Thousands of Canadian drug users are dying as red tape limits aid, advocates say

The historic core of Cobourg, Ont., brims with small-town charm. There are stately buildings, nice shops and old-fashioned iron lampposts decorated with hanging flower baskets. The local business authority even came up with a hashtag, “#8BlocksofAwesome.”

But on Friday night, a stone’s throw from the postcard main street, another side of life comes into view. Volunteers set up camp chairs and folding tables in an alley and stockpile supplies including alcohol swabs, plastic pipes and naloxone kits for use in case of overdoses. All for an unapproved, pop-up safe site for local drug users, aimed specifically at people who inhale rather than inject.

“It seemed like the need was increasing and more and more people were dying,” says Ashley Smoke, one of the organizers. “There are so many people who are struggling and no one who can help.”

Home to 20,000 people on the shores of Lake Ontario east of Toronto, Cobourg has suffered a dozen fatal overdoses in the past 18 months. The nearest official safe consumption location is in Peterborough, nearly 60 kilometers away. And like all government-funded harm reduction facilities in Ontario — and most of the rest of the country — it doesn’t allow drug smoking, only injection, oral and nasal use.

Smoke said the cost of not having supervised spaces for those who inhale drugs can be seen in Canada’s near-record overdose rate.

“The consequences have been death. Many people have lost their lives. There is just so much loss and grief,” they said.

2022, more than 7,300 Canadians died of apparent opioid overdoseswith 87 percent of those deaths in British Columbia, Alberta and Ontario.

Overdose prevention has become a pillar of government efforts to combat the opioid epidemic, with a growing national network of safe consumption sites approved by the federal government and funded by the provinces and territories.

But even if this system expands, it won’t meet the needs of drug users because it largely excludes inhalation — the most common method of consumption, advocates and experts say.

“What the country really lacks is the indoor inhalation places,” said Patrick McDougall, a Vancouver-based harm reduction specialist who helps community groups across the country set up places of consumption.

“There are no safe places for people to use right now, unlike what we have with injection.”

In BC, there have been 3.87 million visits to safe sites since 2017, according to the Department of Mental Health and Addictions, with 25,000 overdoses and only one death. That compares to 2,342 fatal overdoses in homes and on the streets in 2022.

Studies suggest that adding inhalation chambers would save additional lives.

Only BC and Ontario keep statistics on mode of consumption associated with drug deaths, but the trend toward smoking is both clear and long-lasting.

In British Columbia, inhalation overtook injections in 2017, causing 56 percent of drug-related deaths by 2021. Ontario’s numbers flipped five years ago, with smoking responsible for 68 percent of fatalities by the end of 2022.

But there are only five approved indoor inhalation locations nationwide, versus nearly 50 targeting injection .

The reasons for this seem to be mainly bureaucratic.

“In my opinion, it’s red tape,” McDougall said. “And I think the consequence is what we’re seeing now: six deaths a day in British Columbia, 20 deaths a day in Canada … several times what you could get from car accidents and suicides and other deaths combined. “

Health Canada will exempt inhalation sites from federal drug laws and require the same safeguards as for injection or other use, a process that usually takes just a few weeks with community support. But at the provincial level, things seem to be stuck.

$10,000 to build, 18 months to approve

Ontario has one sanctioned smoking location, a small room used exclusively by clients of Casey House, a Toronto specialty HIV hospital. It was easy to build, says Joanne Simons, CEO of the hospital.

“What we had to install was just a really big fan that could blow the smoke out as quickly as possible,” she said. Construction cost about $10,000 and was covered by hospital donors, as well as the room’s ongoing operating costs.

But even with no tax dollars at stake, the approval process took 18 months.

“The piece that initially seemed to be the barrier was around the Smoke Free Ontario Act, because obviously you’re not allowed to smoke in a public facility, especially in a hospital,” Simons said. “And it took some time to understand from a government perspective if they were going to allow us to let people use illegal drugs in this space.”

