Home / National News / Opioid Crisis Impacting African, Caribbean And Black-Canadian Communities In Toronto
Opioid Crisis Impacting African, Caribbean And Black-Canadian Communities In Toronto

Shannon Ryan, left, Executive Director of the Black Coalition for AIDS Prevention (Black CAP) and Michael Nurse, a harm reduction worker at Black CAP. Nurse, who is on the frontlines of the opioid crisis and is from the Caribbean, says he is becoming more aware of the amount of people of African descent that are using needles. Photo by Neil Armstrong.

Opioid Crisis Impacting African, Caribbean And Black-Canadian Communities In Toronto

By Neil Armstrong
PRIDE Contributing Writer

TORONTO, Ontario, November 13, 2017 (PRIDE) — Black people in Canada’s largest city are dying as a result of the opioid crisis gripping Toronto, but no one seems to know how many because that kind of data isn’t kept.

Shaun Hopkins, Manager of the Needle Exchange Program at Toronto Public Health (TPH), says the city is not collecting that type of information, in any coordinated way, at the recently opened safe-injection site in the Dundas Street East and Victoria Street area downtown.

“Because the site that we’ve opened is a temporary site, we don’t have our data collection instruments set up to kind of track ethnicity and background right now. In the future we will have that information, but right now, we don’t,” she said, noting that they’ve only been operating since August 21.

She added that the temporary site was set up to respond to increasing concerns about the opioid crisis in Toronto, and some things are not being collected in this context, because it was set up in a hurry.

Nick Boyce, Director for the Ontario HIV and Substance Use Training Program and a member of the Toronto Overdose Prevention Society (TOPS), says the authorities don’t do a good job of collecting data in Canada, so any analysis would be more anecdotal.

Boyce noted, they don’t collect ethnicity type data of people accessing those services.

“We don’t even have a good estimate on the number of people who use drugs in the province or the city. We just don’t have good epidemiological data and the thing would be so anecdotal at this point as far as I’m aware,” he said.

In May this year, Dr. Eric Hoskins, Minister of Health and Long-Term Care, Dr. David Williams, Chief Medical Officer of Health and Provincial Overdose Coordinator, and Dr. Dirk Huyer, Chief Coroner for Ontario, issued a joint statement on opioid data.

“The opioid crisis in Ontario is a growing and evolving problem, and one we are continuing to work, diligently, to combat.”

They said gathering accurate data on the impact of opioids is a key part of the Strategy to Prevent Opioid Addiction and Overdose.

“As part of our commitment to openness and transparency, Ontario is now launching the Interactive Opioid Tracker, which is a web-based tool that makes available a wide range of data on opioid-related morbidity and mortality. As the data shows, the opioid problem is affecting people of all ages, right across Ontario,” they said.

Data from the interactive tool suggests there has been a steady increase in opioid-related harms in Ontario for more than a decade. Since 2003, the number of deaths has increased 136 percent; and more than 850 Ontarians died from opioid-related causes in 2016. thousa

Boyce thinks Ontario is on track to lose more, maybe 1,000 people this year, not all opioid related.

Harm reduction worker, Michael Nurse, 66, a former drug user, has not used any drugs in five years. Photo by Neil Armstrong.

Harm reduction worker, Michael Nurse, 66, a former drug user, has not used any drugs in five years. Photo by Neil Armstrong.

But Michael Nurse, a harm reduction worker at the Black Coalition for AIDS Prevention (Black CAP), who is on the frontlines of the opioid crisis and is from the Caribbean, says he is becoming more aware of the amount of people of African descent that are using needles.

He says there are no real statistics on how many people in the African community die from drug overdose.

Nurse knows of three who overdosed and died, but the reason he knew, in one case, was because the family knew that he was also a person who use drugs and confided in him.

On August 12, TOPS and Toronto Harm Reduction Alliance (THRA) opened an unsanctioned overdose prevention site in Moss Park as a crisis response to growing numbers of overdoses and overdose deaths in Toronto, an increasingly toxic drug supply, and a lack of coordinated government response to this public health emergency.

