Doug Ford: I don't want to hurt these people. I want to help them. I want them to be productive.

Jan: That was Premier Doug Ford back in March, talking about people with substance use disorders and defending his government's decision to stop supporting Ontario's last publicly funded supervised consumption sites. There were eight of them left, and the funding ran out on June 13th, and sites in London and Ottawa shut down for good last week. The Premier has made his feelings clear.

Doug Ford: What? I don't believe in sticking these injection sites in the middle of a community down the street from a from a school. Needles are all over the place.

Jan: So the government will be going in a different direction. It's investing in homelessness and addiction recovery treatment, also known as HART Hubs. But many experts and frontline workers say that closing the sites will cost lives and that HART Hubs aren't the answer. So we're going to look at how these closures and the safety concerns that drove them are affecting communities across the province. Then we'll look at a new initiative that will connect vulnerable Torontonians with primary care right outside their local library. This is The Rundown. After a woman was killed outside a community health centre in Toronto in 2023. The province conducted a review of supervised consumption sites. It's since introduced a new model and as of this month, cut off support for publicly funded sites. From Odessa, Ukraine. Adam Zivo is a journalist and a columnist for The National Post from Montreal journalist and writer Emma Paling. And here in studio Martin McIntosh is the executive director of the regional HIV Aids connection. Thank you so much for joining us. Thank you so much for joining us in studio. Really appreciate it. Martin, I want to come to you first. What are the thoughts on the closure of provincially funded safe consumption sites across Ontario? You obviously essentially run one run one up until this past weekend in London, Ontario. But what are your thoughts just overall?

Martin McIntosh: Well, I think one of the first thoughts is one of grief. Yeah. And I'm talking about the real human grief related to loss of life and an ongoing crisis that isn't going away. With the closure, there will still be the toxic drug supply. There will still be the need to connect people who are using substances to care and to support. Definitely one of grief and a big challenge for our community.

Jan: Adam.

Adam Zivo: I would say this is long overdue because the evidence clearly shows that supervised consumption sites do not save lives, and that they dramatically increase crime in their immediate vicinity.

Jan: And Emma.

Emma Paling: I would echo what Martin said, which is right away, there's a feeling of grief, especially when you're inside the site, spending time with people who use them. Safe consumption sites have reversed 68,000 overdoses in Canada, and each one of those in a different setting could have been fatal, could have caused permanent brain injury paralysis and a whole host of other permanent health issues to the people experiencing the overdose.

Jan: All right. I want to get a better sense of sort of the inside of what, you know, one of these sites looked at. So, Martin, help me understand. A CTV news report says that Carepoint, the site that's now closed in London, recorded 15,000 visits and responded to 218 overdoses last year. What did the day to day look like in that clinic?

Martin McIntosh: Well, the day to day in that clinic, we actually took a lot of time in consulting community and looking at best practices to eliminate some of those harms to broader community. It's a standalone site and people could come there to use pre obtained drugs in a safe and supervised way. We do not sell drugs. We do not encourage that. But what we do is make sure that if there is an overdose response needed, we are there to deliver that for those individuals. But it goes beyond that. We actually connect people to care, to treatment, to other social supports.

Jan: One of the criticisms, I think a lot of that some people share with these sites when they were existed were that people weren't necessarily using them physically in the space that they would come in, grab sort of the tools and things that they needed, and then they would go out into the neighbourhood. Was that what was being seen in your in your clinic?

Martin McIntosh: No. We build that trust relationship so that people understand and can use those services fully. With the closure of that, we no longer have spaces where people are actually using under supervision. We can get rid of the discarded gear that we would see out in community without. We're losing that, and we're also losing that important connection to additional supports up to treatment, medical supports, as well as social supports.

Jan: Emma, you've come to know and report on the people that were using in Moss Park at the site there and the staff who work there help me understand how have they been feeling sort of up to the run up of the closure of these sites?

Emma Paling: There's a range of emotions, for sure. The day that the closure was announced, there was a lot of grief. You know, when somebody came through the door, they said, who died? Because everybody was sitting on the floor. It was very quiet. It was very sombre, a lot of tears. People are scared. They're mostly scared for their friends. You know, these are people who experience the rise of fentanyl in the mid 20 tens, and they've seen a lot of their friends die. A lot of people have had their spouses die of overdoses. So there's like this very extreme fear of what will happen. And then since the runway was three months, the site kind of returned to day to day. But there's been, I would say, more mental health crises since the closure was announced. People are feeling afraid for their friends. Some people are trying to make plans for the closure, but a lot of way too precarious to really plan. They're just worried about finding somewhere to sleep tonight.

