The Ontario government's proposal to close supervised drug consumption sites may affect more facilities than initially expected, hitting programs that attend to thousands of potentially deadly overdoses a year, as lawyers doubt whether the move is constitutional.
A review by CTV News Toronto of federal government data shows that the sites slated to close because they are within 200 metres of a school or daycare help, on average, more than three people survive overdoses each day in Toronto and almost six a day across Ontario – a good first estimate of the number of people who may die without these programs, experts say.
"As a public health researcher, I feel quite confident in saying that if we cut supervised injection sites and supervised consumption sites in the province of Ontario, there will be increases in fatal overdose rates because we know from the research just how much these services have an impact and how much they do save lives," assistant professor Gillian Kolla said in an interview.
Kolla said about 22 people die from overdoses a day across Canada, a number that rises and falls depending on the toxicity of the unregulated drug supply. She said a drug user is much less likely to die when a health care worker or a peer can revive them with oxygen or naloxone, the opioid antidote.
This week, Ontario's government announced that 10 programs would close across Ontario, with five in Toronto, by March 31, 2025. The centres would not be allowed to move and reopen. The government would instead invest $378 million to open Homelessness and Addiction Recovery Treatment (HART) hubs.
The move came after 44-year-old Karolina Huebner-Makurat was killed by a stray bullet fired during a gun battle outside of one site in Toronto's east end in July 2023. Neither of the two reports commissioned to review that incident called to shut the facilities down. One report called for more security, another for an expansion of supervised consumption services.
The proposed rules seem poised to also affect two of four supervised consumption sites in homeless shelters in the City of Toronto, known as Urgent Public Health Needs Sites, which are only accessible to shelter residents.
In the Homes First site on Lakeshore Boulevard West, drug users can access one of two stainless steel desks in a small room as a staff member watches, prepared to respond with oxygen and naloxone, said director of client services Michael Potvin as he showed a CTV News Toronto reporter the facility.
"If there's an overdose, we have equipment and people who are trained who can respond quickly and save people's lives," he said. "We deal with hundreds of overdoses."
He said without that site people would move to bathrooms, alleyways, or alone in their residences, where they are not watched and an overdose could be fatal, he said. In their facility, the needles are disposed of. If drug users go outside, they are more likely to leave behind needles, which could make the problem around schools worse.
He said no one had died in their supervised consumption site. He said keeping the clients alive is a crucial step in stabilizing them.
"By having the actual safe consumption site, we make sure that people on site who are still using substances are actually able to get the support that they need so they can survive and access treatment tomorrow," Potvin said.
The federal government data indicates that the 10 sites identified by the provincial government refer about 131 people per day on average to other treatment and recovery options.
In 2011, Canada's Supreme Court weighed in on another effort to shut down a supervised consumption site by the federal government in Vancouver. The justices unanimously ordered that Insite, in Vancouver's Downtown Eastside, would stay open.
"The experiment has proven successful. Insite has saved lives and improved health. And it did those things without increasing the incidence of drug use and crime in the surrounding area," the justices wrote at the time, saying that closing the facility would violate the users' charter rights without evidence that the violation was justified.
Lawyer Michael Feder, who represented an intervenor, the Canadian HIV/AIDS Legal Network, said in an interview from Vancouver that for Ontario's moves to pass a legal challenge, it must have solid evidence supporting its plan.
"It's going to be an uphill battle," Feder said. "The government has latitude to do as it wishes. But if you're going to cut people off from something that reduces the risk of disease and death, you'd better have an evidence-based explanation for why you're doing it."
In a statement, a health minister staffer pointed to a rise in crime in neighbourhoods around some sites, but didn't respond to questions from CTV News about how those figures were calculated. The staffer said even if a site wasn't among those initially identified but failed the new criteria, it would have to close under the new rules.
"Open, taxpayer-funded drug consumption should not be happening on the same block as schools and daycares. Yesterday's action will help protect the public, especially for our most vulnerable: Ontario's children," the statement said.
One of the sites slated for closure, in Toronto's Kensington Market, will close because of the proximity to a daycare run by the same organization, The Neighbourhood Group, which it has operated for almost six years without incident, said TNG's CEO, Bill Sinclair.
"These services can co-exist. We can do it safely. We were shocked that our proximity to our own daycare was what shut us down," he said, pointing out that they do English classes for refugees and have an employment program in the same facility.
"The bigger picture is that all the professional advice is that we need more of this, not less. Most of the sites we're talking about are in health care and in community centres, and they're located where people live. And what else is located where people live? Schools and child care. That's the only reason we're in these neighbourhoods. We're serving all of our neighbours, not just one part," he said.
