On February 27, Cast Your Vote to Prevent Overdose Deaths

Thursday, February 27 is election day in Ontario, and lives are on the line. In December 2024, the Ontario government passed legislation that, if not struck down, will result in the closure of 10 supervised consumption sites (SCS) across the province by March 31, 2025. 

SCS are clinical spaces where individuals consume their own drugs in a supervised setting. These sites are operated by community health centres, community organizations, and local public health units, under a federal exemption pertaining to Canadian drug laws.

Between March 2020 and May 2024, trained workers at SCS in Ontario medically-intervened to prevent almost 22,000 overdose deaths. SCS have also been shown to reduce the spread of communicable diseases by ensuring service users have access to sterile instruments. In addition, staff provide information, access and referrals to detox and treatment programs, and connect individuals with other critical health and social services. These professional and non-judgmental frontline services are an essential part of an effective response to Ontario’s growing opioid toxicity crisis. Simply put, SCS save lives.

Right now, 10 SCS are slated to close by the end of March. But it’s not too late to stop the closure of these lifesaving services. The next provincial government can reverse this decision.

See what Ontario political parties are saying about the closure of supervised consumption sites. 

Ontario’s Growing Opioid Crisis

Ontario’s opioid epidemic has taken more Ontarians’ lives than the COVID pandemic. Between 2016 and 2023, 26,673 Ontarians died from an opioid or stimulant overdose. In comparison, 18,873 Ontarians, to date, have died as a result of the COVID pandemic. In 2023, 2,647 Ontarians died from an opioid overdose—a 200% increase in the opioid mortality rate since 2016. 

Toronto residents have been deeply impacted. In 2023, 528 Toronto residents died of opioid-related toxicity—a 75% increase since 2019. More than 500 Toronto residents have died from opioid overdoses each year since 2020. The number of opioid-related deaths in Toronto remains higher than pre-pandemic levels. A major contributor to the overdose crisis is the toxic and unregulated supply of fentanyl and other substances.

The opioid epidemic is taking a devastating toll on the lives and health of people with substance use addictions, and impacting families and communities. It is disproportionately affecting First Nations, Black, low-income, and unhoused individuals and communities in northern Ontario. The rate of opioid-related deaths among youth in Ontario has also dramatically increased. Systemic factors, structural oppression and racism, and ongoing impacts of colonialism contribute to compromised health and wellbeing, unequal health outcomes, and significant barriers to healthcare access and the social determinants of health.

This crisis is also resulting in enormous financial costs. In 2020, the estimated cost related to the opioid epidemic in Ontario was over $2.7 billion, up from $1.3 billion in 2007. Almost 75% of the financial costs in 2020 were due to the lost productivity of individuals who died at a young age as a result of opioid use, and about 25% from direct costs, including health care and the criminal legal system.

Ontario Government Passes Legislation to Shut Down Supervised Consumption Sites, Amidst Opioid Toxicity Emergency

Despite the growing opioid epidemic, the provincial government has passed legislation to shut down essential health care services. In August 2024, the Province announced plans to shut down SCS located within 200 metres of schools, child care centres, and EarlyON child and family centres. In December 2024, the Province delivered on this plan, passing Bill 223, Safer Streets, Stronger Communities Act, 2024 which amended several pieces of legislation including SCS-related policy in the Community Care and Recovery Act, 2024 (CCRA). The government cited public safety concerns—-without evidence––as the reason for the closures. It held no public consultations, failed to engage individuals with lived expertise, organizations operating SCS, harm reduction workers, or public health officials, and ignored an abundance of evidence demonstrating the lifesaving impact of SCS. 

If the legislation is not reversed, 10 out of the 23 SCS currently operating in Ontario will be forced to close by March 31, 2025. Five of the affected sites are located in Toronto. The remaining five sites are in Guelph, Hamilton, Kitchener, Ottawa, and Thunder Bay (the only SCS currently operating in northern Ontario). The Province funds 17 of the 23 sites. The closures will impact nine of these provincially-funded sites and one self-funded site. 

To make matters worse, the legislation puts the remaining SCS in jeopardy and impacts other critical harm reduction services. Under the amended CCRA, Urgent Public Health Need Sites (UPHNS) within the 200-metre “buffer zone” will also be forced to close; UPHNS are overdose prevention sites that are established on a temporary basis to respond to urgent needs in specific areas. 

The amended CCRA requires municipalities and local boards to receive approval from the Ontario Minister of Health in order to: 

• apply for a federal exemption to open new SCS;
• apply to renew a federal exemption to continue operating existing SCS;
• support applications of third parties, such as community organizations, for a federal exemption to operate SCS;
• apply for federal funding for safer supply services or enter into an agreement with the federal government regarding funding for safer supply services.

