By Neil Armstrong
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| Shannon Ryan, executive director of the Black Coalition for AIDS Prevention (Black CAP) and Michael Nurse, a harm reduction worker. |
Black people in Canada’s largest city are dying as a result
of the opioid crisis gripping Toronto but no one seems to know how many because
that kind of data isn’t kept.
Shaun Hopkins, manager of the Needle Exchange Program at
Toronto Public Health (TPH), says the city is not collecting that type of
information in any coordinated way at the recently opened safe-injection site
in the Dundas Street East and Victoria Street area downtown.
“Because the site that we’ve opened is a temporary site we
don’t have our data collection instruments set up to kind of track ethnicity
and background right now. In the future we will have that information but right
now we don’t,” she said, noting that they’ve only been operating since August
21.
She said the temporary site was set up to respond to
increasing concerns about the opioid crisis in Toronto and some things are not
being collected in this context because it was set up in a hurry.
Nick Boyce, director for the Ontario HIV and Substance Use
Training Program and a member of the Toronto Overdose Prevention Society (TOPS)
says the authorities
don’t do a good job of collecting data in Canada so any
analysis would be more anecdotal.
Boyce said they don’t collect ethnicity type data of people
accessing those services.
“We don’t even have a good estimate on the number of people
who use drugs in the province or the city. We just don’t have good
epidemiological data and the thing would be so anecdotal at this point as far
as I’m aware,” he said.
"The opioid crisis in Ontario is a growing and evolving problem, and one we are continuing to work diligently to combat.”
They said gathering accurate data on the impact of opioids is a key part of the Strategy to Prevent Opioid Addiction and Overdose.
“As part of our commitment to openness and transparency, Ontario is now launching the Interactive Opioid Tracker, which is a web-based tool that makes available a wide range of data on opioid-related morbidity and mortality. As the data shows, the opioid problem is affecting people of all ages, right across Ontario,” they said.
Data from the interactive tool suggests there has been a steady increase in opioid-related harms in Ontario for more than a decade. Since 2003, the number of deaths has increased 136 per cent; more than 850 Ontarians died from opioid-related causes in 2016.
Boyce thinks Ontario is on track to lose more, maybe one thousand people this year, not all opioid related.
But Michael Nurse, a harm reduction worker at the Black
Coalition for AIDS Prevention (Black CAP) who is on the frontlines of the
opioid crisis and is from the Caribbean, says he is becoming more aware of the
amount of people of African descent that are using needles.
He says there are no real statistics on how many people in
the African community die from drug overdose.
Nurse knows of three who overdosed and died but the reason
he knew in one case was because the family knew that he was also a person who
use drugs and confided in him.
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| Michael Nurse |
On August
12, TOPS and Toronto Harm Reduction Alliance (THRA) opened an unsanctioned
overdose prevention site in Moss Park as a crisis response
to growing numbers of overdoses and overdose deaths in Toronto, an increasingly
toxic drug supply, and a lack of coordinated government response to this public
health emergency.
Data
collected during the site’s first 12 weeks, until October 29, show the
following: 1,976 injections witnessed, 85 overdoses stopped or reversed, approximately
3,064 visits to the inhalation tent, 1246 naloxone kits distributed, and 130
volunteers, plus 48 medical volunteers. They raised over $30,000 entirely
through voluntary donations from
concerned individuals and organizations.
“If we
were not there to provide these interventions, at least 85 people would be in
emergency departments, costing the system thousands of dollars, or they would
be dead. Not one person has died of an overdose at the Moss Park site – or in
any safer injection site or overdose prevention site, in numerous cities around
the world. Regrettably, people have died from overdoses in Moss Park during
hours we were not open,” said Boyce.
The
overdose prevention site at Moss Park is opened daily from 4:00-10:00 p.m. and staffed
by people who use drugs, injection drug experts, frontline harm reduction
workers, nurses, nurse practitioners, physicians, and other concerned community
members. All of its funding is raised through crowdfunding and donations.
Opioid
drug poisonings and overdoses result in people not being able to breathe, which
can result in brain damage, other health issues and death.
