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Activists get ahead of official response to rising opioid-related deaths by setting up technically illegal supervised drug use site

Volunteer Shawn Craig places a sign for a pop-up supervised drug-use site at Moss Park in downtown Toronto.

A half-dozen volunteers, mostly women, are working quickly, unloading box after box from a rented van at Toronto's Moss Park: shrink-wrapped packs of bottled water, a crate marked "syringes," yellow sharps disposal containers for needles, a pair of oxygen tanks, white plastic pails – each labelled "puke bucket" – and a clear plastic box with "Meth pipes for distro" scrawled on the lid.

They erect white tents, which have their clear plastic arched windows blacked out with tarps. By 4 p.m., the nurses and volunteers who will watch over drug users here at the city's first pop-up supervised drug-use site are ready.

In the month since the site started operating in this gritty east-end park with the tacit approval of police and city officials, volunteers have stopped 27 overdoses. The activists behind the site, who call themselves the Toronto Harm Reduction Alliance, say it's a desperately needed response to the rising wave of opioid overdose deaths caused by the increasing presence of fentanyl in other street drugs.

The crisis shows no signs of abating, but with the cold weather coming, the pop-up's future is uncertain. The mayor and city officials do not want it to become a permanent fixture in the park. Talks are now under way to move it inside, possibly into the basement of the nearby Fred Victor centre for the homeless. Fred Victor and Toronto Public Health officials are also trying to fast-track federal approval for a fully legal, permanent supervised drug-use site there, in addition to the two slated to open this fall in other parts of the city.

But the activists who run the pop-up are concerned about giving up too much control of their creation, which preceded Toronto Public Health rushing to open its own site last month. On the front lines of the crisis, they believe the city's plans for three legal sites are no longer enough. Activists and drug users say those desperate for a hit simply will not walk the 15 minutes from Moss Park to the city's legal drug-use clinic at Yonge-Dundas Square. Some are calling for another pop-up in nearby Allan Gardens, where drug users tend to gather. And even more mobile sites – in other downtown neighbourhoods or to the north, in the suburbs – are going to be needed, activists say, as the opioid crisis intensifies.

A volunteer carries supplies to Moss Park as the site is set up.

With the volunteers in Moss Park still setting up, a handful of drug users have already gathered, chatting with harm-reduction workers and scooping up the free yogurt cups on offer. Many have come from nearby homeless shelters. They are women and men, young and old, black and white.

"Better safe than sorry," says one man wearing a tank top and an Air Jordan baseball cap to his companion as he waits for a spot in the tent, clutching a paper drug-store bag.

The people hanging around this stretch of Queen Street East seem supportive. A man passing by on a bike chants: "Safe site! Safe site! Safe site!" A bearded man in a baseball cap shouts as he marches across the park by the encampment: "All you guys are awesome! Every one of you!"

The nurses and harm-reduction workers from other city clinics who volunteer here leave their day jobs early to run this site from 4 to 10 p.m. If someone overdoses, they administer the drug naloxone, and ambulances are called. There has been some tension with police and paramedics, but for the most part, activists say, they are being allowed to operate freely.

That freedom could be restricted, some fear, with a move inside, although few dispute there is a clock running on this pop-up site.

It remains illegal, operating without the Health Canada drug-law exemption that covers Toronto Public Health's site near Yonge-Dundas Square and the other two planned sites.

Injection supplies that will be given to drug users who visit the pop-up site.

It survives on crowdfunded donations raised online and various in-kind donations. It even gets $20 gifts from the meagre monthly welfare cheques of some of the drug users it serves, activists say. It also relies on the energy of its volunteers, who are susceptible to burnout.

There are no washrooms or running water.

And very soon, it will start to get cold.

But organizer Matt Johnson, who is a harm-reduction worker by day at an east-end clinic, says the pop-up wasn't meant as a temporary "publicity stunt" to shame the city into action. It was meant to serve the drug users of Moss Park. It has also benefited from the help of many volunteers who are drug-users themselves, he says. If moving inside means professionalizing and potentially shutting them out, it's not worth it.

"We could still have volunteer opportunities inside. But people won't feel the same kind of ownership that they do with it being in the park here," he says. "We would like to move inside. But we certainly won't if it would mean giving up things that we just can't live with."

The program doesn’t have Health Canada’s blessing but is much appreciated by drug users.

