Accent: Inside Sudbury's supervised consumption site

·13 min read

For the last few years, Greater Sudbury has been at the epicentre of Ontario's opioid crisis.

In 2022, the city recorded 747 suspected opioid-related incidents, including 439 emergency room visits and 97 deaths. The local mortality rate is 51.1 deaths per 100,000 population every year. That's more than three times higher than the provincial rate of 16 deaths per 100,000.

At the intersection of Brady and Paris Streets, just across from Tom Davies Square, dozens of white crosses have become a reminder that the city is in an acute crisis.

But just a few kilometers away, a small, temporary building is ground-zero for the ongoing effort to get this situation under control.

Last September, Reseau ACCESS Network, in partnership with service providers and harm reduction organizations from across the city, opened Sudbury's first ever Safe Consumptions Site after years of planning.

Though the first sanctioned site in Canada was opened in 2003, it's only in the last decade that the concept has started to spread, as the number of opioid-related medical emergencies and deaths skyrocketed nationwide.

Sudbury's site, like others across the country, provides a safe, clean space and new equipment for people to bring and use their own drugs, in the presence of trained medical staff. The goal of these sites is to prevent accidental overdoses and reduce the spread of infection disease.

"If someone comes in and they have an adverse reaction, like a drug poisoning or overdose, we have trained staff who are able to intervene immediately," said Amber Fritz, manager of supervised consumption services at the site. "When we do intervene, it's done in the least invasive and most supportive way possible."

In its first four months, from September to December 2022, the site had a total of 220 visits and 256 consumptions across 169 unique visitors. In that time, there were five overdoses, but none required a visit to the hospital, and none resulted in deaths.

So far in 2023, the numbers have steadily gone up month-to-month. There were 83 visits and 101 consumptions in January, then 99 visits and 146 consumptions in February. In just the first two weeks of March, they've already had 66 visits.

According to Fritz, member feedback has been key to getting those numbers up. For example, one regular visitor suggested they remain open later on some evening. Since extending their hours from 4 p.m. to 8 p.m. every Tuesday, Fritz said more people have started accessing the site.

“Listening to what folks who access services are saying is going to be the absolute best way to tailor the services to their needs," she said. "The way that the individual described it is that during the day, I’m busy panhandling or doing what anyone needs to do throughout the day to survive. In the evening, less services are open, there’s less places to access. So this becomes a safe place people can go when other things aren’t available."

Inside Sudbury's supervised consumption site

The current site is meant to be temporary, and from the outside, it certainly looks it.

A plain rectangle of metal with a long ramp and small windows, the little portable building tucks away neatly behind surrounding snow banks in the middle of winter.

But when you step inside, it's easy to see why the site has become a safe space for community members. There's a roomy entrance that doubles as a waiting room. The walls have been painted bright colours and plastered with posters and handmade artwork.

Fritz said they've worked hard to make the small space as inviting as possible.

"We really strive to make this a comfortable environment that doesn’t feel overly clinical, that doesn’t feel uncomfortable or uptight," she said. "We just try to really make this an environment people feel like they’re kind of sitting in their living room, hanging out with friends."

The consumption room is clean and bright, with a long metal table split into cubicles running the length of one wall. Mirrors at each station cover the window, while allowing visitors to see everything they're doing and providing an unobtrusive way for staff to check in. And when a visitor is done consuming their drug, they can lounge on the comfy couches of the recovery room, socializing with each other and striking up conversations with staff.

It's a simple, streamlined process with the potential to save lives.

Veronica Mensah is one of the site's registered nurses. She works alongside her co-workers and trained paramedics to ensure that anyone who uses their site leaves safely at the end of their visit.

When a visitor comes in, they let staff know what they'll be consuming and how they'll be consuming it. Then they're given clean new equipment, from needles and tourniquets, to filters, cookers, and pipes.

Currently, the site can accommodate drugs consumed orally, nasally, or by injection, but not inhalation.

Once they're set up at one of the stations, they can prepare and consume their drug as they please.

"We don't really try to pester anybody too much," said Mensah. "We do want to make sure that people feel comfortable and not judged and just relaxed. Just the fact that they're in a space where they don't have to watch their back or be hidden in a corner, where they're warm and they can take their time to do the process of preparing their drugs and then consuming their drugs."

For the most part, the nurses are pretty hands-off.

The site doesn't provide drugs, so all visitors must bring their own. Nurses don't help with preparation, and while they can help someone find a viable vein if needed, they don't insert needles.

But when something does go wrong, the trained medical staff is ready and well-equipped to act.

“We have the background to respond in a way that is more controlled," said Mensah. "We’ll do our assessments as we’re doing the response. We could check for things like their oxygen saturation, respiration rates, things that are important in opioid overdoses. Being able to recognize the signs and assess appropriately provides us with the capacity to respond in a way that is calm, that isn’t traumatic.”

So far, the site has dealt with seven overdoses total: five in 2022 and two so far this year. All were dealt with on-site, without the need for trip to the hospital. None resulted in deaths.

That's especially good news because the majority of visitors—61 per cent—use fentanyl, a synthetic opioid that's 50 times more potent than heroin analgesic and 100 times more potent than morphine.

Since visitors bring their own drugs, much of the fentanyl used on site is not pharmaceutical grade and is acquired on the street. In Sudbury, the supply is often toxic.

While the site doesn't provide drugs, it does have test strips that visitors can use to check their drugs for cross-contamination, from benzodiazepines and xylazine to fentanyl itself. While rapid tests like these will never be as accurate as a full laboratory assessment, they provide an extra safety measure that can prevent an overdose from happening in the first place.