These
overdoses can be stopped or reversed with close monitoring, stimulation,
provision of oxygen and, when necessary, administration of naloxone, a drug that
temporarily reverses opioid overdose.
As someone who does outreach, Nurse says the key thing is to
develop trust with people and in that relationship they will “begin to reveal who
they are and where they’re at.”
He cited the example of a Somali man who approached him
recently to ask for some kits for himself and others in the Gerrard Street and
Sherbourne Street area. He said the man’s friends had not disclosed their
issues so wouldn’t ask him.
Nurse said governments can fund certain programs but do not
really respond to the exact needs that people using drugs have.
In order to stop people from falling through the cracks, he
said the outreach and service agencies are able to bridge that gap.
Nurse said African, Caribbean and Black (ACB) people using
drugs hide that fact because of the stigma applied to the use and the shame
that they live with.
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| Shaun Hopkins, manager of the Needle Exchange Program at Toronto Public Health. Photo contributed |
Hopkins says there is so much stigma and discrimination
associated with injection drug use that people sometimes don’t want their
family members to know, or their friends to know so that can be a barrier.
She says if their friends and family members do know that
they use opiates then TPH would be willing to train a family member or a friend
to have them come in and get a naloxone kit so that they can intervene if
someone is overdosing.
Hopkins said it is a serious situation affecting a number of
different people, and people are dying and it’s a public health emergency.
“One of the barriers, I think, is that stigma and
discrimination about drug use, and so some people don’t let the people that can
help them know that they’re using. And that’s an important step because those
could be the people who are intervening if they do overdose.”
She noted that there are concerns about some of these
programs, like the supervised injection service, that it’s going to bring
people who use drugs into the neighbourhoods where these services exist.
Hopkins said TPH has tried to create three fairly small,
supervised injection services for the people who are currently using its
services. They are at The Works, at Parkdale Queen West Community Centre, and
at South Riverdale Community Health Centre.
“They all have existing harm reduction programs so what
we’re doing is putting injection booths and making injection services available
to those people who are already using that service. These are life-saving
services -- harm reduction – they’re proven to work and not to increase the
likelihood that people are going to use drugs. And just makes it safer for them,
and so being more accepting we know here that people are going to continue to
use drugs despite our best prevention efforts at public health and other
organizations throughout the city and the country.”
Hopkins said people use drugs for a variety of reasons: to
cope with trauma, mental health issues, or perhaps it was an injury that they
sustained and they were prescribed pain medication and that got out of control
a little bit for them.
She said these are people who TPH is trying to do everything
it can to ensure that they receive dignified services, that they have a place
that’s clean and sterile for them to inject the drugs that up until now they’ve
been forced to inject, sometimes, in an alleyway, in a bathroom.
“It’s not very hygienic, they’re rushing, they could
overdose and no one would know that they’re there.
“There are a number of initiatives we know that they work
and they will have an impact in preventing opiate overdose so we need to
implement those programs now and do everything we can to make those programs as
accessible to people as possible.”
Regarding the media attention the opioid crisis is receiving
now, Hopkins said it seems to be a new phenomenon but The Works has been in
existence for over 25 years and over that time TPH has been delivering harm
reduction services, including distribution of injection supplies, supplies for
safer crack-smoking, and overdose prevention.
They have also trained, in the past, a number of their clients
on CPR so if they or someone that they’re using with is experiencing an
overdose they’ll know how to intervene.
She said TPH started its naloxone distribution in 2011
because they did not want to wait until there were a number of deaths, but
instead wanted to prevent every death that they could.
“The one very concrete thing that we can offer people at
that time was naloxone. Supervised injection services had just been made easier
to apply for – there’s funding now, its becoming part of the array of harm
reduction services across Canada. Harm reduction programs have been operating
for a number of years to prevent overdose deaths,” she said.
Hopkins thinks TPH has done a good job, however, the
difference now is that there are more dangerous drugs on the street.
“There is more fentanyl available, it’s higher potency, people
who inject that run a high risk of overdosing. And there’s also fentanyl in
some of the other drugs, like heroin, we’re finding here and so the numbers of
overdose are going up.”
