Carlyn Zwarenstein is the author of Opium Eater: The New Confessions and a Toronto writer. She has written extensively about opioid painkillers, substance use and pain.
In May of last year, I visited the new overdose-prevention site (OPS) run out of St. Stephen’s Community House, a social-service agency and a fixture in Toronto’s Kensington Market for decades. There, I met Angela Kokinos, a frank, friendly 41-year-old peer worker, who was ready to revive drug users at the safe, non-judgmental site in the event they overdosed. She had suffered an overdose from illicit fentanyl-contaminated drugs several times herself, and had quit all opioids weeks before.
“I didn’t want to play Russian roulette,” she said of her decision to quit cold turkey. She said interest in the new site was fuelled by locals’ experience of friends dying when using alone. “I think people are scared,” she told me that sunny May morning. “People don’t want to die.”
And yet, while campaigning to lead Ontario, now-Premier Doug Ford laid out his political position on drugs: “If your son, daughter or loved one ever had an addiction, would you want them to go in a little area and do more drugs? I’m dead against that."
Around 1,265 Ontarians died of preventable opioid-involved overdose in 2017; Canada’s illicit-drug supply is contaminated by non-prescription fentanyl and other nasty surprises, such as the elephant tranquilizer carfentanil, recently found in “heroin” in Toronto, Ottawa and small-town Ontario. Meanwhile, to date, no one – no one anywhere in the world – has ever died in an OPS or supervised consumption site.
If those loved ones, each a son or daughter, had such a “little area,” as Mr. Ford describes them, to use safely, be revived if something went wrong and connect with non-judgmental health services, they’d be alive today.
And yet, late on Friday, the Ontario Progressive Conservative government quietly announced the abrupt closure of six of the mere 21 provincially funded overdose prevention sites across the province, refusing to fund them (after forcing them all to reapply after the onerous process through which they were established in the first place) and rescinding the legal exemption that allows them to operate. Sites run by Ottawa and Toronto public-health units were among those on the list of sites slated for closing.
Once it took power in a province with an already accelerating drug-poisoning crisis involving illicit opioids, the PC government decided to look elsewhere for evidence, as it likes to do even when good evidence lies thick on the ground. The Health Ministry gazed into the sky and, apparently, came up with codswallop.
The lack of background for the government’s decision isn’t surprising, given the rhetorical atmosphere around supervised consumption sites. Critics purvey myths such as the idea that OPSs lead to needle debris in the streets (it’s the opposite, actually), or that they normalize drugs, turning your kids into zombies (nope); that by making life more painful for people who use drugs, we’ll get them to stop using drugs that kill pain (hmm … no), or that OPS increase violence and property damage (wrong again); that they’re a Band-Aid preventing people getting help (nuh-uh – in fact, they’re often the first and best access points to care).
These are all erroneous and stigmatizing beliefs that ignore a fundamental truth, one that I’ve learned from members of Moms Stop the Harm, an organization of bereaved families of young people who’ve died from overdose: If your loved one has an addiction or uses drugs, you love them like hell. And you help them stay alive. Tough love, rock bottom, forced treatment and closing overdose-prevention sites are all deadly choices.
Opioid-use disorder (addiction to opioids) is a chronic, relapsing condition characterized by compulsive use despite the consequences. A person dependent on opioids will typically use several times a day, or become severely, incapacitatingly ill within a few hours. As Ms. Kokinos told me: “When you’re that sick [with withdrawal], all logic goes out the window.” Prescription heroin, hydromorphone, or even OxyContin – Ms. Kokinos, like many others, switched to heroin after “oxys” were reformulated to make them harder to crush or dissolve – offer a very safe, uncontaminated, known-dose source. But the feds flatly refuse to even consider the framework of decriminalization, social supports and safer use that has pulled Portugal out of its own overdose crisis while actually lowering rates of drug use.
To prevent addiction and address related prevalence of pain, suicide and anxiety in Ontario, evidence suggests we must reverse trends toward unaffordable housing, inadequate income and precarious work – and governments must effectively tackle them, rather than fuel them. Most OPS clients are regulars, homeless or insecurely housed, chronically traumatized, with multiple mental- and physical-health challenges.
And so OPS staff have worked over months to build trust, resulting in HIV tests, hepatitis treatment and addiction treatment (medication-based treatment using buprenorphine or methadone – with or without accompanying counselling or other programs – is the gold standard for safely treating opioid addiction) for people who’d otherwise shun the health-care system. Now, in limbo or ordered to close, sites such as Street Health in Toronto scrambled this weekend to shift their tight budget, coming up with their own funding for another month and, with funding “in place,” qualifying for an exemption from the federal government that keeps them temporarily legal so they can be there for weeks to come for clients who need them.
The Ford government is effectively privatizing a life-saving service during a public-health emergency by forcing caring Ontarians to crowd-fund to keep it going – and in Alberta, United Conservative Party Leader Jason Kenney appears to be watching closely. It looks a tiny bit like gutting public-health services, starting with Ontario’s most marginalized. If the feds and GoFundMe don’t fill the gaps, the Ontario government seems willing to bet that Ontarians will let these people die. After all, we’re all kept busy worrying about our own jobs, health care and housing, making us (perhaps) less likely to stand up for poor and working poor users who depend most on OPSs.
Such as Angela Kokinos. In September, Ms. Kokinos died of an overdose – not at the OPS, of course, but in her apartment. I don’t know what happened between May and September, but abstinence actually removes one’s opioid tolerance, increasing likelihood of death if you relapse from your, well, relapsing condition.
She had told me that she feared for friends living in the suburbs where there are few sites, and where there are no people like her to help. Now, she leaves behind a devastated community, family and friends.
Doug Ford’s “dead against” OPS? Dead right.