In the weekly How to Fix Toronto series the Star seeks simple, affordable solutions to the problems faced by Torontonians and the city as a whole.

The problem: With opioid overdoses occurring in shocking numbers, drug users outside the city core don’t have access to life-saving supervised consumption services.

Toronto Public Health’s tracking of suspected overdose calls shows there are hot spots near Jane St. and Sheppard Ave. in North York, along Lawrence Ave. E. in Scarborough and near the lake in Etobicoke, among many other areas scattered throughout the city. These are places where drug users are going into medical distress — and in some cases dying.

A map of the city’s eight supervised injection and overdose prevention sites, on the other hand, looks much different. The sites are clustered downtown, with none west of Parkdale, east of Riverdale or north of College St., which means drug users in the suburbs are left out.

Advocates say it may be time to change that, and mobile consumption units could be a way of doing it.

“There’s no question of the geographic disparity,” said Dr. Chetan Mehta, a Toronto physician on the substance use services team at Women’s College Hospital, who is a proponent of mobile services. “It’s a real problem and it speaks to the lack of services in the periphery.”

Mehta said existing opioid services fall well short of what’s required to put a lid on the epidemic, which led to nearly 300 deaths in Toronto last year.

“This is pretty profound,” Mehta said.

Other cities in Canada have begun using mobile consumption sites, as a way to deliver services in more far-flung areas. Montreal’s mobile injection clinic hit the road in 2017. In Calgary, a mobile unit is awaiting approval. In B.C., where a public emergency was declared over the opioid epidemic in 2016, a vehicle is currently in the works for Vancouver while units are already operating in Kelowna and Kamloops.

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Mobile clinics are best suited to augment existing services and serve as a bridge to a permanent location, said Dr. Silvina Mema, medical health officer for Interior Health, which covers Kelowna and Kamloops.

“It’s a good temporary solution,” she said. “It provides a safe space for people to inject and not die from an overdose.”

In Toronto’s case, where the permanent sites are fixed downtown, Mema said a mobile site may be a way to test public demand for such services outside the core.

Typically, the mobile units are authorized to serve only predetermined locations with regularly scheduled hours.

“A mobile service is a cheaper, easy way to begin to address those needs. To test the demand and see what happens,” Mema said.

According to preliminary data, there were 294 opioid toxicity deaths in Toronto in 2018. There were 308 in 2017.

Data compiled in a recent yearlong public health study shows high fatality rates scattered across parts of the city including Etobicoke, North York and Scarborough.

Public health officials noted downtown accounted for most of the calls, but outside the core, a higher percentage are fatal.

In B.C., Interior Health used retrofitted RV’s to serve Kelowna and Kamloops, serving locations based on 911 data. A study of their efforts found that 90 per cent of those surveyed reported positive experiences in terms of access to services and physical safety of the mobile site. While the study identified problems, such as cramped space for workers and cancelled shifts due to bad weather, it also found a softening of local public resistance.

“Having a mobile option seem to be more palatable for communities to accept,” said Andrew Kerr, team leader for Kelowna’s Mental health and Substance Use Services. “Not every community is welcoming of low barrier substance use services, especially supervised consumption, so offering it in this way gives some flexibility. If the needs changes in a neighbourhood it’s easy to relocate the vehicle.”

It cost Interior Health about $150,000 to transform its RV into a mobile clinic.

Corinne Dolman, a director of substance use at Interior Health who led the implementation, said it could cost anywhere from $300,000 to $500,000 yearly for a registered nurse and social worker to staff the site, 12 hours a day, seven days a week, but those expenditures can be slashed by cutting hours and using a different staffing model.

In Vancouver, where a mobile unit is under development, health officials note the fluctuating nature of the opioid crisis, where contamination can sometimes cause a spike in overdoses.

“You need to be mobile to get to communities experiencing the crisis,” said Sarah Blyth, executive director, Vancouver Overdose Prevention Society.

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Her organization is part of a task force struck by Vancouver Mayor Kennedy Stewart to tackle the overdose epidemic. Some 1,535 people were killed by drug overdoses in B.C. in 2018, according to the B.C. Coroners Service.

In Calgary, the objective was to use the unit as an adjunct support a stationary site, said Leslie Hill, executive director of HIV Community Link, the agency charged with running the mobile operation.

“There are a couple different areas in Calgary that are experiencing higher rates of overdose and overdose deaths, so we wanted to be able to address that geographic disparity in overdoses and respond in multiple communities,” she said.

In Calgary, there are pockets of suburban overdoses happening inside peoples homes, Hill said. The mobile unit will test whether or not people will use the service in neighbourhoods outside the core.

“We can start to understand if that service might be used by people who have housing,” Hill said. Calgary’s mobile safe drug-consumption site is currently undergoing provincial review.

Mehta, the Toronto doctor, said the city could test public appetite for a mobile services in similar fashion.

“You have to go where the deaths are happening,” he said.

At the moment, however, public health officials in Ontario aren’t in a position to expand.

In March, the Ford government released a list of approved sites and indicated that others were under review, including ones that previously received funding.

Each applicant, like Toronto Public Health, had to reapply to the province under a new consumption and treatment services model.

“We appreciate the value of mobile service, but right now we’re focused on ensuring that we’re able to continue to provide the services that we have at (the city-run safe injection site) the Works,” said Dr. Eileen de Villa, Toronto’s medical officer of health.

Since opening in August 2017, the Works has had just under 54,000 visits and reversed about 1,000 overdoses, de Villa said.

“We know there is a demand for this service and that it is saving lives,” she said.

She said the city has looked into a mobile unit as an option and haven’t “closed any doors with respect to the potential of a mobile-type aspect to the service.”

Mehta said while the units can be purchased and retrofitted via fundraisers, its daily operating expense should come from the government’s purse.

“This is a necessary health service,” he said. “Anything that’s deemed an essential health service should be government funded. We don’t leave dialysis to the private sector.”

“Funding this is chump change in terms of government dollars and it could save a lot of emergency room visits and deaths,” Dr. Mehta said. “There is a tremendous cost for not doing this.”