Jan: Adam, there's a couple of points that have been made that I'm sure you want to get in on there.

Adam Zivo: Well, I would argue that this fear for their safety is unfounded, because the data clearly shows that these sites do not save lives. So last year in Toronto, we shut down five sites. Well, nine in total, five in March and then four additional ones throughout the year. And fatal opioids rates did not increase at all. In fact, they were at their lowest level last spring and summer than they were since 2019. And they've remained low. So we've heard all of this fear mongering about there being an explosion of deaths of these sites close. We close the sites in Toronto. We didn't see that explosion in death. Furthermore, in Alberta, they closed a supervised consumption site in Red deer and then did a study where they compared it with a similar city and which still had a supervised consumption site. And they saw that there was no increase in mortality, no increase in hospitalizations, no increase in opioid related ER visits, the evidence base for safer supervised consumption sites have always been really shoddy and low. And this evidence base was politicized from the very beginning. Back in 2003, when Insite was opened, the evaluation contract for that pilot program was given to an Organization that employed two doctors who lobbied for the insights creation, and they were tasked with producing the evaluations for Insite, even though that was clearly a conflict of interest. They subsequently produced over 30 evaluations, all of which were glowing, which then became the foundation for the evidence base for for supervised consumption sites. The RCMP then, around 2006 and 2007, hired their own external evaluator to assess these evaluations. And he found that the studies actually misrepresented the underlying data. We also have another study that was published, a version of it, which was published in late 2024, which looked at supervised consumption sites in Toronto and found that crime dramatically increased within 100m. But then when you look to 200 and 500m, that that increase was diluted and was no longer statistically significant because, of course, when you add in a larger area, that dilutes the crime in the immediate vicinity of the of the site.

Jan: Okay, let me. Get production researcher. Sorry, Adam, I want to get Martin in here. Obviously, you're not based in Toronto, you're in London. But help me understand a couple of points that that Adam made there.

Martin McIntosh: I think that when we look at all the evidence that is being gathered, and I think we will continue to look at this very closely as we move forward. I think that when you you mentioned the lack of overdose deaths in relation to the closures that have happened, I think we need to also look at other parts of the system that have been picking up those strains. So when we look at the number of EMS calls, the number of hospitalizations, picking up that that that gap, that supervised consumption sites have been delivering is really important to look at the holistic picture. And I think sometimes we just zero in on one piece and don't look at the whole picture. These will have significant impacts. And we've seen it in other studies in relation to those closures for EMS and emergency services, as well as for many other parts of the system.

Jan: And I'll get you in on there as well.

Emma Paling: Yeah, I just think to say that somebody is fear mongering when three years ago, they woke up next to their dead spouse to say that their fear mongering when they say they don't want that to happen again and they're scared, really unfair comment to make. I've been inside one for 18 months. And I think it's just a really unfair characterization to say that those overdoses that are happening in a site like Moss Park, where I've been to say they would have no effect elsewhere, is just false. Moss Park reversed 62 overdoses just in March, and each one of those overdoses, it could have been fatal. It could have had a life changing physical disability as a result of those. The evidence is just really clear, actually, that these sites reduce deaths. They reduce other health harms, and they do connect people with services. There's there has reduced his drug use from 17 points of fentanyl, which is 1.7g a day, down to one point because Moss Park connected him to a methadone doctor who actually comes on site and has those appointments with people at the safe consumption site. So those are just a few examples of the ways that the site has improved not just people's lives, but the whole community. In addition to saving 62 lives just last March.

Jan: Now we can gather from our conversation here that, you know, many people argue that harm reduction provides important public health benefits. But as Adam mentioned, you know, Neighbourhood opposition remains strong in many communities. We can just look at, you know, the one that has that's been in headlines in 2023, a stray bullet killed Karolina Huebner near the keepsakes consumption treatment service at Toronto's South Riverdale Community Centre. And I want to read a little snippet. This is from a 2024 Toronto Life article that described sort of the community fallout that followed, and it goes in the weeks after the shooting, two factions had emerged and become entrenched. One side believed that the centre had proven it couldn't handle the assignment, and that this failure had dire consequences. How many deaths would be enough? They didn't want to find out. The other side believed that the site's clients had just as much right to the neighbourhood as anyone. That in fact, they had been there long before the new wave of residents and wanted keepsakes to stay put. Moving the consumption site away from the health centre would cut its clients off from other forms of treatment. With that, Adam, what has been the biggest point of contention for people concerned about safe consumption sites in their neighbourhood and communities?

