Open this photo in gallery Toronto Public Health’s Victoria Street site in the Yonge and Dundas area in Toronto on Oct. 31, 2018. Christopher Katsarov/The Globe and Mail

It was the first legal supervised drug-use site in Toronto to open its doors, hastily set up more than a year ago as the city saw a huge increase in opioid-overdose deaths. But today, the Toronto Public Health clinic is still drawing complaints from neighbours – including local businesses and Ryerson University.

Many of its critics say they support the service itself, which allows drug users to shoot up under the watchful eye of a nurse. More than 300 potentially fatal overdoses have been reversed at this site alone, health officials say. While homelessness and drug use are far from novel in this neighbourhood, which includes the blinking billboards of Yonge-Dundas Square, nearby retailers and the university say not enough is being done to alleviate what they say are the site’s side effects: Crowds of people in front of the clinic’s doors, increasingly disorderly behaviour and drug use and needles found in washrooms and alleyways.

“We just saw more of everything” in the wake of the site’s opening, says Mark Garner, head of the Downtown Yonge Business Improvement Area, which has had to organize training for local shopkeepers to better deal with unruly or intoxicated people. “We saw more crime, we saw more needles, we saw more drug abusers, we saw more dealers. There was just more of those things.”

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No Ryerson official was made available for an interview, but, in a statement, the university says it has seen more vandalism, theft and drug-related security calls since the site opened. The university says it supports “initiatives that offer help and practical options for at-risk populations,” but that “additional services are required.”

All eight of Toronto’s supervised drug-use sites must reapply for their permits and funding from the province, after Ontario’s Progressive Conservative government under Premier Doug Ford – who during the spring election campaign said he was “dead against” the facilities – decided not to axe them last week. The government says it will limit their number, and that the sites must put more emphasis on getting drug users into treatment programs, which now have long waiting lists Queen’s Park has pledged to expand.

The complaints about Toronto Public Health’s Victoria Street site, just steps from the Eaton Centre and Ryerson, far outnumber those about the other sites across the city, says local Councillor Kristyn Wong-Tam, who supports harm-reduction sites but is fresh from a re-election campaign in which the sites were an issue.

She says under the Downtown East Action Plan she has championed, city crews are now cleaning drug-user hot spots as often as several times a day. But crowds of drug users in front of the site, and drug use on the streets around it, remain a problem. She suggests the site should be moved to nearby St. Michael’s Hospital, where more health care could be provided.

Open this photo in gallery A needle drop box near the Victoria Street public health facility in Toronto on Oct. 31, 2018. Christopher Katsarov/The Globe and Mail

The location, known as the Works, is also the only supervised drug-consumption site directly operated by the city’s public health agency, with the rest run by local groups or health clinics. The building is also Toronto Public Health’s head office, and had operated a needle-exchange program for drug users for many years, as well as a methadone clinic, making it a natural place for the new service, according to public health officials at the time.

“They told us not to worry, that they were going to have it under control,” Ms. Wong-Tam said in an interview. “And I think clearly given the conditions that we now see on Victoria Street, they don’t have it under control. It’s very far from being under control.”

Toronto Public Health says it has been acting on the complaints. Since early September, teams of two outreach workers have been patrolling the area every day from 9:30 a.m. to 11 p.m., a large increase from the four hours a week put in place before. They not only find street drug users and encourage them to come inside, they also pick up needles using barbecue tongs and wearing surgical gloves. In an unusual move, the local BIA also hired its own outreach worker, who approaches drug-users and homeless people and tries to help them find shelter while accompanied by a security guard.

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Associate Medical Officer of Health Rita Shahin says the public health agency’s boosted outreach and increased attention by security to the scene outside the site’s doors are making a difference. But she says not all of the area’s problems can be blamed on the Works, noting the city has long wrestled with growing homelessness and a lack of treatment for the mentally ill: “We are concerned about what our neighbours are feeling. ... Not all of it is because of the service."

On a walking tour of the area’s back alleys with a reporter this week, the BIA’s Mr. Garner stoops to point out one of the few needles found that day on the pavement. He acknowledges that street cleanup efforts, including extra crews his BIA pays for, have improved the situation. But he says much more needs to be done.

Back in front of the Victoria Street entrance on Thursday, a group of people who use the Works stand around in the rain, smoking cigarettes in front of a sign warning against loitering. One man in a hoodie and a baseball cap says he injected drugs inside the clinic that morning.

He declines to give his real name because he says he is a drug user and a small-time dealer. He explains that many addicted to drugs also end up selling them, meaning transactions outside the site are common. So is getting robbed, he adds, suggesting more security is needed. Even he says he understands why some in the neighbourhood would want the site moved, as it sits on prime real estate.