One of those drug-using volunteers is Leon Alward, 46, who is known to everyone here as "Pops." He lives in a nearby homeless shelter with one of his teenaged sons and has been volunteering, as well as using the pop-up site, since its launch. With his long dark hair in a ponytail, he helps set up the tents. He knows where everything goes. Harm-reduction workers ask him to tell a group of new volunteers what to do. He says the work makes him feel needed.

Originally from New Brunswick, he began using opiates 19 years ago, an addiction that started when he popped a Percocet while reeling from the death of his father. At his worst, he was dealing drugs to feed a $500-a-day opioid and cocaine habit. About a decade ago, he spent time in jail on drug charges and found God. He spent eight years using only methadone and fentanyl patches.

But after coming to Ontario a year and a half ago, he says he could no longer get his patches through a doctor and returned to street drugs. He lived in Oshawa, where his subsidized housing unit became what he called an "unofficial safe-injection site." He was evicted, forcing him and his son to live for a while in containers by the side of the railway tracks or in abandoned houses, before they ended up on the streets of Toronto.

"I am still trying to find ways to make up to my children what I put them through while I was a heavy, heavy junkie," Mr. Alward says.

When Mayor John Tory made an unannounced, hour-and-a-half-long visit to the site late last month, it was Mr. Alward who showed him how to prepare to inject heroin – to illustrate how easy it is for a user, fearful of being discovered in a dark alley, to make a mistake. The mayor was then invited into the tent to watch a woman inject drugs into her arm.

"He hugged that woman and said, 'God bless you.' I was very impressed with his open-mindedness," Mr. Alward says. "I was expected him to be more stern … against it. But he listened to everything we had to say."

Mr. Tory, who had originally called for the pop-up site to be "dismantled" once the city's own site was open, appeared to soften his stand after his visit, which he described in an interview as moving. But he still maintains that a public park is not an ideal long-term site and that the operation must move indoors as quickly as possible. He said city officials have been in discussions with Ottawa about speeding up the application process to sanction such a site.

"The reality is, what is going on in Moss Park is serving the needs of these people that I have seen with my own eyes," Mr. Tory said. "They are human beings that are struggling with issues that most of us can't imagine … I've never seen any of this in my life. I'd never seen anybody use cocaine, let alone inject drugs."

The nurses and harm-reduction workers from other city clinics who volunteer here leave their day jobs early to run this site from 4 to 10 p.m. If someone overdoses, they administer the drug naloxone, and ambulances are called.

Councillor Joe Cressy, chairman of the city's drug strategy implementation panel, agreed that the city's plan to open just three clinics – a plan that dates back five years – has been overtaken by events: "There's a real recognition here now that … the three neighbourhoods that we have identified are insufficient for the scale of the crisis. So we are looking at additional neighbourhoods now."

Mark Aston, the executive director of Fred Victor, which provides services to homeless people and others across the city, confirmed that talks were under way to run a supervised drug-use site out of his organization's location at Queen and Jarvis streets, near Moss Park.

"It's pretty obvious that Moss Park is one of the epicentres of the overdose crisis," he said.

But how it would be funded, and when it could be opened, remain unknown.

He added it's premature to say if the volunteer-run, but illegal, pop-up could simply operate out of Fred Victor as is. But he said he supported the pop-up's work and that Fred Victor could help in the meantime by, for example, storing the pop-up's equipment.

Back at the park, minutes after opening, drug users are already using the injection tent and the nearby "chillout tent," where they can relax after shooting up and where other users smoke crack or meth. About 20 to 30 visitors will inject drugs here on any given night.

Sarah Ovens, a social worker at a nearby drop-in centre, is in charge of the pop-up this evening. She takes a break to light a cigarette and talk about the activists' mixed feelings about moving inside.

Sarah Ovens, a co-ordinator with Toronto Harm Reduction Alliance, and volunteer Leon Alward, set up the pop-up site.

A more clinical setting may scare off some drug users. And when the pop-up isn't running, she says, people die. Just a few weeks ago, two people died of overdoses one day between 5 a.m. and 8 a.m., not far from where the tents are set up later in the day.

Her eyes water when asked if volunteers are starting to burn out. It's also exhausting going to memorials for overdose victims, she says.

"It's the most helpless feeling to just have people dying and not being able to do anything. … For me, I am so tired and dirty at the end of the day, but I am not just sitting and waiting to hear: Who was it in Moss Park last night? Who did they find in the alleyway? Who did they find in the stairway? You're doing something."