizations, injuries and trauma across Ontario, with an estimated 3,644 drug-related deaths in 2023. Several communities in Ontario have declared a state of emergency due to drug toxicity deaths. SCS, and particularly low-barrier overdose prevention sites, are a necessary emergency response to this crisis and must be immediately scaled up. In 2018, the Ontario government arbitrarily capped funding to only 21 CTS. Six years later, the government has still not delivered on funding 21 sites. Despite overwhelming need and local support, the Ontario government has approved and funded only 17 CTS locations across the entire province. Only one of these is located in northern Ontario (NorWest Community Health Centre in Thunder Bay). Meanwhile, the toxic unregulated drug crisis has taken far too many lives since 2018 – nearly 20,000 and rising, with many more family and friends left grieving.
In the context of this preventable public health emergency, urgent action is required. There are at least five submitted applications for CTS sites that have been inordinately delayed by the Ontario government in Sudbury (30 months since application was submitted), Barrie (28 months), Windsor (19 months), Timmins (13 months), and Hamilton, where the application was withdrawn in October 2023 after two years, in part due to the Ontario government’s delays and lack of transparency in providing the necessary approvals and funding to sustain the site. These delays are unacceptable and deadly.
The tragedy of an isolated instance of gun violence in Toronto must not prevent people in diverse locations across the province from accessing vital health services any longer. The Ontario government’s decision to stop processing applications altogether for more than seven months is punitive and irresponsible. After the significant years of work and investment in each community to prepare the onerous applications under the provincial CTS model, to secure a suitable location and community support, and – in the case of Sudbury, Windsor and Timmins where the sites have been established with municipal stopgap funding – to hire and train staff and build trust and service uptake amongst people who use drugs, these sites are at imminent risk of closure or have been forced to close due to a lack of provincial funding. It should not fall to municipalities to fund healthcare services, which are a provincial responsibility. Moreover, management of these sites is extremely challenged by the Ontario government’s lack of transparency and accountability regarding site funding and approval timelines. In the case of Windsor, lacking the much-needed provincial support, the site has been forced to close.
Of the regions with submitted, pending CTS applications, data released in 2024 from the Office of the Chief Coroner indicates that three of these regions have amongst the ten highest mortality rates in the province: Timmins, Windsor and Sudbury each have an opioid toxicity mortality rate that is nearly three times the provincial average. Further, inhalation now accounts for significantly more overdose deaths than injection in Ontario, according to data from the Office of the Chief Coroner, yet the current CTS model continues to prohibit inhalation services. Services must be designed and supported to reflect the magnitude of the crisis and the data regarding regional need and modalities of drug use.
Failure to equitably provide for lifesaving health services like SCS is discriminatory and violates the right to life and security of the person for people who use drugs. The inordinate delays in processing applications, onerous requirements and lack of inhalation services under the provincial CTS model are also fiscally irresponsible, unsustainable and ineffective for the provision of a service that is fundamentally necessary amidst the worsening public health emergency that is the toxic unregulated drug crisis.
SCS are evidence-based, highly effective, and must be recognized as an integral part of Ontario’s publicly funded healthcare system. As such, these services must be universally available wherever there is need. These sites relieve the burden from overtaxed emergency first responders and are not complex to implement; they require an accessible location, oxygen, naloxone, sterile medical and first aid supplies, and supervising staff. It is indefensible as a matter of public health and fiscal policy that we currently have a two-tiered healthcare system where SCS are available in some southern Ontario communities and not in northern Ontario. It is a violation of the fundamental rights to equality and security of the person.
We call for urgent action from the province, commensurate with the magnitude of the crisis our communities are facing. It is vital that the Ontario government embrace a harm reduction approach to substance use, which centres the dignity, health and safety of people who use drugs while providing pathways to care, services, and community.
We are calling on the Ontario government to:
Immediately provide direct emergency funding on or before March 29 to supervised consumption services (SCS) sites that have submitted their Consumption and Treatment Services (CTS) applications to the province and are under imminent threat of closure or have closed due to lack of funding.
