How should cities decide where to locate safe-injection sites?

London wants to open a supervised drug-use facility in an apartment building where drugs are rife — but residents are feeling left out of the process
By Mary Baxter - Published on May 11, 2018
a house with an ambulance in front
Residents of 241 Simcoe Street say their geared-to-income apartment building has borne the brunt of London's opioid crisis. (Mary Baxter)

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LONDON — Rosetta Haddad fled the civil war in Lebanon more than 30 years ago in hope of a better life in Canada. Now in her early sixties, she faces a different kind of conflict in her home — this time involving the unpredictable and desperate behaviour of people hooked on drugs who are squatting in her geared-to-income apartment building.

Sitting in her tiny eighth-floor apartment at 241 Simcoe Street, the London public housing facility where she has lived off and on since 1997, Haddad recalls a recent early morning encounter in the narrow first-floor hallway. A fellow resident who she knew was a user of injection drugs was hallucinating and pounding on the building’s office door, threatening to kill anyone inside (the office was empty). She was able to slip away and call the police.

Haddad and other residents say they deal with a host of other problems living at the 12-storey former seniors’ residence that has become known as the “Crystal Palace”: petty theft; knife fights in the cramped and often crowded lobby; people sleeping, shooting up, and defecating in the stairwells; people having sex in the laundry room; people hiding needles on the underside of banisters (creating a risk that someone will get jabbed); and emergency exits getting blocked with garbage and grocery carts. One resident says she was punched by someone she believed was high.

The 217-unit building occupies a no-man’s land on the outskirts of London’s up-and-coming Soho neighbourhood. Industrial lots and a Salvation Army emergency shelter share the area with single homes and storefronts in sagging old buildings (a pawn shop, a vaping store, a church-run second-hand clothing store). At 241 Simcoe, Haddad is the “building contact” (a sort of part-time superintendent position that she holds in lieu of paying rent). She believes homeless “guests” — at least three of them loitered in the stairwells on a recent Sunday afternoon — are responsible for the problems. They easily slip past the building’s rudimentary front-door security, she says. When she encounters people in the stairwell, Haddad opens the door to make sure the hallway camera can see her, and she keeps her distance as she instructs them to leave. “I am careful,” she says.

a hallway strewn with clothing and other items

With deadly synthetic opioids such as fentanyl and carfentanil creeping into London’s street drug supply, overdoses and deaths at 241 Simcoe have multiplied, too, say residents and neighbours. In 2017, ambulances were called to the building, more than four times per week on average. (Citing privacy concerns, Middlesex-London Emergency Medical Services won’t reveal how many calls to the building involved drug overdoses.)

Now Haddad has learned about something that she fears would make the problems in her building even worse. Last month the Middlesex-London Health Unit and the London and Middlesex Housing Corporation — the landlord at 241 Simcoe — announced plans to introduce a safe-consumption facility (also frequently known as a safe-injection site) on the ground floor. (Some residents complain that the meeting intended to discuss the issue with building occupants was hastily organized, and many of them missed it.) At the proposed clinic, people would be able to inject drugs under supervision in order to prevent overdoses. It would serve not only residents but also the wider community.

Haddad is among a large number of residents at 241 Simcoe who feel apprehensive about the project, which — if it receives the necessary green light from all three levels of government — will be a Canadian first. This week, London city council voted to support the proposal for the safe-consumption site at 241 Simcoe, as well as another site in the city’s downtown. (The health unit is also proposing to operate a mobile facility.)

Of the roughly two dozen safe-consumption facilities located in residential buildings in Canada, just three — two in Vancouver, one in Ottawa — serve residents as well as the community at large. And those three existing facilities are all located in specialized social housing that provides many other supports for residents who share similar problems.

The 241 Simcoe proposal is the first that would place a safe-consumption site in a building serving a general population. 

The approach of embedding shared or supervised consumption space in residential buildings is barely two years old in Canada. Little, if any, objective data exists on its success rate. Despite the lack of hard numbers, experts say the practice has reduced overdose deaths. But experts also warn that the London project’s unique set of variables might be trickier to manage than its proponents realize, and unless addressed, the challenges could undermine its ability to serve the people it’s supposed to help.

Meanwhile, the existing residents of 241 Simcoe already face a multitude of problems and challenges unrelated to drug use. Ray Ernst and his wife, Sandy Anthony, for instance, ended up in public housing after Anthony fell ill. She could no longer work, and they couldn’t afford rent at market rates. Ernst, the building’s former resident contact, says most people live there because they’re on fixed incomes or social assistance and can’t make ends meet otherwise. Some tenants are refugees. Some are retirees. The number of tenants struggling with multiple and complex problems such as chronic homelessness, mental illness, and addiction is growing as a result of the city’s housing-first policy, a social service approach that prioritizes placing people in housing before addressing their other issues, such as trauma and addiction.

