Kensington Market Overdose Prevention Site in Toronto, Dec. 18, 2024. [Photo credit: Alexandra Keeler]

By Alexandra Keeler

Critics says Ontario’s plan to replace supervised consumption sites with HART Hubs will exacerbate harms to drug addicts and strain the health-care system

The operator of a Toronto overdose prevention site is challenging Ontario’s decision to prohibit 10 supervised consumption sites from offering their services.

In December, Neighbourhood Group Community Services and two individuals launched a constitutional challenge to Ontario legislation that imposes 200-metre buffer zones between supervised consumption sites and schools and daycares. The Neighbourhood Group will be forced to close its site in Toronto’s Kensington Market as a result.

In its court challenge, the organization is arguing site closures discriminate against individuals with “substance use disabilities” and increase drug users’ risk of death and disease.

The challenge is the latest sign of growing opposition to Ontario’s decision to either shutter supervised consumption sites or transition them into Homelessness and Addiction Recovery Treatment (HART) Hubs. The hubs will offer drug users a range of primary care and housing solutions, but not supervised consumption, needle exchanges or the “safe supply” of prescription drugs.

Critics say the decision to suspend supervised consumption services will harm drug users and the health-care system.

“We’re very happy that the HART Hubs are being funded,” said Bill Sinclair, CEO of Neighbourhood Group Community Services. “They’re a great asset to the community.”

“[But] we want HART Hubs and we want supervised consumption sites.”

‘Come under fire’

On Thursday, the Ontario government announced that nine of the 10 supervised consumption sites located near centres with children would transition into HART Hubs. The Neighbourhood Group’s site is the only one not offered the opportunity to transition, because it is not provincially funded.

Laila Bellony, a harm reduction manager at a supervised consumption site at the Parkdale Queen West Community Health Centre in Toronto, says she is worried that drug users may avoid using HART Hubs altogether if they do not facilitate the use of drugs under the supervision of trained staff.

Data show this oversight can prevent deaths by facilitating immediate intervention in the event of an overdose.

Bellony is also concerned the site closures will increase the strain on other health-care services. She predicts longer wait times and bed shortages in hospital emergency rooms, as well as increased paramedic response times.

“I think the next thing that will happen is the medical or health-care system is going to come under fire for being sub-par. But it’s really all starting here from this decision,” she said.

She questions how the HART Hubs will meet demand for detox and recovery services or housing solutions.

Parkdale Queen West Community Health Centre and its sister site, the Queen West Site, serve hundreds of clients, Bellony says. By contrast, Ontario’s HART Hub rollout plan indicates all 19 hubs will together provide 375 new housing units across the province.

“The HART Hub model is not a horrible model,” said Bellony. “It’s the way that it’s being implemented that’s ill-informed.”

In a response to requests for comment, a media spokesperson for the Ontario Ministry of Health directed Canadian Affairs to its August news release. That release lists proposals for increased safety measures at remaining sites, and a link to a HART Hub “client journey.”

On Dec. 3, the Auditor General of Ontario, Shelley Spence, released a report criticizing the health ministry’s “outdated” opioid strategy, noting it has not been updated since 2016.

National data show a 6.7 per cent drop in opioid deaths in early 2024. But experts caution it is too soon to call it a lasting trend. Opioid toxicity deaths in 2023 were up 205 per cent from 2016.

“We concluded that the Ministry does not have effective processes in place to meet the challenging and changing nature of the opioid crisis in Ontario,” the auditor general’s report says.

“The Ministry did not … provide a thorough, evidence-based business case analysis for the 2024 new model … [HART Hubs] to ensure that they are responsive to the needs of Ontarians.”

Parkdale Queen West Community Health Centre’s Queen West Site in Toronto, Dec. 18, 2024. [Photo credit: Alexandra Keeler]

‘Ill-informed’

Ontario has cited crime and public safety concerns as reasons for blocking supervised consumption sites near centres with children from offering their services.

“In Toronto, reports of assault in 2023 are 113 per cent higher and robbery is 97 per cent higher in neighbourhoods near these sites compared to the rest of the city,” Ontario Health Minister Sylvia Jones’ office said in an Aug. 20 press release.

The province has also cited concerns about prescription drugs dispensed through safer supply programs being diverted to the black market.

Police chiefs and sergeants in the Ontario cities of London and Ottawa have confirmed safer supply diversion is occurring in their municipalities.

“We are seeing significant increases in the availability of the diverted Dilaudid eight-milligram tablets, which are often prescribed as part of the safe supply initiatives,” London Police Chief Thai Truong said at a Nov. 26 parliamentary committee meeting examining the effect of the opioid epidemic and strategies to address it.

But Bellony disputes the claim that neighbourhoods with supervised consumption sites experience higher crime rates.

“Some of the things that [the ministry is] saying in terms of crime being up in neighborhoods with safe consumption sites — that’s not necessarily true,” she said.

In response to requests for information about the city’s crime rates, Nadine Ramadan, a senior communications advisor for the Toronto Police Service, directed Canadian Affairs to the service’s crime rate portal.

The portal shows assaults, break-and-enters and robberies in the West Queen West neighborhood have remained relatively stable since the Queen West supervised consumption site opened in 2018.

In contrast, crime rates are higher in some nearby neighbourhoods without supervised consumption sites, such as The Junction.

“While I can’t speak to perceptions about a rise in crime specifically around supervised consumption sites, I can tell you that violent crime is increasing across the GTA,” Ramadan told Canadian Affairs. She referred questions about Jones’ statements about crime data to the health minister’s office.

Jones’ office did not respond to multiple follow-up inquiries.

Mixed feelings

In July, Canadian Affairs reported that business owners in the West Queen West neighbourhood were grappling with a surge in drug-related crime.

