‘People are dying’: What does it take to get a supervised-consumption site?

The Simcoe Muskoka District Health Unit and local organizations are poised to apply for provincial funding. But the process is long and complicated — and there’s no guarantee of success
By Ashley Okwuosa - Published on Jan 21, 2021
Ryan Nayler died of toxic drug poisoning in November 2020 at the age of 34. (Courtesy of Christine Nayler)

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For eight years, Christine Nayler’s son, Ryan, battled mental illness; three years ago, he began using illicit drugs. A librarian and music aficionado, he was, Nayler says, a “born activist.” Although he didn’t use opioids, he had friends who had died as a result of them, and he made sure to have Naloxone with him whenever he could. But as COVID-19 intensified in Barrie and across the province, access to Naloxone and other social supports waned, and drug use skyrocketed. In November 2020, a week before his 35th birthday, Ryan died of toxic drug poisoning.

“No mother should know this pain” says Nayler. “It breaks my heart, and every day that I live without him, it gets harder — the hole gets bigger. And the only thing that's been giving me purpose right now is fighting for things to change.”

For the past three years, the early-childhood educator has chaired a committee in her church that looks at social issues; more recently, the discussion has focused on whether Barrie needs a supervised-consumption site. Her role involves addressing misconceptions about what such a site would mean for the city and about the kind of people who need it.

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“People have this image of what a drug addict looks like,” she says. “They have a bad image, and so they think, ‘Why should we care about those people? We want those people out of Barrie.’”

Facing a rising number of opioid-related deaths, the Simcoe Muskoka District Health Unit and local partner organizations are now poised to apply for provincial funding for a site. But, in Ontario, the process can be a lengthy and complicated one — and there’s no guarantee of success.

In 2018, the Doug Ford government replaced the provincially funded Supervised Consumption Services and Overdose Prevention Site models with Consumption and Treatment Services, and announced that it would cap the number of sites at 21.

The change in title came with a new set of requirements: A CTS, for example, should be located  100 to 200 metres from child-care centres, parks, and schools, and 600 metres from other CTS facilities. Sites must be able to provide or be co-located with an organization that can provide other wraparound social services, such as addiction services and mental-health care. And, while both the provincial and federal governments require thorough community consultations, only the province makes funding conditional on local municipal and council support.

“On the one hand, [the changes] could be seen as a way of trying to ensure the quality of the services across the province,” says Carol Strike, a professor at the University of Toronto’s Dalla Lana School of Public Health. “But it can also be interpreted as a way of impeding their ability to implement consumption services.”

According to Ontario’s Ministry of Health, an organization could apply to the federal government for an exemption from Controlled Drug and Substance Act and operate a supervised site without applying to the province for support — but it would have to find an alternative funding source. Currently, Ontario funds 16 sites; four others received exemptions from the federal government and rely on funding from other sources.

Applying for such an exemption is an option, says Mia Brown, acting program manager of the Substance Use and Injury Prevention Program at the Simcoe Muskoka District Health Unit. But, she adds, without funding from the province, it would be a challenge to even consider moving forward with a supervised site in Barrie: “They cost anywhere from $1.5 million a year to run. So we do have to go through with the process for provincial approval and funding.”

Advocates say that the need for such sites has become only more urgent since COVID-19: research by the Ontario Drug Policy Research Network showed a 38.2 per cent increase in opioid-related deaths in the first 15 weeks of the pandemic. Like Barrie, other cities, such as Sudbury, are speeding to open up consumption and treatment sites before the province reaches its 21-site limit. In an emailed statement to TVO.org, a spokesperson for the Ministry of Health did not respond to questions about whether it would consider raising the limit but stated that “the government is committed to addressing the opioid crisis and to supporting people with an opioid use disorder in getting the help they need,” before listing a number of existing programs in place to address the opioid crisis, such as harm-reduction services and treatment for opioid use-disorder.

Data from the Simcoe Muskoka Health District Unit show that, from March to August 2020, there were 64 confirmed and probable opioid deaths in the region — 31 per cent higher than the 49 deaths in the six months prior to the start of the pandemic.

“Clients are overdosing because of the poor quality of the substances being sold on the street level,” Brown says. “We [also] know that people are using as a response to stress or COVID, and they're at increased risk of using alone because of the physical distancing measures put in place.”

Funding is not the only obstacle Barrie faces — local opposition is another challenge. On June 24, 2019, residents flooded city hall as the council prepared to vote on a proposed location for a CTS in the city’s downtown. Members of a community group, Safe Barrie, held up signs claiming that a site would bring crime to the community and calling the research used to land on the proposed location — 90 Mulcaster Street — flawed. On the other side of the room, residents held signs that read “we support the endorsement of an SCS, the charter supports putting lives first, the supreme court has ruled in favour of an SIS,” among other statements in support of the site. At that meeting, city officials cast a split vote on a motion to pay $50,000 to a consultant to weigh in on a proposed site. “If you are opposed, don’t kick it down the line — just make a decision,” said Barrie mayor Jeff Lehman, who voted against hiring the consultant.

“I was urging the council to make a decision at that time because I see this as an urgent public-health emergency, and those were formal words for ‘people are dying,’” Lehman tells TVO.org. While he supports establishing a site, he doesn’t want people to dismiss the concerns of those who have doubts. “It’s not just NIMBYism,” he says. “Some of the fears associated with supervised-consumption sites need to be recognized.”

Rowley Ramey, a member of Safe Barrie, the organization that opposed the first location, says that he is not debating the merits of or need for a CTS in Barrie. “That support is needed is never the question,” he says, adding that the group opposed the site because it would have exacerbated the issues residents were already facing due to social services already operating nearby. (A petition signed by 20 residents opposed to the proposed downtown location cited incidents of loitering, public drug use, and noise in the early hours of the morning.) 

According to the Simcoe Muskoka District Health Unit, though, a safe-consumption site would make sense downtown. According to its survey, 81 per cent of respondents with lived experience using drugs suggested specific locations in downtown Barrie where the SCS should be located. And, according to Brown, data shows a higher concentration of suspected opioid overdoses in the area. 

According to Strike, research shows that support for supervised-consumption services does grow over time — but, she says, “There are some people who are always going to be opposed to these services. And that’s just a feature of them — allowing a minority of people to determine the availability of a service for a group of people that are very poorly served otherwise seems ill-advised.”

But in Barrie, those who don’t think an SCS will be helpful are not the minority. A community survey performed by the Simcoe Muskoka District Health Unit in 2019, found that 43.7 per cent of respondents didn’t think a supervised-consumption site would be helpful in Barrie.

In response to the council vote over the summer, the site applicants — the Simcoe Muskoka Health District Unit and the Canadian Mental Health Association — formed a selection-advisory committee to explore alternative locations in the downtown area. The committee is made up of representatives from different community organizations, including Safe Barrie.

While Ramey agrees with the premise of the advisory committee, he wants to make sure that residents who want a site but still have questions continue to be heard. “We’re gonna get one shot to do it right,” he says. “And we need to make sure that we do it, not only because it will save lives, but because it will save the greatest number of lives. There are always going to be the never-evers, and there are always going to be the always-always guys. It’s those middle-ground people that I think have not been properly educated or heard.”

In November, Barrie’s Business Improvement Association, which openly shared reservations about a consumption site in the downtown area, joined the advisory committee to offer its input. While the advisory committee is currently considering two sites, Brown says, a third could be added depending on feedback.

Nayler says that she’s hopeful a location will be approved soon, but she has her doubts. “I'm a hopeful person, so I want to believe in the goodness of people,” she says. “But I say that there’s still a 50 per cent chance of it passing.”

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