Urgently provide, improve, and sustain uninterrupted provincial funding for SCS, including inhalation, and ensure equity in regional service availability, particularly in northern communities.
Phase out the Consumption and Treatment Services (CTS) approach to funding SCS, which requires additional and overly stringent conditions over and above Health Canada’s requirements.
In the interim, immediately remove the cap on the number of funded SCS sites and the prohibition on inhalation services under the provincial CTS model.
In the interim, introduce transparency and an expedited 30-day timeline for responding to applications under the provincial CTS model.
Introduce a low-barrier process by which community organizations can seek provincial funding for SCS.
Integrate SCS into Ontario’s core funded healthcare system with ongoing, integrated funding and resources.
Meet with us by March 13.
We look forward to hearing from you as soon as possible on this urgent matter.
Signed by,
DJ Larkin, Executive Director, Canadian Drug Policy Coalition
A misinformation campaign around public use legislation distracts from real solutions
January 31, 2024 | One year ago today, British Columbia decriminalized personal possession of small amounts of some drugs in limited locations in a three-year pilot project. Since then, an organized political campaign has spent time and money to cloud public perception and discredit evidence-based efforts. Let’s cut through the rhetoric and talk about what is and isn’t working with decriminalization, and what a better way forward could be.
It’s understandable people are concerned, as drug poisoning deaths reach their highest-ever levels: with 2511 deaths last year alone, communities across B.C. feel the impact of this crisis. Under decriminalization, adults carrying up to 2.5 grams of opioids, cocaine, methamphetamine and MDMA in specific places will not be subject to criminal charges: police cannot seize their drugs, arrest or charge them for simple possession. Instead, they are directed to services. The pilot excludes schools, childcare facilities, playgrounds, splash pads and skate parks, among other locations. Decriminalization has support amongst public health and policy experts, including B.C.’s provincial health officer and chief coroner.
If you think you are seeing more unhoused people than ever, you’re right – but not because of decriminalization. While drug use rates remain stable, homelessness has risen considerably: up 32 per cent across 11 Lower Mainland communities and 65 per cent in Surrey. Some critics wrongly attribute these worsening social issues to decriminalization. Content creators, treatment industry lobbyists and municipal mayors alike have blamed the policy for alleged spikes in public drug use, fuel for a politicized assault.
But decriminalization cannot build homes; open supervised consumption sites; undo decades of housing divestment; reverse generational traumas of colonization; create responsive health care systems; or influence the unregulated drug market. If the government was serious about tackling the drug poisoning crisis and finding solutions to public drug use, there are clear places to start. Scaling up permanent welfare-rate housing and renewing modular housing leases would reduce visible poverty. Opening overdose prevention services in every community, per the still-unfulfilled 2016 Ministerial Order, would create safer indoor spaces for use while facilitating access to healthcare and treatment, reducing emergency costs, and improving neighbourhood cleanliness.Most importantly, B.C. could prevent deaths by responsibly regulating the drug supply to standardize content, access and use, all while increasing tax revenue and diverting hundreds of millions of dollars of profit from organized crime.
Although evidence-based solutions exist, the government is choosing reactionary politics to push the poorest people in society out of voters’ line of vision. Despite existing limits on decriminalization, the Province introduced Bill 34, which encourages racist and anti-poor stereotyping, ordering police to remove people from public spaces based on suspected rather than observed drug use. Pushing unhoused people into isolation will increase overdose deaths and countless other social harms. So if you are upset about rising poverty and death despite decriminalization, please redirect your anger toward the politicians who care more about getting re-elected than building healthy, happy communities.
Authors:Anmol Swaich, SUDU (Surrey Union of Drug Users) Sarah Lovegrove, the EIDGE (Eastside Illicit Drinkers Group for Education) and Aaron Bailey
Anmol Swaich is a MSc student and Research Assistant in the Faculty of Health Sciences at Simon Fraser University and a Community Organizer with Surrey Union of Drug Users.
Aaron Bailey holds a Master of Science in Health Promotion from Queen’s University, serves as Program Coordinator at the Eastside Illicit Drinkers Group for Education (EIDGE) and supports operations of the VANDU Overdose Prevention Site.