She said there has been media recognition of the problem and
that it is a North American issue, certainly Canada-wide.
“I think there’s more attention because there are higher
numbers but we’ve always lost people, unfortunately, and every life that we’ve
lost is preventable so we need to put these things in place to prevent further
unnecessary deaths.”
Hopkins said the more programs that they can get up and
running, more supervised injection services, maybe mobile services to get to
more hidden populations – all of these will help.
There are a lot of places in the City of Toronto that are
far from the three federally-approved supervised injection services that are
going to be fully opened this fall and winter and so they need to do some
development, she said.
“I know in DC they have a program, a supervised injection
service specifically for women. Now, maybe we need to get to that level of kind
of specialization for different groups that don’t feel comfortable coming in to
the existing program. So, I think we need to work hard at making these services
as accessible as possible.”
Going forward, Hopkins said they would be implementing drug
testing, just specifically for fentanyl, using test strips that will detect
fentanyl in the drugs that people are bringing in.
“Some people actively want to buy fentanyl on the street and
so that’s what they’re looking for and hopefully getting it if that’s what
they’re paying for. And then other people will be purchasing heroin and not
looking to get fentanyl. And so these test strips will be able to detect if there’s
fentanyl in the drug but it doesn’t detect potency so there’s a need for
something. We’re applying for some money to be able to do more specific
testing, in terms of potency, so that people can make a more informed decision
about their drug taking limit here,” she said.
Nurse said many people who attended the funeral of one of
the overdosed persons he knew only understood that the person had a sudden
death.
“I heard from that family a lot of shame that the person was
actually an intravenous drug user or drug user, period, and a lot of shame that
they weren’t able to intervene and save them. A lot of guilt and a lot of shame
and families, I find, in our communities don’t really disclose that.”
He said a lot of that also has to do with how the ACB communities
approach drug use as “a moral defect, a defect in character, and in so doing we
don’t build supports and agencies that allow people to come in and feel
welcomed.”
Nurse said whenever he gets the biggest reprimand for doing
harm reduction outreach it is usually from people within the African community.
There is one man who persistently reminds him that he’s
doing the devil’s work.
Nurse says he is willing to listen to people’s points of
view but will continue to do his work with the hope that over time they will
change their views.
“But my question is usually, in my mind, so this is what I’m
doing, what are you doing? Because it’s easy to sit on the sidelines and judge,
but that is what we do. I find in a way that it allows us to not have to feel
any responsibility. Sometimes, it is a weight to look around you and see
brothers and sisters suffering and feel powerless to do anything about it. And
if you could get that mindset that, hey man, they’re doing their stuff, I’m
doing mine, it allows you to take your hands off and walk away with a certain
comfort, but our drug use is hidden, there’s a lot of stigma.”
Nurse also knows of another family in which a cousin was
struggling but other people in the community didn’t know.
When she was away they thought she “just run away with her worthless
ways” but she was a drug user and she was struggling with it. So when she died
the family didn’t say she died of a drug overdose. A member of the family
shared the information with him.
The person knew that he did harm reduction work and would
ask him from time to time about various things.
He said at present there is a woman in Brampton who is
suffering from the results of a drug overdose and the only reason that is known
is because the story made the news. There is a battle between the family who
wants to keep her on life support and the hospital that wants to take her off.
“Buried inside there is the mention that it resulted from a
drug overdose. If it wasn’t that big story that she was in that situation due
to a drug overdose it probably would not have come out,” he said.
The harm reduction worker said if one were to visit South
Riverdale or Moss Park there are usually memorials to people who died as a
result of their drug use.
“You probably wouldn’t find any names from the African
community on any of those memorials because for one, most of the African people
would not really want to associate in that community to say, hey, I am an
intravenous drug user. And we have no contact with people who feel safe enough
or supported enough to come and say ‘I’m going to let you know that I’m a drug
user. I’m going to come in here regularly and get your support. I make my
statement. I disclose myself and I will live as I am,’ so we don’t have that
kind of connection in the African community. Most of the services for drug
users in the African community are supported by churches and churches are very
judgmental, in terms of drug use,” he said.
