In August, the Ontario government announced a ban on safe-consumption sites within 200 metres of schools and child-care centres. In Toronto, this will mean that five out of the city’s 10 sites will be forced to close their doors by March 31, 2025. A sixth site, which is nearing the end of its lease, is also expected to close around that time.
The province plans to establish Homelessness and Addiction Recovery Treatment Hubs to continue the wraparound supports that will be lost when these sites shutter. These hubs will connect clients with shelter or transitional-housing options and provide amenities such as food and warm showers, as well as mental-health supports. The HART Hub model, however, does not include safe-consumption services.
It is estimated that more than 1,300 people visit safe-consumption sites in Toronto each month, a fraction of those who use opioids and stimulants in the city.
A new study by researchers at Ontario Drug Policy Research Network and the MAP Centre for Urban Health Solutions attempts to estimate the potential impact of the closure of these six safe-consumption sites on the people who have come to rely on them.
TVO Today spoke with lead author Dr. Ahmed Bayoumi, a scientist at the MAP Centre for Urban Health Solutions, about how Toronto’s four remaining sites will be affected — and why he thinks the province should be looking to expand safe-consumption services across the city.
TVO Today: Could you describe the results of your research into the impact of closing these safe-consumption sites?
Dr. Ahmed Bayoumi: So, we did two things. We tried to look at how many people who use drugs would lose potential access to a site, and then we tried to look at people who were current clients of a site and how many of them would lose access. The first thing we did was try to estimate where, specifically, people who use drugs, opioids, or stimulants are located in the city of Toronto. We estimated that just under 10 per cent of them were within 500 metres of an existing site. If six sites close, about half of those people would no longer be within that proximity of a site.
Dr. Ahmed Bayoumi is a scientist at the MAP Centre for Urban Health Solutions. (Courtesy of Dr. Ahmed Bayoumi)
The second thing we did was look at the current clients of the sites. We estimated that there were about 1,366 unique individuals that used these sites every month. If six sites close and people don’t travel more than 500 metres to a site, about 47 per cent of these people would lose access. That assumes that the sites that remain open can accommodate those clients of other sites within their catchment area.
The most important take-home message is this: there already aren’t enough sites in Toronto. Closing these sites will decrease access to a lot of people who benefit from them. A lot of the current clients will be left without supervised-consumption services, and the demand on sites that remain open could be very large.
TVO Today: What happens to those clients who have come to rely on safe-consumption services at these sites that are set to close?
Bayoumi: Unfortunately, no one knows exactly what will happen to them. We know that supervised consumption is associated with a lot of health outcomes. This includes decreased overdoses and deaths from overdose, increased referral for other services, and generally improved health. We also know that the HART hubs that the government has been promoting will provide some of these services, but they won’t provide supervised consumption. So it’s not at all clear to me that they’re going to be a substitute for the services that people are currently receiving. I think there’s a very serious concern that a lot of those people just won’t have those services, and that would then manifest as negative health outcomes.
TVO Today: Tell me more about that.
Bayoumi: The most important would still be overdose and death from overdose. We know that people who use alone are more likely to overdose, and we know that many people who use supervised-consumption sites don’t have a home. Oftentimes, the site itself is where they can use with other people and be supported in their drug use. The other concern is that people will use in public. Even though the government has stressed repeatedly that they want to address the issue of public drug use, our analysis suggests that closing sites is likely to result in many people going back to using in alleyways, streets, and parks.
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TVO Today: You mentioned earlier that a small number of people who use opioids and stimulants in Toronto live within walking distance of a safe-consumption site and that your study proposes expanding the number of sites to serve that population. What kind of impact could that have on the number of opioid-related deaths and hospitalizations in the city?
Bayoumi: That’s the next step in this line of research. But I was a co-author of a study published last year that showed that neighbourhoods that implemented supervised-consumption sites had lower overdose mortality rates than neighbourhoods that didn’t. It’s a reasonable extrapolation to say that, if we had more sites throughout the city — and, particularly, close to where people are using drugs — that it would help decrease the overdose rate.
TVO Today: Anything to add that I haven’t asked about?
Bayoumi: I think one of the novel aspects of our work was really trying to estimate what the demand would be on the sites that remain open. I think that hasn’t been discussed enough in the policy discussions around this: there could be a significant demand for services on sites that are not closing. It would make a lot of sense from a policy and health-services perspective to make sure those sites have sufficient resources to meet the needs of the people they serve.
This interview has been condensed and edited for length and clarity.