Adam Zivo: Well, people like to feel safe and they don't feel safe when they have violent addicts around them who are often threatening them and their children. And Derek Finkel, my colleague at the National Post, has reported extensively on this. Stories of, for example, people who are high off of their minds, threatening to burn down houses and emphasizing that they would do so even if there were children inside, people being threatened by drug dealers. Keep in mind that police are often dissuaded from enforcing the law around consumption sites, because they are told that this would provide a barrier. Now we can talk about anecdotes, but I once again, I do think that addiction policy should be driven by data. And there was a Montreal consumption site that was opened back in 2024. And what's interesting here is that within 50m of the site, emergency calls went up by 1,967% within 250m of the site. Crimes against people increased by 800%, sorry, 93% and mischief calls increased by 800%. So we have the data that consistently shows, you know, going back to the other study that I cited earlier, that these sites are engines of public disorder, and keep in mind that this is only just reported crime.

Jan: With that, Martin, can the two sides find consensus in sort of what works, what's currently in place with HART Hubs? Does that answer sort of some of the questions here, or or do you think we're going backwards with the closures here?

Martin McIntosh: I think that we certainly are going backwards. And when I say that it's it's recognizing that substance use and addiction is really complex. We're talking about two different ends of the spectrum. HART Hubs. Definitely, I welcome them. I welcome recovery for myself in my own personal journey. They were wonderful thing. But at the site where someone is actually in addiction, we need to support them. As one of a close friend of mine who has gone through recovery has said where there's a heartbeat, there is hope. I do believe that from the two sides, instead of pitting against each other, what we need to look at is, okay, it's not perfect. So then how do we address some of those issues in a really concrete and good way, where community actually speaks and we listen. And I think that's really important around safety concerns and other concerns, and then mitigate those risks through action. And we've done that in London. I've seen that being worked on in other sites over the time from last year when those sites were closed to today.

Jan: Emma, with the closure of Mosberg, what comes next for the some of the people that you had talked to, obviously, in terms of the timeline when these closures were announced, a short period of window for for people who are dealing with addiction. But what did they tell you as to what they're doing next?

Emma Paling: So the site staff are preparing to continue reversing overdoses, but without any of the tools that they previously had. So instead of reversing overdoses in a controlled environment with access to oxygen in a setting where they know how much the person used and what substances the person use, these staff are going to be carrying backpacks with naloxone and bag valve masks, and they're going to be just responding to people screaming or banging on the door. They're going to be running at full speed around the neighbourhood and reversing overdoses in alleyways, in Tim Hortons bathrooms, in porta potties, in those types of environments. And what Sarah Greig, the director of the site, told me was that this community has taken care of themselves and each other for many decades. People were reversing their friends overdoses before safe consumption sites existed, and they're going to have to continue. Unfortunately, there was a real opportunity here to do something long term, very innovative with addiction, to actually continue these long term relationships and let people build on the progress that they've made over the past eight years, and that opportunity is going to be lost. So really, a group of people who are pretty alienated and living very precarious, unpredictable lives are about to become more alienated, more angry at the government and living more chaotic lives.

Jan: Adam, what would those opposed to safe consumption sites like to see in harm reduction going forward?

Adam Zivo: I think more of a focus on recovery and more of an understanding of the trade offs that come with treating people struggling with addiction. Obviously, we all want people who are struggling with addiction to seek treatment and to survive. No one likes the idea of people overdosing on the streets. However, many people who were formerly supportive of harm reduction strategies who were open to the concept in the late 2010s found that their empathy was exploited and that they were vilified because they were speaking out about the fact that they felt unsafe. So I think understanding that there are competing interests here that need to be balanced is important. And I think that there also needs to be more of a focus on evidence.

Jan: Martin, I'm going to be the last word here in terms of leaving a sort of next steps forward, what you would like to see. But also, as you know, there are two sides to this conversation and has been quite contentious from from the start of it. But what do you want to leave people with in terms of the conversation that we're having today, but also moving forward?

