It’s generally fair to wait for a policy to unfold, to leave some time to judge its effects, before we decide whether it will succeed or fail. The Ford government has done its critics a favour this week, however, with its announced changes to drug policy in Ontario, shutting more than half of the province’s safe consumption sites. The logic adopted by the government and its defenders is that because the province’s overall high rate of opioid deaths has continued, these safe consumption sites are a failure. This is despite the fact that no patient has died of an overdose at these sites precisely because they’ve been monitored and treated.
The bad news for the government, and the good news for its critics, is that if the benchmark for success is "reducing the rate of opioid overdose deaths in Ontario” then nothing announced this week will succeed. That’s not because an emphasis on treatment over harm reduction is itself indefensible. It’s because the scale of the problem that Ontario faces is so far beyond the resources that have so far been committed, and because addiction itself is such a wicked problem for health policy.
Health minister Sylvia Jones announced this week that the government would be replacing supervised consumption sites with 19 “homelessness and addiction recovery treatment hubs,” or HART hubs. The government promises “up to” 375 supportive housing units as part of this treatment plan. Assuming charitably that all of those beds are delivered promptly, that amounts to a tiny fraction of the at least 31,000 homeless across the province (a number that is certainly a conservative estimate) and certainly won’t cover the population that needs treatment. The province’s own data shows that on average, more than 200 people die each month from opioid overdose — and that’s been true for years now. The demand for supportive housing must obviously be many times larger than that.
To put it another way, even if I were 100 per cent convinced this policy change was the right call from the government, the resources being announced this week aren’t commensurate with the policy problem. It’s possible that future expansions — more money, more staff, more beds — would make it more effective, but that’s a charitable interpretation that this government never extended to harm reduction. Instead, it opposed those methods almost from the beginning and forced practitioners to operate on a shoestring. That’s not my opinion: the government’s own experts said the answer to the problems associated with safe consumption sites was more resources.
Even if the government were proposing an intervention many times larger, addiction is simply a problem that defies the easy prescription of politicians. Most people don’t die of their addictions, and most can live lives free of drug abuse eventually. But relapses are a totally normal part of recovery, as well. If someone leaves one of these HART hubs sober, but then later relapses or even dies, was the treatment a success or failure? What’s the answer to that question if we apply the same reasoning used to condemn safe consumption sites?
The surge in homelessness in Ontario is also, it needs to be said, downstream of the failure of this government (and its predecessor) to tackle the housing crisis seriously. Homelessness is a housing problem, and unless the government gets serious about housing policy in a way they haven’t thus far, all of the measures announced this week will be overwhelmed by further growth in the homeless population.
It's not even clear that the government has solved a political (as opposed to policy) problem for itself. The government is responding to some chronic cases of public disorder, as well as some high-profile acute examples such as the sincerely tragic shooting of Karolina Huebner-Makurat in Toronto. The public isn’t wrong to want to feel safe in their neighbourhoods and the government isn’t wrong to respond to that demand. The problem with half-measures like the ones announced this week is that it’s far from clear that public disorder will actually recede. As a resident of Toronto I can say that it’s not like public disorder has been limited to the areas around safe consumption sites — the explosion of homelessness in the city is all over.
The government’s announcement comes amid a drive by conservatives across the country to argue that harm reduction isn’t just a cause of public disorder but also harmful for addicts themselves. In Alberta, Marshall Smith has been one of the most prominent advocates for this argument, and that province has committed to building not hundreds but thousands of new residential treatment spaces. Still, actual success has been elusive: while the numbers this year so far have been more promising, 2023 was still the deadliest year on record in Alberta.
I’m willing to be convinced that different models of drug policy can work in principle. But whatever policy choice a government makes has to be matched to the resources necessary to see it succeed. The announcements by Ford and Jones this week suggest the government is trying to appease its ideological allies without having to find more room in the budget. Whatever else it might be, this isn’t a recipe for success.
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