Injection sites ‘are being pushed backwards’
Ottawa supervised injection site operator criticizes latest provincial hoops
The Ontario government is trying to smother supervised druginjection sites with paperwork, says the woman in charge of one at the Shepherds of Good Hope shelter in Lowertown, where they’ll be applying for permission to operate for the third time in barely a year.
“I think that we are being pushed backwards. We’re not being propelled forwards. If you look at the results from SISes across the province, the results are very positive,” said Wendy Muckle, the executive director of Inner City Health.
The agency’s trailer off Murray Street was built for about 50 visits a day; it’s averaging 110. Workers there have seen 1,100 different people since it opened last November and they contend with an average of seven drug overdoses and suspected overdoses a day, Muckle said.
That’s the main job for Inner City Health’s site and the three others in Ottawa: monitoring people who use drugs to make sure they don’t overdose and die, as the supply of street drugs such as heroin has been mixed with other opioids whose potencies are unpredictable, especially powdered fentanyl.
Inner City Health spent two years seeking federal approval to open its injection site under rules set by the federal Conservatives, satisfying 26 separate and detailed requirements.
“From the very beginning, they were legislated and regulated so it would be so difficult for people to operate them that you’d be discouraged from opening one before you even started,” Muckle said. “We had to do everything from describing how people physically walk into the site. We had to outline plans for security. We had to describe where our security cameras are. We had to submit detailed plans for how you’d deal with any situation you could possibly imagine.”
Then Muckle and her team had to redo that application after the Liberals won the 2015 federal election and changed the rules. Overall the process got easier, but Inner City Health still had to go through it again.
Now the provincial Progressive Conservatives are recasting supervised injection sites as “consumption and treatment services” and demanding that all the current operators apply again for funding and permission to keep running. Inner City Health gets about $2 million a year in provincial money.
Inner City Health doesn’t yet know precisely what the provincial government will demand. Muckle said she hasn’t heard anything but Health Minister Christine Elliott’s public announcement Monday morning. The minister’s stated goal is to make sure that the services also “offer connections to health and social services, including primary care, mental-health supports, housing and employment.” The ministry says the plan is to open the new applications in January and to have them squared away by April.
“We provide primary care in our SIS. We provide actual substanceabuse treatment in our SIS. And we have partnerships with organizations outside our SIS,” Muckle said. “It’s a pretty comprehensive model.”
According to Muckle’s figures, 160 of the 1,100 users of the site by the Shepherds shelter have been accepted into drug-treatment programs and 246 have started taking methadone or Suboxone, prescription drugs that suppress opioid cravings without the high.
“If you want to start on methadone, you have to have a health card. We actually physically take people to ServiceOntario so they can get a health card,” Muckle said. “We physically take them to a clinic to start methadone treatment.”
Inner City Health runs a primary-care clinic at the Ottawa Mission. It runs supportivehousing buildings for people with mental illnesses and addictions. It runs a hospice for people who are dying without homes. Proving, again, that it’s a real health-care organization is a needless burden, she said.
Although observing drug users for a time after they take drugs is the simplest of Inner City Health’s dozen programs and services, the injection site at the Shepherds is the most scrutinized thing the agency does, she said. “We had to put an additional door on, for the weather when it got cold. We had to apply for permission,” she said.
The province’s plan to keep any more injection sites from opening, besides the 21 already operating, is arbitrary and harmful, she said. “It’s not like the opioid crisis is getting better in Ontario; it’s getting worse.”
Public Health Ontario, a provincial agency, says opioid overdoses killed 1,263 Ontarians last year. The rate of emergencydepartment visits for suspected overdoses dipped in the second half of last year, as supervised injection sites opened around the province, but started to rise again last February. The sites have taken some of the load off hospitals but they aren’t keeping up.
This might have been the best Elliott could do. Premier Doug Ford said during last spring’s election campaign that he’s dead against supervised injection sites, but here Elliott’s proposing to keep at least the ones we’ve got. It’s still a lot of work that will occupy front-line staff who could be doing other things.
Ottawa has three sites in Lowertown and Sandy Hill, and one in a community-health centre in Chinatown. All their operators say they intend to try to stay open. Health clinics in Centretown and Carlington have done preliminary work toward a fifth and sixth in the city, but those plans are now in doubt.
Ottawa’s public-health unit, which operates a site on Clarence Street, is as keen as Inner City Health is to see exactly what the Health Ministry wants.
“Under the new provincial model, OPH looks forward to working with our partners and the government to continue to develop integrated and seamless services for people who use drugs, including connections to substance use and treatment services, mental health services, and social supports that they might need,” spokeswoman Donna Casey said by email Tuesday.
The health unit’s site, which is smaller and open shorter hours, sees 20 people a day and handles an average of six overdoses a month, Casey said.
It’s not like the opioid crisis is getting better in Ontario; it’s getting worse.