He said the Taibu Community Health Centre in Scarborough is
guided by a harm reduction philosophy and is the only African-based service
organization he knows of in the city.
In terms of areas in Toronto, like Jane and Finch, Woolner
Avenue, Falstaff Avenue, down Vaughan Road, Ossington Avenue, Nurse said apart
from the outreach of Black CAP he knows of no organization that focuses on this
community.
Nurse said one of the challenges and one of the setbacks from
that is that people do not come out for the supports where they are.
The harm reduction worker said he was using crack cocaine
for probably about 15 years before he found out where to get a clean crack
pipe.
“I used to see people with them now and then. I didn’t even
know where they existed and that was before I became homeless -- because once I
became homeless then I had to come into shelters and stuff and I got exposed to
the broader services that were there.”
Nurse said he hid the fact that he was homeless and would
hide and sneak into buildings within his community and would sleep on the top
of the stairs, and hide underneath after they were closed.
“I didn’t even know that there were shelters available that
I could come and walk into and sleep because I didn’t want anyone to know that
I was homeless,” he said.
Nurse said there was a time when people didn’t want anyone
to know that they smoke crack but then crack use is a thing that will reveal
itself.
He said needle use can be hidden and it is hidden. “It is
hidden from the stigma, from the judgment and from the shame that exist in our
communities. And they’re people dying from it. You see the one thing about
African people who use intravenous drugs and living in that community -- that
sort of transient homeless community -- is that people disappear. You just lose sight of people, you
don’t know, and this is all people – white, black, Chinese.”
Nurse, 66, has not used any drugs in five years. He
remembered just before he stopped using in October 2015 that in July of that
year he had an overdose.
“I had stopped using and then I started to use some
marijuana and the reaction was kind of sudden. And my heart muscles went and I
collapsed at South Riverdale. I went there for coffee and I collapsed there,
and they called an ambulance and I was taken to hospital and I was told that I
had a muscle spasm of the heart.”
He remembered that while in hospital they were doing some
tests and assessments. He was there for three days and one morning while
walking towards the nurses’ station he overheard a conversation about the
demand for beds and how they could meet it.
Nurse heard the head nurse say, “What about that guy there
in bed three, we might as well kick him out because all he’s going to do is go
back out and get high again so why are we wasting the bed on him?”
It took a while for him to realize that they were talking
about him.
“That is the way that the authorities treat people, particularly
if you’re a black man dying from drugs, they’re like why are we going to bother
anyway.”
He said this is the tragedy of drug use in general,
intravenous drug use in particular, and this overdose crisis is that it is
hidden.
“Until we decide to
embrace human beings as human beings, it is going to remain hidden and we will
continue to feel the tragedy because the impact of it hits because we’ve got
children who don’t have parents.”
He said there are families who lose productive members and
they don’t get support from the community.
“It’s not just that one person dies when using drugs. It
affects generations and we turn our heads from it and pretend that it isn’t
happening and we judge the people that it’s happening to. But, if we look, harm reduction didn’t start
in the black community; it started in the white community. It’s because people
started to care about each other and figured these lives are important, these
lives have value just like ours, and they opened up to it and they made a
stand,” he said.
Nurse said the pop-up overdose prevention site in Moss Park
is another example of the government not responding to the need.
He said for years there was a long discussion about pop-up
sites and the need to change the law so that people wouldn’t get arrested. Then
they had to do renovations to the buildings, he said, in order to accommodate
and all the while people were dying.
“It took a group of volunteers – harm reduction workers –
just like it started with handing out crack kits, who decided we’re going to
organize this thing, we’re going to get nurses, and boom, one day they set it
up in the park. Cut through the red tape, cut through the government stalling
and the harm reduction pop-up site was in the park happening.”
The harm reduction worker said this has transformed city
hall and that he has never seen such political currency, in terms of changing
people’s attitudes and people’s positions.
“All of a sudden, The Works, which is a Toronto Public
Health operation, all of a sudden they were going to do a quick emergency site.
