Most overdoses in Canada happen when people smoke, but the system is still geared toward injection
The old town center of Cobourg, Ontario, is full of small-town charm. There are grand buildings, cute shops, and old-style iron lampposts with flower baskets hanging from them. The business leader in the area even came up with the hashtag “#8BlocksofAwesome.”
But on Friday nights, just a few steps off the main street that looks like a picture postcard, you can see a different side of life. In an alley, volunteers are setting up camp chairs and folding tables and putting out things like alcohol swabs, plastic pipes, and naloxone kits in case someone overdoses. All for a pop-up, unofficial safe place for people who use drugs in the area, with a focus on people who smoke rather than inject.
One of the organizers, Ashley Smoke, said, “It seemed like there was more and more need, and more and more people were dying.” “There are just so many people in trouble and no one to help them.”
Cobourg is a city of 20,000 people on the shore of Lake Ontario east of Toronto. In the last 18 months, there have been 12 deaths from drug overdoses. The closest safe place to use cannabis legally is in Peterborough, which is almost 60 kilometers away. And like all government-funded harm reduction centers in Ontario and most of the rest of the country, it doesn’t let people smoke drugs. Instead, they can inject, swallow, or inhale them.
Smoke said that Canada’s nearly record number of overdoses shows how much it costs not to have supervised places for people who use drugs.
“People have died because of it. There have been a lot of deaths. They said, “There’s just so much loss and sadness.”
Overdoses from opioids killed more than 7,300 Canadians in 2022, and 87 percent of those deaths happened in British Columbia, Alberta, and Ontario.
With a growing national network of safe consumption sites approved by the federal government and paid for by the provinces and territories, overdose prevention has become a key part of the government’s fight against the opioid epidemic.
Advocates and experts say that even though this system is growing, it isn’t meeting the needs of drug users because it mostly doesn’t cover inhalation, which is the most common way to use drugs.
Patrick McDougall, a harm-reduction specialist in Vancouver who helps community groups across the country set up consumption sites, said that what the country really needs are places where people can smoke drugs inside.
“There aren’t any safe places for people to use drugs right now, unlike with injections.”
The Ministry of Mental Health and Addictions says that there have been 3.87 million visits to safe sites in B.C. since 2017. There have been 25,000 overdoses and only one death. In 2022, there will be 2,342 overdose deaths in homes and on the streets.
Studies show that adding spaces for inhalation would save even more money.
Only B.C. and Ontario keep track of how drugs lead to death, but the trend toward smoking is clear and has been going on for a long time.
Inhaling drugs caused 56% of drug deaths in British Columbia in 2021, which was the case in 2017.In Ontario, the numbers changed five years ago, and by the end of 2022, smoking will be responsible for 68% of deaths.
But there are only five approved indoor inhalation sites left in the country, while there are almost 50 places where people can get drugs by injection.
Most of the reasons seem to have to do with how things are set up.
“It’s just too much paperwork,” said McDougall. “I think the result is that six people die every day in British Columbia and 20 people die every day in Canada… Many times more than what you might get from car accidents, suicides, and other causes of death put together.”
Health Canada will exempt inhalation sites from federal drug laws, but they will have to have the same safety measures as injection or other uses. With community support, this process usually only takes a few weeks. But it seems like things are getting stuck at the provincial level.
It costs $10,000 to build and 18 months to get approval
Ontario has one legal place to smoke, which is a small room used only by people who go to Casey House, a hospital in Toronto for people with HIV. CEO of the hospital Joanne Simons said it was easy to build.
She said, “All we needed to do was put in a big fan that could blow the smoke out as fast as possible.” The construction cost about $10,000, which was paid for by donations to the hospital. The operating costs of the room are also paid for by donations.
But the approval process still took 18 months, even though no taxpayer money was at risk.
“At first, the Smoke Free Ontario Act seemed to be a problem, since you can’t smoke in a public building, especially a hospital,” said Simons. “And from the government’s point of view, it took some time to figure out if they would let people use illegal drugs in this space.”
