Toronto harm reduction workers call for robust safe supply program to prevent deaths

A naloxone kit is shown in Vancouver, B.C., on Monday November 13, 2017. Harm reduction workers in Toronto say supervised consumption sites and safe supply programs need to be expanded to prevent more overdose deaths in the city.THE CANADIAN PRESS/Darryl Dyck

Harm reduction workers say supervised consumption sites and safer supply programs need to be expanded to prevent further overdose deaths in Toronto, a call that comes in the wake of several recent suspected opioid deaths.

Toronto Public Health issued a drug alert recently, saying there were 10 suspected opioid overdose-related deaths between July 17 and 21.

Dayn Kent, co-ordinator of the consumption and treatment service at the Regent Park Community Health Centre, said he's read multiple reports of people dying of overdoses in the city who he saw just days prior at the centre's supervised consumption site - a hygienic space for people to bring their own drugs to use in the presence of trained staff.

“We see people on a Tuesday and we don't see them Wednesday and Thursday, and we get a notice that they've died of an overdose on Friday, because they were using when a service wasn't open,” he said.

Kent said these notices and alerts indicate “system-wide failures” because some of those most vulnerable to overdoses are individuals who were accessing treatment programs in prison and got released from prison with no follow-up supports, or individuals who could not access a supervised consumption or safer supply site in the city due to their limited hours.

“Most sites are open during the day. There's no 24 hour sites. There's no seven days a week sites. So people are using (drugs) safely when they have the option,” Kent said.

“But if that option is unavailable, they're still going to use.”

Kent said “robust” safer supply programs - which provide prescribed medications as alternatives to illegal drugs - are necessary to address the “toxic supply” in Toronto. These programs should be “consistent and permanent” to ensure people who are using substances can do so safely and feel supported in the long-term, he added.

Hayley Thompson, project manager of Toronto's drug checking service, shared a similar sentiment.

Thompson said the recent drug alert issued in Toronto reflects “the consequences of an increasingly toxic and volatile, specifically fentanyl, supply” and that policy responses are not happening quickly enough to “reduce new tragedies.”

She said supervised consumption sites and safer supply programs need to be “scaled up” to prevent overdose-related deaths since the supply of illicit drugs is “becoming more toxic and more unpredictable.” The average amount of fentanyl detected in an expected fentanyl sample in the city is about four per cent, which can be fatal for someone who has never used fentanyl before, but that percentage has jumped to 5.8 per cent in the past two weeks, Thompson noted.

“We have some safer opioid supply pilots going on in the province and in downtown Toronto, but not nearly enough people have access to them that would benefit from them and then be able to better understand their tolerances and their needs,” she added.

“Ultimately, we'd like to see an established, regulated system for opioids and non-medical drugs, because we have the policy responses available to us to dramatically reduce what we're seeing in terms of both fatal and non-fatal overdoses.”

Ontario's Ministry of Health did not respond to a request for comment.

In a statement, Toronto Public Health said the COVID-19 pandemic has “exacerbated the opioid crisis, contributing to an unprecedented increase in opioid-related deaths.” Preliminary data from the Toronto Overdose Information System show that there were 511 confirmed opioid toxicity deaths in the city in 2021 and 539 such deaths in 2020 - record high numbers.

“The increased contamination of other drugs alongside opioids means that what we are facing goes beyond an opioid poisoning crisis and is now most accurately described as a drug poisoning crisis,” the public health unit said.

In response to the drug poisoning crisis, TPH said it launched the Toronto Overdose Action Plan in 2017, followed by an updated plan in 2019, and “continues to implement a number of urgent actions,” working across city divisions and with local community and health providers. This includes mobilizing more than 60 agencies across Toronto to offer harm reduction supplies and services at more than 100 locations.

Nick Boyce, director of the Ontario Harm Reduction Network, said governments should support safer alternatives for illegal drugs to prevent further overdose deaths.

“Until the federal government decriminalizes and regulates drugs, and other levels of government support safer alternatives, such as pharmaceutical quality options, we will keep seeing alerts and people will continue to die unnecessary deaths from the volatile, toxic unregulated drug supply,” Boyce said.

In a June report, Toronto's chief medical officer of health recommended that the city's Board of Health reiterate its call to the federal government to support the “immediate scale up” of prevention, harm reduction and treatment services and additional safer supply options in Toronto.

TPH submitted a request to Health Canada in January to decriminalize illicit drugs for personal use through an exemption to the federal Controlled Drugs and Substances Act. Health Canada has approved a similar request in British Columbia.

The public health unit said it's been in “active discussions” with Health Canada officials and has been conducting “extensive engagements with a range of stakeholders, including people who use drugs” ever since.

“The decriminalization of illicit drugs for personal use can reduce stigma, discrimination, and high-risk behaviours that can lead to overdose and other harms. This change has the potential to improve health outcomes,” TPH added.

In a statement, Health Canada said the request from TPH remains under review.

The department added that the federal government has approved a number of prescription drugs that provinces, territories and authorized health practitioners can access for drug treatment and safer supply programs and invested more than $64 million to support 17 safer supply projects in Ontario, British Columbia, Quebec and New Brunswick.

“The Government of Canada is committed to working with all partners to address the overdose crisis, save lives, and support people who use drugs,” Health Canada said.

This report by The Canadian Press was first published July 29, 2022.

This story was produced with the financial assistance of the Meta and Canadian Press News Fellowship.