Canada is known around the world as a leader in harm reduction. It is host to the first, and only supervised consumption site in North America, Insite, which has saved lives and helped to build a healthier community in one of the most at-risk neighbourhoods in the county. Unfortunately, the federal government has moved away from harm reduction and more towards a criminal approach to drugs. Of course, there is a way forward. In our policy brief, we make the case that not only should the federal government restore the harm reduction model, but expand upon what is already in place. Please click and read below.
The tragedy of drug overdose has increased dramatically in recent years. The rise of fentanyl, an extremely potent opioid, has dramatically increased overdose deaths in recent months. Policy change at the federal level is urgently needed. Fortunately, overdoses are preventable. From allowing for easier access to lifesaving medication such as naloxone, to testing the purity level of street drugs, there are several actions the government can take right now to put an end to these avoidable deaths. Our policy brief contains many commonsense policy solutions that the government can enact immediately. Please click and read.
Cannabis law is changing around the world. From the United States to Latin America, a wider consensus is growing that cannabis prohibition has failed to prevent both the sale and consumption of the plant for non-medicinal purposes. Public opinion in Canada and worldwide is experiencing a paradigm shift, and the mindset of policymakers needs to change with it. Clearly, an alternative strategy to this broken system needs to be taken seriously. In the following brief, we outline our strategic recommendations on how the federal government can end prohibition, and use its power to begin the process to create a regulatory system that works.
In 2013, 308 people lost their lives due to illicit drug overdoses in BC alone. The worst part? Drug-related deaths from opiate overdose are entirely preventable.
And not in the sense that “well if people didn’t use drugs… there wouldn’t be overdoses.” Because while that’s essentially true, we know that people will use drugs. One hundred years of prohibiting drugs and arresting and incarcerating people who sell and use drugs hasn’t stopped that.
We need to be realistic and practical. Drug use does happen and it will happen. So let’s get on with preventing deaths and injuries from drug overdose. Here at the Canadian Drug Policy Coalition, we’ve worked with experts across the country to come up with set of policy changes that can save lives and make Canada safer for all.
While putting together this brief, we met many dedicated, compassionate people who work in frontline overdose prevention programs across Canada. One of the most pragmatic and effective interventions to prevent overdose injury and death is the “take-away naloxone program.” Based on 180 similar initiatives in the US, the program involves distributing overdose response kits – dubbed take-home-naloxone kits – to people who have been trained to prevent, recognize and respond to an overdose. Naloxone is a 40-year old medication that when administered during an opiate overdose reverses the effects of the drug. It has no narcotic effect and people cannot become dependent on this drug.
Streetworks in Edmonton pioneered this initiative in Canada and similar programs have spread throughout Canada. The country’s most robust overdose program – “take-home naloxone” (THN) – can be found at British Columbia’s Centre for Disease Control’s (BCCDC) harm reduction resource Toward the Heart.
Through a series of participating organizations throughout BC, the naloxone program operates in 35 sites, from large urban hubs such as Vancouver and Surrey, to smaller rural centres such as Cranbrook, Campbell River and Fort St. John. Nearly 1000 people have been trained including staff and volunteers at health and social service agencies, as well as friends and family members of people who use drugs. Over 600 kits have been dispensed to clients who use opioids and various resource materials are being developed to assist community partners to increase the reach of the program. Since its origins in 2012, 55 overdoses have been reversed.
While these simple yet effective initiatives are demonstrably preventing overdoses, significant challenges prevent these programs from being scaled up. Naloxone remains a prescription-only medication, and it’s costly and not covered by provincial drug plans. An even more significant challenge is the lack of a national Good Samaritan law, one that prevents people from being arrested and charged with drug possession if they call for help during an emergency. Eleven US states have passed Good Samaritan laws, often with bipartisan support from legislators.
Our hope is that this policy brief will help support efforts to clear away the barriers blocking overdose programs. That’s the most realistic way to prevent drug-related deaths from opiate overdose.
