Last spring, Toronto’s Casey House opened its second controlled use (SCS) site, an outpatient facility that has a specially designed room for people who choose to smoke their drugs.
More than four months later, this well-ventilated space, which was built at the request and input of the hospital’s clients/patients, is still unused.
“We’ve been in discussions with the province on how to determine the guidelines to open it up. … We really want to move forward on this,” Casey Shaple, harm reduction coordinator for Casey House, told CP24.com.
“If we can open it up, it will be much safer for the people we serve.”
Chappelle said that when staff are available, they go outside to keep an eye on patients who choose to inhale their substances. The situation is not ideal, he admitted.
“This leads to a separation of resources. We can’t 100 percent keep an eye on those inside,” he said, adding that if someone who smokes drugs overdoses outside, the time it takes staff to respond is much longer.
“Having an inhalation site would actually make it safer for our patients and our staff.”
Casey House chief executive Joanne Simons said they were well aware of the “increasing prevalence of inhalant drug use and the significant increase in inhalant-related deaths”.
Just last month in the city, 10 people died of overdoses within five days after reportedly smoking the drug, prompting Toronto Public Health to issue an alert.
Last October, Toronto’s drug strategy secretariat issued another alert following an increase in overdose deaths where drug inhalation equipment was used.
Simons said the hospital also learned through its customers and community members that having “the ability to safely inhale substances is very important” to them, and so with their new outpatient SCS, they sought an exemption from Health Canada specifically to more safe inhalation and have built a cabin for it.
“We are working to offer this life-saving service as soon as possible,” she said.
The proportion of overdose deaths linked to smoking opioids has increased
Currently, in Ontario, the provincially funded Consumption and Treatment Services (CTS) program does not include controlled inhalation services.
However, Casey House does not rely on money from the province to operate its SCS and can offer controlled inhalation if it is “in accordance with other applicable federal, provincial and municipal legislation to maintain public health and public safety,” Natalie Mohamed, a a spokesperson for Health Canada/Public Health Agency of Canada told CP24.
There are currently no controlled consumption facilities in this province that provide inhalant services.
Any organization that wants to offer controlled consumption services in this country must have an exemption under Section 56 of the Controlled Drugs and Substances Act (CDSA) in order to operate.
Epidemiologist Dr. Tara Gomez, the lead principal investigator for 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, Gomez told CP24 that she and her team are looking to data from the Office of the Chief Coroner/Ontario Forensic Pathology Services to form a better understanding of how drugs are consumed when a person dies of an overdose.
The latest figures from the Ontario Medical Examiner’s Office show that deaths from “opioid smoking” accounted for 30 per cent of the 164 accidental deaths from opioid toxicity in Toronto between April 1, 2020 and March 31, 2021. All of these “deaths from opioid toxicity’ have evidence of smoking drugs and represents a 43 per cent increase in the proportion of total overdose deaths in Toronto compared to 2019 and a 178 per cent jump in overdose deaths with evidence of pipe or foil alone .
Gomez’s May 2021 report, Changing Circumstances of Opioid-Related Deaths in Ontario During the COVID-19 Pandemic, noted a “significant shift from opioid-related deaths with injection-only evidence … to deaths with evidence for inhalation tube/film 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 per cent before the pandemic.
“Regardless of whether the pandemic specifically spurred this change, the increasing prevalence of inhalation as the predominant mode of drug use suggests a need for tailored harm reduction services – including supervised inhalation services – in Ontario,” the report said.
Gomez said she and her team are currently part of a study that focuses more closely on drug use patterns among people who die of drug overdoses.
“I don’t have much I can share specifically about this right now, other than to say that the patterns we saw in this earlier report are that among those who have a fatal overdose, inhalation is increasingly common met,” she said.
“I think this definitely speaks to the need to consider how existing harm reduction services are designed and to find opportunities to expand the services provided to take into account the creation of safe spaces for people to inhale drugs.” It’s something we’re increasingly calling for as we see these patterns.”
Provincially funded facilities cannot operate controlled inhalation spaces
Since late 2017 in Leslieville, South Riverdale Community Health Center (SRCHC) has operated a provincially funded controlled consumption site called keepSIX. There, people who use drugs can inject, snort or take their substances by mouth in a clean and safe environment under the supervision of trained staff.
One of the services the center wants to start offering as soon as possible is controlled inhalation, but that can only happen if the province secures funding to renovate their space and hire more staff.
Paula Tully, program manager for keepSIX, said that over the past two years, she and her team have seen a “steady increase” in requests from community members for controlled inhalation on their site.
If staff are available, they can sometimes bring someone outside to watch them while they smoke their drugs, but for many reasons, they would prefer to offer in-house services, she said.
Tooley, who has worked directly with drug users in downtown Toronto for 30 years, said those new to using opioids and other substances usually start by smoking them. She said that smoking the drug is less invasive and poses less risk of infection and other related illnesses than intravenous drug use, but this method is certainly not without risk.
“I’m seeing more infections than ever before,” Tooley said, adding that controlled consumption sites in Ontario that offer inhaling services will give people more options.
She also said the lack of provision of controlled inhalation services excludes a large portion of the population whose staff can help access other essential programs, services and referrals.
“(Monitored inhalation) is something that is needed. It’s just a matter of figuring out the logistics,” she said, adding that while some see providing safer places to use illegal drugs as “a bit of a radical idea,” the services save lives.
“One of the worst things about the drug poisoning crisis is how much potential has been lost, all the young people who have died needlessly.”
Kate Mason, SRCHC research co-ordinator, said she contacted the province late last year about how the east end center would offer controlled inhalation, but said it could be a long way off because exactly what is required is a bit unclear.
“We’re building the plane as we fly it,” Mason said, adding that requirements and expectations vary from province to province, but generally relate to ensuring the health and safety of staff and patients/customers.
Once all those details are ironed out, and if Ontario decides to allow inhalation in its provincially funded controlled consumption facilities, Mason said SRCHC will go back to Health Canada to request that inhalation be added to their CDSA exemption.
CP24.com has reached out to the provincial government several times for clarity on this matter, but has not received a response.
Meanwhile, the harm reduction team at SRCHC will tour Casey House’s new inhalation space later this month to learn more about it as they continue to push for this additional service.
DYK ppl who smoke drugs can get an #overdose. If you smoke drugs, see ⬇ for tips to reduce drug overdose: Check your meds before you use them⏲️Keep calm and take breaks Use with someone you trust who can help if you fall ✅Carry naloxone pic .twitter.com/0CRNqVo0QS
— Toronto Public Health (@TOPublicHealth) August 1, 2022
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