Data collected during the site’s first 12 weeks, until October 29, show the following: 1,976 injections witnessed, 85 overdoses stopped or reversed, approximately 3,064 visits to the inhalation tent, 1246 naloxone kits distributed, and 130 volunteers, plus 48 medical volunteers. They raised over $30,000 entirely through voluntary donations from concerned individuals and organizations.

“If we were not there to provide these interventions, at least 85 people would be in emergency departments, costing the system thousands of dollars, or they would be dead. Not one person has died of an overdose at the Moss Park site – or in any safer injection site or overdose prevention site, in numerous cities around the world. Regrettably, people have died from overdoses in Moss Park during hours we were not open,” said Boyce.

The overdose prevention site at Moss Park is opened daily from 4:00p.m. to 10:00 p.m. and staffed by people who use drugs, injection drug experts, frontline harm reduction workers, nurses, nurse practitioners, physicians, and other concerned community members. All of its funding is raised through crowd-funding and donations.

Opioid drug poisonings and overdoses result in people not being able to breathe, which can result in brain damage, other health issues and death.

These overdoses can be stopped or reversed with close monitoring, stimulation, provision of oxygen and, when necessary, administration of naloxone, a drug that temporarily reverses opioid overdose.

As someone who does outreach, Nurse says the key thing is to develop trust with people and, in that relationship, they will “begin to reveal who they are and where they’re at”.

He cited the example of a Somali man who approached him, recently, to ask for some kits for himself and others in the Gerrard Street and Sherbourne Street area. He said the man’s friends had not disclosed their issues, so he wouldn’t ask him.

Nurse said governments can fund certain programs, but do not really respond to the exact needs that people using drugs have.

In order to stop people from falling through the cracks, he said the outreach and service agencies are able to bridge that gap.

Nurse said African, Caribbean and Black (ACB) people using drugs hide that fact because of the stigma applied to the use and the shame that they live with.

Hopkins says there is so much stigma and discrimination associated with injection drug use that people sometimes don’t want their family members to know, or their friends to know, so that can be a barrier.

Shaun Hopkins, manager of the Needle Exchange Program at Toronto Public Health. Photo contributed.

Shaun Hopkins, manager of the Needle Exchange Program at Toronto Public Health. Photo contributed.

She says if their friends and family members do know that they use opiates then TPH would be willing to train a family member or a friend to have them come in and get a naloxone kit, so that they can intervene if someone is overdosing.

Hopkins said it is a serious situation affecting a number of different people, and people are dying and it’s a public health emergency.

“One of the barriers, I think, is that stigma and discrimination about drug use, and so some people don’t let the people that can help them know that they’re using. And that’s an important step because those could be the people who are intervening if they do overdose.”

She noted that there are concerns about some of these programs, like the supervised injection service, that it’s going to bring people who use drugs into the neighbourhoods where these services exist.

Hopkins said TPH has tried to create three fairly small, supervised injection services for the people who are currently using its services. They are at The Works, at Parkdale Queen West Community Centre, and at South Riverdale Community Health Centre.

“They all have existing harm reduction programs, so what we’re doing is putting injection booths and making injection services available to those people who are already using that service. These are life-saving services — harm reduction – they’re proven to work and not to increase the likelihood that people are going to use drugs. And that just makes it safer for them, and so, being more accepting, we know here, that people are going to continue to use drugs, despite our best prevention efforts at public health and other organizations throughout the city and the country.”

Hopkins said people use drugs for a variety of reasons: to cope with trauma, mental health issues, or perhaps it was an injury that they sustained and they were prescribed pain medication and that got out of control a little bit for them.

She said these are people who TPH is trying to do everything it can, to ensure that they receive dignified services, that they have a place that’s clean and sterile for them to inject the drugs that, up until now, they’ve been forced to inject, sometimes, in an alleyway, or in a public bathroom.

“It’s not very hygienic, they’re rushing, they could overdose and no one would know that they’re there.

“There are a number of initiatives we know that they work and they will have an impact in preventing opiate overdose, so we need to implement those programs, now, and do everything we can to make those programs as accessible to people as possible.”

Regarding the media attention the opioid crisis is receiving now, Hopkins said it seems to be a new phenomenon, but The Works has been in existence for over 25 years and, over that time, TPH has been delivering harm-reduction services, including distribution of injection supplies, supplies for safer crack-smoking, and overdose prevention.