Simons hopes that future approvals will go faster now that these questions have been answered.
But there are still a lot of big bureaucratic problems, especially for safe sites that get money from the province.
Kerri Kightley is in charge of consumption treatment services at a facility in Peterborough, Ont., a city of 135,000 people where 59 people died of overdoses in 2022 and 38 more died of overdoses in 2023.This year’s first six months. Her safe site has as many as 70 users a day, which she thinks would be at least three times as many if smoking were allowed.
“There has been a big change away from injecting and toward inhaling, but the provincial government hasn’t caught up,” said Kightley.
Under the current funding agreement with the province, safe sites in Ontario can only use government money to help people who inject, eat, or sniff drugs. Even using the same materials, space, or staff to help people smoke could be a violation.
“The rules don’t let us use the provincial money for anything other than what we’re approved for,” Kightley said. “It’s a bit hard to understand.”
CBC News asked Ontario’s Minister of Health Sylvia Jones for an interview several times, but neither her office nor the Ministry of Health replied.
We also asked the Alberta government what its plans were for sites where people can smoke drugs under supervision. The only place to smoke in the province, which was part of a building in Lethbridge, will close in 2020.a provincial auditFound signs that money was not being handled well.
Dan Williams, Alberta’s minister of mental health and addiction, said in a statement that his focus is on treatment and holding criminals “accountable.”
“Our dream for Alberta is for families to be able to live in safe, healthy places where people don’t use or sell illegal drugs. We want people who are addicted to drugs to be able to get help right away,” he wrote, pointing to plans for 11 new “recovery communities.”
This winter, British Columbia started a three-year trial where small amounts of opioids, cocaine, and methamphetamine are no longer illegal. The province has also quickly made it easier to smoke safely, with one indoor facility and 16 indoor/outdoor hybrid sites in tents and other shelters now open.
According to the latest report from the Ministry of Mental Health and Addictions, more than 35,000 people went to the inhalation sites in April.
But it’s not clear how useful these hybrid sites might be in parts of the country with harsher winters or if the political climate is right for them, since Conservative Leader Pierre Poilievre and his federal party are against harm reduction strategies like safer drug supplies.
Users told smoking is safe
Experts like Tara Gomes, an epidemiologist in Toronto and the lead researcher for the Ontario Drug Policy Research Network, are worried about all of this.
Gomes and her colleagues Have been keeping an eye on the move to inhalation— a trend made worse by pandemic isolation, the wear and tear on veins from injecting powerful opioids like fentanyl, and public health advice that smoking reduces risk from an increasingly toxic supply.
She compares how the government handled the COVID-19 pandemic to how it is handling the opioid crisis.
“One thing that worries many of us who work in this field is that we might not be able to get enough money to change the law if we need to in order to deal with this emergency. “During the pandemic, we saw how quickly that could happen,” Gomes said.
“Unfortunately, because substance abuse has a bad reputation, this doesn’t get as much attention as it should, even though we lose thousands of people across the country and thousands in Ontario every year because of it.”
Back in Cobourg, people have had a lot of different thoughts about the temporary inhalation site.
When volunteers set up a tent to give users privacy, the town council sent out bylaw officers and threatened fines of up to $50,000 for zoning violations.
Cobourg police, on the other hand, have made it clear that they support harm-reduction programs and won’t just arrest people for having illegal drugs on their person. The table and chairs have been left alone so far.
John, a Friday night smoker who CBC News doesn’t fully know who he is, said that he hopes a solution can be found.
“These people need something down here. He told them, “They need a safe place to go.” He suggested putting up a trailer near the beach where users could meet and look out for each other.
“Being out here with kids on the street, the police, and everything else is just too much,” he said. “It’s not safe for these people to be out here. They are not getting the help they need.”
Jonathon Gatehouse can be reached by email at [email protected] or through the CBC’s digitally encrypted Securedrop system at [email protected].Https://www.cbc.ca/securedrop/