Toronto’s medical officer of health was unequivocal on Monday morning about the lethal consequences of the provincial government forcing closures of supervised drug consumption sites.

“I expect you will see deaths,” said Dr. Eileen de Villa.

“I don’t think that’s hyperbole nor do I think that’s exaggeration. I think it’s calling the facts as they are.”

De Villa was speaking at a city hall news conference alongside councillors and front line workers days after the province quietly announced three sites would lose funding and legal status and two more not yet opened would be under review, as would a third operated by the city.

Two of the sites losing funding are in Toronto and got the news mid-afternoon Friday. The call from the province did not include any suggestions or offers of help on how to safely wind down, operators told the Star — they were just told to shut their doors and be prepared to direct clients to another location. Before 6 p.m. Friday, however, those two agencies were able to confirm that the federal government would provide emergency exemptions allowing them to legally remain open.

But while the doors can stay open the agencies must use or raise their own operating dollars. That means the two sites may only serve clients until money they have budgeted or fundraised runs out.

A total of 15 sites were approved for continued operations after Minister of Health Christine Elliott announced a new program and set of criteria to judge the sites this past summer. Six are in Toronto. Individual sites in Hamilton, Kingston, St. Catherines, London and Guelph were also approved.

Overdose prevention sites, like the two threatened with closure in Toronto, are meant as an emergency solution to a mounting crisis, a nimble model that allows front-line workers to quickly set up shop and provide life-saving services in areas where need is high. Staffed by a mix of nurses, activists, social workers and volunteers, including past and present users, those locations provide not just a safe and sterile place where people can consume drugs under supervision but also connection to community and access to additional support services. The workers monitor for signs of infection or overdose and are trained to reverse an overdose in progress.

Safe injection sites offer similar services but are meant to be permanent. A lengthy application process must take place before the sites can open.

At the city-run safe injection site, The Works, on Victoria St. near Yonge-Dundas Square — the busiest site in the province, recording over 40,000 visits since August 2017 — a some 750 overdoses have reversed since opening.

Still, there were more than 300 known deaths resulting from drug overdoses in 2017 in Toronto alone.

Every one of those deaths, de Villa said, was preventable.

“As your medical officer of health I need to tell you that the opioid overdose crisis faced here in our city, in our province and actually throughout our country, is the defining health crisis of our time . . . Now is not the time to be withdrawing services, rather it’s the time for all levels of government, for all health providers and agencies, for community stakeholders to band together and provide more services.”

The medical officer herself got a call from the provincial Health Ministry that The Works, Toronto Public Health’s lone site, was under review. Funding will continue — for now. The call came with few details about concerns the ministry has about the site, de Villa said, but added she looks forward to learning more.

Also receiving calls Friday were those who operate the Street Health site at Dundas and Sherbourne Sts. and St. Stephen’s Community House in Kensington Market.

Kapri Rabin, the executive director of Street Health, said the site is located at an intersection that has the second highest number of calls for paramedics in Toronto.

“It’s a neighbourhood in great need,” she said. Since opening in June, they have reversed over 30 overdoses — about one every 10 days.

“We know that the data is staggering,” she said. “So, why is the government of Ontario cutting services? The government should be doing everything it can to prevent the number of deaths due to overdoses from increasing in 2019. We know that these services save lives. They’re evidenced-based.”

It costs about $20,000 monthly to run the site, she said, but additional requirements brought in by the province would increase those costs.

Each site is different in terms of scale and cost, the medical officer of health noted, responding to local needs in the neighbourhoods they are in.

Bill Sinclair, the executive director of St. Stephen’s said those accessing their consumption services are also turning to counselling they provide. Over 500 counselling appointments were made in the last year for clients using the overdose prevention site, he said.

The criteria and review the province announced continues to be an unwelcome approach to health care, advocates said.

The new provincial guidelines for supervised consumption services require that a designated health professional be on site, that locations have on-site or “designated pathways” to mental and physical health services, addiction services and housing, and that staff report back on how those services are being accessed. Community consultation is also required and sites must include accessible washrooms, a hand washing station and foot bath.

Loading... Loading... Loading... Loading... Loading... Loading...

Proximity to similar sites and other city services like child-care and parks also factor in.

“When the province announced an arbitrary cap of 21 sites within the province, that placed a cap on live-saving health care,” said Councillor Joe Cressy, the chair of the board of health who organized Monday’s news conference.

On Monday, Premier Doug Ford — who said during the provincial campaign he was “dead against” supervised consumption sites — told reporters he had a “great conversation” with an association representing Cabbagetown residents, who had complained they had as many as four sites within a kilometre of each other.

“They’re upset,” Ford said. “I always believe in listening to neighbourhoods, listening to the people and I’m going to go down there and pay them a visit.”

He also said he is “passionate about helping people that have an addiction” and called the number of deaths “unacceptable.”

“That’s a high priority. I don’t want these people dying,” he said. “We’re going to be supporting these people as much as we can.”

Asked if the sites the province intended to close were not doing just that, Ford told a reporter he would go “ballistic” if one of the sites was beside his house and the reality is people don’t want them in their backyards.

In 2017, 1,265 people died of opioid overdose related deaths in Ontario, according to the province’s public health website.

Among the victims were Pierre Gregoire, a 28-year-old aspiring musician who overdosed in the washroom of a Kentucky Fried Chicken restaurant in downtown Toronto, and Justin Lidstone, found in the stairwell of an upscale downtown condominium just a few months shy of his 23rd birthday.

The sharp rise in overdose deaths is linked to a somewhat new and entirely unregulated drug infecting the street supply, the synthetic opioid fentanyl. In its prescription form the drug is used during surgery and given to patients dying of cancer. What is being bought and sold across the province is the product of local laboratories, or shipped into Canada in packages so small they can escape detection. While some intravenous users seek it out and have developed a tolerance, the different compositions make it almost impossible to know the strength of the drug until it is consumed — and often too late. Of the 1,265 fatal overdoses in 2017, more than 63 per cent, or 805, involved fentanyl.

In Lidstone’s case, a doctor who reviewed the results of a coroner’s report said, despite consuming what was certainly a fatal dose of a fentanyl, if somebody had administered naloxone — a drug that can reverse the effects of an overdose — and called for help it was very likely he would have lived.

Councillor Gord Perks, the chair of the city’s drug strategy implementation panel, closed the news conference by talking about the son of a friend who had died on an overdose. He remembers holding him as a baby, helping to change his diapers, watching him grow. His name was Sam. He was 28. He was not the first.

“Sam is no longer with us as so many hundreds of other people are no longer with us. They’re our family members, they’re our loved ones, they’re people we work with,” Perks said.

“Premier Ford, if you’re listening, you have it in your hands now to save lives like Sam’s.

“Many try to say there are a whole lot of sides to the issue but when someone is about to die, there are no complexities. There’s merely a moral duty to save that life. Right now in city of Toronto, we’re banding together to save lives and we’re calling on the Province of Ontario not only to fund and reinstate these sites, but to expand the number of sites in this city and across the province. Lives are at stake.”