Rob Sysak, executive director of the West Queen West Business Improvement Association, says there are mixed feelings about their neighbourhood’s site ceasing to offer safe consumption services.

“I’m not saying [the closure] is a positive or negative decision, because we won’t know until after a while,” said Sysak, whose association works to promote business in the area.

Sysak says he has heard concerns from business owners that needles previously used by individuals at the site may now end up on the street.

Bellony supports the concept of HART Hubs offering addiction and support services. But she says she finds the province’s plan for the hubs to be unclear and unrealistic.

“It seems very much like they kind of skipped forward to the ideal situation at the end,” she said. “But all the steps that it takes to get there … are unaddressed.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Adam Zivo

“Vulnerable individuals are being targeted by criminals who exchange these prescriptions for fentanyl, exacerbating addiction and community harm,” said London Police Chief Thai Truong.

Thai Truong, the police chief of London, Ontario, testified in parliament last week that “safer supply” opioids are “obviously” being widely diverted to the black market, leading to greater profits for organized crime. His insights further illustrate that the safer supply diversion crisis is not disinformation, as many harm reduction advocates have speciously claimed.

Truong’s testimony was given to the House of Commons Standing Committee on Health, which is in the midst of an extended study into the opioid crisis. While the committee has heard from dozens of witnesses, Truong’s participation was particularly notable, as safer supply was first piloted in London in 2016 and the city has, since then, been a hotbed for opioid diversion.

“While the program is well intentioned, we are seeing concerning outcomes related to the diversion of safe supply medications… these diverted drugs are being resold within our community, trafficked to other jurisdictions, and even used as currency to obtain fentanyl, perpetuating the illegal drug trade,” he said in his opening speech. “Vulnerable individuals are being targeted by criminals who exchange these prescriptions for fentanyl, exacerbating addiction and community harm.”

He later clarified to committee members that these vulnerable individuals include women who are being pressured to obtain safer supply opioids for black market resale.

Safer supply programs are supposed to provide pharmaceutical-grade addictive drugs – mostly 8-mg tablets of hydromorphone, an opioid as potent as heroin – as an alternative to riskier street substances. The programs generally supply these drugs at no cost to recipients, with almost no supervised consumption, and have a strong preference for Dilaudid, a brand of hydromorphone that is manufactured by Purdue Pharma.

Addiction experts and police leaders across Canada have reported that safer supply patients regularly divert their hydromorphone to the black market. A recent study by Dr. Brian Conway, director of Vancouver’s Infectious Disease Centre, for example, showed that a quarter of his safer supply patients diverted all of their hydromorphone, and that another large, but unknown, percentage diverted at least some of their pills.

Truong’s parliamentary testimony, which mostly rehashed information he shared in a press conference last July, further corroborated these concerns.

He noted that in 2019, the city’s police force seized 847 hydromorphone pills, of which only 75 were 8-mg Dilaudids. Seizures increased after access to safer supply expanded in 2020, and, by 2023, exploded to over 30,000 pills (a roughly 3,500 per cent increase), of which roughly half were 8-mg Dilaudids. During this period, the number of annual overdose deaths in the city also increased from 73 to 123 (a 68 per cent increase), he said.

Relatedly, Truong noted that the price of hydromorphone in London – $2-5 a pill – is now much lower than in other parts of the province.

As an increasing number of police departments across Canada have publicly acknowledged that they are seeing skyrocketing hydromorphone seizures, some safer supply advocates have claimed, without evidence, that these pills were mostly stolen from pharmacies, and not diverted by safer supply patients. Truong’s parliamentary testimony dispelled this myth: “These increases cannot be attributed to pharmacy thefts, as London has had only one pharmacy robbery since 2019.”

The police chief declined to answer repeated questions about the efficacy of safer supply, or to opine on whether the experimental program should be replaced with alternative interventions with stronger evidence bases. “I’m not here to criticize the safe supply program, but to address the serious challenges associated with its diversion,” he said, noting his own lack of medical expertise.

The chief emphasized that, while more needs to be done to stop safer supply diversion, the addiction crisis is a “complex issue” that cannot be tackled solely through law enforcement. He advocated for a “holistic” approach that integrates prevention, harm reduction and treatment, and acknowledged the importance of London’s community health and social service partners.

In response to Truong’s testimony, NDP MP Gord Johns, an avid safer supply advocate, downplayed the importance of the diversion crisis by arguing that “people aren’t dying from a safer supply of drugs; they’re dying from fentanyl.”

While it is true that 81 per cent of overdose deaths in 2024 involved fentanyl, addiction physicians across Canada have repeatedly debunked Johns’ argument as misleading. The dangers of diverted hydromorphone is not that it directly kills users, but rather that it easily hooks individuals into addiction, leading many of them to graduate to deadly fentanyl use.

Johns previously faced criticism when, in a September health committee meeting, he seemingly used parliamentary maneuvers to reduce the speaking time of a grieving father, Greg Sword, whose daughter, Kamilah, died of drug-related causes after she and her friends got hooked on diverted hydromorphone.

There is currently no credible evidence that safer supply works. Most supporting studies simply interview safer supply patients and present their opinions as objective fact, despite significant issues with bias and reliability. Data presented in a 2024 study published in the British Medical Journal, which followed over 5,000 drug users in B.C., showed that safer supply led to no statistically significant mortality reductions once confounding factors were fully filtered out.

An impending update to Canada’s National Opioid Use Disorder Guideline, which was recently presented at a conference  organized by the Canadian Society of Addiction Medicine, determined that the evidence base for safer supply is “essentially low-level.” Similarly, B.C’s top doctor acknowledged earlier this year that safer supply is “not fully evidence-based.”

This article was syndicated in The Bureau, an online media publication that investigates foreign interference, organized crime, and the drug trade.