None of it happened until the people on the ground – the harm reduction workers
– figured, ‘Look, we dealing with this every day. The people are dying, we know
we need this site, let’s just do it.’ Because then the commonsense of it, the
practicality of it is right there and nobody can say, hey don’t do it. Even the
police in this division decided you know what you guys have organized this so
well, we just going to not bother you, we’re not going to arrest anybody,” he
said
In his analysis, Nurse said if one looks at the current
change in laws around marijuana use where there is an effort to legalize
recreational use of marijuana it is happening mainly within communities of
people outside the African community.
“If you look at the discussions around setting up dispensaries
it is outside of our community, yet all of this marketing and all of this is
happening on the backs of the efforts that were made within the Black and
Caribbean community. People have gone to jail to establish this market. I
looked at the price that they said that they were going to charge - $10 –
that’s the price that was developed within the African Caribbean community.”
He said there are black people who got criminal records from
within that marijuana industry and that hasn’t been addressed.
“We’re going to have a community that is going to lose
substantially the money that has been generated from the sale of marijuana. But
yet, we as a community, continue to maintain the stigmatization and the shaming
of people who operate in the drug industry rather than advocate for changes in
laws and changes in practices so that people can develop and join into this
market in a respectable and meaningful way.”
The harm reduction worker said there are people in jail who
are from the community and when they come out they will come back into the
community and there is no mechanism for welcoming them back – in terms of skills
development or making them feel that they can live.
“This is an opportunity to raise awareness. It is an
opportunity to say, hey, what about this, what about that, because we don’t
talk about it. We don’t talk about it and it hurts,” said Nurse emotively.
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| Shannon Ryan |
Shannon Ryan, executive director of Black CAP, says staff
has participated in a range of training, including naloxone and fentanyl.
“I think as an organization we really recognize that harm
reduction and drug use is not just siloed in the harm reduction program. Drug
use really affects all of the populations that Black CAP works with – people
living with HIV, queer communities, homeless communities, under-housed
communities, people on the street – and as a team we need to build our capacity
to be able to work with those communities and to understand the context of
risks and how to respond to some of those risks, should an overdose present
itself in our reception area. I think there’s a real good chance that could
happen. I think we want to make sure we’re an open space for all folks that
Black CAP works with and as a result we need to be prepared to create as safe a
space as possible.”
Ryan said they will be doing additional training in this
area as well because although they are better prepared to respond to this issue
they’ve got a lot more work to do.
Nurse noted that community health centres are accessible and
they are welcoming.
However, he said a lot of agencies, even ones that say
they’re following a harm reduction philosophy, are not welcoming and they
discriminate.
“Even when we as a people work within agencies that follow a
particular philosophy or set of policies, we still bring about that judgment
and shaming on people even by the way we look at them, the way we talk, the way
we answer questions. But community health centres have developed and are
developing a lot of good programs that are welcoming to everybody. And I find
that is our best access really to awareness, to education that builds
awareness, and also to resources that help us develop skills and to deal with
challenges.”
Nurse said the challenge is that within areas where there
are high populations of African people there are no services available and he
describes this as a tragedy.
“It’s like saying we don’t deserve this service. We don’t
deserve this care.”
Ryan said there is historical underinvestment from
government in relation to black-specific services doing this kind of work.
He said Black CAP and Taibu are the only two organizations
in the city of Toronto who are funded to do this type of work, specifically
with black people and substance use.
“This is for a population of more than a quarter million people
in a community where substance use as much as we want to deny it is incredibly
common whether it’s alcohol or marijuana or crack or what have you. We’re not
seeing as much investment as we need. We need the government of Ontario, we
need the City of Toronto to really double and triple and quadruple its
investment in these areas. There’s a gap in services but it also comes down to
governments recognizing they need to invest in services in this area,” he said.
In terms of how family and friends can help their loved ones,
Nurse said first there has to be a connection, somebody has to initiate that
connection.
“Even if it’s a family member saying, okay, let’s reach out
to support, like to grieve, to strengthen, to talk because that isn’t happening
and dialogue has to happen and if there’s no dialogue happening there’s nothing
happening.”