They have also trained, in the past, a number of their clients on CPR, so if they or someone that they’re using with is experiencing an overdose, they’ll know how to intervene.

She said TPH started its naloxone distribution in 2011, because they did not want to wait until there were a number of deaths, but instead, wanted to prevent every death that they could.

“The one very concrete thing that we could have offered people at that time was naloxone. Supervised injection services had just been made easier to apply for – there’s funding now, its becoming part of the array of harm reduction services across Canada. Harm reduction programs have been operating for a number of years to prevent overdose deaths,” she said.

Hopkins thinks TPH has done a good job, however, the difference now is that there are more dangerous drugs on the street.

“There is more fentanyl available, it’s higher potency, and people who inject that run a high risk of overdosing. And there’s also fentanyl in some of the other drugs, like heroin we’re finding here, and so the numbers of overdoses are going up.”

She said there has been media recognition of the problem and that it is a North American issue, certainly Canada-wide.

“I think there’s more attention because there are higher numbers, but we’ve always lost people, unfortunately, and every life that we’ve lost is preventable so we need to put these things in place to prevent further unnecessary deaths.”

Hopkins said the more programs that they can get up and running, more supervised injection services, maybe mobile services to get to more hidden populations – all of these will help.

There are a lot of places in the City of Toronto that are far from the three federally-approved supervised injection services that are going to be fully opened this fall and winter, and so they need to do some development, she said.

“I know in DC they have a program, a supervised injection service specifically for women. Now, maybe we need to get to that level of specialization for different groups that don’t feel comfortable coming in to the existing program. So, I think we need to work hard at making these services as accessible as possible.”

Going forward, Hopkins said they would be implementing drug testing, just specifically for fentanyl, using test strips that will detect fentanyl in the drugs that people are bringing in.

“Some people actively want to buy fentanyl on the street and so that’s what they’re looking for and, hopefully getting it, if that’s what they’re paying for. And then other people will be purchasing heroin and not looking to get fentanyl. And so these test strips will be able to detect if there’s fentanyl in the drug, but it doesn’t detect potency so, there’s a need for something. We’re applying for some money to be able to do more specific testing, in terms of potency, so that people can make a more informed decision about their drug taking limit here,” she said.

Nurse said many people who attended the funeral of one of the overdosed persons he knew, only understood that the person had a sudden death.

“I heard from that family a lot of shame that the person was actually an intravenous drug user or drug user, period, and a lot of shame that they weren’t able to intervene and save them. A lot of guilt and a lot of shame and families, I find, in our communities don’t really disclose that.”

He said a lot of that also has to do with how the ACB communities approach drug use as “a moral defect, a defect in character, and in so doing, we don’t build supports and agencies that allow people to come in and feel welcomed”.

Nurse said whenever he gets the biggest reprimand for doing harm reduction outreach it is usually from people within the African-Canadian community.

There is one man who persistently reminds him that he’s doing the devil’s work.

Nurse says he is willing to listen to people’s points of view, but will continue to do his work, with the hope that, over time, they will change their views.

“But my question is usually, in my mind, so this is what I’m doing, what are you doing? Because it’s easy to sit on the sidelines and judge, but that is what we do. I find, in a way, that it allows us to not have to feel any responsibility. Sometimes, it is a weight to look around you and see brothers and sisters suffering and feel powerless to do anything about it. And if you could get that mindset that, hey man, they’re doing their stuff, I’m doing mine, it allows you to take your hands off and walk away with a certain comfort, but our drug use is hidden, there’s a lot of stigma.”

Nurse also knows of another family, in which a cousin was struggling, but other people in the community didn’t know.

Nurse feels that trust and safety are missing on the street for people who use drugs. Photo by Neil Armstrong.

Nurse feels that trust and safety are missing on the street for people who use drugs. Photo by Neil Armstrong.

When she was away, they thought she “just run away with her worthless ways”, but she was a drug user and she was struggling with it. So when she died, the family didn’t say she died of a drug overdose. A member of the family shared the information with him.

The person knew that he did harm reduction work and would ask him, from time to time, about various things.