Martin McIntosh: For me, I think that it's not just a two sided piece. There are other elements for the response that are needed when we talk about mental health and addiction, we need to look at prevention as well. How are we responding to the increasing mental health and addiction issues that are presenting themselves? We need more prevention. We need more recovery. We also need to meet people where they're at in addiction to make sure that they have the opportunity to move forward with their lives.

Jan: This is a story that we will continue to follow. Of course, as we know, this only happened last weekend. I want to thank you, Emma Martin, Adam, for your time and for your insights on this very important topic. Thank you so much.

Emma Paling / Martin McIntosh / Adam Zivo: Thank you. Thank you, thank you.

Jan: If you're in Toronto, you may start seeing something new outside your local library branch, a mobile health clinic aimed at connecting more people with primary care. Doctor Andrew Boozary is the executive director of the Guangzhou Centre for Social Medicine. Aly Velji senior manager, adult services at Toronto Public Library, and they both join us in our studios. Great to have you both. How are you doing? Thank you.

Andrew Boozary / Aly Velji: Good. Thanks for having us.

Jan: Andrew. Let's talk about how did the idea of a mobile health unit come about?

Andrew Boozary: So I think there's been terrific work for many decades from community health centres and various community organizations that have been able to try to advance mobile health options to get health care to where people are. And so Sherbourne Health, Parkdale, Queen West Community Health Centre, Anishinaabe Health have had mobile vans or mobile clinics for some time, and we've been able earlier to partner with some of the organizations to evaluate, is this something that can work? What we found in the last few years is that the mobile health clinics are incredibly effective at providing the sort of care that can keep people out of resorting to the emergency department. For 37% of the folks who are able to be seen, they said that actually averted an emergency department visit. So there's a long standing history and evidence base for mobile options, which is really pushing back against the mantra we've had in health care is that if you build it, people will come. The reality is, for folks who've been marginalized from the system, who have obstacles and barriers to reach the system, you have to go out to where people are. And so to me, what's really unique about this work and this initiative is the partnership with Toronto Public Library, who I'm the longest standing fan and public fan of public libraries, and I believe they've been the original social medicine hubs. And so to me, it's a really long overdue marriage to try to ensure that we are continuing to build a relationship and a connective tissue between hospital and community that will prevent more people from falling through the cracks.

Jan: All right. We do have some photos of the van that I want to pull up. So this is the exterior of it. You wouldn't know what's inside of it. And we do have a photo inside just a little bit, a little sneak peek. You can see a bit of a chair setup, a little sort of what you would see in a regular clinic, but there's a little bit more in there. Tell me, what are the services that are provided. Tell me what it looks like inside.

Andrew Boozary: So it's rather comprehensive from the outside. You look at it sort of as a usual sort of van, but there was a lot of work in designing the space. So as you can see at the front, there's a sitting area. Again, we're trying to rebuild trust with people who can sit, have conversations that are private again, whether that's around access to various mental health and addiction supports, or really being able to have a reassessment of where they are in terms of their health care journey. And then in the back of the van, there's a full clinical space, just like where I was working this morning. You've got a bed, the blood pressure cuffs, all of the screening tools that you would need to ensure that you can provide high quality primary care. And so I think that was a lot of the co-design with people with lived experience of what kind of experience would they want and what kind of setting can be as dignified, given that you've got some limitations with a mobile clinic, but the importance of it having the ability to, to provide high quality primary care, and that's basically all the things that you can access in a clinic office.

Jan: All right, Ali, the first one, this this mobile clinic here is outside the Sanderson Library branch near Bathurst and Dundas in the city's downtown core. Why this location?

Aly Velji: Yeah. So I think, you know, as libraries overall are open and accessible spaces. And we serve a lot of individuals, especially those that are looking for social supports and other health supports as well. And this library specifically serves a wide range of a wide range of individuals, including newcomers, including individuals who are under housed and who are looking for those kind of supports. So the Sanderson Library made perfect sense because it was also right next to just across. And I know Andrew and his team did a lot of research as well to identify spaces that that needed that extra support.

Jan: Now, talk to me a little bit about sort of the wraparound services as well that the library provides that people, once they've, you know, gotten in the van, done their check-up. What else are we providing?

Aly Velji: Yeah, for sure. So it's as soon as they visit the clinic, they're able to come by to the library, they're able to meet our staff where we can find out a little bit more about what they need. Of course, we're going to want to make sure that they get a library card. After that, we'll have a conversation with them to find out what else they need support in. So you might have a newcomer family that is looking for some support. So we'll link them up with the library partnerships that we have or settlement agency in the area. They might be an individual who's looking for work so we can help them build their resume. We can also help them with the necessary digital literacy skills that they need. Or you might get an individual who is lonely and isolated and really need some support. So we might be able to allow them, sorry, might be able to help them find out ways to get online so they can get connected or even join one of our many programs that we.