This post first appeared in the Centre for Addictions Research of BC’s blog Matters of Substance.
Despite the pragmatic nature of harm reduction programs, and their demonstrated ability to save lives, controversy still dogs efforts to scale-up harm reduction. One of the most misunderstood and controversial initiatives are safer consumption services (SCS).
In the last 20 years, SCS services (sometimes also known as safer injection services (SIS) have been integrated into drug treatment and harm reduction programs in Western Europe, Australia, and Canada. The focus of these services is facilitating people to safely consume pre-obtained drugs with sterile equipment. These services can be offered using a number of models including under the supervision of health professionals or as autonomous services operated by groups of people who use drugs.
The objectives of SCS include preventing the transmission of blood-borne infections such as HIV and hepatitis C; improving access to health care services for the most marginalized groups of people who use drugs; improving basic health and well-being; contributing to the safety and quality of communities; and reducing the impact of open drug scenes on communities.
Safer consumption services grew out of the recognition that low-threshold, easily accessible programs to reduce the incidence of blood-borne pathogens were effective and cost-effective. This was the conclusion of over 30 research studies on Vancouver’s own supervised injection site known as Insite.
Research has found that SIS services:
are actively used by people who inject drugs including people at higher risk of harm;
reduce overdose deaths — no deaths have occurred at Insite since its inception;
reduce behaviours such as the use of shared needles which can lead to HIV and Hep C infection;
reduce other unsafe injection practices and encourage the use of sterile swabs, water and safe needle disposal. Users of these services are more likely to report changes to their injecting practices such as less rushed injecting;
increase the use of detox and other treatment services. For example, the opening of Insite in Vancouver was associated with a 30% increase in the use of detoxification services and in Sydney, Australia, more than 9500 referrals to health and social services have been made since the service opened, half of which were for addiction treatment;
are cost-effective. Insite prevents 35 new cases of HIV and 3 deaths a year providing a societal benefit of approximately $6 million per year. Research estimates that in Sydney, Australia, only 0.8 of a life per year would need to be saved for the service to be cost-neutral;
reduce public drug use; and reduce the amount of publically discarded injection equipment; and
do not cause an increase in crime.
Professional groups such as the Canadian Medical Association, the Canadian Nurses Association, the Public Health Physicians of Canada, the Registered Nurses Association of Ontario, and the Urban Public Health Network have expressed their support for SCS.
Clearly it’s time to move beyond controversy and get on with creating more of these life-saving programs.
It’s 9/30 and way past time for the federal government to get moving on safer consumption services.
September 30, 2013 (9/30) marks the two-year anniversary of Canada’s Supreme Court decision that unanimously granted constitutional protection to Vancouver’s supervised injection site, Insite. To mark this important anniversary, the Canadian Drug Policy Coalition is spearheading a campaign to let our federal government know that there is widespread support for safer consumption services. In conjunction with the Canadian HIV/AIDS Legal Network and PIVOT Legal Society, we’ve created a sign-on letter to federal Minister of Health Rona Ambrose. Our letter demands that the federal government get going in the right direction to support the scale up of these important and life-saving services.
That decision recognized the improved public health and public order that stems from the implementation of this service. The Court also recognized that, under the Canadian Charter of Rights and Freedoms, people who need such life-saving health services should not face possible criminal prosecution and imprisonment for attempting to use them. The decision created an important precedent supportive of expanding similar services in other communities.
An overwhelming amount of research evidence on supervised injection sites (SIS) has been published in a wide range of scientific and medical journals since Insite first opened its doors in 2003. The evidence of Insite’s positive benefits is conclusive and these services should be scaled up where needed across Canada. Indeed numerous localities are working towards this.
Supervised consumption services (SCS) have been proven to:
• decrease overdose death and injury;
• decrease risk behaviours associated with HIV and hepatitis C infection;
• increase access to health services for people who are most marginalized;
• save health care costs; and
• decrease open drug use and publicly discarded drug use equipment.
Furthermore, the evidence shows that such services do not increase crime, nor do they increase drug use.