He wants to see the embracing of people in the ACB
communities who have made decisions “that have developed more challenges in
their lives than everybody else.”
“We need to recognize that people are hurting and that when
people are hurting within our communities our communities hurt,” he said.
Nurse thinks the biggest barrier is shame and self-esteem.
“I mean supports are necessary, but in terms of creating an
initiative, I don’t think people realize when you’re in that place where you
feel like you’ve exhausted everything and you feel worthless. It comes with
that sense of being powerless to change anything.
“At that place in time you’re really looking for an opening,
you’re looking for a reason to believe. That is where the community comes.
You’ve got to develop that sense that as a community we’ve got to be based
really on compassion and encouragement. We’ve got to be giving people hope. If
we’re not doing that then we’re not really functioning as a community. Those
are the things that I find that we need to build.”
The harm reduction worker said there is a movement within
government to recognize that funding is necessary to provide people with safe space
and there’s also a change in the mindset of police, “in particular, so that
what is happening here is that where there was a broad criminalization of drug
use, at least now there’s an opening of response as a health crisis rather than
as a wave of crime. That, in and of
itself, is a huge change.”
There is an after hours harm reduction drop-in held once a
month on Wednesdays at Black CAP.
“It’s a drop-in where we invite folks who are street
involved or under-housed, who typically live in downtown Toronto to come in and
participate in, I think, a couple of important things. One, is a safe space
where you’re not hopefully going to be judged for your history with substance
use. You’re just going to walk in and you’ll be hopefully among your peers and
not experience judgment, rejection. It’s also an opportunity for us to do harm
reduction education with folks to say this is emerging practice, do you know
what an overdose looks like, do you know what to do, do you know the risk
related to this drug or that drug so we can do some of that work. But also I
think more often than not, it’s just a space for black people who are using
substances to come together to have a conversation about the issues that are most
important to them that day,” said Ryan.
Nurse said trust and safety are missing on the street for
people who use drugs.
“To find a safe space, that is a gem, where you can open up
to people around you,” he said.
Meanwhile, Hopkins said at the TPH safe injection site
people are able to inject their drugs that they bring in and that there is a
bit of a misconception for some people that TPH is providing drugs for
injection but they are not.
“People bring their drugs into the site and they go through
a bit of an assessment. It’s a very brief assessment about the drugs that
they’re intending to use. Have they had any overdoses in the last little while?
Is there anything that might be affecting their tolerance and the likelihood
that they would overdose? Because that just helps us to be more ready, so if we
know that someone is bringing fentanyl in we’ll be a little bit more on guard
about watching them for signs of overdose. Or if they’ve been sick or in jail where
maybe they’ve had a break in their use, or their tolerance is down, then we can
watch them closer,” she said.
Hopkins said after the assessment they are placed in the
injection area where they sit at a table and inject their drugs, while staff
supervise from a respectful distance to make sure everything is okay.
“If the person needs help with what needle to use, what
injection supplies to use, not everybody is really good about knowing what all
the harm reduction supplies are and how to use them properly. So, we’ll help
with injection technique if people need help with that, if they’re having
problems finding a vein or they’ve had a lot of injection-related wounds
helping them to prevent that in the future choosing another site where they can
inject into maybe some vein that they hadn’t used before.”
She said they try to keep people for about fifteen minutes
after because if they’re going to overdose it will probably happen within that
time.
The manager said if someone overdoses they will intervene
with some oxygen or naloxone and call 911, if the person needs that level of
medical intervention.
While they are there, TPH also provides counseling and
support so if they want to talk to a staff member they can, or if they prefer a
peer with lived experience that they are more comfortable with talking about
what they’re experiencing they can do that too.
Toronto Public Health also gives take-home naloxone so if
somebody is an opioid user or uses with other people who are at risk of opioid
overdose then TPH will provide them with a naloxone kit and make sure that they
know how to use it.
If the substance user comes in with someone else then they
also make sure that the person knows how to use the naloxone kit.
