CCBI News: Safe Consumption Sites

December 2, 2024

Dear Friends of CCBI,

Safe Consumption Sites: Good or Evil?

While the debate about ‘safe sites’ continues, the Ontario government announced plans to close many of them, replacing several with a single facility but with greater capacity. At roughly the same time, Unity Health in Toronto announced that it is facing the problem of accommodation for homeless patients who suffer from addictions by opening a 36-bed detox space in downtown Toronto for homeless patients, although it will be open to others. The space offers group and individual therapy, with addictions counsellors and nurses available 24/7. It is free and funded by the Ministry of Health, as one of four residential detox facilities in Toronto that aims to help those with addictions. Different approaches, raising questions about closings and openings. There are ethical questions!

Illicit fentanyl emerged in Ontario ten or eleven years ago, part of the opioid crisis that has overtaken many Canadians, with overdose deaths rising in most provinces. Last year, nearly 2,600 Ontarians died, from fentanyl overdose, sometimes used with drugs such as benzodiazepine. Statistics show that number is 50% higher than in 2019, which calls for a stronger, more focused response. Instead, a Globe article relates that half of Toronto’s clients will lose access to supervision

The research was conducted at St. Michael’s Hospital’s MAP Centre for Urban Health Solutions. The issue has become increasingly political since most public health experts advocate for the sites to continue, since they are staffed with trained personnel who know how to respond to respond if there is an overdose.

The government’s closings are part of a ban of supervised consumption sites located in proximity to schools and child-care centres, which sounds more than reasonable. Why situate them there? That seems like the real problem, not the sites themselves. The move sounds as if the government approves a shift in addictions policy that focuses on treatment and recovery and away from harm reduction measures. That sounds like a reasonable plan, except when we learn that harm reduction experts point to statistics saying safe sites work: they save lives.

Opposing Views

Two letters in The Globe and Mail, (December 2, 2024), illustrate opposing views. One is from an addictions medical professional who points to the success of opioid agonist therapy which reduces cravings and “… creates a protective effect at the opioid receptors in the brain,” reducing the risk of overdose fatalities. He is against ‘enabling drug use’ through safe sites and calls for expanding primary mental health services. This combination would be helpful if both parts were covered more fully by health care budget allocation and is a reasonable proposal, while rejecting safe sites. The other letter writer tells us that, “…from 2020-2024 there have been 43, 566 overdoses at safe consumption sites with ZERO fatalities.” That is an impressive number of lives saved! The question needing to be asked is: which path is more ethically sound?

Recognizing the ongoing question of costs as applying to both modes of proceeding, must one path rule out the other? One is shown to be curative now, while the other aims to keep people alive in the here and now in order to benefit from treatment in the future. Keeping people alive—this is surely good in itself in these situations? Most of us react to the number of overdose deaths with alarm: something should be done to prevent as many deaths as possible! At this time of crisis, differing views can be assessed perhaps only in relation to deciding which is the lesser evil: cutting off access to safe sites or allowing people to use their own drugs at supervised sites to prevent potentially fatal overdoses, keeping them alive for their own sake and in the hope that they might benefit from medical treatment in the long term. I opt for the latter, but it would be interesting to learn more about the factors that are influencing government decisions.

A Multi-Pronged Approach

This is a highly charged issue and the ethics around it are debatable. All involved, medical professionals, politicians, ethicists, parents and family of users, etc., must remain open to learning from statistical evidence on which to base and evaluate policies. Cutting off access to safe sites which, while affecting social environments because of thoughtlessly being placed near schools or housing, at the same time are saving lives, represents a failure to do all that is possible to help those severely addicted. Move the sites if they are causing harm—do not close them, unless statistics show they are ineffective! AND at the same time provide better mental health and addiction services. It is clear that a multi-pronged approach is needed to prevent more deaths while the opioid crisis persists.

Sources

Ontario’s closing of supervised consumption sites will cause half of Toronto clients to lose access: study – The Globe and Mail
Editorials, The Globe and Mail, December 2, 2024

Pope Francis’ intentions for December

For pilgrims of hope
We pray that this Jubilee Year strengthen our faith, helping us to recognize the Risen Christ in our daily lives, and that it may transform us into pilgrims of Christian hope.

Moira and Bambi