There are over 90 SCSs operating around the world today, and considerable research about the positive public health and safety outcomes of SISs. There is also broad agreement among health professionals that SCSs should be part of a comprehensive continuum of health services for people who use drugs.
INSITE, Vancouver BC
On September 30, 2011, the Supreme Court of Canada (SCC) ruled that it would infringe constitutional rights to security of the person to deny an exemption from the provisions of the Controlled Drugs and Substances Act so that Insite could operate without staff or users fearing criminal prosecution when using this health service. The Court declared unequivocally: “Insite saves lives. Its benefits have been proven.” The Court also stated: “Where, as here, a supervised injection site will decrease the risk of death and disease, and there is little or no evidence that it will have a negative impact on public safety, the Minister should generally grant an exemption.”
All across Canada organizations of people who use drugs, front-line organizations, researchers, professionals, and community members who work with people who use drugs, are demanding increased access to supervised consumption services. It is unacceptable that a decade after Insite first opened, Vancouver remains the only city in Canada with a sanctioned supervised consumption service – and only one such service of this sort, which numerous studies have demonstrated is simply inadequate to meet local needs.
It is unethical, unconstitutional and damaging to both public health and the public purse to block access to supervised consumption services which save lives and prevent the spread of infection.
It’s time to stand up for people’s lives and take the leadership to ensure that supervised consumption services become a part of the continuum of care for people who use drugs in Canada.
On June 6, 2013, the Conservative government tabled amendments to the Controlled Drugs and Substances Act that creates 20 additional conditions required for applications for supervised consumption services. Entitled the “Respect for Communities Act”, these amendments essentially give police, public safety officials, and municipalities a veto over health services. The tabling of these amendments is clearly an attempt to head off applications expected within the year from a number of Canadian cities. Media coverage was swift and mixed. But the both the Canadian Medical Association and the Canadian Nurses Association quickly condemned the legislation and chastised the government for letting fear trump sound scientific evidence. Immediately following the release the Canadian HIV/AIDS Legal Network, the Canadian Drug Policy Coalition and PIVOT Legal Society issued a media release challenging these amendments.
The new requirements will not only be costly and time consuming but they will likely prevent the expansion of these much-needed services. The intention of the legislation seems to be to give a broad range of community members an opportunity to comment on any proposal to create a service. There’s a sense of grievance in the government’s press releases that somehow communities have been excluded from playing a role in deciding the fate of these services. It seems ironic given the heavy-handed approach used by the Harper government, that suddenly they care about what communities think. What’s more likely is that they care about what the opponents of these services think. Of course communities should play a part in these discussions. But we can’t let one group of people, guided by fear and ignorance, prevent the implementation of life-saving and cost-effective services.
No sooner had the legislation been tabled than an email blast from the Conservative Party to its members whipped up fears about supervised consumption services. Entitled “Keep heroin out of our backyards”, the CP missive uses language like “do you want a supervised drug consumption site in your community”. Clearly this is an attempt to stir up opposition to these life-saving services and to the people who use these services. Do they not realize that the “addicts” they fear so much are potentially their family and friends? We need to stop treating substance use as an “us” and “them” issue. At some point in our lives, many of us have been, or will be, touched by drugs and alcohol.
In the last 20 years, supervised injection services (SIS) have been integrated into drug treatment and harm reduction programs in Western Europe, Australia and Canada. These services grew out of the recognition that low-threshold, easily accessible programs to reduce the incidence of blood-borne pathogens were effective and cost efficient. Since 2003, the city of Vancouver has been the location of a rigorously evaluated and highly successful stand-alone supervised injection site (SIS). More than 30 peer-reviewed studies describing the impacts of Insite indicate that it has several beneficial outcomes. The service is used by the people it was intended to serve, which includes over 10,000 clients. It is being used by people who would otherwise inject drugs in public spaces. Insite has reduced the sharing of needles and provided education on safer injecting practices. Insite has promoted entry into treatment for drug dependence and has improved public order. It has also been found to reduce overdose deaths and provide safety for women who inject drugs.
