Harm-reduction advocates have a great case to make ... or they would, if they could resist overselling it
I don’t envy the folks in Belleville, Ont. currently assigned to address an alarming spike of opioid overdoses in the city of roughly 55,000, about halfway between Toronto and Ottawa. At one point earlier this month there were 23 overdoses in just 48 hours — the equivalent to nearly 1,200 in a city the size of Toronto, and a clear indication of a dodgy supply arriving on the streets.
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On Wednesday, Mayor Neil Ellis complained the province had not been forthcoming with a $2-million request for a new “community hub” that would serve the city’s homeless, addicted and mentally ill residents. He vowed to forge ahead with the project anyway. Not among the city’s stated plans, however, is to offer a supervised consumption site (SCS) — a facility that’s all but guaranteed to save everyone suffering an overdose from the worst outcome. (Toronto Public Health recently reported a weekly average of 14 overdoses successfully reversed at its SCS facilities.)
A SCS could be a hard sell nowadays, both at Queen’s Park (which has paused approving new such sites) and in the court of public opinion, where harm-reduction efforts are more and more often portrayed as partly or even mainly to blame for the crisis. The fact that Belleville had no SCS or “safer supply” programs in place, and suffered this crisis anyway, should be proof enough that’s wildly oversimplified.
But a Toronto Star reporter’s recent visit to Belleville yielded some, shall we say, much less sympathetic proposals for dealing with the crisis. “A salon owner downtown questions if people being revived actually want to be saved,” the paper reported.
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Meanwhile, harm-reduction proponents — of which I am one, although I acknowledge serious issues around community safety — continue to wildly oversell their case to an understandably skeptical population.
Last week The Lancet published a study of Toronto that harm-reduction advocates held up as proof that supervised-injection sites save lives not just on the individual level —— but (per its lead author) “at the community level or population.”
“The study … found a 67 per cent reduction in overdose deaths in neighbourhoods within 500 metres of supervised consumption sites” in Toronto, the Star reported. That’s a remarkable figure, considering such radii cover most of the city’s downtown, which remains Ground Zero for its opioid crisis.
Toronto recorded 137 opioid deaths in 2015, rising slowly to 315 in 2019, then through the roof during the pandemic: 545 in 2020 and 599 in 2021. How could SCS sites be reducing the number of overall deaths in the part of the city worst affected by the crisis, while the overall number of opioid deaths has surged?
The answer: the Lancet study only compared two three-month periods: May 1–July 31, 2017 — which was just before Toronto launched its SCS program — and May 1–July 31, 2019, two years later. And indeed, as the study points out, there was a city-wide drop in deaths over that period — heavily influenced, it suggests, by SCS.
But if we compare Jan. 1–March 31, 2017 (also before SCS) to Jan. 1–March 31, 2019 (also SCS in place), we find a nearly 50-per-cent increase in deaths. That’s the unmistakeable long-term trend. With so much data available, it’s passing strange the researchers chose to focus on those particular three-month periods.
That doesn’t mean supervised consumption isn’t saving lives, or isn’t worthwhile, within that enormous overall surge in cases. I think Belleville would be well advised to explore it, provincial moratorium be damned. Remarkably, that spate of 23 overdoses earlier in the month apparently resulted in no fatalities. But that luck is going to run out.
If harm-reduction advocates have trouble making that case, they need to look themselves in the mirror — or have a stern talk with their colleagues. Every time they oversell their position, every time they attack someone raising serious concerns about SCS sites and neighbourhood safety, or the diversion of prescribed pharmaceutical-grade opioids onto to the street, they embolden a similarly political and simplistic response from those who think “enabling” drug use is the root of the problem.
Good luck, Belleville — and good luck to all the other Canadian cities in towns in the same situation, struggling to do anything with this opioid disaster other than letting it run its deadly course.
National Post
cselley@postmedia.com
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