Closure of supervised consumption sites could lead to more overdoses, paramedic stress: TPH report

Toronto Public Health is reporting that the closure of five supervised consumption sites in the city this year will hamper its ability to provide life-saving services, while increasing the workload of paramedics.

The new report, examining the expected impacts the closures will have on Toronto Public Health (TPH) and the city's emergency responders, was prepared by acting Medical Officer of Health Na-Koshie Lamptey. It's slated to be presented to the city's board of health Monday.

Last year, the Ontario government passed legislation that will prohibit supervised consumption sites, which allow for safe consumption of illicit drugs in the presence of trained staff, from being within 200 metres of schools and daycares. 

"The new legislation will reduce access to an evidence-based clinical healthcare service leading to an anticipated increase in preventable fatal and non-fatal overdoses," the TPH report says.

Emergency responders likely to receive more calls: report

That's likely to add strain to Toronto Paramedics Services, the report found after consulting emergency responders.

Since 2019, paramedics have had a 54 per cent increase in calls related to drug toxicity, the report says, and they expect a further increase as more people use drugs unsupervised.

In 2023, Toronto Paramedic Services attended 4,802 calls for suspected opioid overdoses, the report found. That same year, there were 2,941 emergency department visits and 456 hospitalizations due to opioid poisoning at Toronto hospitals.

From March 2020 to May 2024, there were almost 400,000 visits at Toronto's supervised consumption sites, and staff responded to nearly 11,000 overdoses with no fatalities. 

The report also consulted Toronto Fire and Toronto Police Service, whose emergency responders are trained to respond to overdose calls. Both services said they couldn't predict what impact the site closures might have, however, Toronto police reported that calls for service have generally gone down in areas around supervised consumption sites compared to pre-pandemic levels.

Earlier this month, the province said nine supervised consumption sites will transition to Homelessness and Addiction Recovery Treatment (HART) Hubs that will focus on addiction treatment and recovery instead of harm reduction. The government will also spend $378 million to open 19 new HART Hubs.

But the TPH report finds these facilities won't be as effective without safe consumption or needle exchanges, and it's recommending that the board of health urge the province to allow those services. The report also recommends the province provide plans for mitigating health-care system impacts due to the closures. 

In an email, Ministry of Health spokesperson Ema Popovic said the province is responding to safety concerns it's heard from parents, families and communities worried about supervised consumption sites near schools and daycares.

"Enough is enough, and our government is taking action to protect children and their families while taking the next step to create a system of care that prioritizes community safety, treatment, and recovery," she said.

All provincially funded supervised consumption sites set to close have applied and been approved to transition into HART Hubs, which will offer primary care, addiction care and access to social services, Popovic said.

A new survey commissioned by the Canadian AIDS Treatment Information Exchange found that Ontarians support supervised consumption sites two-to-one.

TPH, emergency responders brace for end of March

Ten of the province's 23 safe injection sites are now set to close. Four of those sites are in Toronto, along with a fifth, privately-funded site in Kensington Market.

Pending a legal challenge currently before the courts, the supervised consumption sites would close at the end of March.

During a city budget committee meeting Wednesday, Coun. Chris Moise asked Toronto Emergency Management if they would step up in April to help TPH and paramedics respond to a potential rise in opioids, but staff said that would not be the case.

Harm reduction worker Zoe Dodd is concerned that the TPH report doesn't include a plan for any increase in overdoses that it predicts may come from the closures.

TPH operates its own supervised consumption site, called The Works, which will be converted into a HART Hub some time after March. Outdoor overdoses rose immediately in the surrounding area when it closed its doors at the start of the COVID-19 pandemic, Dodd noted.

"We already know from our own past experience that this will happen again," she said. "What will the plan be if The Works does close its doors to people?" 

Toronto Public Health declined to comment on its report before presenting it to the board of health on Monday.

From 2015 to 2023, roughly 3,400 people have died of opioid-related toxicity in Toronto, according to the report, with annual numbers since 2020 much higher than pre-pandemic levels.