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People hold drug paraphernalia in a parking lot in London, Ont., that abuts Stephanie De La Celle's yard. She worries that the sight of public substance use is too much for her children, who range from ages 5 to 14.Nicole Osborne/The Globe and Mail

Living in downtown London, Ont., right next to a mission for people who are poor and homeless, Stephanie De La Celle’s children often see people using illegal drugs. Playing in the park, riding their bikes or just going to the store for ice cream, they come across men and women openly smoking or injecting. That bothers Ms. De La Celle, 41, who has five-year-old twins, an 11-year-old and a 14-year-old under her roof.

“They shouldn’t be exposed to that at their age,” she says.

Her complaint is a common one these days. As Canada’s opioid crisis rolls on relentlessly, drug use has come out of the back alleys and into the open. In many places, it is no longer rare to see people using illicit drugs such as methamphetamine or opioids on buses, in parks and at playgrounds.

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Stephanie De La Celle stands in her neighbourhood park, where she sometimes encounters people using drugs.Nicole Osborne/The Globe and Mail

The debate over what – if anything – to do about it is breaking out in towns and cities across the country. Parents, neighbourhood groups and some police chiefs say that open drug use puts communities in danger and contributes to a sense of deteriorating public order. Advocates for drug users reply that a lack of housing is partly to blame, and that pushing users back into the shadows will only heighten the threat of overdoses, worsening a crisis that is already taking 22 lives a day in Canada.

The issue may come up in the next federal election. Conservative Leader Pierre Poilievre has been a strong opponent of attempts to loosen drug laws and create a government-run supply of regulated drugs, and he blames the Liberal government of Justin Trudeau for making things worse. “Crime and chaos, drugs and disorder rage in our streets,” he told the House of Commons last May.

The debate grew fiercer after a recent court ruling in British Columbia, which got a federal exemption a year ago to decriminalize possession of small amounts of certain illicit drugs. After several cities complained that the exemption was leading to more open drug use and other problems in their streets, the province passed legislation to ban open use in a variety of public spaces. But then a judge blocked the new law.

The deepening dispute is part of a much wider clash about how to combat the country’s overdose epidemic. Overdoses have claimed more than 40,000 lives in Canada since 2016, and the annual death tolls are worsening in some provinces.

Harm-reduction advocates say that drug users are a persecuted minority and should not be compelled to stop doing what their addiction or trauma leads them to do. Their opponents argue that even a caring society must enforce some rules and standards.

In London, Ont., two caring addiction doctors sit on either side of the safe supply divide

Though drug users remain “deeply stigmatized,” says Stanford University professor of psychiatry Keith Humphreys, something has gone wrong when people are injecting drugs openly on buses and subways. “We’ve accepted too much in our public spaces and we’ve all become callous as a result,” says Prof. Humphreys, the author of Addiction: A Very Short Introduction.

But to Nicholas Boyce, a policy analyst with the Canadian Drug Policy Coalition, “targeting public drug use is really about targeting poor and underhoused people who use drugs.” For many of them, using in the open “may be the safest thing.” Cracking down on the practice would force them to use alone and in private, with no one around to call 911 or revive them if they suffer an overdose, he said in an e-mail response. He would like to see authorities end the prohibition on drugs and make them legal, but regulated like alcohol and cannabis, with limits on where they can be consumed.

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A Naloxone kit hangs from a stairway in a Timmins, Ont., where people sometimes go to use opioids.Fred Lum/The Globe and Mail

Not so long ago, there was little dispute about how to handle open drug use. It was simple: Possessing and using illicit drugs was forbidden. Those who used them in public could expect to be arrested, or at least told to move along.

But attitudes changed with the onset of the opioid crisis. As pain pills and then the deadly synthetic opioid fentanyl flooded Canadian streets, killing thousands, authorities concluded that treating drug use mainly as a criminal matter was not working.

They shifted to a “harm reduction” approach, which meant accepting that, like it or not, some people, especially those with addictions, were going to use prohibited drugs. The focus should then be on helping them to consume those drugs safely, without getting an infection or having a potentially fatal overdose.

Health clinics started handing out sterile needles, drug pipes and other equipment. Many cities opened supervised-consumption sites where people could use their drugs under supervision in case of overdose. Some addiction doctors began giving their patients prescription opioids, hoping it would steer them away from dangerous street drugs.

For many Canadians, already concerned about seeing more homeless people in their communities, more tents in public parks and more threatening behaviour on transit vehicles, the spread of open drug use is shocking.

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Ms. De La Celle says her family has seen public drug use often since moving to London a few years ago.Nicole Osborne/The Globe and Mail

When Ms. De La Celle and her children moved into a house in downtown London a couple of years ago, they started seeing people using drugs all the time, whether in a nearby park or on a central avenue that is a hangout for those who live on the city’s margins. Her kids found needles in the park, saw violent fights, witnessed open drug deals and heard people cursing at each other on the sidewalk. Ms. De La Celle’s daughter came to her one day to say her Grade 6 class had been assigned a project on drugs. “She just kind of broke down, saying ‘it scares me and I see it all the time when I go to the park and I just really don’t like it.’ ”

Almost worse, says Ms. De La Celle, would be if her kids stopped being upset. “You just pray they don’t become desensitized to it, kind of numb, like it’s normal to them,” she says.

Families that live near a supervised-consumption site in Toronto’s Leslieville neighbourhood have similar worries. They have complained repeatedly about open drug use near the South Riverdale Community Health Centre. Andrea Nickel says that, walking her 10-year-old son to school, “every week without fail, we’d see someone shooting up with a needle in their arm, or preparing their drugs or fighting over drugs.” Of 150 reports that neighbours compiled about troubling behaviour near the centre, half were about open drug use.