The Ontario Minister of Health Sylvia Jones has stated that her government will not allow SCS to relocate and will not permit any new SCS to open under any circumstances. 

Under the amended legislation, municipalities and local boards will not be able to apply for federal exemptions to decriminalize personal possession of controlled substances, unless the Province changes regulations to allow it. Drug checking services which operate under a federal exemption will also be affected. These services help to protect the health and lives of people who use drugs by analyzing the contents of drugs, identifying the presence of dangerous toxic properties, and communicating this information to people who use drugs, SCS, and other key service providers. 

Province Announces Plans to Introduce Abstinence-Only “HART Hubs”

In August 2024, the Ontario Minister of Health announced the Province’s plans to transition to an abstinence-only recovery and treatment model through the creation of 19 Homeless and Addiction Recovery Treatment (HART) Hubs. Rather than working from a harm reduction model, the Province indicated that the HART Hubs will focus on addiction recovery, detox, treatment, and supportive housing, but will ban supervised consumption services, needle exchange, and safer supply services. In January 2025, the Province announced a plan to create a total of 27 HART Hubs, (an expansion of its original plan of 19), through a total investment of $529 million over three years. The provincial government’s stated goal is to open all HART Hubs by April 1, 2025. The expanded plan maintains the ban on harm reduction services.

Increased investment in addiction treatment programs, detox services, and supportive housing is an essential part of an effective response to Ontario’s opioid crisis. However, an abstinence-only model, which includes the closure of SCS and a move to eliminate evidence-based and effective harm reduction measures, presents grave risks for people with substance use addictions and broader goals of promoting public health and public safety. 

Province Ignores the Evidence, Including Its Own Internal Research

In its decision to close SCS and prohibit other harm reduction measures, the Province has ignored the large body of local, provincial, national and international evidence demonstrating the cost-effective and lifesaving impact of SCS, the role of SCS as a means to access addiction treatment and other critical services, and how SCS improves public safety. 

Ontario SCS statistics for the period of March 2020–May 2024 show:

• 178,253 unique clients collectively made over 1.12 million visits to SCS;
• 21,979 overdoses were successfully reversed by SCS staff on site;
• 533,624 service and substance use treatment referrals were made by SCS staff. 

Statistics for the 10 sites that the Province plans to close for the period of 2022/23 show: 

• over 1,600 clients collectively made more than 92,000 visits to these sites;
• over 1,500 overdoses were successfully reversed by staff at these sites; 
• not one person died.  

A recent Toronto study found the city-wide overdose mortality rate decreased by 42% after SCS were implemented. In neighbourhoods where SCS were implemented, the overdose mortality rate decreased by an astounding 67%, with no significant decrease in other neighbourhoods. 

A comprehensive review of research and evaluation studies of SCS found no evidence that SCS causes individuals who are in recovery to relapse or for individuals who don’t use drugs to start. In addition, research shows SCS are associated with improved access to health care services, a positive influence on high risk behaviours, and a reduction in public drug use.

A Calgary study found health care cost savings of approximately $1,600 for every overdose that was managed at a SCS. Applying these results to Ontario’s SCS experience (21,979 overdoses successfully reversed over a five-year period), the cost savings would be over $35 million.

The provincial government has stated that the ban on SCS is necessary to address public safety concerns, claiming a link between SCS and violent crime. However, analysis of Toronto crime data showed the opposite:

• An analysis of 13 years of homicide data showed a “minimal but significant decrease in the homicide rate” in areas within 500 metres of a SCS following their opening. In contrast, areas located three kilometres or more from a SCS experienced a “minimal but significant increase” in the homicide rate. 
  
  
• An analysis of nine years of Toronto Police Service crime statistics showed a significant decrease in assault and robbery rates in neighbourhoods with SCS, after a SCS was opened, while no similar decrease was found in other downtown neighbourhoods. In neighbourhoods with and without SCS, there was no significant change in rates of theft over $5,000 after SCS were implemented. In neighbourhoods with and without SCS, break and enter rates increased after SCS were first implemented, followed by a significant decline in these rates. 

Despite the Province’s claims, the research supports SCS as an important public health and public safety measure.

Dire Consequences Anticipated From Closure of Supervised Consumption Sites

The Province’s plan to shutter these sites and abandon lifesaving harm reduction measures has been met with vocal opposition and deep concern about the impact of these decisions. Further, internal government documents (see here and here) show that the provincial government is well aware of the serious public health and public safety consequences of its decision to close these sites. 

