Despite the increase in overdose deaths related to smoking drugs, there are no supervised inhalation services in Ontario

Last spring, Toronto’s Casey House opened its second supervised consumption site (SCS), an outpatient one that has a room specially designed for people who choose to smoke their drugs.

More than four months later, this well-ventilated space, which was built at the request and with input from the hospital’s clients/patients, is still unused.

“We have been in talks with the province on how to establish the guidelines to open it. … We really want to move this forward,” said Casey Schapel, harm reduction coordinator for Casey House.

“If we can open it up, it will be much safer for the people we serve.”

Schapel said that currently, when staff are available, they go out to check on patients who choose to inhale their substances. Not an ideal situation, he admitted.

“This results in the division of resources. We can’t 100 percent police those inside,” she said, adding that if someone who smokes drugs overdoses outside, the time it takes for staff to respond is much longer.

“Having an inhalation site would actually make it safer for our patients and our staff.”

Casey House CEO Joanne Simons said they are well aware of the “increasing prevalence of inhalant drug use and the significant increase in inhalation-related deaths.”

Just last month in the city, 10 people died of an overdose in a span of five days after they reportedly smoked drugs, prompting the Toronto Department of Public Health to issue an alert.

Last October, the Toronto Drug Strategy Secretariat issued another alert following a spike in overdose deaths when using drug snorting equipment.

Simons said the hospital has also learned through its clients and community members that having the “ability to safely inhale substances is very important” to them and that is why with its new outpatient SCS they sought a waiver of Health Canada specifically for safer inhalation and built a booth. for it.

“We are working to offer this life-saving service as soon as possible,” he said.

The proportion of overdose deaths related to smoking opioids has increased

Currently in Ontario, the provincially funded Consumer and Treatment Services (CTS) program does not include supervised inhalation services.

Casey House, however, does not rely on money from the province to operate its SCS and could offer supervised inhalation if it “complies with other applicable federal, provincial and municipal laws to maintain public health and public safety,” Natalie Mohamed, a said. to CP24 the spokesperson for Health Canada/Public Health Agency of Canada.

At this time, there are no supervised consumption sites in this province that provide inhalation services.

Any organization that wants to offer supervised drinking services in this country must have an exemption under Section 56 of the Controlled Drugs and Substances Act (CDSA) to operate.

Epidemiologist Dr. Tara Gomes, senior senior fellow at the Ontario Drug Policy Research Network, said it’s difficult to quantify how many people who use drugs in Ontario choose to smoke them.

Instead, Gomes told CP24 that she and her team are seeking data from the Office of the Chief Medical Examiner/Ontario Forensic Pathology Services to better understand how drugs are consumed when a person dies of an overdose.

The most recent data from the Ontario Coroner’s Office found that people who died from “smoked opioids” accounted for 30 percent of the 164 accidental opioid toxicity deaths in Toronto between April 1, 2020, and March 31, 2020. 2021. All of these “opioid toxicity deaths” had evidence of drug smoking and represented a 43 percent increase in the proportion of overall overdose deaths in Toronto compared to 2019 and a 178 percent increase in deaths from overdose with only evidence of pipe or aluminum foil present.

Gomes report from May 2021, Changing Circumstances Around Opioid-Related Deaths in Ontario During the COVID-19 Pandemicnoted a “significant shift from opioid-related deaths with evidence of injection only…to deaths with evidence of a snorting pipe/sheet at the scene.”

The researchers noted that just over a third of overdose deaths in Ontario during the pandemic appeared to be the result of inhalant drug use, compared to 22.5 percent before the pandemic.

“Regardless of whether the pandemic is specifically driving this change, the increasing prevalence of sniffing as the predominant mode of drug use suggests a need for personalized harm reduction services, including supervised sniffing services, across Ontario,” said the report.

Gomes said she and her team are currently in the middle of a study looking more closely at patterns of drug use among people who die from drug overdoses.

“I don’t have much that I can share specifically on that at this point, except to say that the patterns that we saw in that earlier report hold among those who do fatally overdose, inhalation is becoming more common,” he said.

“I think this definitely speaks to the need for us to consider how existing harm reduction services are designed and find opportunities to expand the services provided to account for creating safe spaces for people to inhale drugs. This has been something we have asked for more and more as we see these patterns.”

Provincially funded facilities may not operate supervised inhalation spaces

In Leslieville, the South Riverdale Community Health Center (SRCHC) has operated a provincially funded supervised use site called keepSIX since late 2017. There, people who use drugs can inject, snort, or take their substances orally. in a clean and safe environment under the supervision of trained personnel.

One of the services the center wants to start offering as soon as possible is supervised inhalation, but that can only happen if the province provides funds to renovate its space and hire more staff.

Paula Tooley, program manager for keepSIX, said that over the past two years she and her team have seen a “steady increase” in supervised inhalation requests from community members on their site.

If staff are available, they can sometimes escort someone outside to supervise them while they smoke their drugs, but for many reasons they would prefer to offer in-house services, he said.

Tooley, who has worked directly with people who use drugs in downtown Toronto for 30 years, said those who are new to opioids and other substances usually start out by smoking them. She said smoking drugs is less invasive and poses a lower risk of infections and other related illnesses than intravenous drug use, but that method is certainly not without risk.

“I see more infections than ever before,” Tooley said, adding that having supervised consumption sites in Ontario that offer inhalation services would give people more options.

It also said not providing supervised inhalation services leaves out a large portion of the population, whom staff could help access other essential programs, services and referrals.

“(Supervised inhalation) is something that is necessary. It’s just a matter of figuring out the logistics,” he said, adding that while providing people with safer places to use illegal drugs may be considered by some to be a “little radical idea,” the services save lives.

“One of the worst things about the drug intoxication crisis is how much potential has been lost, all the young people who have died unnecessarily.”

Paula Tooley of SRCHC's keepSIX SCS

Kate Mason, research coordinator for the SRCHC, said she reached out to the province late last year about how the far east center would offer supervised inhalation, but said it could be a long way since exactly what is required is unclear. .

“We are building the plane as we fly it,” Mason said, adding that requirements and expectations vary by province, but generally have to do with ensuring the health and safety of staff and patients/customers.

Once all those details are worked out and if Ontario decides to allow inhalation at its provincially funded supervised consumption sites, Mason said SRCHC will return to Health Canada to request that inhalation be added to its CDSA exemption. contacted the provincial government several times to clarify this issue, but received no response.

In the meantime, the SRCHC harm reduction team will be touring the new Casey House inhalation space later this month to learn more about it as they continue to push for this additional service.

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