Ms. Nickel says authorities acted on the complaints only after a local mother of two, Karolina Huebner-Makurat, was killed in the crossfire of a gunfight outside the centre last summer. The centre has since hired security guards and erected a big fence around an open space next door where drug dealing and drug use were common. But Ms. Nickel says neighbours still see open use and find discarded needles. In an area with six daycares and two schools, she says, that’s unacceptable.

Toronto police say that whether they take action over public drug use depends on the circumstances, “but we rarely arrest and charge people in Toronto for simple possession,” according to spokeswoman Stephanie Sayer. They made just 15 arrests for single counts of simple possession in 2023. If police intervene, she said, “it will likely be a conversation and providing a bridge to support services, not an arrest.”

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Torontonians hold a public vigil last July for Karolina Huebner-Makurat, a mother of two killed by a stray bullet in her Leslieville neighbourhood.Chris Young/The Canadian Press

After the Leslieville shooting, the Ontario government launched a review of the site and put a pause on approving others. Premier Doug Ford has cast cold water on Toronto’s application to follow British Columbia’s example and decriminalize possession of drugs in small amounts. He called it the “craziest thing I’ve ever heard.”

In Alberta, too, authorities have steered away from decriminalizing drugs or providing users with a safe supply. The United Conservative Party government is stressing treatment and recovery, saying the goal should be to help people with addictions get sober and find a better path.

The latest figures from that province, which is seeing overdose deaths reach an all-time peak, show that 43 per cent of deaths took place in public spaces in the third quarter of 2023. That is up from 23 per cent in the third quarter of 2022.

Authorities in Edmonton have had enough. Police Chief Dale McFee said last fall that, after a jump in crime in the city, the force would be cracking down on the “criminality and disorder associated with open-air drug use and drug trafficking.”

That crackdown has been under way for a couple of months now. Chief McFee says that when police see people using openly, they may simply tell them to move along because “we can’t be doing that here in front of the mall.” Or they may use the encounter as an “intervention point,” offering to get the user help with finding a place to live or dealing with an addiction.

Edmonton, the chief says, doesn’t want to go the way of other cities where open use is common.

“You can look at Seattle, you can look at Portland, you can look at San Francisco, or parts of Vancouver. You have no rules, and you can predict what’s going to happen.”

Edmonton’s city council is considering a new bylaw that would ban public drug use completely. It would give bylaw officers the power to fine people $500 for openly possessing or consuming an illegal drug in any public space. A staff report on the bylaw said that, during public consultations, 89 per cent of Edmontonians said they were “extremely or very concerned with visible drug use.”

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At Edmonton's City Hall, lawmakers are considering measures to ban public drug use.Jason Franson/The Canadian Press

Peterborough, Ont., is another city that is cracking down. Its police force announced last October that “we will be taking a no-tolerance approach when it comes to open-air illicit drug use in our community.” It said that while police favoured “a compassionate response for those suffering with addictions and expects officers to be kind in their engagements with individuals,” the community expects “that public places such as parks, places of business, and most importantly places where our children go, such as playgrounds, should also be safe.”

Merchants in Montreal’s Chinatown, too, are pressing their city to get tough. Along with local residents, they held a news conference last fall to complain about a plague of vandalism, fighting and open drug use.

Even in the nation’s capital, store owners and residents say they are seeing much more open use. Keith Nuthall, who lives in a condo in downtown Ottawa, says it’s common to see users injecting drugs in their arms or between their toes and sprawled semi-conscious on the sidewalk. “You don’t know whether they are alive or dead.”

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People navigate an underpass near Ottawa's Rideau Centre mall that, in warmer months, is frequented by those experiencing homelessness and addiction issues.Spencer Colby/The Globe and Mail

Those who work with drug users, however, say that many use their drugs in the open simply because they are homeless or mentally ill and most shelters won’t let them use inside.

“People aren’t using drugs in public because it’s fun,” says Charlene Lazenby, who runs a London, Ont., shelter. “This is not a party. It’s survival.” Her shelter, called Unity Project, lets tenants use drugs in their rooms, but not in common areas.

She says she understands why people are upset when they see public drug use, especially if they have children. “I know that those conversations are hard to have with kids, but it is the reality we live in right now.”

Part of that reality is homelessness. At about 2,000, the homeless population in London is twice what it was before the pandemic.

In British Columbia’s Lower Mainland, a recent homeless count found a 32-per-cent increase since 2020. B.C.’s outgoing chief coroner, Lisa Lapointe, who supports decriminalization and other harm-reduction policies, has said that many people using drugs in public simply have no place to live.

“They’re trying to stay warm or stay dry or stay safe, all in the public eye. We may see them using drugs outdoors because the outdoors is their living space,” she said at a recent news conference announcing the province’s worst year ever for fatal overdoses.

Pushing them back into “alleys and dark corners” would only make their lives more dangerous. “We see many focus on stigmatizing, vilifying and marginalizing our community members who use drugs, beating them down instead of helping them out, and focusing on punishment,” Ms. Lapointe, who is retiring this month, told a recent news conference.

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B.C.'s outgoing chief coroner, Lisa Lapointe, says she's been frustrated at the politicization of the ongoing overdose crisis.Chad Hipolito/The Canadian Press

Advocates of harm reduction view the uproar about open use as part of a wider backlash against the approach, and they are promising to resist.

In the recent court case in British Columbia, a group of nurses who work with drug users challenged a new law that prohibits drug use around sports fields, beaches, building entrances and bus stops. Chief Justice Christopher Hinkson of the B.C. Supreme Court ruled in their favour, saying the ban could cause “irreparable” harm and imposing a temporary injunction against it.

“When people are isolated and out of sight, they are at a much higher risk of dying from an unreversed overdose,” he wrote.

The province’s NDP government is appealing the court’s decision.

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