Through a freedom of information request, the Centre on Drug Policy Evaluation obtained an internal Ontario Ministry of Health and Long-Term Care report. The 2018 report summarized the evidence on SCS and overdose prevention sites, making clear the public health benefits of these services. Peer-reviewed evidence showed that these services reduce the risk of overdose-related deaths, improve access to health care services including access to addiction treatment, are associated with a decrease in public drug use, are cost-effective, result in health care savings, and are not associated with an increase in drug-related crime or drug dealing.  

In November 2024, media reported on a confidential, internal government document that warned the Province about the consequences of SCS closures and the likelihood that the government’s decision violates provisions in the Canadian Charter on Rights and Freedoms. According to Global News, the internal government report states:

There is a high risk that reducing access to harm reduction and overdose support services will result in increased emergency department visits, health impacts, overdose and death…Indigenous, Black and low-income individuals may be more adversely impacted as they face higher barriers to healthcare and for Indigenous populations, disproportionately higher rates of opioid-related deaths…There is an associated risk that closure of supervised consumption sites will make drug use and discarded drug paraphernalia more dispersed and more visible in the community. 

– D’Mello and Callan, Hospitalizations and death: Ontario’s internal warnings over supervised consumption site ban, Global News

The internal document also noted that the government’s decision to ban SCS “creates a ‘high risk’ of infringing the Canadian Charter of Rights and Freedoms”, particularly with regard to section seven of the charter that protects “life, liberty, and security of the person”.

On December 9, 2024, two SCS service users and the Toronto Neighbourhood Group Community Services (TNGCS), a multi-service community organization which operates a SCS, launched a charter challenge, making the case that the CCRA violates sections 7, 12 and 15 of the charter. These sections refer to the “right to life, liberty, and security of the person”, protections from “cruel and unusual punishment”, and guarantees the “right to be free from discrimination”, respectively. The Province’s own lawyers seem to agree with regard to section seven of the charter.

The lawsuit also argues that the CCRA is unconstitutional, as the amendments to the Act pertain to criminal law which is the “exclusive jurisdiction” of the federal government under the constitution. The application will be heard by the Ontario Superior Court of Justice on March 24 and 25, just days before the SCS ban is set to take effect. 

Is the Province rethinking its deadly decision to force the closure of SCS? It would seem not. A recent media report reveals that the Province has contracted private investigators who have been questioning people in some neighbourhoods with SCS to “gather additional evidence” about the impact of these services in advance of the court date.

Community Opposition to the Closure of Safe Consumption Sites

The closure of the sites will undoubtedly result in a significant loss of life. Those of us that use the sites do not have a death wish as some may think. Please be aware of the devastation that will occur when those who rely on the sites are unable to access them. 

– Katie Resendes, SCS service user and applicant on the charter challenge

We are going to see an increase in Indigenous people and other racialized people pay the price of this Bill. This is going to have its ripple effects in our community. When we look at our toxic drug supply, and we know that our people are out there on the streets… the most vulnerable they could possibly be, it is only in safe consumption sites that they receive the safety and supports that they need. 

– Mskwaasin Agnew, a Cree-Dene practitioner with Toronto Indigenous Harm Reduction, in Yellowhead Institute publication

[T]he opioid overdose emergency and the need for an integrated approach to mental health and addictions, the root causes of the opioid crisis are multi-faceted and compounded by decades of provincial failure to adequately invest in social systems that support income security, provide deeply affordable housing, and prevent or address mental health and addictions. A complex challenge like the opioid crisis cannot be solved by simple, short-term, stand-alone solutions. To meaningfully address this crisis, action is needed across a whole continuum of interventions, including investments in prevention, treatment, and enforcement/justice systems, and harm reduction. These actions are inherently connected and supportive of one another.

– Association of Municipalities of Ontario (AMO), The Opioid Crisis: A Municipal Perspective

The Supreme Court of Canada has recognized that addiction is a disease, and that preventing people with addictions from accessing health services offered through safe injection sites threatens their health and indeed their lives. Blocking a municipality from being able to directly seek federal funding or to apply to Health Canada to establish or operate a supervised consumption site directly impacts the rights to life, liberty and security of the person for people with addictions. 

– Anaïs Bussières McNicoll, Director of the Fundamental Freedoms Program, Canadian Civil Liberties Association

What Are Ontario Political Parties Saying About the Closure of Supervised Consumption Sites? 