The public health department has also provided referrals,
counseling and support to a number of the people that have come in to use the
site.
Hopkins says what TPH recommends to people is that they have
family members or friends get trained on how to use naloxone, how to recognize
overdose and then how to intervene even if it’s just calling 911 and staying
with the person if they don’t feel comfortable administering naloxone.
“But we’re distributing right now the intranasal. I’m sure
it’s daunting for someone because you don’t have to use needles and people are
concerned about that. It’s a lot easier to administer the intranasal,” she
said.
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| “This is an opportunity to raise awareness. It is an opportunity to say, hey, what about this, what about that, because we don’t talk about it. We don’t talk about it and it hurts,” says Nurse. |
“We’ve been sitting in that park since August 12 doing this
and we were there in the first place because of the slowness of the response so
the opioid deaths have been something we’ve known. This has been happening for
over a decade now in Ontario just ever escalating so from a harm reduction
perspective we’ve been warning about this, talking about it for a long time,”
he said.
He said the opioid epidemic is now starting to get attention
because it is the middle class white people who are now being affected and
dying.
“When you get pictures in the paper of young white girls
that suddenly gets a lot more attention than it used to. That’s a sad reality
of the world.”
Boyce referenced a January 2016 article on the Vox website entitled: “Why are black
Americans less affected by the opioid epidemic? Racism, probably.”
The writer, German Lopez, alludes to a story in the New York
Times that doctors were more reluctant to prescribe painkillers to minority
patients, worrying that they might sell them or become addicted.
“The disproportionate impact of the
current epidemic on white communities, however, may be one reason the response
to the crisis has been fairly different from the response to previous drug
epidemics. While the crack cocaine epidemic, for instance, produced a response mostly
through the criminal justice system, the opioid epidemic has led mostly to a
public health response. Race offers one explanation for that historical
discrepancy,” Lopez writes.
Boyce said the Ontario government’s attention to the issue
and publicly stating this and putting resources publicly into it recently is a
recognition that these kinds of approaches – the harm reduction approaches –
are effective.
“And the larger implication around that is really to start
talk about this idea of decriminalization. What we’ve done in Moss Park is
really create a space where drug use has become decriminalized so the police do
not come on site, they don’t harass people on site, they don’t arrest people on
site. That has huge implications, in terms of people’s safety and overall
health,” he said.
Boyce said the research for the three permanent supervised
injection sites – ones involving the formal process of applying for an
exemption to Health Canada – was done over five years ago. At the time the
suggestion was to have five sites across the city.
In order to operate a permanent site, the city or province
needs an exemption from Health Canada so that staff or people coming on site to
use do not get charged with drug possession.
Boyce said the three permanent sites are still not actually
open but should be within the next month or two.
He said TPH recently had a soft launch at the site at Dundas
Street East and Victoria Street. They’re just waiting for some final equipment
to be brought in so that permanent site within the next one to two weeks will
be up and running.
Boyce said over the five years it took to make a decision
about the three sanctioned sites, the numbers have continued to escalate, more
people are dying and the drug supply has become more and more toxic.
“So there’s a reason we’re in Moss Park because there’s a
lot of overdoses and deaths happening in that neighbourhood and none of the
three permanent sites service Moss Park.”
He said some people thought that once the site near Dundas
Square opens people who use drugs from Moss Park can head over there, but that
won’t necessarily be the case.
“Well, that might be true if you have legs you can walk on
and bus tokens, and don’t mind dealing with tourists. But we know talking to
folks in Moss Park these are very marginalized people, highly stigmatized. They’ve
had trouble with the law; they’re not going to leave their comfort zone or
their immediate neighbourhood. Or if you’re in really bad physical withdrawal
from drugs and you’ve just got some new drugs to take to stop feeling sick
you’re not going to wait to go somewhere, you need to have services easily
accessible. We talk about low threshold services so for sure there’s a whole
bunch of people in Moss Park that are never going to leave it. But it also
means there are other pockets in the city where people are not going to leave
their immediate neighbourhood. So we need to make things easy and accessible
for people and that means opening sites elsewhere across the city.”