He said, at present, there is a woman in Brampton who is suffering from the results of a drug overdose, and the only reason that is known is because the story made the news. There is a battle between the family, who wants to keep her on life support and the hospital that wants to take her off.

“Buried inside there is the mention that it resulted from a drug overdose. If it wasn’t for that big story that she was in that situation, due to a drug overdose, it probably would not have come out,” he said.

The harm reduction worker said if one were to visit South Riverdale, or Moss Park, there are usually memorials to people who died as a result of their drug use.

“You probably wouldn’t find any names from the African community on any of those memorials because, for one, most of the African people would not really want to associate in that community to say, hey, I am an intravenous drug user. And we have no contact with people who feel safe enough or supported enough to come and say ‘I’m going to let you know that I’m a drug user. I’m going to come in here regularly and get your support. I make my statement. I disclose myself and I will live as I am,’ so we don’t have that kind of connection in the African community. Most of the services for drug users in the African community are supported by churches and churches are very judgmental, in terms of drug use,” he said.

He said the Taibu Community Health Centre in Scarborough is guided by a harm reduction philosophy and is the only African-based service organization he knows of in the city.

In terms of areas in Toronto, like Jane and Finch, Woolner Avenue, Falstaff Avenue, Vaughan Road, Ossington Avenue, Nurse said, apart from the outreach of Black CAP, he knows of no organization that focuses on this community.

Nurse said one of the challenges and one of the setbacks from that, is that people do not come out for the supports where they are.

The harm reduction worker said he was using crack cocaine for probably about 15 years, before he found out where to get a clean crack pipe.

“I used to see people with them now and then. I didn’t even know where they existed and that was before I became homeless — because once I became homeless then I had to come into shelters and stuff and I got exposed to the broader services that were there.”

Nurse said he hid the fact that he was homeless and would hide and sneak into buildings within his community and would sleep on the top of the stairs, and hide underneath after they were closed.

“I didn’t even know that there were shelters available that I could come and walk into and sleep, because I didn’t want anyone to know that I was homeless,” he said.

Nurse said there was a time when people didn’t want anyone to know that they smoked crack, but then crack use is a thing that will reveal itself.

He said needle use can be hidden and it is hidden. “It is hidden from the stigma, from the judgment and from the shame that exist in our communities. And they’re people dying from it. You see the one thing about African people who use intravenous drugs and living in that community — that sort of transient homeless community — is that people disappear. You just lose sight of people, you don’t know, and this is all people – white, black, Chinese.”

Nurse, 66, has not used any drugs in five years. He remembered just before he stopped using in October 2015, that in July of that year, he had an overdose.

“I had stopped using and then I started to use some marijuana and the reaction was kind of sudden. And my heart muscles went and I collapsed at South Riverdale. I went there for coffee and I collapsed there, and they called an ambulance and I was taken to hospital, and I was told that I had a muscle spasm of the heart.”

He remembered that while in hospital they were doing some tests and assessments. He was there for three days and, one morning while walking towards the nurses’ station, he overheard a conversation about the demand for beds and how they could meet it.

Nurse heard the head nurse say, “What about that guy there in bed three, we might as well kick him out because all he’s going to do is go back out and get high again, so why are we wasting the bed on him?”

It took a while for him to realize that they were talking about him.

“That is the way that the authorities treat people, particularly if you’re a black man dying from drugs, they’re like why are we going to bother anyway.”

He said this is the tragedy of drug use in general, intravenous drug use in particular, and this overdose crisis is that it is hidden.

“Until we decide to embrace human beings as human beings, it is going to remain hidden, and we will continue to feel the tragedy, because the impact of it hits because we’ve got children who don’t have parents.”

He said there are families who lose productive members and they don’t get support from the community.

“It’s not just that one person dies when using drugs. It affects generations and we turn our heads from it and pretend that it isn’t happening and we judge the people that it’s happening to. But, if we look, harm reduction didn’t start in the black community, it started in the white community. It’s because people started to care about each other and figured these lives are important, these lives have value, just like ours, and they opened up to it and they made a stand,” he said.

Nurse said the pop-up overdose prevention site in Moss Park is another example of the government not responding to the need.

He said for years there was a long discussion about pop-up sites and the need to change the law so that people wouldn’t get arrested. Then they had to do renovations to the buildings, he said, in order to accommodate and all the while people were dying.