Green Party

Green Party election platform:

Reopen the safe consumption and treatment sites closed by the Ford government and expand the number of sites across the province, prioritising areas with high opioid deaths like the North.

--Ontario Greens, Our Plan for Fairness

Following the final vote on Bill 223, Ontario Green Party Leader Mike Schreiner remarked:

We need CTS [consumption and treatment services] sites and harm reduction. We need HART Hubs and more supportive housing with wrap-around services. In my own community, the City of Guelph has increased the budget for paramedic services now by half-a-million dollars because of the anticipated closure of CTS sites and the additional pressure that's going to place on paramedics and our health-care system.

Liberal Party

Liberal Party election platform:

Act decisively and collaboratively with those on the frontline to bring deaths caused by opioid use down to zero in four years through expanded treatment, recovery and rehabilitation.

—Liberal Party of Ontario, Getting the Basics Right: A Plan to Do More for You

Following the final vote on Bill 223, the Trillium: Queen’s Park News reported:

When asked why the [Liberal] party supported a bill it has criticized as potentially leading to the deaths of drug users, Party Leader Bonnie Crombie and parliamentary leader John Fraser said they agreed with the bill’s overall aim of banning supervised drug consumption sites (SCSs) from being within 200 metres schools and daycares.

"There are measures in the bill that are very supportable," Fraser said, pointing to the new Homelessness and Addiction Recovery Treatment (HART) hubs the legislation proposes. “Bills aren't always black and white.”

Fraser said he still supports supervised consumption sites because they "keep people alive, and it's up to the government now to fulfil the commitment that they made for the HART hubs, to do that fast and to make sure that they keep people alive."

Crombie added that while the Liberals "don't support consumption sites near schools, near daycares or other sensitive uses,’ but added a Liberal government would ‘follow the science’ and preserve access to consumption treatment services for those who need it, although she didn’t elaborate on how.”

New Democratic Party (NDP)

NDP election platform:

We will establish universal basic mental health care and increase funding to community mental health service providers, like CMHA and AMHO, that provide crucial services to help people with addictions. We will follow the advice of experts and use evidence-based strategies to address the opioid epidemic. We will fund the addition of detox beds and residential treatment beds and establish wage parity for health care workers in community settings so they can also offer mental health support.

—Ontario NDP, On Your Side: Our Plan to Fight Rising Costs and Restore Ontario’s Promise 

In December 2024, CBC News reported on the release of an Auditor General’s report documenting the Province’s poor performance in implementing the provincial Opioid Strategy. The article states: “New Democrat and Opposition Leader Marit Stiles blasted [Ontario Health Minister] Jones for her handling of the opioid crisis, especially the move away from harm reduction and supervised consumption sites.

"More people will die, lives will not be saved in the interim and they had no intention to," Stiles said.

"They weren't going to look at the data, they weren't looking at the science, they weren't looking at the experience and they certainly didn't want to hear from any people about how this might impact them.’”

Progressive Conservative Party (PC)

PC election platform:

Making Parks and Public Spaces Safe Again

We have made record investments to clean up our parks and public spaces and keep them safe, but more action is required. A re-elected PC government will continue working with municipal partners to improve public safety by:

• Enforcing the ban on drug consumption sites within 200 metres of schools and licensed child-care centres. This includes enforcing legislation that prohibits municipalities or any organization from setting up new consumption sites or participating in federal so-called “safer” supply initiatives and also prohibits municipalities from requesting the decriminalization of illegal drugs from the federal government.

• Investing $530 million to create 27 new Homelessness and Addiction Recovery Treatment (HART) Hubs across the province to support people struggling with addiction and mental health issues by focusing on addiction recovery and supportive housing solutions instead of supporting further hard drug use at drug injection sites.

• Providing municipalities and police with new resources and enforcement tools to address the growing problem of homeless encampments and crack down on illegal drug use in parks and public spaces, including by dedicating $75.5 million for programs that provide more long-term stable housing and temporary accommodations for those living in encampments.

• Passing the Safer Municipalities Act, which is supported by mayors across the province, to provide tools to keep public places safe by increasing penalties on people who continually and deliberately trespass on private and public lands in illegal encampments, and specifically banning the consumption of illegal drugs in all public spaces and encampments.

—Ontario PC, Protect Ontario: Our Plan to Protect Ontario

Know Before You Vote

Before you cast your vote on February 27th, be sure to ask your candidate how they plan to address the increasing rates of opioid-related deaths in Ontario and work with community organizations and public health experts to create solutions for the opioid crisis.

Many thanks to TMU social work student Michelle Nykolaiszyn for her research and writing work on this backgrounder.