Northwestern Health Unit report recommends safe consumption services in 4 Ontario communities

A study commissioned by the Northwestern Health Unit (NWHU) suggests more safe consumption services are needed in the Ontario region amid rising drug overdose rates,but questions remain about how to get the broader public on board.

At a safe consumption site, also called a supervised consumption/injection site, people can bringdrugs and use them in the presence of health-care providers. They have access to new needles, drug supplies and naloxone kits that can reverse the effects of an opioid overdose.

There are currently 24 safe consumption sites in Ontario and 38 across Canada. The only one in northwestern Ontario isin Thunder Bay.

The NWHU, with LBCG Consulting for Impact Inc., launched thefeasibility study last spring. The results were released Thursday morning after several months of delays.

The safe consumption study examined the potential forservices in Dryden, Fort Frances, Kenora and Sioux Lookout.

More than 1,850 stakeholders were consulted forthe study, including people who use drugs, health-care professionals, service providers, Indigenous partners, businesses, municipal representatives and the general public.

In short, "there is a strong consensus amongst all consulted that there is a need for more supports for [people who use drugs] across the NWHU region," says the report.

Addiction and substance use disorders are complex conditions, but providing harm reduction services before people access treatment is essential to save lives,Dr. Kit Young Hoon, the health unit's medical officer of health, saidin a media briefing Thursday morning.

"Research has shown that the sites can have benefits including reducing overdose deaths, decreasing the spread of infectious diseases, reducing discarded drug equipment near the site, and increasing the use of health-care services, including treatment services."

The assessment was prompted by the alarming rates of opioid-related deaths and hospitalizations across the region: Between 2019 and 2021, emergency department visits increased by 158 per cent, opioid-related hospitalizations rose by 111 per centand opioid-related deaths increased by 243 per cent all higher than the provincial rates during this time.

There are also ongoing concerns about the spread of infectious diseases, namelyan HIV outbreak that began at the end of last year.The health unit has confirmed seven new HIV cases in its catchment area so far in 2023, five of which are in Kenora. Ten caseswere reported last year, with nine of themin Kenora.

Public opinions divided

Across the four communities, 271 people who used drugs were involved in the study. There was an overall consensus "the target population are willing and interested in using supervised consumption services and that they see benefit from it," said Young Hoon.

However, people who use drugs also said the stigma they face is one of the biggest barriers to implementing these services successfully.

The report foundthe general public "varied substantially" on whether safe consumption services may benefit or harm their communities. While some people see these sites as essential in preventingoverdose deaths, others expressedconcerns about whether these sites would increase crime and result in other public safety issues, such as loitering and discarded drug supplies.

"The general research at this point indicates that for supervised consumption services, there is no impact on criminal activity near the site," said Young Hoon. "There are even some research reports that outline that criminal activity actually decreases once the site has been implemented."

Young Hoon said the health unit will continue to play a key role in educating the public about what harm reduction strategies, includingsafe consumption services, entail.

Who would operate these sites?

The NWHUitself would not necessarily operate safe consumption sites in the region. Rather, it plans to support appropriate agencies within each community in implementing such services, explained Young Hoon.

Several factors must be keptin mind when determining who would best operate a site, she said.

"This is a service that needs to have evening hours. It's a client-based service. It is preferable if the service is co-located or easy to refer to other services such as treatment services, social services and other health-care services. There are also some agencies that have that connection with the target population already."

Health Canada approves applications for safe consumption sites across the country. An agency looking to operate such asite must apply for a federal exemption for medical purposes under Section 56.1 of the Controlled Drugs and Substances Act. It may also apply for provincial funding.

Applications must include information on the intended health benefits of the site, including:

• The impact of the site on crime rates.
• The local conditions indicating a need for the site.
• The administrative structure in place to support the site.
• The resources available to support the maintenance of the site.
• Expressions of community support or opposition.

The NWHU's next steps are to bring the study's results to the appropriate stakeholders within each of the four communities to determine how to move forward with the recommendations, and who the best lead agency or agencies might be, said Young Hoon.

"Northwestern Health Unit plans to support the process as much as we can within our capacity,so, support the discussion and of course, participate in operations if it's felt to be appropriate," she said.

Before applying to Health Canada, a thorough plan must be in place for each site,which involves identifyinglocations, funding, staffing, policies and procedures, and what additional resources may be offered there.

Roadmap of recommendations

While the NWHU's report provides regional and community-specific findings, stakeholders must consider six overarching recommendations:

1. There is a need for more harm reduction and treatment services in all four communities. Safe consumption services are recommended to reduce the risk of harm, overdose and overdose deaths among people who use drugs.
2. Safe consumption services should be led by health, social and mental health, and Indigenous service providers.
3. Implementation plans require the involvement of key stakeholders, including municipal governments, emergency services, Indigenous partners and the broader community.
4. Safe consumption services should be part of the larger community-level approach to mental health and addiction services.
5. Education and awareness for stakeholders and the broader public is key.
6. Evaluation plans must be in place for any safe consumption services implemented.

People with lived experience must lead the way, say advocates

Doctor Jonny Grek of the Sunset Country Family Health Team in Kenora has been advocating for safe consumption services in the city for years. He provides street medicine to vulnerable members of the population wherever they are comfortable accessing treatment.

Though not surprised by results of the study nor the public's perceptions of safe consumption services, Grek said he is optimistic about the outcomes of the report, particularly with its emphasis on Indigenous leadership.

Of the 271 people who use drugs who were involved in the study, 77.2 per cent of respondents identified as First Nations and/or Mtis (6.3 per cent).

"Given that the majority of respondents are Indigenous, services must be geared towards supporting these populations. Hiring staff, including management, who are Indigenous will be important to ensure an understanding of the needs of the clients accessing services," states the report.

Grek said he wholeheartedly agrees with that analysis, and stressed the importance of people with lived experience being at the forefront of the design and operations of a safe consumption site.

"[It is] predominantly Indigenous people who are being affected by these tragedies of overdose deaths and blood borne infections and therefore stand the most to potentially gain from a site like this," said Grek. "So that is clear to me: must be Indigenous-led."

Marlene Elder is a leading member of the community coalition Kenora Moving Forward, which oversees warming and cooling spaces and provides food to members of the street community.

She said the results of the study helped validate what she and her peers see and hear from people who use drugs daily. A safe consumption site has been at the top of their wish list for ages, she said, and she hopes Kenora Moving Forward can be part of the process of bringing one to the city.

"For us at Kenora Moving Forward, it's making sure that the people, that the users, are involved inwhat's going to work for them or it's not going to work," Elder said.