Ontario shutting down supervised consumption sites without assessing harm to drug users: auditor

The 10 supervised drug consumption sites being forced to shut down this spring prevented nearly 1,600 fatal opioid overdoses in one year, Ontario’s auditor general has found.

In her annual report tabled Tuesday, Auditor General Shelley Spence was highly critical of the province’s opioid strategy. She calculated the number of fatal overdoses prevented at each supervised consumption site (SCS) in the 2022-23 fiscal year. 

The statistics call into question assurances from Health Minister Sylvia Jones that "people are not going to die" after the closure of the facilities. 

The auditor general also found that the government has made no attempt to determine if anyone will die or not as a result of the site closures. Nor did the Progressive Conservatives talk to anyone who might be affected by the closures, such as the SCS operators, the people who use them, or the Northern Ontario communities who will be left without any access to an SCS despite having the worst opioid statistics in the province.

The PCs passed the legislation closing the facilities, Bill 223, on Monday, one day before Spence's report. 

"The ministry did not develop a comprehensive plan to assess and quantify the impacts on public health and Ontario’s health system — for example, a potential increase in overdoses and emergency department visits — prior to finalizing the decision to introduce (Bill 223)," the report concludes.

The government also "has not developed plans to mitigate the risks" that the Ministry of Health's internal documents acknowledge are the likely result of closing the SCSs, including "an increased risk of deaths," financial and operational "burden" on emergency rooms, more public drug use and discarded needles, and leaving "Northern Ontarians with no access to supervised consumption services going forward."

During a press conference on Monday, Spence noted that the government is "still doing ongoing work around the risks of overdoses" from the closures, but that work has not been completed. 

"We do encourage them to look into those risks," said Spence, who stopped short of predicting that the closures will cost lives.

“There is a potential that those overdoses could occur elsewhere if they're not happening in the safe consumption site. That's forward-thinking information, and I can't, I can't say one way or another.”

When pressed, Spence said that the government has acknowledged that increased deaths are a risk, “but they haven't identified their mitigation processes around that risk.”

Two SCSs closed in Timmins and Sudbury earlier this year after the province refused to approve their applications for provincial funding, despite Timmins seeing a 227 per cent increase in opioid-related deaths between 2018 and 2023, and Sudbury experiencing a 184 per cent increase.  

Minister Jones denied responsibility for the closures since they were municipally funded when they had opened, but the AG report states that allowing them to close will still hurt residents in Northern Ontario.   

Bill 223's passage will also force the closure of the SCS in Thunder Bay, a community which experienced 55 opioid-related deaths per 100,000 residents in 2023, the highest per capita rate in the province. The rate for all of Ontario is 37 deaths per 100,000, compared to the rate for all of Ontario at 17 per 100,000.

The death rate for Indigenous people in Ontario is 11.4 per 100,000, compared to 1.6 deaths per 100,000 for non-Indigenous people, the report states.

“The ministry’s actions to address the needs of these communities have been insufficient,” concluded the report, while noting that the province had not consulted with northern Ontario municipalities before shuttering their SCS, or anyone else outside the government.  

Nor did it consult with Public Health Ontario, finding it only included internal stakeholders, including other ministries and Ontario Health.   

During a press conference in the afternoon, Health Minister Sylvia Jones said the government “did actually study consumption treatment sites,” pointing to the study of SCSs the government ordered following the death of Karolina Huebner-Makurat, who was hit by a stray bullet from a shooting near the SCS in Leslieville in 2023.

Jones neglected to mention that the final report from that review recommended that SCSs be kept open and expanded. 

The health minister defended not doing an assessment of the impact of shutting down sites because the government has the “motivation to get things done.”

Reporters repeatedly pressed Jones on the likelihood of deaths as a result of the closures, but the minister wouldn’t explicitly acknowledge the concern and instead turned the question back at the media.

“Are you suggesting, as we see rising opioid use in our neighbourhoods, in our communities across Canada, that we should not be acting and responding to that? I vehemently oppose and disagree with you,” she said.

The government is planning to create Homelessness and Addiction Recovery Treatment (HART) hubs as it shuts down the 10 SCSs, which Jones said will get drug users into treatment rather than “facilitating drug use.”

“Swapping a dirty needle for a clean one is not a pathway out and does not give people hope,” she said.  

However, the AG report found that the decision to adopt the HART hub model was made "without proper planning."

"The Ministry’s investment of $378 million for the HART Hubs was decided upon without a needs-based assessment," the report points out.

The report recommends to the Ministry of Health that it "complete all necessary planning work before transitioning to the new HART Hubs," including impact, risk and financial analysis, to "engage with all relevant stakeholders, and come up with a framework for measuring the HART Hubs' performance — something the province also doesn't have.

The ministry said it agrees with the recommendations and will perform "outreach to public health units to update their harm reduction strategies. It also notes that HART hubs will be subjected to a "third-party evaluation to determine outcomes, lessons learned and areas for improvement."

"Results of the evaluation will inform future decisions on mental health and addictions services, including HART hubs in Ontario," the ministry said while promising to make sure the new hubs also "collect the necessary data to support the evaluation."

Data collection, however, has not been the government's strong suit when it comes to the opioid crisis.

The AG report also blasts the province for not "adequately" collecting the data or measuring performance when it comes to combating the opioid crisis. The report found that only 10 of the 24 performance indicators the province promised to track five years ago " were consistently tracked."

"Examples of these indicators include the number and rate of hospitalizations for opioid overdoses, the percentage of people who are prescribed opioids and subsequently develop an opioid addiction, the number and proportion of patients who are referred from Rapid Access Addiction Medicine Clinics to primary care, and the number of CTS site client visits," the report explains.

When asked why they were not all being tracked, the ministry explained that it had fallen along the wayside when the province introduced its health care system reform strategy, Roadmap to Wellness, in 2020, which included a new opioid strategy with new provincial standards for data collection.

"That foundational work is yet to be completed," the report notes.

The 2020 strategy also created the Mental Health and Addictions Centre of Excellence to oversee the implementation of the new strategy. However, the new agency admitted to the AG that "it does not have reliable, validated and standardized data on mental health and addictions services" and that this "limits (its) ability to perform meaningful analysis to identify service gaps."

Official Opposition Leader Marit Stiles said the report’s findings show why the PCs used time allocation motions to pass Bill 223.  

“The government rammed through their legislation at record speed (because the) auditors general's report was coming out today,” said Stiles, adding that the lack of an assessment is in keeping with a wider theme in the report showing that the PCs have little interest in “data or expertise” when making policy decisions.

“This is a government that is just off the rails. They want to do what they want to do, and they don't really care about data or evidence — or in this case, honestly, saving lives.”

Jones insists that the government has “not bypassed due process” in its haste to accomplish its policy objectives. 

The Liberals’ reaction was more muted, with parliamentary leader John Fraser calling the report’s findings “concerning” and suggesting the PCs didn’t ask questions about the impact of their policy decisions because “they didn’t want the answer.”

“I guess they knew they weren't as ready as they led us all to believe,” Fraser told reporters. 

(This story has been updated to include responses from the auditor general, minister of health, and opposition leaders.)  

EDITOR’S NOTE: This article originally appeared on The Trillium, a Village Media website devoted to covering provincial politics at Queen’s Park.