Boyce said TOPS does not have the resources to keep doing
that because it is entirely volunteer-driven.
“It’s going to require some sort of government support to
start opening more sites. It doesn’t all have to be these big fancy facilities.
Sometimes, it’s literally a room and a table and a couple of chairs and someone
just to look after you. I’m not sure what’s going to happen moving forward but
the fact that the provincial government is now sort of dedicating resources to
Moss Park is an indication, I think, that they recognize the value of that kind
of service.”
On
November 1, TOPS and the THRA held a press conference at Moss Park calling for
government help as the winter approaches and they continue to provide
life-saving health services outdoors in makeshift conditions.
Since
early September, both groups have been engaged in discussions with municipal
city councillors, representatives from the Toronto Central Local Health
Integration Network (LHIN), Toronto Public Health, and Fred Victor Centre, on a
plan to sustain the essential lifesaving services and move the operation
indoors for the winter, notes a press release.
Given the
significant number of people accessing services at the Moss Park site, the
ongoing number of overdoses in the area, and that none of the three
federally-approved permanent supervised injection sites will service people in
the neighbourhood, there was recognition of the need for a permanent site in
the immediate area.
A local
agency, Fred Victor Centre, expressed interest in applying to Health Canada for
a federal exemption to open such a service, which would mean neither clients
nor staff would be at risk of criminal prosecution for drug possession while
receiving or providing this health service.
However,
this is a lengthy process that would take many months; therefore, in the
meantime, TOPS believed there was an understanding with the City and Fred
Victor to allow the existing Moss Park OPS [Overdose Prevention Site] to move
into the basement of Fred Victor Centre, located nearby the current site, and
to continue to operate without a federal exemption, until a sanctioned site was
ready. The province, through the Toronto Central LHIN, supported the idea and
made money available to help operate it, the release said.
“Unfortunately,
the City of Toronto and Fred Victor Centre have now backed out of this
arrangement; the deal we had been working on since early September has fallen
victim to the same forces of bureaucracy and official indifference that have already
contributed to so many preventable deaths,” said Zoë Dodd of TOPS. “As yet, the
City has failed to collaborate with us to find any alternate interim solution.”
They
demanded that the city and province take immediate action to support the
sustainability of the Moss Park overdose prevention site.
“The city
must work with us to procure a nearby indoor space with electricity, running
water, a bathroom, and heat as soon as possible. Until then, the City should
assist us in procuring a temporary construction trailer and a place to put it
in the immediate vicinity.”
They also
asked again that the province publicly declare its support for the vital work
of overdose prevention sites in Ontario in responding to this crisis, and to
provide the immediate, concrete support these services need to operate and
expand.
“The
provincial government and provincial public health authorities have the power
to take such steps. We also call on the federal government to relax the rules
and process for opening sanctioned sites; unnecessarily bureaucratic processes
continue to contribute to hundreds of needless deaths,” they said.
One day
after the press conference, Dr. Hoskins announced that the province’s Emergency
Medical Assistance Team (EMAT) would be dispatched to set up an insulated and
heated tent at Moss Park.
Since its
installation, harm reduction workers have complained that the province told
them that open flames used to heat drugs inside the tent would be a fire hazard
because of the presence of oxygen tanks in the tent for overdose monitoring and
resuscitation procedures.
As a
result, the workers are back to using their unheated tent where people using
drugs can use their lighter to heat their drugs.
In the
meantime, the province is exploring alternatives heating methods to find a
solution to the matter.
In a memo to the chair and members of
the Board of Health in September this year, Joe Cressy, chair of the Toronto
Drug Strategy Implementation Panel, focusing on urgent additional measures to
address the overdose crisis in Toronto notes that: “While we do not have
“real-time” information about overdoses, we know from community service
providers, including people who use drugs, that many more overdoses are
happening and too many people are dying as a result.”
It notes that the Board of Health (BOH)
approved, Toronto Overdose Action Plan,
contains many measures that will help
address the overdose crisis but they are not being implemented fast enough to
address the current situation.
“We need action now to save lives,” it
says.
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