Jan: Have in terms of the, the staffing of the van and sort of the role of the library, but also the health workers there. What's what's the crossover? How many people are actually in the in the van? And then what's the crossover with staff?

Aly Velji: So so I'll let Andrew speak about who's in the van.

Andrew Boozary: Yeah. I think you've nailed it. It's about trying to build one team with the library workers that I think Alise mentioned have done incredible work to try to stitch together different options, whether it's from loneliness to accessing income supports, but they also have a good idea of what some of those needs are of the clients and folks who are in the library. And so the Sanderson branch is less than a block away from Toronto Western Hospital. So you could literally throw a football from the door of Sanderson Branch to the emergency department. And so the reality is that there has not been that kind of connection and relationship between these two institutions that serve many shared patient populations. And so with the mobile health clinic, it's about having a community health worker, an RN, a nurse practitioner from a primary care piece, but also from the mental health and addiction support that can be there. And so that's how the teams are starting to integrate. And beyond whoever's on the mobile health clinic service, it's also about being able to call a community health worker as part of the centre for Social Medicine and say, you know, I'm a little bit worried about so and so. They've seemed to deteriorate over the last few weeks. It may be worth for a check in. And then also vice versa. That might be clinical staff or folks who are working at the hospital or at the centre say, what kind of supports could be there from tax support to housing support to, again, loneliness and isolation, which can't be effectively or fully addressed in the clinical setting or inside the hospital walls.

Jan: Why is this needed? Now? I know this is not something that just you guys put together in a couple of months, those couple of years in in terms of the process here. But just knowing that, you know, what Andrew talked about, the libraries being this hub, I'm sure you guys have noticed that this is a great idea. This is something that we need now. But why now?

Aly Velji: Yeah for sure. I mean, I think we are always facing, you know, individuals who are looking for those kind of supports and we're always doing our best to be able to refer them to other agencies. So I think the the timing was perfect where we were finally able to bring those services into our spaces, allow them to meet supports in a safe and welcoming environment, and then being able to support them in whatever else other way we can.

Jan: I was gonna say, Andrew, I think a lot of people will see this clinic and also see the timing of, you know, funding being pulled from safe injection sites, a safe consumption sites. And I think a lot of people make those connections. But as you mentioned, this has been in the works for a couple of years. But why why now? Or is that timing kind of a good thing?

Andrew Boozary: Look, I think the timing is urgent. Wherever you look across the system, we know that there are millions of people who can't access primary care in Ontario. And again, across the country. That's been a real challenge. And fundamentally, I would say if we believe in a universal health system, you need strong primary care is the bedrock of a high performing system, and we believe in universal healthcare. I think that's what we continue to hear from people across the country, from people in the city. And there have not been enough options that have been able to go out and, again, really partner with community and be able to ensure that there's access. So, one, I think that is fundamentally important in delivering on our promise of universal health care. Two, I think the other realities are that we are facing a toxic drug overdose crisis, that there have been far too many lives lost. And we look at some of the most recent data from Toronto Paramedic Services. There's been a doubling in the amount of non-fatal overdoses, the amount of calls to EMS. And as Ali mentioned earlier, I mean, this is an intersection at Bathurst and Dundas that has seen increasing poverty. We've seen a doubling in homelessness in the last four years in our city, probably a tripling just around the Toronto Western. And so we need a real concerted approach. We need different responses. Mobile health clinics, by themselves alone, are not going to solve the primary care crisis or the toxic drug overdose crisis. But I think it's finally starting to learn both from community, from our partners, from the needs of patients, about trying to mobilize options that have been denied for far too many people.

Jan: I think it's a fantastic idea. I wish we did it sooner, but I want to thank you, gentlemen, I would agree. Yeah, exactly. Gentlemen, I want to thank you so much. Keep doing the great work. I really appreciate your time. Thank you.

Andrew Boozary / Aly Velji: We appreciate it.

Jan: I'm Jan, thanks for watching The Rundown. We'd love to know what you think of the show. So send your suggestions and feedback along to Rundown at TVO.org. Or as always, you can leave us a comment on our YouTube page. Until then, I will see you tomorrow.