Drug dealers have also moved in, Ernst says. “We can have anywhere up to four to six dealers here at a time that I know of.” He complains that police and management don’t seem to do anything about it. “All night long you can hear [the dealers’ clientele] walking up and down in the corridors.”

exterior of apartment building

The CEO of a Vancouver social housing non-profit that has introduced these sites into many of its residences says designating a space for shared or supervised consumption alleviates the kinds of problems residents have experienced at 241 Simcoe. “If people have a safe place to use, where they’re welcome and where they’re not being judged, they probably won’t be sitting in stairwells and using or in hallways on the way to the washroom,” says Janice Abbott, CEO of Atira Women’s Resource Society.

The London and Middlesex Housing Corporation says embedding the site in the geared-to-income facility will allow it to deliver other services at the same time, in keeping with the housing corporation’s goal of supporting the needs of its tenants. Along with supervised injection, a safe-consumption site can connect willing clients to other life-changing social and medical services such as addictions counselling and HIV testing — a benefit of consumption sites that Ontario Liberal leader Kathleen Wynne noted in a televised debate earlier this week.

Looking west for models

Another practical consideration drove the site selection: Shaya Dhinsa, manager of sexual health for Middlesex-London Health Unit, says her organization didn’t have a lot of options in London. Earlier this year, a downtown landlord nixed an agreement to host a site after neighbours complained. “Other cities are experiencing the same scenario,” she says. “In that vicinity [of 241 Simcoe], we did explore [other] locations.”

Dhinsa meanwhile denies that the project is being rushed through. The health unit spent years studying the issue, she says, and undertook community consultations and a feasibility study.

However, most of the models for residence-based facilities are in British Columbia, and it’s not clear how carefully the health unit studied them. In an interview with TVO, Dhinsa didn’t know how the facilities in B.C. were different from what is being proposed in London.

Instead, she pointed to London’s downtown temporary site that opened earlier this year as a model. Located on the ground floor of a privately owned residential apartment building where the city’s needle exchange program is already housed, the site serves the community at large. Dhinsa says it has already prevented overdose deaths and reduced drug paraphernalia litter in the area. But it doesn’t have the objective of also serving tenants in the building, as the proposed site at 241 Simcoe does.

Russell Maynard, a spokesperson for the B.C.-based, non-profit PHS Community Services Society, has reservations about the London proposal. He says adding a safe-consumption facility to a building with such a diverse population makes it extremely difficult to create a supportive environment for people who wrestle with complex issues such as homelessness and addiction. It can be done, “but it has to be well managed. If you … do it halfway, it’s not going to work,” he says.

His organization focuses exclusively on housing people experiencing complex issues, and Maynard says staff create a safe and constructive environment for residents any way they can — offering everything from morning coffee to advice on dealing with the justice system. Fostering a supportive community is the best way to break down stigma, Maynard says. When people feel less stigmatized, they’re more able to talk about making changes to their lives.

When it opened a federally approved safe-consumption site in a Victoria residential building in 2016, PHS restricted the site’s services to residents and their guests. Maynard believes it would be impossible for staff to offer specialized supports and a constructive environment with “hundreds of people pouring in and out of the building.”

Looking at the plan for London, Maynard says drug-dealing activity at 241 Simcoe has to stop: dealing invites violence and the activity is counter-productive to the well-being of the building’s community. PHS works with local police to address the problem. “It’s no different than your or my neighbourhood. The same laws apply.”

Another B.C.-based expert, Shannon Riley, a clinical nurse educator with Vancouver Coastal Health, calls the London proposal a “great idea” but says it’s important to achieve consensus in a residence before going ahead with adding a dedicated space for consumption. At 241 Simcoe, residents were surveyed after the decision was made, not before. “We all need to feel safe in our home,” Riley says, and it helps “to feel like we are part of a collaborative process instead of a top-down process.”

Since announcing its plans for a consumption site at 241 Simcoe, London and Middlesex Housing Corporation has held meetings and solicited tenant feedback including a survey that showed the majority of residents who responded recognized benefits of having the facility there, despite concerns including the presence of more drug use in the building. So far, those discussions are leading to plans to enhance security — for example, by having guards do sweeps at random times both inside and out of the building.

Before the project at 241 Simcoe can go ahead, it needs exemption under the federal Controlled Drugs and Substances Act to legally operate — and the federal government requires applicants to get provincial approval first. Not all of Ontario’s political parties approve of safe-consumption sites. The Liberal government has supported them, as do the NDP and Green Party. However, Progressive Conservative leader Doug Ford has twice changed his stance on the issue, and most recently has said he opposes the sites.

Given the possibility the government will change in the coming weeks, pressure is on to obtain provincial blessing (in a London Free Press report, the city’s medical officer of health has hinted this might happen soon, despite the fact that there’s an election afoot).

The chair of the housing corporation notes that whether the project will even reach the stage of implementation is up in the air because of its many “moving parts” — including the results of the provincial election and the municipal rezoning approvals needed before renovations.

“No one can predict how this will work out,” says Michael Buzzelli, London Middlesex Housing Corporation board chair. “Our hope is that we can be part of the solution, but the community needs something and that’s the stand that we’ve taken.”

This is one in a series of stories about issues affecting southwestern Ontario. It's brought to you with the assistance of faculty and students from Western University’s Faculty of Information and Media Studies.

Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.

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