Safe sites play vital part amid drug crisis

If you peruse recent stories about Toronto’s supervised drug consumption sites, you might get the sense that you’re reading a tale of two cities — or perhaps more accurately, two tales of a city.

In the first tale, supervised consumption sites benefit society by reducing overdose deaths, syringe sharing and infectious disease transmission, and by increasing uptake of health-care services and addiction treatment.

The most recent chapter of this tale appeared in February, as a study in the British medical journal The Lancet found that neighbourhoods surrounding the sites experienced a dramatic reduction in overdose deaths.

In the second tale, the sites harm society by increasing public drug use, unsafe disposal of syringes, criminal activities and violence, and by reducing the liveability of their surrounding communities.

The latest chapter of this tale also appeared in February, as residents and businesses in South Riverdale proposed a classaction lawsuit due to the “rapid” deterioration of their neighbourhood — including the killing of a woman by a stray bullet — since a site was opened six years ago.

The two tales therefore tell two very different stories, and whether those stories are hopeful or tragic depends on whose interests you consider: Consumption sites, it seems, are very good for drug users, and very bad for everyone else.

This narrative was largely inevitable since the sites are designed to reduce the harms of illicit drug use, and medical studies therefore tend to focus on their impact on illicit drug users. And armed with these studies, advocates and public officials also emphasize the benefits to users.

In contrast, the effect on communities has received comparatively little attention, which stokes the fears of residents and business owners who worry that their lives and livelihoods are at stake.

That said, a limited number of studies have investigated consumption sites’ impact on neighbourhoods, and they tell a littleknown story very different from the one we’ve been hearing.

Indeed, studies from Australia, Denmark, Germany, Italy, Netherlands, Spain and Vancouver have all found that consumption sites are associated with improvements in public order, including reductions in public injecting and unsafe disposal of syringes.

While contrary to the predominant narrative, these findings are intuitively plausible since using a consumption site eliminates the need to use and dispose of syringes in public.

Also contrary to popular belief, there’s little evidence that the sites act as a focal point of criminal behaviour (the so-called “honeypot effect”): Studies from Australia, the United Kingdom and Vancouver found no increase in the number of thefts, robberies, assaults or drug trafficking in surrounding neighbourhoods after the establishment of the sites.

To be sure, the studies didn’t find any decrease in crime either. Consumption sites clearly aren’t a panacea, nor were they intended to be. But the evidence demonstrates that the sites aren’t the magnet for crime that many people believe.

Finally, by reducing overdose deaths and HIV transmission, several Canadian studies have estimated that consumption sites save hundreds of thousands or millions of health-care dollars annually.

None of this means that consumption sites are all we need, of course. Substance use requires a multi-faceted approach, including prevention, harm reduction and treatment services.

It also doesn’t mean that every site operates effectively, or that everything is fine in South Riverdale. The concerns expressed by residents and business owners deserve a thorough hearing and investigation, and if there are problems with the site, they need to be rectified.

But it does mean this: Consumption sites need not be — and in most cases are not — zero sum games, where drug users win and their surrounding communities lose.

Rather, both users and their communities can and often do win. And that’s the tale that remains untold, a tale in which consumption sites benefit both users and communities, thereby forming a small, but vital, part of the response to problematic drug use.