“It took a group of volunteers – harm reduction workers – who started with handing out crack kits and decided, we’re going to organize this thing, we’re going to get nurses, and boom, one day they set it up in the park. Cut through the red tape, cut through the government stalling, and the harm reduction pop-up site was in the park, happening.”

The harm reduction worker said this has transformed city hall and that he has never seen such political currency, in terms of changing people’s attitudes and people’s positions.

“All of a sudden, The Works, which is a Toronto Public Health operation, all of a sudden they were going to do a quick emergency site. None of it happened until the people on the ground – the harm reduction workers – figured, ‘Look, we’re dealing with this every day. The people are dying, we know we need this site, let’s just do it.’ Because then the commonsense of it, the practicality of it is right there and nobody can say, hey don’t do it. Even the police in this division decided, you know what, you guys have organized this so well, we’re just going to not bother you, we’re not going to arrest anybody,” he said.

In his analysis, Nurse said if one looks at the current change in laws around marijuana use, where there is an effort to legalize recreational use of marijuana, it is happening mainly within communities of people outside the African community.

“If you look at the discussions around setting up dispensaries, it is outside of our community, yet all of this marketing and all of this is happening on the backs of the efforts that were made within the Black and Caribbean community. People have gone to jail to establish this market. I looked at the price that they said that they were going to charge – $10 – that’s the price that was developed within the African Caribbean community.”

He said there are black people who got criminal records from within that marijuana industry and that hasn’t been addressed.

“We’re going to have a community that is going to lose substantially the money that has been generated from the sale of marijuana. But yet, we, as a community, continue to maintain the stigmatization and the shaming of people who operate in the drug industry, rather than advocate for changes in laws and changes in practices, so that people can develop and join into this market in a respectable and meaningful way.”

The harm reduction worker said there are people in jail who are from the community and when they come out they will come back into the community and there is no mechanism for welcoming them back – in terms of skills development or making them feel that they can live.

“This is an opportunity to raise awareness. It is an opportunity to say, hey, what about this, what about that, because we don’t talk about it. We don’t talk about it and it hurts,” said Nurse emotively.

Shannon Ryan, Executive Director of Black CAP, says staff has participated in a range of training, including naloxone and fentanyl.

Shannon Ryan. Photo credit: Neil Armstrong.

Shannon Ryan. Photo credit: Neil Armstrong.

“I think, as an organization, we really recognize that harm reduction and drug use is not just siloed in the harm reduction program. Drug use really affects all of the populations that Black CAP works with – people living with HIV, queer communities, homeless communities, under-housed communities, people on the street – and as a team, we need to build our capacity to be able to work with those communities and to understand the context of risks and how to respond to some of those risks, should an overdose present itself in our reception area. I think there’s a real good chance that could happen. I think we want to make sure we’re an open space for all folks that Black CAP works with and as a result we need to be prepared to create as safe a space as possible.”

Ryan said they will be doing additional training in this area as well, because although they are better prepared to respond to this issue, they’ve got a lot more work to do.

Nurse noted that community health centres are accessible and they are welcoming.

However, he said a lot of agencies, even ones that say they’re following a harm reduction philosophy, are not welcoming and they discriminate.

“Even when we, as a people, work within agencies that follow a particular philosophy or set of policies, we still bring about that judgment and shaming on people, even by the way we look at them, the way we talk, the way we answer questions.

“But community health centres have developed and are developing a lot of good programs that are welcoming to everybody. And I find that is our best access really, to awareness, to education, that builds awareness, and also to resources that help us develop skills and to deal with challenges.”

Nurse said the challenge is that within areas, where there are high populations of African people, there are no services available, and he describes this as a tragedy.

“It’s like saying, we don’t deserve this service. We don’t deserve this care.”

Ryan said there is historical underinvestment from government, in relation to black-specific services doing this kind of work.

He said Black CAP and Taibu are the only two organizations in the city of Toronto that are funded to do this type of work, specifically, with black people and substance use.

“This is for a population of more than a quarter million people in a community where substance use, as much as we want to deny it, is incredibly common, whether it’s alcohol or marijuana or crack or what have you.