According to Fritz, it's often worries about the supply that brings visitors in for the first time.

"Folks recognize that the illicit supply is incredibly toxic and volatile," said Fritz. "When they come through here, they know that they’re safe. The process is easy and low barrier."

Prevention key to addressing opioid crisis

Just off the site's waiting room is a spacious supply closet, packed with shelves of sealed equipment for anyone to access, judgement free, at any time.

There's injection equipment, oil, pipes, stems for cocaine, and foil. They also have sex barriers like condoms and dental dams. And packed in neat, zippered kits, they have injectable and nasal Naloxone, a medication anyone can administer to rapidly reverse an overdose until help can arrive.

Kiely Raciborski, one of the site's harm reduction workers, said ensuring community members have access to clean equipment while they’re off-site is just as important as giving them a safe place to consume drugs.

"Some folks aren’t able to access other services that hand out supplies," she said. "New supplies and being able to come in and be comfortable getting the supplies is a big thing."

Reusing or sharing old equipment can contribute to the spread of infections like Hepatitis C and HIV. It can also result in cross-contamination of the drugs themselves, which can worsen their toxicity.

"It only takes one time when you’re using a needle," said Raciborski. "After that, it just doubles and they develop abscesses and all sorts of things, especially with what’s being put into drugs nowadays.”

Reseau ACCESS Network does not run the site alone. They rely on insights and information from other partner organizations, including Public Health Sudbury and Districts, to understand what's in the current supply.

But just as much as they rely on their official partners, they rely on the members of the community.

"It's very much like a knowledge exchange," said Mensah, the RN. "We're learning from people and people are learning from us."

Fritz added, "They share knowledge about what's going on in the drug using community. We will find out that a certain colour has caused adverse reactions. We find this out (from them) and then we can pass on that information. It's almost like a pipeline of information, which is really helpful. People who are actually consuming these drugs, they know what's going on and they will have the most realistic view of what's on the street."

Site can't be effective without building trust, addressing stigma

When the site first opened in September, it seemed as though few people were utilizing it.

Timmins, which has the only other supervised consumption site in northeastern Ontario, had 17 times more visits in October compared to Sudbury, despite having a population that's a quarter the size.

But since the New Year, Sudbury’s numbers have grown, and that's in large part due to word of mouth.

"We find that the thing that makes people come here the most is when one of their friends comes through here and has a great experience, then goes to their friends and says, Hey, I went to that place and it was great," said Fritz. "People leave with a smile on their face and they always say, Oh, this isn’t what I was expecting. Because of course, rumours fly around. So word of mouth is great. We can say that this place is great until we’re blue in the face, but from the community, it carries so much more weight."

Building relationships with the visitors that come through is one of the most important things staff does to make the site effective. Having staff that are well-established within the community has helped.

"I'm someone with lived experience, so I'm very, very close with the community," said Raciborski. "I find that really helps draw people in, as well as having the good rapport with them. To see a familiar face when they come in, they don’t feel as nervous."

Case manager Scarlet Ward, who helps visitors connect with outside service providers for things like housing and food, said the slow trickle in is an indication that the community's trust has been shaken.

"It’s very important to rebuild that relationship with service providers," she said. "I think some of our members have been historically treated badly or stigmatized, and I think (they) internalize a lot of that and sometimes feel pretty undeserving. For them to come in and know that no matter what they’ve done, they are deserving of these things, and we can provide that to them."

To start that process, Ward said they take a "member-centred" approach.

She said visitors are never judged or made to feel guilty for using drugs or having an addiction. They are not pressured to change their habits or seek rehab. They can get answers to questions if they have them, and they're left alone if they don't. While staff provide educational information on safe consumption habits, they never try to cross the line.

The services are also confidential. While visitors fill-out an intake form, they aren't required to show any ID or provide their real name.

"Some folks I’ve seen one time; we’ve had one discussion and I might not see them again," said Ward. "The outcome of them making a change is not necessarily required. They don’t need to do anything that I suggest. It’s just up to them. It’s good to give people the option."

But even if they can rebuild trust with the community as service providers, they still have to contend with the stigma that surrounds drug use.

The site itself has never received unanimous support from the outside community, especially during the years-long planning process.

Critics worried that the site would encourage more people to use, centralize drug use to the downtown core, and increase crime in the area. They also worried that the issue of drug paraphernalia, which was already littering streets and public bathrooms, would only get worse.

But seven months in, Fritz has seen some community members come around as their fears failed to realize.

"The neighbours we have around here, they received us really well," she said. "We make a point, if we're outside and see one of the business owners, if they approach us we interact with them. We say: if you find any needles on your property, don't hesitate to reach out. We had one gentleman (whose) response was, you know, since you guys opened, I really don't notice that as much. There's so much NIMBYism when it comes to harm reduction service, but I find our neighbours have been receiving us really well, and I think that's beautiful."

Treating addiction, or stopping people from using drugs, is not the point of their services, said Fritz.

"When people walk in through the door, it’s focused on them. If they don’t want to access case management services, that’s totally fine. If they don’t want to swab before they inject, we provide education as to why that’s helpful, but we’re not going to look down on someone. They’re not going to be penalized. People can walk through the space knowing that however they are in that moment, in that day, that’s fine. We accept them for exactly who they are."

She added, "People have always and will always use drugs and it’s just a part of life. If people can do so in a safe, supportive, welcoming environment, then all the better."

The Local Journalism Initiative is made possible through funding from the federal government.

Twitter: @mia_rjensen

Colleen Romaniuk, Local Journalism Initiative Reporter, The Sudbury Star