Now that such questions have been answered, Simons hopes future approvals will be faster.

But other major bureaucratic hurdles remain, especially for safe sites that receive provincial funding.

Kerri Kightley is the manager of consumption treatment services for a facility in Peterborough, Ontario, a city of 135,000 people who will experience 59 drug overdose deaths and 38 overdose deaths by 2022. the first six months of this year. Her safe site serves as many as 70 users a day, a number she estimates would at least triple if smoking were allowed.

“There’s been a dramatic shift from using injections to using inhalations and the county government just hasn’t caught up,” Kightley said.

Under the existing funding agreement with the province, Safe Sites in Ontario must use their government funds to support injection, oral and nasal drug use and nothing else. Even using the same supplies, room or personnel to facilitate smoking can be a violation.

“The requirements prevent us from using the provincial funds for anything other than what we’re approved for,” Kightley said. “It’s a bit complicated.”

CBC News made repeated requests for an interview with Sylvia Jones, Ontario’s health minister, but received no response from her office or the ministry.

We also asked the Alberta government about its plans for supervised inhalation sites. The county’s only smoking room, part of a facility in Lethbridge, then closed in 2020 a provincial check found evidence of financial mismanagement.

Dan Williams, Alberta’s minister of mental health and addiction, issued a statement saying his focus is on treatment and “holding accountable” criminals.

“Our vision for Alberta is one in which families have the opportunity to live in healthy communities free from illegal drug use and drug trafficking. Our vision is one in which addicts have immediate access to treatment,” he wrote, pointing to plans for 11 new ‘recovery communities’.

British Columbia, which began a three-year trial last winter to decriminalize possession of small amounts of opioids, cocaine and methamphetamine, has also rapidly expanded access to safe smoking, with one indoor facility and 16 indoor-outdoor hybrid locations in tents and other shelters now in operation.

In April, the inhalation sites recorded more than 35,000 visits, according to the latest update from the Department of Mental Health and Addictions.

But it’s not clear how practical such hybrid sites might prove to be in parts of the country with harsher winters or whether the political climate favors such innovations, with Conservative leader Pierre Poilièvre and his federal party on the offensive over harm reduction strategies. , such as safer drug supplies .

Users told that smoking is safer

All this worries experts like Tara Gomes, a Toronto-based epidemiologist and principal investigator for the Ontario Drug Policy Research Network.

Gomes and her colleagues have followed the switch to inhalation — a trend fueled by multiple factors: pandemic isolation, the wear and tear on veins from injecting potent opioids like fentanyl, and public health advice that smoking reduces the risk of an increasingly toxic supply.

She contrasts the government’s response to the COVID-19 pandemic and the opioid crisis.

“An ongoing concern for many of us who work in this space is just the ability to mobilize funds to be able to change legislation if necessary to respond to this emergency. We have seen how quickly that could happen during the pandemic” Gomes said. .

“And unfortunately because of the stigma that exists around substance use, this often doesn’t have the same urgency, even though we lose thousands of people in our country and thousands of people in Ontario every year because of it.”

Back in Cobourg, the reaction to the pop-up inhalation site is decidedly mixed.

When volunteers set up a tent to provide users with privacy, the city council responded by sending officials and threatening fines of up to $50,000 for zoning violations.

However, the Cobourg Police Department has made it clear that they support sanctioned harm reduction approaches and will not arrest individuals for possession of illegal drugs alone. So far, the arrangement of the table and chairs has been left alone.

John, a Friday night smoker whom CBC News does not fully identify, said he is hopeful a compromise can be found.

“The people down here need something. They need a safe place to go,” he said. Maybe just a trailer by the beach, he suggested, a place where users can watch out for each other.

“Being here with kids on the street and the police and everything is just too much,” he said. “These people are not safe here. They don’t have the help they need.’

Jonathon Gatehouse can be reached via email at jonathon.gatehouse@cbc.ca or via the CBC’s digitally encrypted Securedrop system at https://www.cbc.ca/securedrop/