“We’re not seeing as much investment as we need. We need the government of Ontario, we need the City of Toronto to really double and triple and quadruple its investment in these areas. There’s a gap in services, but it also comes down to governments recognizing they need to invest in services in this area,” he said.

In terms of how family and friends can help their loved ones, Nurse said first, there has to be a connection, somebody has to initiate that connection.

“Even if it’s a family member saying, okay, let’s reach out to support, like to grieve, to strengthen, to talk because that isn’t happening and dialogue has to happen and if there’s no dialogue happening there’s nothing happening.”

He wants to see the embracing of people in the ACB communities who have made decisions “that have developed more challenges in their lives than everybody else”.

“We need to recognize that people are hurting, and that when people are hurting within our communities, our communities hurt,” he said.

Nurse thinks the biggest barrier is shame and self-esteem.

“I mean supports are necessary, but in terms of creating an initiative, I don’t think people realize when you’re in that place where you feel like you’ve exhausted everything and you feel worthless. It comes with that sense of being powerless to change anything.

“At that place in time, you’re really looking for an opening, you’re looking for a reason to believe. That is where the community comes in. You’ve got to develop that sense that, as a community, we’ve got to be based, really, on compassion and encouragement. We’ve got to be giving people hope. If we’re not doing that, then we’re not really functioning as a community. Those are the things that I find that we need to build.”

The harm reduction worker said there is a movement within government to recognize that funding is necessary to provide people with safe space, and there’s also a change in the mindset of police, “in particular, so that what is happening here, is that where there was a broad criminalization of drug use, at least now there’s an opening of response as a health crisis rather than as a wave of crime. That, in and of itself, is a huge change.”

There is an after hours harm reduction drop-in held, once a month on Wednesdays, at Black CAP.

“It’s a drop-in, where we invite folks who are street-involved or under-housed, who typically live in downtown Toronto, to come in and participate in, I think, a couple of important things. One, is a safe space where you’re not, hopefully, going to be judged for your history with substance use. You’re just going to walk in and you’ll be, hopefully, among your peers and not experience judgment, rejection. It’s also an opportunity for us to do harm reduction education with folks, to say, this is emerging practice, do you know what an overdose looks like, do you know what to do, do you know the risk related to this drug or that drug so we can do some of that work. But also, I think, more often than not, it’s just a space for black people, who are using substances, to come together to have a conversation about the issues that are most important to them that day,” said Ryan.

Nurse said trust and safety are missing on the street for people who use drugs.

“To find a safe space, that is a gem, where you can open up to people around you,” he said.

Meanwhile, Hopkins said, at the TPH safe injection site, people are able to inject their drugs that they bring in, and that there is a bit of a misconception for some people that TPH is providing drugs for injection, but they are not.

“People bring their drugs into the site and they go through a bit of an assessment. It’s a very brief assessment about the drugs that they’re intending to use. Have they had any overdoses in the last little while? Is there anything that might be affecting their tolerance and the likelihood that they would overdose? Because that just helps us to be more ready, so if we know that someone is bringing fentanyl in, we’ll be a little bit more on guard about watching them for signs of overdose. Or if they’ve been sick or in jail where maybe they’ve had a break in their use, or their tolerance is down, then we can watch them closer,” she said.

Hopkins said after the assessment, they are placed in the injection area where they sit at a table and inject their drugs, while staff supervise from a respectful distance to make sure everything is okay.

“If the person needs help with what needle to use, what injection supplies to use, not everybody is really good about knowing what all the harm reduction supplies are and how to use them properly. So, we’ll help with injection technique if people need help with that, if they’re having problems finding a vein or they’ve had a lot of injection-related wounds helping them to prevent that in the future choosing another site where they can inject into maybe some vein that they hadn’t used before.”

She said they try to keep people for about 15 minutes after, because if they’re going to overdose, it will probably happen within that time.

The manager said if someone overdoses they will intervene with some oxygen or naloxone and call 911, if the person needs that level of medical intervention.

While they are there, TPH also provides counseling and support so if they want to talk to a staff member they can, or if they prefer a peer with lived experience that they are more comfortable with talking about what they’re experiencing they can do that too.

