On the surface, the Ontario government’s move to keep funding supervised injection sites of some form across the province signals a victory for the people who run and depend on those sites.
Health Minister Christine Elliott made the announcement on Oct. 22, after a months-long review of Ontario’s supervised consumption sites and overdose prevention sites. Currently there is a distinction between the two, but the new model may change that.
Although Premier Doug Ford has previously said he is “dead against” supervised injection sites, the ministry’s review concluded the sites save lives and connect people who use drugs with primary care, treatment and rehabilitation. According to federal government figures, the opioid crisis claimed nearly 4,000 lives across Canada in 2017.
“This model echoes what we heard from healthcare workers, police, business owners, community members and people with lived experience,” Elliott said.
But the devil is in the details, according to Sarah Ovens, a main organizer with the Toronto Overdose Prevention Society, and for the people closest to Ontario’s opioid addiction crisis, the announcement signals the beginning of a potential new phase of limbo.
Ovens has worked extensively with Toronto’s overdose prevention sites and knows how uncertainty can affect people giving and receiving care.
“We think it’s really positive in that we really thought there was a real chance they might shut down all these sites,” she said. “But it’s very concerning because we don’t know what the process will look like.”
According to the Ontario government, the new model will maintain the overdose prevention element, with an emphasis on connecting people addicted to opioids with addiction services, health and social services, primary care, mental health support systems. The organizations that run the sites will need to apply to offer treatment and rehabilitation services. The application process will also include elements from initial and ongoing public consultations.
Elliott made no mention of an increase in funding for the sites, which worries Ovens.
“I think that what the workers manage to do on a shoestring budget is pretty amazing,” she said. “But I’m concerned about what they’re going to be expecting of us and whether they’re not providing the resources for us to realistically be able to do that.”
“What the workers manage to do on a shoestring budget is pretty amazing.” – Sarah Ovens
Ovens expressed the desire for the new government to keep these services in line with what the Liberals had introduced when they were in power.
“If they are throwing out that previous framework and instituting a new one that’s much more onerous, difficult and time consuming, then it’s going to hamper our ability to respond to this crisis,” Ovens said. “Especially in smaller communities across the province where there are fewer resources.”
There are currently two types of sites in Ontario: supervised consumption sites and overdose prevention sites. Low-barrier overdose prevention sites differ from supervised consumption sites in that they operate under shorter-term permits and are not embedded in an established community centre. Theoretically, the only equipment an overdose prevention site needs to operate is a table, chairs and naloxone, Ovens said.
While both are considered life-saving services, Ovens said overdose prevention sites allow staff and volunteers to more quickly position themselves where they are needed most. However, because they operate under shorter-term permits, the staff who run them can only plan ahead a few months at a time.
Ovens said she doesn’t know which elements of those models the new framework will incorporate, which makes it hard to plan ahead. She is concerned the new framework will raise the already existing barriers to new sites opening at a time when they are critically needed.
“This is just not way to provide health-care services in general,” she said. “We are in an emergency, we need to be able to respond quickly. We need to be nimble, we need to be flexible, we need this to be low-barrier for communities to open these sites where they are needed.”
Still, knowing overdose prevention organizations will be allowed to continue their work — however how vague the definition of that work is — is an improvement over not knowing whether they would still be operating from week-to-week, as was the case throughout the government’s review process, Ovens said.
“From the time that this review started, we’ve been really in limbo,” she said. “You want really good staff at these places, but asking the best nurses to leave their jobs for a three-month contract when you don’t know what’s going to happen after that, it’s really hard to plan,” she said, adding that clients addicted to opioids are sensitive to that uncertainty, too.
“Asking the best nurses to leave their jobs for a three-month contract when you don’t know what’s going to happen after that, it’s really hard to plan.” – Sarah Ovens
“The impact on the people who use the services is huge,” she said. “Not knowing if the service is going to exist from one day to the next, it’s really destabilizing for people and it really does impact people’s health and well-being.”
The provincial government said approved sites could begin the transitioning to the new model in January 2019, with the 21 approved sites slated to open by April under the new model. Ontario is also planning to expand access to addiction treatment by adding new detox beds to high needs communities.
Through the uncertainty, Ovens remains optimistic.
“We’re glad that these sites are going to be allowed to continue operating,” she said. “I think the health minister said a lot of positive things in her announcement. I think she really listened to the people that she consulted with, and she acknowledged that these sites save lives.”