Toronto Public Health (TPH) also gives take-home naloxone, so if somebody is an opioid user or uses with other people who are at risk of opioid overdose, then TPH will provide them with a naloxone kit and make sure that they know how to use it.

If the substance user comes in with someone else, then they also make sure that the person knows how to use the naloxone kit.

The public health department has also provided referrals, counseling and support to a number of the people that have come in to use the site.

Hopkins says what TPH recommends to people is that they have family members or friends get trained on how to use naloxone, how to recognize overdose, and then how to intervene, even if it’s just calling 911 and staying with the person if they don’t feel comfortable administering naloxone.

“But we’re distributing, right now, the intranasal. I’m sure it’s daunting for someone because you don’t have to use needles and people are concerned about that. It’s a lot easier to administer the intranasal,” she said.

Meanwhile, Boyce thinks the response from the city and the province to the opioid crisis has been late in the game.

“We’ve been sitting in that park, since August 12, doing this and we were there in the first place because of the slowness of the response, so the opioid deaths have been something we’ve known. This has been happening for over a decade now in Ontario, just ever-escalating so, from a harm reduction perspective, we’ve been warning about this, talking about it for a long time,” he said.

He said the opioid epidemic is now starting to get attention because it is the middle class, white people who are now being affected and dying.

“When you get pictures in the paper of young, white girls, that suddenly gets a lot more attention than it used to. That’s a sad reality of the world.”

Boyce referenced a January 2016 article on the Vox website entitled: “Why are black Americans less affected by the opioid epidemic? Racism, probably.”

The writer, German Lopez, alludes to a story in the New York Times that doctors were more reluctant to prescribe painkillers to minority patients, worrying that they might sell them or become addicted.

“The disproportionate impact of the current epidemic on white communities, however, may be one reason the response to the crisis has been fairly different from the response to previous drug epidemics. While the crack cocaine epidemic, for instance, produced a response mostly through the criminal justice system, the opioid epidemic has led mostly to a public health response. Race offers one explanation for that historical discrepancy,” Lopez writes.

Boyce said the Ontario government’s attention to the issue and publicly stating this and putting resources publicly into it, recently, is a recognition that these kinds of approaches – the harm reduction approaches – are effective.

“And the larger implication around that is, really to start talk about this idea of decriminalization. What we’ve done in Moss Park is really create a space where drug use has become decriminalized so the police do not come on site, they don’t harass people on site, they don’t arrest people on site. That has huge implications, in terms of people’s safety and overall health,” he said.

Boyce said the research for the three permanent supervised injection sites – ones involving the formal process of applying for an exemption to Health Canada – was done over five years ago. At the time the suggestion was to have five sites across the city.

In order to operate a permanent site, the city or province needs an exemption from Health Canada, so that staff or people coming on site to use do not get charged with drug possession.

Boyce said the three permanent sites are still not actually open, but should be within the next month or two.

He said TPH recently had a soft launch at the site at Dundas Street East and Victoria Street. They’re just waiting for some final equipment to be brought in so that permanent site within the next one to two weeks will be up and running.

Boyce said, over the five years it took to make a decision about the three sanctioned sites, the numbers have continued to escalate, more people are dying and the drug supply has become more and more toxic.

Nick Boyce, the Director for the Ontario HIV and Substance Use Training Program, is also a member of the Toronto Overdose Prevention Society (TOPS). Photo credit: OHSUTP.

Nick Boyce, the Director for the Ontario HIV and Substance Use Training Program, is also a member of the Toronto Overdose Prevention Society (TOPS). Photo credit: OHSUTP.

“So there’s a reason we’re in Moss Park, because there’s a lot of overdoses and deaths happening in that neighbourhood and none of the three permanent sites service Moss Park.”

He said some people thought, that once the site near Dundas Square opens, people who use drugs from Moss Park can head over there, but that won’t necessarily be the case.

“Well, that might be true, if you have legs you can walk on and bus tokens, and don’t mind dealing with tourists. But we know, talking to folks in Moss Park, these are very marginalized people, highly stigmatized. They’ve had trouble with the law; they’re not going to leave their comfort zone or their immediate neighbourhood. Or if you’re in really bad physical withdrawal from drugs and you’ve just got some new drugs to take to stop feeling sick, you’re not going to wait to go somewhere, you need to have services easily accessible.

We talk about low threshold services, so for sure there’s a whole bunch of people in Moss Park that are never going to leave it. But it also means there are other pockets in the city where people are not going to leave their immediate neighbourhood. So we need to make things easy and accessible for people and that means opening sites elsewhere across the city.”

Boyce said TOPS does not have the resources to keep doing that because it is entirely volunteer-driven.

“It’s going to require some sort of government support to start opening more sites. It doesn’t all have to be these big fancy facilities. Sometimes, it’s literally a room and a table and a couple of chairs and someone just to look after you. I’m not sure what’s going to happen, moving forward, but the fact that the provincial government is now sort of dedicating resources to Moss Park, is an indication, I think, that they recognize the value of that kind of service.”

On November 1, TOPS and the THRA held a press conference at Moss Park, calling for government help as the winter approaches, and they continue to provide life-saving health services outdoors in makeshift conditions.

Since early September, both groups have been engaged in discussions with municipal city councillors, representatives from the Toronto Central Local Health Integration Network (LHIN), Toronto Public Health, and Fred Victor Centre, on a plan to sustain the essential lifesaving services and move the operation indoors for the winter, notes a press release.

Given the significant number of people accessing services at the Moss Park site, the ongoing number of overdoses in the area, and that none of the three federally-approved permanent supervised injection sites will service people in the neighbourhood, there was recognition of the need for a permanent site in the immediate area.

A local agency, Fred Victor Centre, expressed interest in applying to Health Canada for a federal exemption to open such a service, which would mean neither clients nor staff would be at risk of criminal prosecution for drug possession while receiving or providing this health service.

However, this is a lengthy process that would take many months; therefore, in the meantime, TOPS believed there was an understanding with the City and Fred Victor to allow the existing Moss Park OPS [Overdose Prevention Site] to move into the basement of Fred Victor Centre, located near by the current site, and to continue to operate without a federal exemption, until a sanctioned site was ready. The province, through the Toronto Central LHIN, supported the idea and made money available to help operate it, the release said.

“Unfortunately, the City of Toronto and Fred Victor Centre have now backed out of this arrangement; the deal we had been working on since early September has fallen victim to the same forces of bureaucracy and official indifference that have already contributed to so many preventable deaths,” said Zoë Dodd of TOPS. “As yet, the City has failed to collaborate with us to find any alternate interim solution.”

They demanded that the city and province take immediate action to support the sustainability of the Moss Park overdose prevention site.

“The city must work with us to procure a nearby indoor space with electricity, running water, a bathroom, and heat as soon as possible. Until then, the City should assist us in procuring a temporary construction trailer and a place to put it in the immediate vicinity.”

They also asked again that the province publicly declare its support for the vital work of overdose prevention sites in Ontario in responding to this crisis, and to provide the immediate, concrete support these services need to operate and expand.

“The provincial government and provincial public health authorities have the power to take such steps. We also call on the federal government to relax the rules and process for opening sanctioned sites; unnecessarily bureaucratic processes continue to contribute to hundreds of needless deaths,” they said.

One day after the press conference, Dr. Hoskins announced that the province’s Emergency Medical Assistance Team (EMAT) would be dispatched to set up an insulated and heated tent at Moss Park.

Since its installation, harm reduction workers have complained that the province told them that open flames used to heat drugs inside the tent would be a fire hazard, because of the presence of oxygen tanks in the tent for overdose monitoring and resuscitation procedures.

As a result, the workers are back to using their unheated tent where people using drugs can use their lighter to heat their drugs.

In the meantime, the province is exploring alternative heating methods to find a solution to the matter.

In a memo to the chair and members of the Board of Health in September this year, Joe Cressy, chair of the Toronto Drug Strategy Implementation Panel, focusing on urgent additional measures to address the overdose crisis in Toronto notes that: “While we do not have ‘real-time’ information about overdoses, we know from community service providers, including people who use drugs, that many more overdoses are happening and too many people are dying as a result.”

The memo notes that the Board of Health (BOH) approved, Toronto Overdose Action Plan,

contains many measures that will help address the overdose crisis but they are not being implemented fast enough to address the current situation.

“We need action now to save lives,” it says.

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